literature review on higher education

Influence of e-learning on the students’ of higher education in the digital era: A systematic literature review

• Published: 16 April 2024

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• Rashmi Singh   ORCID: orcid.org/0000-0001-9195-5301 1 ,
• Shailendra Kumar Singh 1 &
• Niraj Mishra 1  

The integration of digital technologies into educational practices has reshaped traditional learning models, creating a dynamic and accessible global landscape for higher education. This paradigm shift transcends geographical boundaries, fostering a more interconnected and inclusive educational environment. This comprehensive literature analysis explores the impact of e-learning on higher education students in the digital era. A meticulous review of 53 studies, sourced from reputable databases including Web of Science, Taylor & Francis, Springer Link, ProQuest, Elsevier, and Scopus, was conducted. Employing the content analysis method, the selected studies spanning from November 2012 to April 2023 were systematically examined. Predominantly utilizing quantitative methods, the studies, largely originating from the United States, China, Malaysia, and India, focused on university students. Key variables such as student engagement, perception, and academic performance were consistently employed across diverse educational settings. The synthesis of findings revealed that e-learning technologies positively impacted academic achievement, student satisfaction, and collaborative efforts. Moreover, challenges associated with technology usage and internet access were identified, which impact e-learning implementation. The study proposes further investigation through a mixed-methods approach to explore students’ interactions with the educational environment while utilizing e-learning technology in institutions of higher education.

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Singh, R., Singh, S.K. & Mishra, N. Influence of e-learning on the students’ of higher education in the digital era: A systematic literature review. Educ Inf Technol (2024). https://doi.org/10.1007/s10639-024-12604-3

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The Hopkins Press Journals Ethics and Malpractice Statement can be found at the ethics-and-malpractice  page.

The Review of Higher Education expects all authors to review and adhere to ASHE’s Conflict of Interest Policy before submitting any and all work. The term “conflict of interest” means any financial or other interest which conflicts with the work of the individual because it (1) could significantly impair the individual’s objectivity or (2) could create an unfair advantage for any person or organization. Please refer to the policy at ashe.ws/ashe_coi .

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RHE publishes book reviews of original research, summaries of research, or scholarly thinking in book form. We do not publish reviews of books or media that would be described as expert opinion or advice for practitioners.

The journal publishes reviews of current books, meaning books published no more than 12 months prior to submission to the associate editor in charge of book reviews.

If you want to know whether the RHE would consider a book review before writing it, you may email the associate editor responsible for book reviews with the citation for the book.

Reviewers should have scholarly expertise in the higher education research area they are reviewing.

Graduate students are welcome to co-author book reviews, but with faculty or seasoned research professionals as first authors.

Please email the review to the associate editor in charge of book reviews (Timothy Reese Cain, [email protected] ), who will work through necessary revisions with you if your submission is accepted for publishing.

In general, follow the APA Publication Manual, 7th edition.

Provide a brief but clear description and summary of the contents so that the reader has a good idea of the scope and organization of the book. This is especially important when reviewing anthologies that include multiple sections with multiple authors.

Provide an evaluation of the book, both positive and negative points. What has been done well? Not so well? For example the following are some questions that you can address (not exclusively), as appropriate:

What are the important contributions that this book makes?

What contributions could have been made, but were not made?

What arguments or claims were problematic, weak, etc.?

How is the book related to, how does it supplement, or how does it complicate current work on the topic?

To which audience(s) will this book be most helpful?

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Use quotations efficiently to provide a flavor of the writing style and/or statements that are particularly helpful in illustrating the author(s) points. 

If you cite any other published work, please provide a complete reference.

Please include a brief biographical statement immediately after your name, usually title and institution. Follow the same format for co authored reviews. The first author is the contact author.

Please follow this example for the headnote of the book(s) you are reviewing: Stefan M. Bradley. Upending the Ivory Tower: Civil Rights, Black Power, and the Ivy League. New York: New York University Press, 2018. 465 pp. $35. ISBN 97814798739999.

Our preferred length is 2,000–2,500 words in order for authors to provide a complete, analytical, review. Reviews of shorter books may not need to be of that length.

The term “conflict of interest” means any financial or other interest which conflicts with the work of the individual because it (1) could significantly impair the individual’s objectivity or (2) could create an unfair advantage for any person or organization. We recommend all book reviewers read and adhere to the ASHE Conflict of Interest Policy before submitting any and all work. Please refer to the policy at ashe.ws/ashe_coi

NOTE: If the Editor has sent a book to an author for review, but the author is unable to complete the review within a reasonable timeframe, we would appreciate the return of the book as soon as possible; thanks for your understanding.

Please send book review copies to the contact above. Review copies received by the Johns Hopkins University Press office will be discarded.

Penny A. Pasque,         The Ohio State University

Thomas F. Nelson Laird,         Indiana University-Bloomington

Associate Editors

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Timothy Reese Cain (including Book Reviews),         University of Georgia

Milagros Castillo-Montoya,         University of Connecticut

Tania D. Mitchell,         University of Minnesota

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Federick Ngo,        University of Nevada, Las Vegas

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Stephanie Nguyen,         Indiana University Bloomington

Monica Quezada Barrera,         The Ohio State University

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Sonja Ardoin,         Clemson University

Peter Riley Bahr,        University of Michigan

Vicki Baker,      Albion College

Allison BrckaLorenz,        Indiana University Bloomington

Nolan L. Cabrera,        The University of Arizona

Brendan Cantwell,        Michigan State University

Rozana Carducci,        Elon University

Deborah Faye Carter,         Claremont Graduate University

Ashley Clayton,         Louisiana State University

Regina Deil-Amen,         The University of Arizona 

Jennifer A. Delaney,     University of Illinois Urbana Champaign

Erin E. Doran,    Iowa State University

Antonio Duran,   Arizona State University 

Michelle M. Espino,        University of Maryland 

Claudia García-Louis,        University of Texas, San Antonio

Deryl Hatch-Tocaimaza,        University of Nebraska-Lincoln

Nicholas Hillman,        University of Wisconsin-Madison

Cindy Ann Kilgo,        Indiana University-Bloomington

Judy Marquez Kiyama,  University of Arizona

Román Liera,        Montclair State University

Angela Locks,        California State University, Long Beach

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Rebecca Natow,         Hofstra University 

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OiYan Poon,         Spencer Foundation 

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Vanessa Sansone,         The University of Texas at San Antonio

Tricia Seifert,        Montana State University

Barrett Taylor,         University of North Texas 

Annemarie Vaccaro,  University of Rhode Island

Xueli Wang,        University of Wisconsin-Madison

Stephanie Waterman,         University of Toronto 

Rachelle Winkle-Wagner,         University of Wisconsin-Madison

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The Review of Higher Education is the journal of Association for the Study Higher Education (ASHE) and follows the ASHE Bylaws and Statement on Diversity. 

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• Electronic Collections Online, vol.20, no.1, 1996-vol.35, no.2, 2011
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• PsycFIRST, vol.24, no.3, 2001-vol.33, no.1, 2009
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Original research article, quality of higher education: a bibliometric review study.

• 1 Department of Administrative Sciences, University of Bisha, Bisha, Saudi Arabia
• 2 Department of Management Sciences, University of Oum El Bouaghi, Oum El Bouaghi, Algeria
• 3 Department of Computer and Information Systems, University of Bisha, Bisha, Saudi Arabia
• 4 Department of Comparative Literature, Binghamton University, Binghamton, NY, United States
• 5 Department of Education, Nazareth College of Rochester, Rochester, NY, United States

For more than three decades, higher education has attracted growing interest from scholars, students, and academic institutions worldwide. This paper aims to analyze the literature review of quality of higher education, using the bibliometric analysis adapted from VOSviewer software to examine the data of 500 studies published in the Web of Science from 2000 to 2018 related to this topic. The results were presented and discussed with the following approaches: keywords, authors, references (research papers), research work, countries, and research institutions. The study found that bibliometric analysis is fundamental in detailing the theoretical literature and developing an integrated theoretical framework on quality of higher education. This review provides reference points for entry into this interdisciplinary field.

Introduction

Perhaps the diversity of knowledge fields in administrative sciences has contributed to the diversity and multiplicity of research work. Preparing any study in these sciences is linked to different and complex frameworks.

Previous studies have been very repetitive; their abundance makes it very difficult for researchers to define concepts and chart the right course of the research, and could result in losing the right direction due to a lack of knowledge of prestigious studies or influential researchers. Who can rely on, control, and deal with this large number of research? Some databases organize them (like Science Web, ISI, Scopus, and Google Scholar). Management sciences and researchers have led to distinguished studies’ preparation, which creates the need to explore how to deal with this spread.

Computer programs help manage a large amount of data and organize, store, publish, distribute, and deal with many studies. Software such as Citespace and VOSviewer and programs help gather the most influential researchers in the world. Therefore, the field should focus on references, keywords, research cases, and organizations.

The study examines bibliometric analysis and its importance compared to previous studies’ methods (meta-analysis and systematic review), especially concerning quality of higher education. Therefore, this paper analyses higher education’s scientific production as indexed in Web of Science (WOS) and Scopus (2000–2018). The motivation of the study is directly related to the purpose. By doing so, we will detect its scope and identify research trends for this area; this could help in increasing the number of readers familiar with the topic and enable the scientific community to become more knowledgeable about the development of higher. The justification and significance of this study’s analysis is based on seven research questions that guided the study. The primary motivation is to understand the higher education trends in the scientific literature and detect the source titles, organizations, authors, and countries with the highest scientific output on higher education. According to Mulet-Forteza et al. (2021) , the research questions of this study are as follows:

RQ. What is bibliometric analysis’s contribution to the review and development of the theoretical literature on quality of higher education?

The sub-questions are:

RQ 1. What is the importance of bibliometric analysis in defining the theoretical frameworks for the quality of higher education?

RQ2. What structure is formed by the publications and citations in the quality of higher education?

RQ3. Which keywords do authors on the quality of higher education use the most frequently?

RQ4. Who are the most cited authors in the field of quality of higher education?

RQ5. Which research documents are cited the most frequently by authors in the field of quality of higher education?

RQ6. What are the most important research institutions concerning the production of research papers in quality of higher education?

RQ7. What are the most important countries concerning the production of research papers in quality of higher education?

The study aims to determine the bibliometric analysis results and the results of the process, which will benefit the researchers in administrative sciences in drawing the correct direction. This study, then, includes identifying keywords, the most influential researchers in the field, the research work, reference sources, countries, and reference research institutions. Therefore, the study compares bibliometric analysis with traditional literature reviews in administrative sciences and the methods of bibliometric analysis and methodology for studying bibliometric studies in administrative sciences, as well as offering a bibliographic analysis of the issue of quality of higher education.

Literature Review

Bibliographic studies have developed a new style of reviewing the theoretical literature in various fields of knowledge, including management science, theories associated with these studies, or bibliometric analysis. Quality and education are an essential part of society. Getting an excellent education is a fundamental pillar in looking at the future of nations, as it reveals the educational development they are going through ( de Matos Pedro et al., 2020 ). Therefore, ensuring quality of higher education is also crucial for social development ( Salas-Zapata et al., 2018 ). The concept refers to service quality, particularly from a higher education sector research perspective ( Rieckmann, 2012 ).

The Initial studies from the educational sector indicate that the idea of quality in higher education has become unclear and agrees that quality is the result of comparing service expectations with the perception of actual service received ( Seymour, 1992 ; Green, 1994 ; Quinn et al., 2009 ). The study by Cameron et al. concluded that it focuses on integrating effective participatory methods into the teaching process, motivating members to obtain knowledge, the educational community, social future, knowledge, skills, attitudes, and core values.

Carvalho and de Oliveira Mota (2010) studied the educational model dynamics’ position the student, as the recipient of education, has, turning them into service recipients. Then, in their study, DiDomenico and Bonnici (1996) analyze the quality of service they require to thrive in a competitive environment and discussof the quality of educational services that provide a degree of quality assurance. Investing in education will help us in the long run, as it will provide for future generations.

Bibliometric analysis, according to Lotka (1926) , is the “Method for measuring researchers’ productivity.” Bradford (1934) defines it as “Laws for Dissecting Scientific Knowledge.” Zipf (1949) states it to be “A template for the distribution of words and the frequency in the text.” Pritchard (1969) describes it as “A collection of studies intended to qualify research communications operations.” Fonseca (1973) defines it as a quantitative and statistical method for measuring scientific production rates and disseminating scientific knowledge. For Abdi et al. (2018) , a number of definitions of bibliometric analysis were cited, the first of which was referred to by Hung as a set of methods used to examine or measure texts and information. Also, Hussain, Fatima, and Kumar believe it to be a system that uses a quantitative approach based on various aspects of written articles and publishers.

According to Merigó and Yang (2017) , bibliometric analysis is defined as “a quantitative study of bibliographic material (data) and provides a general picture of a research field that research papers, authors, and fields can include categories.”

Tsay believes that bibliometric analysis techniques rely on references used in research work to develop statistical models for the flow of scientific relationships between them ( Tsay and Shu, 2011 ). For example, citations can be used to map relationships between files, journals, or others. On this basis, it can be noted that the analysis of bibliometric analysis or reference citations is a quantitative analysis of written research works (scientific production), such as articles, books, and research papers. The search network of relationships’ linking and privacy of work (titles, authors, research institutions, countries, keywords) is also included, where this network is based on items or indicators such as reference citations, bibliographical links, and co-authors. This allows readers to find out more about the most influential research, researchers, research institutions in the field.

The studies of Zupic and Čater (2015) mentioned the importance of this type of analysis compared to the classical method of reviewing theoretical literature. They mentioned the importance of this type of analysis compared to the classical method of reviewing. Theoretical literature was among studies in bibliometric analysis methods in administrative sciences. “The volume of research work has increased dramatically in recent years, making it difficult for researchers to track the literature relevant to their field of work, which has led them to use quantitative bibliometric analysis methods that can deal with this wealth of data. Also, to filter research work through estimating their impact and discovering the foundation.”

Traditional methods of reviewing and evaluating the theoretical literature are primarily meta-analysis and systematic literature review. A meta-analysis seeks to gather empirical evidence from quantitative studies ( Aguinis et al., 2011 ). Through this, the researcher selects lessons based on the exact relationship he wishes to explore ( Raghuram et al., 2010 ) and combines multiple findings in these relationships to discover one comprehensive finding. That is a compelling method, but it is limited in the studies’ nature and breadth that can be analyzed. A systematic review can address the diversity of tasks and methodological approaches. This method can provide an in-depth analysis of the literature and understand the conceptual context ( Raghuram et al., 2010 ). However, this process is time-consuming, and the number of works analyzed is limited and subject to research bias, so there is a real possibility of excluding essential studies.

Compared to traditional methods, scientific mapping using bibliometric methods provides a different perspective in this field; any study can analyze the link between the current studies and the studies’ analyses. Therefore, bibliometric research offers an opportunity to engage in various tasks to avoid bias and studies’ choices ( Mulet-Forteza et al., 2019 ).

Further, bibliometric analysis methods cannot be considered an alternative to traditional theoretical literature reviews in administrative sciences. However, they are complementary because they help the researcher choose the most important research studies in the field, the most influential researchers in the area, the basic ones in the field, and even research institutions and countries in the field.

There are three basic laws of bibliometric analysis: the law of Lotka on the scientific productivity of researchers, the law of Bradford on the dispersion of scientific production, and the law of Zipf on the appearance of words in the text. More details on Bizotto et al. (2015) the basic laws of bibliometric analysis can be found in Table 1 .

Table 1. Fundamental laws of bibliometric analysis.

It is evident from the Table 1 that bibliometric analysis has axes regarded as empirical predictors ( Waltman and Noyons, 2018 ). Moreover, Corrall et al. (2013) imply a quantitative calculated scientific finding, scientific factors, and scientific collaboration as objectives of the bibliometric analysis. These are based on indicators such as quotations, bibliographical conjugations, reference quotes, researchers participating in the authorship, and more.

This review studied 500 studies published in the WOS from 2000 to 2018 related to quality of higher education. The bibliometric review was adapted using VOSviewer software packages and discusses the following approaches: keywords, authors, references (research papers), research work, countries, and research institutions.

Here, a distinction must be made between the indicators corresponding to the analysis method and the unit of analysis, where the indicators are authorship researchers, quotation, bibliographic conjugation, reference quotation, and level of appearance ( Gingras, 2016 ). The analysis units are authors, terms or keywords, research papers, journals or resources, research institutions, and countries. For reference, the indicators provide quantitative measurements for research units, and it is understood that there are different bibliometric analysis methods.

Materials and Methods

This science mapping study of the literature used bibliometric methods to review research on higher education. Research reviews grounded in bibliometric practices do not examine the substantive findings of studies. Instead, their value extends from the capability to document and synthesize broad trends that describe a knowledge base’s landscape, composition, and intellectual structure. Thus, science mapping offers insights into knowledge accumulation patterns that would be difficult to “see” using traditional research reviews ( Zupic and Čater, 2015 ).

Zupic and Atherater ( Zupic and Čater, 2015 ) provided a summary of the methods of bibliometric analysis, as shown in Table 2 .

Table 2. Bibliometric analysis approaches.

As mentioned above, the approach pointed to several indicators used to link research units as a map or an information network in the bibliometric analysis. As shown, the data quality and the package or software used in the study is affected.

Bibliographic analysis requires reliable data sources since the WOS developed by Clarivate Analytics and Scopus developed by Elsevier is the most widely used (requires subscription) ( Aria and Cuccurullo, 2017 ). Google Scholar is characterized as free database with quality problems of data. Google Scholar also uses Google Scholar (free of charge, but with data quality problems). Databases may also operate in a specific cognitive field such as INSPIRE (High Energy Physics), MathSciNet (Mathematics), PsycINFO (Psychology), and PubMed (Biomedical Research). For a bibliometric analysis that focuses on a specific region, they can use data sources particular to that region, such as the Russian citation base or the Chinese citation base ( Waltman and Noyons, 2018 ).

In this study, we chose the WOS databases; all resources published from 2000 to 2018 related to quality of higher education were selected. This data was analyzed with VOSviewer software using the following approaches: keywords, authors, references (research papers), research work, countries, and research institutions.

The software used in the bibliometric analysis has evolved and diversified with the diversity of approaches to this type of research; basic software is widely used internationally in this field, as shown in Table 3 ( Van Eck and Waltman, 2014 ).

Table 3. Software used in bibliometric analysis.

According to Zupic and Čater (2015) , the practical steps for conducting bibliometric analysis are study design, collection of bibliometric data, analysis, results presentation, and interpretation. The VOSviewer used in the study is widely use in the international publication of scientific articles in the bibliometric research.

Methodology and Data for the Bibliometric Study

The data used in the bibliometric analysis are the basis for the achievement of accurate results based on sound methodology and selected approaches. As mentioned earlier, the approach pointed to some indicators used to link research units as a map or an information network in the bibliometric analysis. Each of these methods has its advantages and disadvantages. It is also affected by the quality of the data and the package or software used in the analysis. The study selected 500 studies published from 2000 to 2018 related to quality of higher education (Article, Article; Proceedings Paper, Book Review, Correction, Editorial Material, Letter, Meeting Abstract, News Item, Review) (Q3; R2).

Then, a co-citation analysis was performed to obtain an initial picture of the documents that contributed to this literature’s development. Based on the methods and approaches of bibliometric analysis, emphasis may be placed on analytical methods that relate to indicators such as quotation, reference quotes, bibliographic association, co-authoring, and terminology sharing, and may focus on analysis units such as keywords (Co-occurrence of all keywords), authors (Co-citation authors), sources (Co-citation sources), organizations (Citation organizations), and countries (Citation countries) (Q3; R2). According to the objectives of the study, the focus was on analysis units to determine what is essential in the quality of higher education for these units: the definition of keywords; the most influential authors; and the most important sources, countries, and reference research institutions. To define the density and networks of units the data is filtered as follows: 65 keywords selected based on Co-occurrence of all key-words, 75 authors according to Co-citation, 80 sources according to Co-citation, 37 organizations selected based on citation, and 43 countries selected based on citation (Q5; R2).

The experimental stages and preparation of the bibliometric study (study design, data collection, analysis, presentation, interpretation) was done using the VOSviewer [see guides ( Van and Waltman, 2018 ) and ( VOSViewer Manual, 2020 )]. A leader in the field and the preparation of international articles with several pieces of software can be used, allowing the researcher to summarize the bibliometric study results in summarized maps and networks. They also, shown in the following section, related to the bibliometric analysis results of quality of higher education.

Discuss the Results

Based on the WOS data for quality of higher education and using VOSviewer, the bibliometric analysis units were presented and discussed a set of results.

The Most Frequently Occurring Keywords

The Figure 1 shows the network and intensity of words or keywords according to their level of visibility in the database or the WOS quality education sources.

Figure 1. Network and density of the appearance of keywords in the quality of higher education.

Previous concepts and essential words that can be considered keywords appear in Figure 1 (see Appendix 1 ); the researcher must focus on the subject of quality of higher education, the first of which is higher education, which appears 140 times in the data. The second is quality assurance (61 times) and the third is quality (51 times); those three words must be researched in-depth because they form the basis of the subject of quality education, and they deepened to a lesser degree in terms of quality of service, management, performance, students, and university (universities). In-depth research is conducted to a lesser extent on contentment, model (models) Expectations, accountability, quality of the educational process, and atmospheric management comprehensive results, results, and policy.

It is also clear that there are research clusters that the researcher directs when he focuses on a specific part of the quality of higher education, and this did not appear clearly in the network ( Raghuram et al., 2019 ). For example, in density, when we speak in a research paper on quality assurance as part of research on the quality of higher education, we initially talk about the research cluster. The second demonstrates the VOSviewer, which includes seven terms, quality assurance, institutional quality, quality of higher education, quality improvement, quality management, quality indicators, and quality culture to these clusters, which are parts of the research areas the researcher should determine in the case of his focus.

The lines linking the keywords express the sharing of their appearance in the same research work. For example, the term “higher education in blue” is a part of the words universities, expectations, quality management, overall quality management, and quality of higher education; the thickness of the line connecting these words to a basket is linked to each other through research. They also constitute another criterion for choosing the fields of research in which the researcher moves.

The Most Cited Authors in the Quality of Higher Education

It is remarkable to understand the knowledge of the most influential researchers in the field through the analysis of previous studies, and this is what VOSviewer provides, where the researcher can know this through joint citation, as shown in Figure 2 .

Figure 2. (A) The network of the most cited authors in the quality of higher education. (B) The density of the most cited authors in the quality of higher education.

The author’s co-citation analysis has been used to reveal the knowledge base’s intellectual structure in quality of higher education. This was accomplished in VOSviewer, which created an author’s co-citation map depicting similarities between scholars strongly cited in this literature.

Figure 2 (see Appendix 2 ) presented the most influential authors in the field of quality of higher education are, who are Lee Harvey, A Parsu Parasuraman, and Bjørn Stensaker. The researcher should rely on their theories and ideas in this field. Harvey, who is a Professor of Higher Education at Copenhagen Business School in Denmark, specializes in research and further research on defining the quality of higher education in five aspects: quality in the sense of excellence, quality in the mind of error, quality in the sense of relevance to objectives, quality as cash value, and quality in the sense of transformation ( Harvey and Askling, 2003 and ( Gingras, 2016 ). Parasuraman is Professor of Higher Education and Research Fellow at the University of Interest at the University of Miami in the United States of America and his colleagues Valarie A. Zeithaml and Leonard L Berry are famous for the SERVQUAL quality service model; these dimensions are represented by responsiveness, reliability, response, warranty, and sympathy ( Parasuraman et al., 2002 ). Stensaker is a professor at the University of Oslo, Norway, best known for his quality assurance and higher education management work.

Other researchers located in the orange or yellow ocean (see density), who include Abdullah, Marginson, and Owlia, should also be relied on, particularly in quality of higher education, as they are prominent in this field.

Hence, in the author co-citation map, the “clusters” of co-authors are treated. A common color map indicates these combinations in the citation map. The author’s importance in the literature is indicated by the size of the node and the density of “links” to other authors. Links between authors represent citations shared between these particular authors. A cross-citation map between groups and schools that included the QHE knowledge base was revealed.

The Most Cited References in the Quality of Higher Education

The presentation and analysis of the researchers’ results provided knowledge on the most influential researchers in the field of quality of higher education. However, these have many and varied contributions. Which of them and which of their research contributions and works were the most influential and most reliable in the field? This is known as the analysis of research works, as shown in Figure 3 (see Appendix 3 ).

Figure 3. Network and density of the most referenced research papers in the field of quality of higher education.

Reference is made to the research work most frequently cited and referred to in quality of higher education, which has made researchers more influential in this field, such as Harvey, Parasuraman, Stensaker, and others. Harvey’s work defines quality in higher education through: higher education appreciation and evaluation ( Harvey and Green, 1993 ), changing higher education ( Harvey and Knight, 1996 ), fifteen years of higher education quality ( Harvey and Williams, 2010 ). Parasuraman works on the SERVQUAL model which is a multidimensional measure of assessing the quality of services through customer perception ( Parasuraman et al., 1994 ), SERVQUAL Scale Refining and Reassessing ( Parasuraman et al., 1991 ) and others.

These works, which represent the original studies in quality of higher education, must be relied upon by the researcher as a previous reference study. Then, the necessary research work is based throughout the stages of his research.

The Most Cited Sources in the Quality of Higher Education

The Figure 4 shows that the researcher’s resources should include quality of higher education, and in-depth readings of their content help in building his research vision. He uses necessary references, mainly referred to or based on researchers and specialists in this field.

Figure 4. The network and density of the most relevant sources in the field of quality of higher education.

Figure 4 (see Appendix 4 ) shows that the primary references or resources of quality of higher education Springer with 281 citations, discussing quality assurance in education, Emerald with 253 citations, discussing quality in higher education (quality in higher education) Routledge with 181 citations, discussing measurement and evaluation in higher education, by 173 citations, followed by other journals such as higher education studies, overall quality management, marketing journal, overall quality management, and business excellence.

These sources or references, which are located in the orange desert areas in density, and with large circles in the network, must be carefully considered by the researcher in the field of quality of higher education, in particular in terms of depth of reading or in terms of frequent reference to and dependence on research. On the other hand, it should be noted that the most influential researchers in the field, the research work of these researchers, and the most relevant works in quality of higher education are undisputedly identified in these essential references, or preferably sources, which call for the researcher to obtain them.

The Most Cited Countries in the Quality of Higher Education

The Figure 5 shows the presentation and analysis of the results of most cited countries, research work, and citations in the field of quality of higher education, which the researcher should refer to in this search for knowledge.

Figure 5. The network and density of the countries with the highest reference in the field of quality in higher education.

Figure 5 (see Appendix 5 ) shows that the most influencing countries on quality of higher education are England, known internationally as the Quality Assurance Agency for Higher Education (QAA), the United States, known internationally by quality award models, such as the Malcolm Baldrige National Quality Award (MBNQA), Australia, known internationally as the Tertiary Education Quality and Standards Agency (TEQSA), which is well-known for its ranking in the Shanghai International University Rankings, and Spain, which is hypothetically known as the University Rankings (Webometrics Ranking of World Universities.) These countries appear in large circles in the grid of orange and yellow spaces in density, as shown in Figure 5 .

Those are countries that the researcher should refer to in the field of quality of higher education. He knows or can work on the research and consider them successful examples and experiences to build his research model on. Perhaps he could suggest a model for his country based on these countries. Let us talk about the classification of these countries in terms of the quality of higher education. We find them ranked, which confirms the accuracy of these results and the VOSviewer software’s effectiveness.

The Most Cited Institutions in the Quality of Higher Education

The most referenced research institutions on the quality of higher education at the international level shown is in the following form:

Let us talk about universities that are considered research institutions that produce knowledge (research work). According to Figure 6 (see Appendix 6 ), we find that the leaders in quality of higher education are Western Australia University, the University of London, the University of Arizona, United States, Rochester Institute of Technology, United States, University of East Anglia, England, and DePaul University, United States.

Figure 6. The network and density of the most renowned research institutions in the field of quality of higher education.

These are the first in terms of citation and citation intensity and the most relevant research work in quality of higher education. These results are consistent with the presentation and analysis of country results in Figure 6 . Therefore, research institutions impact the quality of quality of higher education research authors to broaden their conceptual development paths and research paths. Collecting the bibliometric analysis results of all of the elements mentioned above (words, researchers, research works, sources, countries, and research institutions) concludes by providing a general summary.

This study discusses bibliometric analysis and analysis concepts compared to classical studying theoretical literature in management sciences–rules, foundations, methods, methods, data, and software. The bibliometric study’s process and stages discuss quality of higher education related to the emergence of words, the most influential researchers in this field, critical research work, reference sources, reference countries, and references. Research institutions rely on the VOSviewer network, density software outputs, research results, and suggestions.

A bibliometric analysis using the VOSviewer software on quality of higher education is an example of study knowledge and research work ( Hallinger and Kovačević, 2019 ). The analysis also discusses the most influential researchers in the field, as well as reference sources. Others also made available a database of all research work on this topic during (2000–2018), accordingly, from the research bias that was avoided.

The bibliometric analysis stated that it is necessary to refer to some important research works, references, the most influential researchers, and essential terms on quality of higher education, countries, and reference research institutions on this subject; these results intersect with the findings of the study by Baporikar (2021) . This contributes to the definition of theoretical frameworks for the quality of higher education. Bibliographic analysis contributes to quality of higher education theoretical frameworks by identifying terms, most influential researchers, studies, sources, countries, and reference research institutions, and this is extremely important for future research directions.

This paper has investigated the theoretical analysis of the various concepts related to bibliometric analysis and the presentation and discussion on quality of higher education. We achieved results in the bibliometric analysis compared to traditional methods, which allowed for a wide range of studies (databases) to avoid bias and search selection problems. The researcher choice complements the bibliometric analysis methods but cannot substitute the traditional methods of reviewing the theoretical literature. The bibliographic analysis is also valuable for defining key terms, the most influential researchers in the field, research work and reference sources, and countries and reference research institutions (analytical units).

This study indicates a set of indicators [keywords, authors, references (research papers), research work, countries, and research institutions] that confirm this united existence. We have obtained an accurate bibliometric analysis of the appearance of terms. The basic terms of quality of higher education are higher education, quality assurance, quality, and exploration.

The bibliometric analysis of the researchers shows that the most influential researchers in the field of quality of higher education are Lee Harvey, A Parsu Parasuraman, and Bjørn Stensaker, and they should be relied upon by the researcher to theorize this field and to surround their theories with exceptional research depth. The research work in quality of higher education has returned to the most influential researchers in this field. Reference sources in quality of higher education should be based on the bibliometric analysis of references in the following international journals: Journal of Higher Education, Quality Assurance of Education, Quality in Higher Education Measurement, and Evaluation in Higher Education. These are the references that the researcher must have in this field.

In conclusion, the countries most researched in quality of higher education are England, the United States of America, Australia, China, and Spain. The Benchmark higher education research institutions are represented internationally at the following universities: University of Western Australia, University of London, University of Arizona America, Rochester Institute of Technology America, East Anglia University, and DePaul America.

This study will help researchers and educational policymakers in higher learning to understand the status of quality requirements and identify trends in higher education. This study also reinforces the growing recognition that education plays a significant role in society and will allow for quality of higher education trends, especially digital education and its requirements, to be achieved.

This is also evident by the growth path of the quality of higher education literature, its interdisciplinary composition, the breadth of areas displaying quality of higher education content, and the quality of journals and scholars who have participated in this topic.

This study’s results can determine the quality assessment of higher education institutions and take measures and policies that support the future quality of higher education trends. More specifically, the results can be used directly by higher education institutions to assess quality as strategic dimensions and to influence policymakers’ visions.

Data Availability Statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

Author Contributions

KC and SB conceived of the presented idea. AA and RZ contributed to the design and implementation of the research and performed the revision. SB, AM, and KC verified the analytical methods and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.

The authors extend their appreciation to the Deputyship for Research and Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number (UB-56-1442).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors would like to thank the reviewers and the editor for their insightful comments and suggestions.

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Appendix Table 1. The most frequently occurring keywords.

Appendix Table 2. The most cited authors in the quality of higher education.

Appendix Table 3. The most cited references in the quality of higher education.

Appendix Table 4. The most cited sources in the quality of higher education.

Appendix Table 5. The most cited countries in the quality of higher education.

Appendix Table 6. The most cited research institutions in the quality of higher education.

Keywords : bibliometric analysis, quality of higher education, VOSviewer, network, density

Citation: Brika SKM, Algamdi A, Chergui K, Musa AA and Zouaghi R (2021) Quality of Higher Education: A Bibliometric Review Study. Front. Educ. 6:666087. doi: 10.3389/feduc.2021.666087

Received: 09 February 2021; Accepted: 06 April 2021; Published: 19 May 2021.

Reviewed by:

Copyright © 2021 Brika, Algamdi, Chergui, Musa and Zouaghi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Said Khalfa M. Brika, [email protected]

This article is part of the Research Topic

Psychosocial Factors and Teaching Trends in Higher Education: Active Methodologies and Sustainable Development

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• Library website

Education Literature Review: Education Literature Review

What does this guide cover.

Writing the literature review is a long, complex process that requires you to use many different tools, resources, and skills.

This page provides links to the guides, tutorials, and webinars that can help you with all aspects of completing your literature review.

The Basic Process

These resources provide overviews of the entire literature review process. Start here if you are new to the literature review process.

• Literature Reviews Overview : Writing Center
• How to do a Literature Review : Library
• Video: Common Errors Made When Conducting a Lit Review (YouTube)  

The Role of the Literature Review

Your literature review gives your readers an understanding of the evolution of scholarly research on your topic.

In your literature review you will:

• survey the scholarly landscape
• provide a synthesis of the issues, trends, and concepts
• possibly provide some historical background

Review the literature in two ways:

• Section 1: reviews the literature for the Problem
• Section 3: reviews the literature for the Project

The literature review is NOT an annotated bibliography. Nor should it simply summarize the articles you've read. Literature reviews are organized thematically and demonstrate synthesis of the literature.

For more information, view the Library's short video on searching by themes:

Short Video: Research for the Literature Review

(4 min 10 sec) Recorded August 2019 Transcript 

Search for Literature

The iterative process of research:

• Find an article.
• Read the article and build new searches using keywords and names from the article.
• Mine the bibliography for other works.
• Use “cited by” searches to find more recent works that reference the article.
• Repeat steps 2-4 with the new articles you find.

These are the main skills and resources you will need in order to effectively search for literature on your topic:

• Subject Research: Education by Jon Allinder Last Updated Aug 7, 2023 2810 views this year
• Keyword Searching: Finding Articles on Your Topic by Lynn VanLeer Last Updated Sep 12, 2023 14587 views this year
• Google Scholar by Jon Allinder Last Updated Aug 16, 2023 9210 views this year
• Quick Answer: How do I find books and articles that cite an article I already have?
• Quick Answer: How do I find a measurement, test, survey or instrument?

Video: Education Databases and Doctoral Research Resources

(6 min 04 sec) Recorded April 2019 Transcript 

Staying Organized

The literature review requires organizing a variety of information. The following resources will help you develop the organizational systems you'll need to be successful.

• Organize your research
• Citation Management Software

You can make your search log as simple or complex as you would like.  It can be a table in a word document or an excel spread sheet.  Here are two examples.  The word document is a basic table where you can keep track of databases, search terms, limiters, results and comments.  The Excel sheet is more complex and has additional sheets for notes, Google Scholar log; Journal Log, and Questions to ask the Librarian.  

• Search Log Example Sample search log in Excel
• Search Log Example Sample search log set up as a table in a word document.
• Literature Review Matrix with color coding Sample template for organizing and synthesizing your research

Writing the Literature Review

The following resources created by the Writing Center and the Academic Skills Center support the writing process for the dissertation/project study. 

• Critical Reading
• What is Synthesis 
• Walden Templates
• Quick Answer: How do I find Walden EdD (Doctor of Education) studies?
• Quick Answer: How do I find Walden PhD dissertations?

Beyond the Literature Review

The literature review isn't the only portion of a dissertation/project study that requires searching. The following resources can help you identify and utilize a theory, methodology, measurement instruments, or statistics.

• Education Theory by Jon Allinder Last Updated May 1, 2022 315 views this year
• Tests & Measures in Education by Kimberly Burton Last Updated Nov 18, 2021 17 views this year
• Education Statistics by Jon Allinder Last Updated Feb 22, 2022 20 views this year
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Books and Articles about the Lit Review

The following articles and books outline the purpose of the literature review and offer advice for successfully completing one.

• Chen, D. T. V., Wang, Y. M., & Lee, W. C. (2016). Challenges confronting beginning researchers in conducting literature reviews. Studies in Continuing Education, 38(1), 47-60. https://doi.org/10.1080/0158037X.2015.1030335 Proposes a framework to conceptualize four types of challenges students face: linguistic, methodological, conceptual, and ontological.
• Randolph, J.J. (2009). A guide to writing the dissertation literature review. Practical Assessment, Research & Evaluation 14(13), 1-13. Provides advice for writing a quantitative or qualitative literature review, by a Walden faculty member.
• Torraco, R. J. (2016). Writing integrative literature reviews: Using the past and present to explore the future. Human Resource Development Review, 15(4), 404–428. https://doi.org/10.1177/1534484316671606 This article presents the integrative review of literature as a distinctive form of research that uses existing literature to create new knowledge.
• Wee, B. V., & Banister, D. (2016). How to write a literature review paper?. Transport Reviews, 36(2), 278-288. http://doi.org/10.1080/01441647.2015.1065456 Discusses how to write a literature review with a focus on adding value rather and suggests structural and contextual aspects found in outstanding literature reviews.
• Winchester, C. L., & Salji, M. (2016). Writing a literature review. Journal of Clinical Urology, 9(5), 308-312. https://doi.org/10.1177/2051415816650133 Reviews the use of different document types to add structure and enrich your literature review and the skill sets needed in writing the literature review.
• Xiao, Y., & Watson, M. (2017). Guidance on conducting a systematic literature review. Journal of Planning Education and Research. https://doi.org/10.1177/0739456X17723971 Examines different types of literature reviews and the steps necessary to produce a systematic review in educational research.

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Chapter 1: Introduction

Learning objectives.

At the conclusion of this chapter, you will be able to:

• Identify the purpose of the literature review in  the research process
• Distinguish between different types of literature reviews

1.1 What is a Literature Review?

Pick up nearly any book on research methods and you will find a description of a literature review.  At a basic level, the term implies a survey of factual or nonfiction books, articles, and other documents published on a particular subject.  Definitions may be similar across the disciplines, with new types and definitions continuing to emerge.  Generally speaking, a literature review is a:

• “comprehensive background of the literature within the interested topic area…” ( O’Gorman & MacIntosh, 2015, p. 31 ).
• “critical component of the research process that provides an in-depth analysis of recently published research findings in specifically identified areas of interest.” ( House, 2018, p. 109 ).
• “written document that presents a logically argued case founded on a comprehensive understanding of the current state of knowledge about a topic of study” ( Machi & McEvoy,  2012, p. 4 ).

As a foundation for knowledge advancement in every discipline, it is an important element of any research project.  At the graduate or doctoral level, the literature review is an essential feature of thesis and dissertation, as well as grant proposal writing.  That is to say, “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research…A researcher cannot perform significant research without first understanding the literature in the field.” ( Boote & Beile, 2005, p. 3 ).  It is by this means, that a researcher demonstrates familiarity with a body of knowledge and thereby establishes credibility with a reader.  An advanced-level literature review shows how prior research is linked to a new project, summarizing and synthesizing what is known while identifying gaps in the knowledge base, facilitating theory development, closing areas where enough research already exists, and uncovering areas where more research is needed. ( Webster & Watson, 2002, p. xiii )

A graduate-level literature review is a compilation of the most significant previously published research on your topic. Unlike an annotated bibliography or a research paper you may have written as an undergraduate, your literature review will outline, evaluate and synthesize relevant research and relate those sources to your own thesis or research question. It is much more than a summary of all the related literature.

It is a type of writing that demonstrate the importance of your research by defining the main ideas and the relationship between them. A good literature review lays the foundation for the importance of your stated problem and research question.

Literature reviews:

• define a concept
• map the research terrain or scope
• systemize relationships between concepts
• identify gaps in the literature ( Rocco & Plathotnik, 2009, p. 128 )

The purpose of a literature review is to demonstrate that your research question  is meaningful. Additionally, you may review the literature of different disciplines to find deeper meaning and understanding of your topic. It is especially important to consider other disciplines when you do not find much on your topic in one discipline. You will need to search the cognate literature before claiming there is “little previous research” on your topic.

Well developed literature reviews involve numerous steps and activities. The literature review is an iterative process because you will do at least two of them: a preliminary search to learn what has been published in your area and whether there is sufficient support in the literature for moving ahead with your subject. After this first exploration, you will conduct a deeper dive into the literature to learn everything you can about the topic and its related issues.

Literature Review Tutorial

1.2 Literature Review Basics

An effective literature review must:

• Methodologically analyze and synthesize quality literature on a topic
• Provide a firm foundation to a topic or research area
• Provide a firm foundation for the selection of a research methodology
• Demonstrate that the proposed research contributes something new to the overall body of knowledge of advances the research field’s knowledge base. ( Levy & Ellis, 2006 ).

All literature reviews, whether they are qualitative, quantitative or both, will at some point:

• Introduce the topic and define its key terms
• Establish the importance of the topic
• Provide an overview of the amount of available literature and its types (for example: theoretical, statistical, speculative)
• Identify gaps in the literature
• Point out consistent finding across studies
• Arrive at a synthesis that organizes what is known about a topic
• Discusses possible implications and directions for future research

1.3 Types of Literature Reviews

There are many different types of literature reviews, however there are some shared characteristics or features.  Remember a comprehensive literature review is, at its most fundamental level, an original work based on an extensive critical examination and synthesis of the relevant literature on a topic. As a study of the research on a particular topic, it is arranged by key themes or findings, which may lead up to or link to the  research question.  In some cases, the research question will drive the type of literature review that is undertaken.

The following section includes brief descriptions of the terms used to describe different literature review types with examples of each.   The included citations are open access, Creative Commons licensed or copyright-restricted.

1.3.1 Types of Review

1.3.1.1 conceptual.

Guided by an understanding of basic issues rather than a research methodology. You are looking for key factors, concepts or variables and the presumed relationship between them. The goal of the conceptual literature review is to categorize and describe concepts relevant to your study or topic and outline a relationship between them. You will include relevant theory and empirical research.

Examples of a Conceptual Review:

• Education : The formality of learning science in everyday life: A conceptual literature review. ( Dohn, 2010 ).
• Education : Are we asking the right questions? A conceptual review of the educational development literature in higher education. ( Amundsen & Wilson, 2012 ).

1.3.1.2 Empirical

An empirical literature review collects, creates, arranges, and analyzes numeric data reflecting the frequency of themes, topics, authors and/or methods found in existing literature. Empirical literature reviews present their summaries in quantifiable terms using descriptive and inferential statistics.

Examples of an Empirical Review:

• Nursing : False-positive findings in Cochrane meta-analyses with and without application of trial sequential analysis: An empirical review. ( Imberger, Thorlund, Gluud, & Wettersley, 2016 ).
• Education : Impediments of e-learning adoption in higher learning institutions of Tanzania: An empirical review ( Mwakyusa & Mwalyagile, 2016 ).

1.3.1.3 Exploratory

Unlike a synoptic literature review, the purpose here is to provide a broad approach to the topic area. The aim is breadth rather than depth and to get a general feel for the size of the topic area. A graduate student might do an exploratory review of the literature before beginning a synoptic, or more comprehensive one.

Examples of an Exploratory Review:

• Education : University research management: An exploratory literature review. ( Schuetzenmeister, 2010 ).
• Education : An exploratory review of design principles in constructivist gaming learning environments. ( Rosario & Widmeyer, 2009 ).

1.3.1.4 Focused

A type of literature review limited to a single aspect of previous research, such as methodology. A focused literature review generally will describe the implications of choosing a particular element of past research, such as methodology in terms of data collection, analysis and interpretation.

Examples of a Focused Review:

• Nursing : Clinical inertia in the management of type 2 diabetes mellitus: A focused literature review. ( Khunti, Davies, & Khunti, 2015 ).
• Education : Language awareness: Genre awareness-a focused review of the literature. ( Stainton, 1992 ).

1.3.1.5 Integrative

Critiques past research and draws overall conclusions from the body of literature at a specified point in time. Reviews, critiques, and synthesizes representative literature on a topic in an integrated way. Most integrative reviews are intended to address mature topics or  emerging topics. May require the author to adopt a guiding theory, a set of competing models, or a point of view about a topic.  For more description of integrative reviews, see Whittemore & Knafl (2005).

Examples of an Integrative Review:

• Nursing : Interprofessional teamwork and collaboration between community health workers and healthcare teams: An integrative review. ( Franklin,  Bernhardt, Lopez, Long-Middleton, & Davis, 2015 ).
• Education : Exploring the gap between teacher certification and permanent employment in Ontario: An integrative literature review. ( Brock & Ryan, 2016 ).

1.3.1.6 Meta-analysis

A subset of a  systematic review, that takes findings from several studies on the same subject and analyzes them using standardized statistical procedures to pool together data. Integrates findings from a large body of quantitative findings to enhance understanding, draw conclusions, and detect patterns and relationships. Gather data from many different, independent studies that look at the same research question and assess similar outcome measures. Data is combined and re-analyzed, providing a greater statistical power than any single study alone. It’s important to note that not every systematic review includes a meta-analysis but a meta-analysis can’t exist without a systematic review of the literature.

Examples of a Meta-Analysis:

• Education : Efficacy of the cooperative learning method on mathematics achievement and attitude: A meta-analysis research. ( Capar & Tarim, 2015 ).
• Nursing : A meta-analysis of the effects of non-traditional teaching methods on the critical thinking abilities of nursing students. ( Lee, Lee, Gong, Bae, & Choi, 2016 ).
• Education : Gender differences in student attitudes toward science: A meta-analysis of the literature from 1970 to 1991. ( Weinburgh, 1995 ).

1.3.1.7 Narrative/Traditional

An overview of research on a particular topic that critiques and summarizes a body of literature. Typically broad in focus. Relevant past research is selected and synthesized into a coherent discussion. Methodologies, findings and limits of the existing body of knowledge are discussed in narrative form. Sometimes also referred to as a traditional literature review. Requires a sufficiently focused research question. The process may be subject to bias that supports the researcher’s own work.

Examples of a Narrative/Traditional Review:

• Nursing : Family carers providing support to a person dying in the home setting: A narrative literature review. ( Morris, King, Turner, & Payne, 2015 ).
• Education : Adventure education and Outward Bound: Out-of-class experiences that make a lasting difference. ( Hattie, Marsh, Neill, & Richards, 1997 ).
• Education : Good quality discussion is necessary but not sufficient in asynchronous tuition: A brief narrative review of the literature. ( Fear & Erikson-Brown, 2014 ).
• Nursing : Outcomes of physician job satisfaction: A narrative review, implications, and directions for future research. ( Williams & Skinner, 2003 ).

1.3.1.8 Realist

Aspecific type of literature review that is theory-driven and interpretative and is intended to explain the outcomes of a complex intervention program(s).

Examples of a Realist Review:

• Nursing : Lean thinking in healthcare: A realist review of the literature. ( Mazzacato, Savage, Brommels, 2010 ).
• Education : Unravelling quality culture in higher education: A realist review. ( Bendermacher, Egbrink, Wolfhagen, & Dolmans, 2017 ).

1.3.1.9 Scoping

Tend to be non-systematic and focus on breadth of coverage conducted on a topic rather than depth. Utilize a wide range of materials; may not evaluate the quality of the studies as much as count the number. One means of understanding existing literature. Aims to identify nature and extent of research; preliminary assessment of size and scope of available research on topic. May include research in progress.

Examples of a Scoping Review:

• Nursing : Organizational interventions improving access to community-based primary health care for vulnerable populations: A scoping review. ( Khanassov, Pluye, Descoteaux, Haggerty,  Russell, Gunn, & Levesque, 2016 ).
• Education : Interdisciplinary doctoral research supervision: A scoping review. ( Vanstone, Hibbert, Kinsella, McKenzie, Pitman, & Lingard, 2013 ).
• Nursing : A scoping review of the literature on the abolition of user fees in health care services in Africa. ( Ridde, & Morestin, 2011 ).

1.3.1.10 Synoptic

Unlike an exploratory review, the purpose is to provide a concise but accurate overview of all material that appears to be relevant to a chosen topic. Both content and methodological material is included. The review should aim to be both descriptive and evaluative. Summarizes previous studies while also showing how the body of literature could be extended and improved in terms of content and method by identifying gaps.

Examples of a Synoptic Review:

• Education : Theoretical framework for educational assessment: A synoptic review. ( Ghaicha, 2016 ).
• Education : School effects research: A synoptic review of past efforts and some suggestions for the future. ( Cuttance, 1981 ).

1.3.1.11 Systematic Review

A rigorous review that follows a strict methodology designed with a presupposed selection of literature reviewed.  Undertaken to clarify the state of existing research, the evidence, and possible implications that can be drawn from that.  Using comprehensive and exhaustive searching of the published and unpublished literature, searching various databases, reports, and grey literature.  Transparent and reproducible in reporting details of time frame, search and methods to minimize bias.  Must include a team of at least 2-3 and includes the critical appraisal of the literature.  For more description of systematic reviews, including links to protocols, checklists, workflow processes, and structure see “ A Young Researcher’s Guide to a Systematic Review “.

Examples of a Systematic Review:

• Education : The potentials of using cloud computing in schools: A systematic literature review ( Hartmann, Braae, Pedersen, & Khalid, 2017 )
• Nursing : Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality. ( Pimpin, Wu, Haskelberg, Del Gobbo, & Mozaffarian, 2016 ).
• Education : The use of research to improve professional practice: a systematic review of the literature. ( Hemsley-Brown & Sharp, 2003 ).
• Nursing : Using computers to self-manage type 2 diabetes. ( Pal, Eastwood, Michie, Farmer, Barnard, Peacock, Wood, Inniss, & Murray, 2013 ).

1.3.1.12 Umbrella/Overview of Reviews

Compiles evidence from multiple systematic reviews into one document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address those interventions and their effects. Often used in recommendations for practice.

Examples of an Umbrella/Overview Review:

• Education : Reflective practice in healthcare education: An umbrella review. ( Fragknos, 2016 ).
• Nursing : Systematic reviews of psychosocial interventions for autism: an umbrella review. ( Seida, Ospina, Karkhaneh, Hartling, Smith, & Clark, 2009 ).

For a brief discussion see “ Not all literature reviews are the same ” (Thomson, 2013).

1.4 Why do a Literature Review?

The purpose of the literature review is the same regardless of the topic or research method. It tests your own research question against what is already known about the subject.

1.4.1 First – It’s part of the whole. Omission of a literature review chapter or section in a graduate-level project represents a serious void or absence of critical element in the research process.

The outcome of your review is expected to demonstrate that you:

• can systematically explore the research in your topic area
• can read and critically analyze the literature in your discipline and then use it appropriately to advance your own work
• have sufficient knowledge in the topic to undertake further investigation

1.4.2 Second – It’s good for you!

• You improve your skills as a researcher
• You become familiar with the discourse of your discipline and learn how to be a scholar in your field
• You learn through writing your ideas and finding your voice in your subject area
• You define, redefine and clarify your research question for yourself in the process

1.4.3 Third – It’s good for your reader. Your reader expects you to have done the hard work of gathering, evaluating and synthesizes the literature.  When you do a literature review you:

• Set the context for the topic and present its significance
• Identify what’s important to know about your topic – including individual material, prior research, publications, organizations and authors.
• Demonstrate relationships among prior research
• Establish limitations of existing knowledge
• Analyze trends in the topic’s treatment and gaps in the literature

1.4.4 Why do a literature review?

• To locate gaps in the literature of your discipline
• To avoid reinventing the wheel
• To carry on where others have already been
• To identify other people working in the same field
• To increase your breadth of knowledge in your subject area
• To find the seminal works in your field
• To provide intellectual context for your own work
• To acknowledge opposing viewpoints
• To put your work in perspective
• To demonstrate you can discover and retrieve previous work in the area

1.5 Common Literature Review Errors

Graduate-level literature reviews are more than a summary of the publications you find on a topic.  As you have seen in this brief introduction, literature reviews are a very specific type of research, analysis, and writing.  We will explore these topics more in the next chapters.  Some things to keep in mind as you begin your own research and writing are ways to avoid the most common errors seen in the first attempt at a literature review.  For a quick review of some of the pitfalls and challenges a new researcher faces when he/she begins work, see “ Get Ready: Academic Writing, General Pitfalls and (oh yes) Getting Started! ”.

As you begin your own graduate-level literature review, try to avoid these common mistakes:

• Accepts another researcher’s finding as valid without evaluating methodology and data
• Contrary findings and alternative interpretations are not considered or mentioned
• Findings are not clearly related to one’s own study, or findings are too general
• Insufficient time allowed to define best search strategies and writing
• Isolated statistical results are simply reported rather than synthesizing the results
• Problems with selecting and using most relevant keywords, subject headings and descriptors
• Relies too heavily on secondary sources
• Search methods are not recorded or reported for transparency
• Summarizes rather than synthesizes articles

In conclusion, the purpose of a literature review is three-fold:

• to survey the current state of knowledge or evidence in the area of inquiry,
• to identify key authors, articles, theories, and findings in that area, and
• to identify gaps in knowledge in that research area.

A literature review is commonly done today using computerized keyword searches in online databases, often working with a trained librarian or information expert. Keywords can be combined using the Boolean operators, “and”, “or” and sometimes “not”  to narrow down or expand the search results. Once a list of articles is generated from the keyword and subject heading search, the researcher must then manually browse through each title and abstract, to determine the suitability of that article before a full-text article is obtained for the research question.

Literature reviews should be reasonably complete, and not restricted to a few journals, a few years, or a specific methodology or research design. Reviewed articles may be summarized in the form of tables, and can be further structured using organizing frameworks such as a concept matrix.

A well-conducted literature review should indicate whether the initial research questions have already been addressed in the literature, whether there are newer or more interesting research questions available, and whether the original research questions should be modified or changed in light of findings of the literature review.

The review can also provide some intuitions or potential answers to the questions of interest and/or help identify theories that have previously been used to address similar questions and may provide evidence to inform policy or decision-making. ( Bhattacherjee, 2012 ).

Read Abstract 1.  Refer to Types of Literature Reviews.  What type of literature review do you think this study is and why?  See the Answer Key for the correct response.

Nursing : To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing.

An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care.

Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents.

General information available on patient safety should be incorporated in paediatric nursing care. ( Wegner, Silva, Peres, Bandeira, Frantz, Botene, & Predebon, 2017 ).

Read Abstract 2.  Refer to Types of Literature Reviews.  What type of lit review do you think this study is and why?  See the Answer Key for the correct response.

Education : The focus of this paper centers around timing associated with early childhood education programs and interventions using meta-analytic methods. At any given assessment age, a child’s current age equals starting age, plus duration of program, plus years since program ended. Variability in assessment ages across the studies should enable everyone to identify the separate effects of all three time-related components. The project is a meta-analysis of evaluation studies of early childhood education programs conducted in the United States and its territories between 1960 and 2007. The population of interest is children enrolled in early childhood education programs between the ages of 0 and 5 and their control-group counterparts. Since the data come from a meta-analysis, the population for this study is drawn from many different studies with diverse samples. Given the preliminary nature of their analysis, the authors cannot offer conclusions at this point. ( Duncan, Leak, Li, Magnuson, Schindler, & Yoshikawa, 2011 ).

Test Yourself

See Answer Key for the correct responses.

The purpose of a graduate-level literature review is to summarize in as many words as possible everything that is known about my topic.

A literature review is significant because in the process of doing one, the researcher learns to read and critically assess the literature of a discipline and then uses it appropriately to advance his/her own research.

Read the following abstract and choose the correct type of literature review it represents.

Nursing: E-cigarette use has become increasingly popular, especially among the young. Its long-term influence upon health is unknown. Aim of this review has been to present the current state of knowledge about the impact of e-cigarette use on health, with an emphasis on Central and Eastern Europe. During the preparation of this narrative review, the literature on e-cigarettes available within the network PubMed was retrieved and examined. In the final review, 64 research papers were included. We specifically assessed the construction and operation of the e-cigarette as well as the chemical composition of the e-liquid; the impact that vapor arising from the use of e-cigarette explored in experimental models in vitro; and short-term effects of use of e-cigarettes on users’ health. Among the substances inhaled by the e-smoker, there are several harmful products, such as: formaldehyde, acetaldehyde, acroleine, propanal, nicotine, acetone, o-methyl-benzaldehyde, carcinogenic nitrosamines. Results from experimental animal studies indicate the negative impact of e-cigarette exposure on test models, such as ascytotoxicity, oxidative stress, inflammation, airway hyper reactivity, airway remodeling, mucin production, apoptosis, and emphysematous changes. The short-term impact of e-cigarettes on human health has been studied mostly in experimental setting. Available evidence shows that the use of e-cigarettes may result in acute lung function responses (e.g., increase in impedance, peripheral airway flow resistance) and induce oxidative stress. Based on the current available evidence, e-cigarette use is associated with harmful biologic responses, although it may be less harmful than traditional cigarettes. (J ankowski, Brożek, Lawson, Skoczyński, & Zejda, 2017 ).

• Meta-analysis
• Exploratory

Education: In this review, Mary Vorsino writes that she is interested in keeping the potential influences of women pragmatists of Dewey’s day in mind while presenting modern feminist re readings of Dewey. She wishes to construct a narrowly-focused and succinct literature review of thinkers who have donned a feminist lens to analyze Dewey’s approaches to education, learning, and democracy and to employ Dewey’s works in theorizing on gender and education and on gender in society. This article first explores Dewey as both an ally and a problematic figure in feminist literature and then investigates the broader sphere of feminist pragmatism and two central themes within it: (1) valuing diversity, and diverse experiences; and (2) problematizing fixed truths. ( Vorsino, 2015 ).

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Literature Reviews for Education and Nursing Graduate Students Copyright © by Linda Frederiksen is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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How Higher Education Institutions Walk Their Talk on the 2030 Agenda: A Systematic Literature Review

Affiliations.

• 1 Department of Management & Yunus Social Business Centre, University of Bologna, Via Capo di Lucca, 34, 40126 Bologna, Italy.
• 2 Department of Management, University of Bologna, Via Capo di Lucca, 34, 40126 Bologna, Italy.
• PMID: 35765671
• PMCID: PMC9226290
• DOI: 10.1057/s41307-022-00277-x

Universities are rethinking their teaching and research programs and their whole third mission in response to the framework provided by the Sustainable Development Goals (SDGs). But how do universities walk the talk? What are the main strategies and activities undertaken by universities to implement the 2030 Agenda? While the higher education literature has documented the growing number of practices and strategies around SDGs, there have been few attempts to synthesize these scholarly resources. Moreover, the knowledge base revolves around an array of activities, which makes the literature seem fragmented. To fill this gap, the present paper conducts a systematic literature review and derives a method of categorizing activities that can support further knowledge growth. We classified 130 selected papers based on the type of university activities considered (research, teaching, third mission, and managing operations) and the level of the implemented action (macro, meso, and micro). Subsequently, we identified the main gaps in the literature and discussed future research avenues for addressing higher education's role in accomplishing SDGs.

Supplementary information: The online version contains supplementary material available at 10.1057/s41307-022-00277-x.

Keywords: Higher education; SDG; Sustainability; Sustainable development goals; Systematic literature review; University.

© International Association of Universities 2022.

The impacts of higher education institutions on sustainable development: A review and conceptualization

International Journal of Sustainability in Higher Education

ISSN : 1467-6370

Article publication date: 2 January 2019

Issue publication date: 22 February 2019

This paper aims to conceptualize impacts of higher education institutions (HEIs) on sustainable development (SD), complementing previous literature reviews by broadening the perspective from what HEIs do in pursuit of SD to how these activities impact society, the environment and the economy.

Design/methodology/approach

The paper provides a systematic literature review of peer-reviewed journal articles published between 2005 and 2017. Inductive content analysis was applied to identify major themes and impact areas addressed in the literature to develop a conceptual framework detailing the relationship between HEIs’ activities and their impacts on SD.

The paper identifies six impact areas where direct and indirect impacts of HEIs on SD may occur. The findings indicate a strong focus on case studies dealing with specific projects and a lack of studies analyzing impacts from a more holistic perspective.

Practical implications

This systematic literature review enables decision-makers in HEIs, researchers and educators to better understand how their activities may affect society, the environment and the economy, and it provides a solid foundation to tackle these impacts.

Social implications

The review highlights that HEIs have an inherent responsibility to make societies more sustainable. HEIs must embed SD into their systems while considering their impacts on society.

Originality/value

This paper provides a holistic conceptualization of HEIs’ impacts on SD. The conceptual framework can be useful for future research that attempts to analyze HEIs’ impacts on SD from a holistic perspective.

• Higher education institutions
• Sustainability
• Sustainable development

Findler, F. , Schönherr, N. , Lozano, R. , Reider, D. and Martinuzzi, A. (2019), "The impacts of higher education institutions on sustainable development: A review and conceptualization", International Journal of Sustainability in Higher Education , Vol. 20 No. 1, pp. 23-38. https://doi.org/10.1108/IJSHE-07-2017-0114

Emerald Publishing Limited

Copyright © 2018, Florian Findler, Norma Schönherr, Rodrigo Lozano, Daniela Reider and André Martinuzzi.

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Since the UN Conference on the Human Environment in 1972, higher education institutions (HEIs) have increasingly undertaken active measures to contribute to sustainable development (SD) ( Amaral et al. , 2015 ). SD in HEIs has been promoted, for example, through declarations and charters ( Lozano et al. , 2013b ), the redesign of curricula ( Du et al. , 2013 ; Qian, 2013 ), regional and global partnerships ( Kawabe et al. , 2013 ) and sustainable campus initiatives ( Vaughter et al. , 2016 ). HEI engagement with SD has significantly increased since 1987 ( Lozano et al. , 2013b ) and was further promoted through the UN Decade of Education for Sustainable Development (DESD, 2005-2014), which aimed to integrate the principles of SD into all aspects of HEIs (United Nations Educational, Scientific and Cultural Organization [ UNESCO], 2014 ).

Several literature reviews have been published, providing a comprehensive picture of the state of knowledge on the implementation of initiatives and commitments for SD and the motivations of HEIs to engage with the topic. For example, Wiek et al. (2011) reviewed the significant body of literature on education for SD and identified key competencies in sustainability for academic program development. Wu and Shen’s (2016) systematic review notes that an integrated understanding of SD in higher education curricula (beyond environmental and engineering-related topics) has only recently emerged. Other issues that have received significant attention include the implementation of sustainability initiatives ( Velazquez et al. , 2005 ), regional partnerships for SD ( Karatzoglou, 2013 ) and emerging practices such as sustainability reporting and assessment in HEIs ( Ceulemans et al. , 2015 ). Within this discourse, campus operations have received the largest share of scholarly attention ( Lozano et al. , 2015 ).

While these reviews have greatly improved our understanding of what HEIs do in pursuit of SD, less is known about what they actually achieve by their various activities for society, the natural environment and the economy, i.e. what impact they have on SD. Vaughter et al. (2013) note this research gap in their examination of comparative empirical research. They find that the literature on SD in HEIs remains mostly focused on case studies within institutional operations, with little examination of broader SD policies or impacts on SD. Koehn and Uitto (2014 , p. 624) similarly highlight the impacts on SD as an under-researched aspect in the discourse, which has tended to neglect that “impact involves real-world changes in ecological sustainability, policies, and people’s well-being”.

This poses two problems: First, for many HEIs, the communication of their impacts on SD is becoming an essential part of satisfying emerging accountability expectations from public and private funders, policymakers, accreditation agencies, students and faculty ( Bonaccorsi et al. , 2010 ). Second, there is a lack of clarity and a divergent understanding of the concept ( Gooch et al. , 2017 ; Koehn and Uitto, 2014 ). Greater clarity on and deeper knowledge of such impacts is a prerequisite for well-informed strategic decisions and improved contribution to SD ( Lozano et al. , 2013a ).

What themes are addressed within the literature of the impacts of HEIs on SD?

What are the impact areas outside the HEI system in which change occurs?

This literature review is organized as follows. The second section provides insights into the conceptual basics of the impacts of HEIs on SD. The third section presents the method and the approach to the systematic literature review. The fourth section lays out the quantitative and qualitative results, and the fifth section discusses these results and provides a conceptual framework of HEIs’ impacts on SD. The last section concludes the review.

The impacts of higher education institutions on sustainable development

According to Maas and Liket (2011) , impacts generally refer to the effects caused by an organization or an intervention (policy, program, project, product, technology or measure) that occur outside the organization in society or the natural environment. Several definitions of “impact” have been advanced for the HEI context. The UK’s Research Excellence Framework (REF) describes research impact as “an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia” ( REF, 2016 , para. 1). For Koehn and Uitto (2014 , p. 624), the impacts of sustainability initiatives of HEIs consist of “real-world changes in ecological sustainability, policies, and people’s well-being.” Thomas and Ormerod (2017) differentiate between traditional academic impacts (e.g. scholarly influence) and nonacademic impacts on civil society, public policies or media.

According to Gupta and Singhal (2017) , impacts arise from the core elements of the HEI system (as proposed by Lozano et al. , 2013b ). Sustainability activities in these core elements cause overall social, environmental and economic impacts ( Gupta and Singhal, 2017 ). Impacts on SD materialize along complex pathways, particularly in the area of research and education ( Koehn and Uitto, 2014 ). They can be direct and indirect, intended and unintended and positive and negative; they may present themselves after a significant time lag, at a distance from the HEI’s location, or at a systems level ( Lebeau and Cochrane, 2015 ). As Bowen (2018 , p. 26) notes, “For individuals, the outcomes of higher education are harvested over adult lifetimes averaging fifty to sixty years after graduation from college. For society the impacts may persist through centuries.” This complexity makes the measurement of impacts challenging, and, consequentially, impacts are usually not systematically considered part of sustainability assessments in higher education ( Yarime and Tanaka, 2012 ).

Impacts in this article are, therefore, to be understood as the effects that an HEI has outside of its organizational or academic boundaries – namely, on its stakeholders, the natural environment, the economy and society. This includes the impacts of the HEI as an organization, and the impacts caused by activities in the core elements ( Lozano et al. , 2013b ): education, research, campus operations, outreach, campus experiences, institutional framework and assessment and reporting. Outreach activities (e.g. community teaching) are not regarded as impacts because they take place within the sphere and under the direct control of the HEI and should not be confused with their potential effects (e.g. contribution to school and career achievements).

question formulation;

locating studies;

study selection and evaluation;

analysis and synthesis; and

reporting and applying the results.

Building on the research questions provided in the Introduction (Step 1), this article used the ProQuest and the ScienceDirect electronic databases to find studies to review. The articles were all written in English and published in peer-reviewed, scholarly journals, which are regarded as the most useful sources for literature reviews ( Saunders et al. , 2012 ). The publication time span ranged from 2005, the starting year of the DESD, to 2017.

Due to the lack of clarity in understanding impacts in the literature, a combination of several keywords was searched among the publication titles and abstracts. The keywords included the concept of sustainability in HEIs and related terminology and the term “impact” in different application contexts (e.g. research impact). The keyword search aimed to identify relevant articles within and beyond the sustainability literature. In the first step, a tag cloud was created to identify relevant studies in the fields of HEIs and SD; it consisted of the following search terms: (“higher education” OR “campus” OR “universit*” OR “academia” OR “college*”) AND (“sustainab*” OR “sustainable development” OR “Green”) AND (“outreach” OR “impact*” OR “assessment”) . The same approach was followed in the second step of the search to capture additional impact-relevant articles with the following search terms: (“higher education” OR “universit*”) AND (“research impact*” OR “economic impact*” OR “social impact*” OR “ecological impact*” OR “impact assessment” OR “outreach”) .

After the exclusion of duplicates, book reviews, editorials, commentaries and keynotes, the studies were manually and independently checked for appropriate content to ensure that all articles dealt with SD issues in HEIs. This resulted in a sample of 429 articles. In the next step, the sample was screened in light of the understanding of “impact” provided in the previous section, namely, as the effects an HEI has outside of its organizational boundaries on its stakeholders, the natural environment, the economy and society. Building on this distinctive characteristic, all articles addressing the impacts of an HEI on SD were included, while articles solely addressing sustainability activities within organizational boundaries were eliminated. The final sample consisted of 113 articles, which were analyzed in the review.

The studies in the final sample were subjected to inductive content analysis using the MAXQDA 12 qualitative analysis software ( Verbie, 2016 ). Content analysis allows for the systematic reduction of sources and analyzes document characteristics in quantitative and qualitative manners to identify themes ( Berg, 2001 ; Krippendorff, 2004 ). The articles were coded for journal distribution, date of publication and applied research method to support the quantitative analysis. The content analysis of the impacts of HEIs on SD used a concept-centric approach ( Webster and Watson, 2002 ).

As with other reviews in higher education ( Bizerril et al. , 2018 ), the basis of the content analysis was the concept of the seven core elements by Lozano et al. (2013b) : education, research, campus operations, outreach, campus experiences, institutional framework and assessment and reporting. Each paper was classified into one, or, in a few cases, more than one core element. Studies that did not fit into this categorization were classified as “generalist papers.” This category included papers dealing with impacts of the entire HEI. The major findings were systemized for each category and synthesized into a set of themes emerging from the literature. Based on this, a conceptual framework of the impacts of HEIs on SD was derived.

The first two authors independently conducted all steps of the analysis to ensure reliability ( Seuring and Müller, 2008 ). Inter-coder reliability was high (Kappa value of 0.877), and any differences among the coders were resolved through discussion until consensus was achieved.

Like other systematic literature reviews ( Ceulemans, et al. , 2015 ), this study also has limitations. First, the focus on peer-reviewed journals excluded conference papers, reports, book chapters and sources from grey literature. Second, ProQuest and ScienceDirect are not the only databases available. To ensure that all relevant journals in the research area were considered, the results were crosschecked with recent literature reviews in the field of higher education ( Blanco-Portela et al. , 2017 ; Ceulemans et al. , 2015 ). To identify all relevant studies, the term “universit*” was used as a search term. This led to some irrelevant results, due to authors’ affiliations, which usually included “university.” Inappropriate papers were excluded by manually checking all articles for appropriate content. Third, content analysis can sometimes be prone to the misinterpretation of documents. The use of MAXDAQ 12 and performing the review as a team reduced the likelihood of such flaws and enhanced the reliability of the results.

Findings of the literature review

The literature reviewed consisted of 113 articles representing the state of knowledge on HEIs and impacts on SD. There was a steady increase in publications between 2005 and 2017, which shows this relatively recent field of study is still emerging. The largest number of articles was published within the past four years (56.64 per cent of the sample). Papers published between 2005 and 2009 were primarily case studies; qualitative and quantitative studies mainly occurred since 2010. Overall, the sample consisted mostly of case studies (48.67 per cent) and quantitative studies (20.35 per cent). Theoretical contributions (14.16 per cent), mixed methods (8.85 per cent), qualitative empirical research (6.20 per cent) and literature reviews (1.77 per cent) are rather limited, having been published only in the later years of the sample period.

The discourse on the impacts of HEIs on SD remains relatively fragmented and spread over a wide range of journals, with 72.57 per cent of the sample from journals with not more than three contributions. Journal of Cleaner Production had the largest number of contributions (13.27 per cent of the sample). Other strongly represented journals in the sample are Journal of Higher Education Outreach and Engagement presenting 7.08 per cent of the sample, and International Journal of Sustainability in Higher Education, which has published 3.54 per cent of the contributions in the sample. Journal of Cleaner Production and International Journal of Sustainability in Higher Education are the most prominent journals in other literature reviews of sustainability in HEIs (as discussed by Blanco-Portela et al. , 2017 and Ceulemans et al. , 2015 ).

As shown in Figure 1 , the results of the inductive content analysis reveal a strong focus on the core elements outreach (21.99 per cent) and assessment and reporting (19.86 per cent). None of the articles was classified under the core element institutional framework. Thirty articles (21.28 per cent) were classified into the category generalist papers. Some articles dealt with crosscutting themes and were categorized into two core elements. Selected findings of each core element are presented in detail below.

The outreach activities of HEIs are discussed in 31 articles. This category consists of a large part of case studies reporting on specific local outreach projects and their impacts. The main emphasis of these studies is on school collaborations and the support of small businesses and the local community. Anand et al. (2015) illustrated how students’ understanding of SD can be fostered by their participation in a regional education initiative aimed at integrating SD into the member institutions. Other studies exemplified the support of HEIs to establish a high school archival program ( Fernekes and Rosenberg, 2008 ), to reopen a closed school ( Officer et al. , 2011 ), and to educate high school students ( Lynch, et al. , 2005 ). The support of local businesses is described by Hill et al. (2016) , who analyzed the process of knowledge exchange from an HEI to rural businesses, and Riebe (2012) , who studied the benefits of university-based entrepreneur centers for women. These works show positive impacts of outreach engagement, which is confirmed by MacPherson and Zilokowski (2005) for university-based industrial extension services. The increasing importance of outreach activities and their contribution to economic development is highlighted by Rubens et al. (2017) , who examined the benefits of policies that reward staff engagement in outreach activities. Several studies illustrate the impacts of local outreach activities on different populations. For example, Anstadt (2009) demonstrated how a community connection program managed to reduce the social isolation of seniors, caregivers and international students, while providing foreign students the opportunity to practice the local language and to learn about local culture. Scull and Cuthill (2010) examined a project that supports access to higher education for people from marginalized socioeconomic backgrounds and highlight the importance of a long-term strategy as success factor for the project. Patterson et al. (2014) analyzed the effects of community-based research and outreach to the reduction of homelessness. There is also a variety of other studies focusing on outreach projects that aim to foster SD in local communities ( Trencher et al. , 2014 ). Other studies such as Lehmann et al. (2009) emphasized the positive impacts of outreach activities on the HEI itself. They concluded that HEIs benefit from such engagement by improving their ability to cope with emerging SD problems and developing more successful SD education programs.

Twenty-eight studies address the core element assessment and reporting . These articles applied a variety of different approaches, such as simulations ( Pastor et al. , 2013 ) and input–output models ( Agiomirgianakis et al. , 2017 ) to examine socioeconomic impacts of HEIs. Roessner et al. (2013) used an input–output model to evaluate the economic impacts of licensed commercialized research inventions. Pienaar-Steyn (2012) proposed the millennium development goals (MDGs) as framework for the development of monitoring tools for the evaluation of community outreach engagement, while Lynch-Alexander (2017) discussed the Lynch Outreach Assessment model (LOAM) as a tool for HEIs to assess their outreach engagement. Carteron et al. (2014) analyzed the potential of a sustainability literacy test for students as a monitoring system for tracking educational impacts. The reviewed studies also used footprint and inventory analyses to assess greenhouse gas (GHG) emissions ( Li et al. , 2015 ) or combined life cycle assessments with material flow analysis to evaluate the metabolism of HEIs ( Lopes Silva et al. , 2015 ).

Twenty-four articles focused on the nonacademic impacts of research . These articles addressed impacts on policy, research uptake in business practice, societal impacts and the impacts of co-creation research. Aguinis et al. (2014) argued for the adoption of a pluralistic concept of research impacts that considers also nonacademic stakeholders and fosters engaged scholarship to increase the relevance of research. In the same vein, Bozeman and Youtie (2017) studied the socioeconomic impacts of government funded research through a case analysis of four publicly funded research projects and provide a framework to compare such projects and their impacts. Marcella et al. (2016) concluded that the REF increases awareness of nonacademic impacts among researchers. The interview data of Smith and Stewart (2017) , however, revealed certain concerns about how the REF works in practice. Research impacts on the national economy are estimated based on a national input–output model with licensing of research inventions to industry by Roessner et al. (2013) . Their estimates indicate a significant impact on gross domestic product (GDP) and employment. Regarding economic impacts, it is argued that most university spin-off companies remain small, as most of them are “technology lifestyle businesses not dynamic high-growth potential start-ups” ( Harrison and Leitch, 2010 , p. 1241). The uptake of research by policymakers and other practitioners is examined in the case of medical ( Balas and Elkin, 2013 ), social science ( Cherney et al. , 2015 ) and tourism research ( Thomas and Ormerod, 2017 ). Thomas and Ormerod (2017) pointed out that research with high academic citation scores is also likely more cited by policymakers and practitioners. Impacts of action research ( Banks et al. , 2017 ; Haigh, 2006 ) and co-creation ( Greenhalgh et al. , 2016 ) are also discussed. For instance, Greenhalgh et al. (2016) identified key principles for the success of co-creation activities and highlighted the importance of metrics apt to capture complex impact pathways linking such activities and their potential societal impacts.

The impacts of education on SD are exemplified in 13 articles that have their thematic focus on sustainable lifestyles, economic impacts, distance learning and impacts on culture. Rodríguez-Barreiro et al. (2013) highlighted the relationship between the conversation perspective in education programs and students’ sustainability intentions and behaviors. Rauch and Hulsink (2015) and Fretschner and Weber (2013) examined the impact of entrepreneurship education on entrepreneurial attitudes, intentions and behavior. Their studies indicated an effect of program or course participation on willingness to engage in entrepreneurial activities. Jones et al. (2017) concluded that entrepreneurship education helps to foster business start-ups and fosters employability. Escobar-Tello and Bharma (2013) described an education project that resulted in the reduction of students’ energy consumption and the enhancement of their happiness to promote sustainable lifestyles. Crucial for the project’s success was the implementation of a reward system and a social network platform for information sharing among the participants. The reduction of GHG emissions was discussed in the context of distance learning ( Roy et al. , 2008 ) and online education ( Versteijlen et al. , 2017 ). Both studies concluded that distance learning contributes to the reduction of student GHG emissions by reducing travel and energy consumption on campus. GHG emissions of e-learning are slightly lower than those associated with print-based distance learning ( Roy et al. , 2008 ). Yao and Bai (2008) studied the economic and cultural impacts of international students. They concluded that student exchange is particularly beneficial for cultural diversity and exchange in rural areas.

The category of campus operations comprised 11 case studies and one theoretical contribution. These studies mainly addressed impacts on the natural environment. Three case studies solely discussed the impacts of GHG emissions of campus operations with a particular focus on the indirect emissions caused by the consumption of staff ( Gómez et al. , 2016 ), student behavior ( Li et al. , 2015 ) and institutional purchases ( Thurston and Eckelman, 2011 ). All three studies highlighted the significance of indirect GHG emissions, which comprise a significant share of the overall carbon footprint of HEIs (up to 80 per cent in the case of the University of Castilla-La Mancha, see Gómez et al. , 2016 ). Hancock and Nuttman (2014) identified staff and student transport as an important contributor to indirect GHG emissions and highlighted the importance of behavior change toward sustainable modes of transport. To achieve behavior change and a reduction of individual staff and student transport, Rotaris and Danielis (2015) considered bus subsidies and parking restrictions as effective. Two articles examined the impacts of land and water use ( Chen et al. , 2016 ) and generated waste and water use ( Strasburg and Jahno, 2017 ) in relation to campus cafeterias and restaurants. Chen et al. (2016) argued that environmental impacts of ingredients strongly vary depending on their provenance and that the adoption of a lacto-vegetarian diet can have both positive and negative environmental impacts. In this context, Barlett (2011) highlighted the importance of campus sustainable food projects to foster alternative food systems. Another aspect of campus operations is the relationship between the campus and its surrounding area. Muller and Tempelhoff (2016) pointed out the relevance of the environmental status of the campus in the context of local communities. Lee (2014) concluded that campus noise emissions not only negatively affect on-campus activities (e.g. student learning) but also the surrounding area.

Three articles address campus experiences and discuss societal challenges. Orme and Coghill (2014) explored how sensible drinking patterns are facilitated on UK campuses. Their study highlights the importance of alcohol policies, staff training and community involvement to promote sensible drinking habits among students. The second paper in this category examines the impacts of green campuses on students’ health ( Hipp et al. , 2016 ). This study indicated a relationship between the campus greenness that students perceive and the quality of their lives. In the third article, Kermath (2007) examined the impacts of a campus and urban landscape project aiming to foster biodiversity and ecological literacy by expressing sustainability values.

Thirty papers were classified within the generalist category, which included papers that could not be assigned to one of the core elements. Such studies discuss impacts caused by the entire HEI (rather than a single core element). Ten of these studies analyze the regional economic impacts of HEIs ( Alves et al. , 2015 ), while other studies focus on contributions to regional socioeconomic development (see Robinson and Adams; Saúde et al. , 2014 ). The local economic impacts of HEIs are caused by spending on goods and services and spending by staff and students, as well as by indirect effects on local supply chains, e.g. via job creation ( Alves et al. , 2015 ). Estimates of GDP contributions vary between 2 and 11 per cent ( Alves et al. , 2015 ). Robinson and Adams (2008) examined how HEIs contribute to regional regeneration and neighborhood renewal. They concluded that in the UK many HEIs contribute to regeneration, but there is still untapped potential to strengthen deprived areas. Hubbard (2008) analyzed the impacts of HEIs on demographics. He considered policies as an instrument to integrate students into the local community to prevent social and cultural problems caused by “studentification,” i.e. the effect of growing student populations in the area around an HEI. Orme and Dooris (2010) emphasized the enormous potential of HEIs to influence society. They introduced the concept of a “healthy university” that follows a whole system approach and aims to leverage the synergies between SD, public health and climate change mitigation.

The growing number of publications on the impacts of HEIs on SD since 2014 illustrates the increasing relevance of the growing field of study, in practice and academia ( Bonaccorsi et al. , 2010 ; Wals, 2014 ). The review shows that the literature on the SD impacts of HEIs have been mostly case studies that largely focus on specific HEIs and their impacts on society ( Anstadt, 2009 ; Escobar-Tello and Bharma, 2013 ), the economy ( Alves et al. , 2015 ) or the natural environment ( Chen et al. , 2016 ; Thurston and Eckelman, 2011 ). The reviewed single case studies provide rich narratives on individual HEIs in the context of SD impacts, but there remains a lack of whole institution and holistic approaches and perspectives. This is confirmed by the fact that none of the contributions addresses the institutional framework, despite the importance of broad-scale policies to facilitate the implementation of SD across all core elements of HEIs ( Lozano et al. , 2013b ). A whole institution approach, as called for by the DESD ( UNESCO, 2014 ), would require a shift of attention from activities implemented in specific core elements to a focus on the natural environment and a sustainable society as integrative going concern.

Across the reviewed literature, there is an apparent focus on specific projects and economic impacts. Due to predefined tasks, a comprehensive examination of project impacts is less challenging compared with an assessment of the complex pathways between research and educational activities and their impacts on SD. Studies on economic impacts can make use of a variety of methods to determine and aggregate the effects of HEIs’ activities on local, regional and national economies (e.g. input–output systems proposed by Agiomirgianakis et al. , 2017 ). The difficulty of systematically accounting for the impacts of HEIs on SD is exacerbated by many impacts occurring with significant time lags and cannot always be directly attributed to specific core elements. Such indirect impacts (GHG emissions caused by students, Gómez et al. , 2016 ; entrepreneurial activities of graduates, Jones et al. , 2017 ) pose significant assessment challenges. In contrast, direct, short-term impacts can be much more easily observed, described and quantified (GHG emissions caused by operations, contribution to local economy). Tackling the complexity of causal pathways between activities and indirect impacts would be an important step toward fulfilling the requirements of the whole institution approach ( UNESCO, 2014 ).

The impacts of HEIs on SD must account for two fundamental dimensions. First, impacts can be conceptualized depending on the extent to which they are specific to a core element or integrative in nature. Second, impacts must be considered whether they are directly (short term effects) or indirectly (long-term effects) attributable to HEIs’ activities. This paper proposes a framework conceptualizing the impacts of HEIs on SD under consideration of these two dimensions ( Figure 2 ).

The core elements ( Lozano et al. , 2013b ) in which different organizational and individual activities take place may cause a variety of influences on SD impact areas: economy, societal challenges, natural environment, policies, culture, and demographics. Within these impact areas, this review has resulted in a set of specific themes that further specify direct and indirect impacts on SD, which may be plausibly attributed to HEIs. Systematic and reliable assessment of the impacts of HEIs is a crucial premise for managing and improving the contribution of HEIs to SD. The framework not only highlights the assessment and reporting as a cross-cutting requirement but also identifies it as one of the fundamental challenges to more systematic consideration of impacts. This is because many assessment approaches focus on SD performance within HEIs ( Yarime and Tanaka, 2012 ) but appear not to have been designed to assess impacts from the perspective of a whole institution approach, particularly regarding indirect impacts.

Conclusions

This paper systematically reviewed the existing literature on impacts of HEIs on SD with a view to providing an integrative conceptualization of core themes and SD impact areas. It complements previous reviews of the integration of SD issues in the context of higher education by specifically eliciting the impacts of HEIs on SD.

The SD impact framework of HEIs highlights direct and indirect impacts on SD arising from the activities of HEIs. The framework can provide a useful framing for reflecting on and mapping the potential impacts of HEIs, thereby contributing to a more holistic understanding of how HEIs affect their stakeholders, the natural environment, the economy, and society. This can help to identify and prioritize SD impact areas of HEIs.

Two major gaps in the literature provide ample space for future research in this rapidly evolving field of inquiry. First, more research with a holistic perspective that considers the impacts of all core elements would be a fruitful addition to the many in-depth case studies available. This would allow for a comprehensive understanding of the impacts of HEIs on SD. Such a whole institution approach would also help identify impact areas and stakeholder groups that are currently underrepresented in the literature. For instance, cultural impacts and impacts on policy, social cohesion, individual behavior and life paths of alumni are currently underexplored and merit further attention. Second, the lack of holistic assessment approaches for the impacts of HEIs on SD offers a major avenue for future research. Existing sustainability assessment tools in higher education could be analyzed regarding their ability to effectively examine the direct and indirect impacts of HEIs on SD. Given the difficulty of quantifying long-term indirect impacts, it might be of interest to explore how far qualitative approaches that use narratives can capture impacts that are difficult to measure with quantitative indicators.

Distribution of articles among the core elements

The SD impact framework of HEIs

Agiomirgianakis , G. , Serenis , D. and Tsounis , N. ( 2017 ), “ A distance learning university and its economic impact in a country’s peripheries: the case of hellenic open university, international ”, Journal of Operational Research , Vol. 17 No. 1 , pp. 165 - 186 .

Aguinis , H. , Shapiro , D.L. , Antonacopoulou Gnosis , E.P. and Cummings , T.G. ( 2014 ), “ Scholarly impact: a pluralist conceptualization ”, Academy of Management Learning and Education , Vol. 13 No. 4 , pp. 623 - 639 .

Alves , J. , Carvalho , L. , Carvalho , R. , Correia , F. , Cunha , J. , Farinha , L. , Fernandes , J. , Ferreira , M. , Lucas , E. , Mourato , J. , Nicolau , A. , Nunes , S. , Nunes , S. , Oliveira , P. , Pereira , C. , Pinto , S. and Silva , J. ( 2015 ), “ The impact of polytechnic institutes on the local economy ”, Tertiary Education and Management , Vol. 21 No. 2 , pp. 81 - 98 .

Amaral , L.P. , Martins , N. and Gouveia , J.B. ( 2015 ), “ Quest for a sustainable university: a review ”, International Journal of Sustainability in Higher Education , Vol. 16 No. 2 , pp. 155 - 172 .

Anand , C.K. , Bisaillon , V. , Webster , A. and Amor , B. ( 2015 ), “ Integration of sustainable development in higher education – a regional initiative in Quebec (Canada) ”, Journal of Cleaner Production , Vol. 108 , pp. 916 - 923 .

Anstadt , S.P. ( 2009 ), “ Community connections: An intergenerational and multicultural community group program ”, Journal of Intergenerational Relationships , Vol. 7 No. 4 , pp. 442 - 446 .

Balas , E.A. and Elkin , P.L. ( 2013 ), “ Technology transfer from biomedical research to clinical practice: measuring innovation performance ”, Evaluation and the Health Professions , Vol. 36 No. 4 , pp. 505 - 517 .

Banks , S. , Herrington , T. and Carter , K. ( 2017 ), “ Pathways to co-impact: action research and community organizing ”, Educational Action Research , Vol. 25 No. 4 , pp. 541 - 559 .

Barlett , P.F. ( 2011 ), “ Campus sustainable food projects: critique and engagement ”, American Anthropologist , Vol. 113 No. 1 , pp. 101 - 115 .

Berg , B.L. ( 2001 ), Qualitative Research Methods for the Social Sciences , Allyn and Bacon , Boston .

Bizerril , M. , Rosa , M.J. , Carvalho , T. and Pedrosa , J. ( 2018 ), “ Sustainability in higher education: a review of contributions from portuguese speaking countries ”, Journal of Cleaner Production , Vol. 171 , pp. 600 - 612 .

Bowen , H. ( 2018 ), The Individual and Social Value of American Higher Education , Routledge , New York, NY .

Bozeman , B. and Youtie , J. ( 2017 ), “ Socio-economic impacts and public value of government-funded research: lessons from four US national science foundation initiatives ”, Research Policy , Vol. 46 No. 8 , pp. 1387 - 1298 .

Blanco-Portela , N. , Benayas , J. , Pertierra , L.R. and Lozano , R. ( 2017 ), “ Towards the integration of sustainability in higher education institutions: a review of drivers of and barriers to organisational change and their comparison against those found of companies ”, Journal of Cleaner Production , Vol. 166 , pp. 563 - 578 .

Bonaccorsi , A. , Daraio , C. and Geuna , A. ( 2010 ), “ Universities in the new knowledge landscape: tensions, challenges, change – an introduction ”, Minerva , Vol. 48 No. 1 , pp. 1 - 4 .

Carteron , J.-C. , Haynes , K. and Murray , A. ( 2014 ), “ Education for sustainable development, the UNGC PRME initiative, and the sustainability literacy test: Measuring and assessing success ”, S.A.M. Advanced Management Journal , Vol. 79 No. 4 , pp. 51 - 58 .

Ceulemans , K. , Molderez , I. and van Liedekerke , L. ( 2015 ), “ Sustainability reporting in higher education: a comprehensive review of the recent literature and paths for further research ”, Journal of Cleaner Production , Vol. 106 , pp. 127 - 143 .

Chen , D.M. , Tucker , B. , Badami , M.G. , Ramankutty , N. and Rhemtulla , J.M. ( 2016 ), “ A multi-dimensional metric for facilitating sustainable food choices in campus cafeterias ”, Journal of Cleaner Production , Vol. 135 , pp. 1351 - 1362 .

Cherney , A. , Head , B. , Povey , J. , Boreham , P. and Ferguson , M. ( 2015 ), “ The utilisation of social science research – the perspectives of academic researchers in Australia ”, Journal of Sociology , Vol. 51 No. 2 , pp. 252 - 270 .

Denyer , D. and Tranfield , D. ( 2009 ), “ Producing a systematic review ”, in Buchanan , D. and Bryman , A. (Eds), The Sage Handbook of Organizational Research Methods , Sage , London , pp. 671 - 689 .

Du , X. , Su , L. and Liu , J. ( 2013 ), “ Developing sustainability curricula using the PBL method in a Chinese context ”, Journal of Cleaner Production , Vol. 61 , pp. 80 - 88 .

Escobar-Tello , M. and Bharma , T. ( 2013 ), “ Happiness as a harmonising path for bringing higher education towards sustainability ”, Environment, Development and Sustainability , Vol. 15 No. 1 , pp. 177 - 197 .

Fernekes , W.R. and Rosenberg , H.Z. ( 2008 ), “ Building a high school archives program: a case study in school–university collaboration ”, Journal of Archival Organization , Vol. 6 No. 3 , pp. 151 - 168 .

Fretschner , M. and Weber , S. ( 2013 ), “ Measuring and understanding the effects of entrepreneurial awareness education ”, Journal of Small Business Management , Vol. 51 No. 3 , pp. 410 - 428 .

Gómez , N. , Cadarso , M.-Á. and Monsalve , F. ( 2016 ), “ Carbon footprint of a university in a multiregional model: the case of the university of Castilla-La Mancha ”, Journal of Cleaner Production , Vol. 138 , pp. 119 - 130 .

Gooch , D. , Vasalou , A. and Benton , L. ( 2017 ), “ Impact in interdisciplinary and cross-sector research: opportunities and challenges ”, Journal of the Association for Information Science and Technology , Vol. 68 No. 2 , pp. 378 - 391 .

Greenhalgh , T. , Jackson , C. , Shaw , S. and Janamian , T. ( 2016 ), “ Achieving research impact through co-creation in community‐based health services: literature review and case study ”, Milbank Quarterly , Vol. 94 No. 2 , pp. 392 - 429 .

Gupta , H. and Singhal , N. ( 2017 ), “ Framework for embedding sustainability in business schools: a review ”, Vision: The Journal of Business Perspective , Vol. 21 No. 2 , pp. 195 - 203 .

Haigh , M.J. ( 2006 ), “ Promoting environmental education for sustainable development: the value of links between higher education and non-governmental organizations (NGOs) ”, Journal of Geography in Higher Education , Vol. 30 No. 2 , pp. 327 - 349 .

Hancock , L. and Nuttman , S. ( 2014 ), “ Engaging higher education institutions in the challenge of sustainability: sustainable transport as a catalyst for action ”, Journal of Cleaner Production , Vol. 62 , pp. 62 - 71 .

Harrison , R.T. and Leitch , C. ( 2010 ), “ Voodoo institution or entrepreneurial university? Spin-off companies, the entrepreneurial system and regional development in the UK ”, Regional Studies , Vol. 44 No. 9 , pp. 1241 - 1262 .

Hill , A. , Scott , J. , Moyes , D. and Smith , R. ( 2016 ), “ Supporting knowledge exchange in rural business – a case story from dumfries and galloway, Scotland ”, Local Economy: The Journal of the Local Economy Policy Unit , Vol. 31 No. 7 , pp. 812 - 824 .

Hipp , J.A. , Betrabet Gulwadi , G. , Alves , S. and Sequeira , S. ( 2016 ), “ The relationship between perceived greenness and perceived restorativeness of university campuses and student-reported quality of life ”, Environment and Behavior , Vol. 48 No. 10 , pp. 1292 - 1308 .

Hubbard , P. ( 2008 ), “ Regulating the social impacts of studentification: a loughborough case study ”, Environment and Planning A , Vol. 40 No. 2 , pp. 323 - 341 .

Jones , P. , Pickernell , D. , Fisher , R. and Netana , C. ( 2017 ), “ A tale of two universities: graduates perceived value of entrepreneurship education ”, Education + Training , Vol. 59 Nos 7/8 , pp. 689 - 705 .

Karatzoglou , B. ( 2013 ), “ An in-depth literature review of the evolving roles and contributions of universities to education for sustainable development ”, Journal of Cleaner Production , Vol. 49 , pp. 44 - 53 .

Kawabe , M. , Kohno , H. , Ikeda , R. , Ishimaru , T. , Baba , O. , Horimoto , N. , Kanda , J. , Matsuyam , M. , Moteki , M. , Oshima , Y. , Sasaki , T. and Yap , M. ( 2013 ), “ Developing partnerships with the community for coastal ESD ”, International Journal of Sustainability in Higher Education , Vol. 14 No. 2 , pp. 122 - 132 .

Kermath , B. ( 2007 ), “ Why go native? Landscaping for biodiversity and sustainability education ”, International Journal of Sustainability in Higher Education , Vol. 8 No. 2 , pp. 210 - 223 .

Koehn , P.H. and Uitto , J.I. ( 2014 ), “ Evaluating sustainability education: lessons from international development experience ”, Higher Education , Vol. 67 , pp. 672 - 635 .

Krippendorff , K. ( 2004 ), Content Analysis: An Introduction to Its Methodology , Sage , Thousand Oaks .

Lebeau , Y. and Cochrane , A. ( 2015 ), “ Rethinking the ‘third mission’: UK universities and regional engagement in challenging times ”, European Journal of Higher Education , Vol. 5 No. 3 , pp. 250 - 263 .

Lee , H.Y. ( 2014 ), “ Long-term evolution of campus noise emissions: a case of new university development ”, Journal of Environmental Planning and Management , Vol. 57 No. 8 , pp. 1169 - 1182 .

Lehmann , M. , Christensen , P. , Thrane , M. and Jørgensen , T.H. ( 2009 ), “ University engagement and regional sustainability initiatives: some danish experiences ”, Journal of Cleaner Production , Vol. 17 No. 12 , pp. 1067 - 1074 .

Li , X. , Tan , H. and Rackes , A. ( 2015 ), “ Carbon footprint analysis of student behavior for a sustainable university campus in China ”, Journal of Cleaner Production , Vol. 106 , pp. 97 - 108 .

Lopes Silva , D. , de Oliveira , A.J. , Saavedra , Y.M.B. , Ometto , A.R. , Rieradevall i Pons , J. and Gabarrell Durany , X. ( 2015 ), “ Combined MFA and LCA approach to evaluate the metabolism of service polygons: A case study on a university campus ”, Resources, Conservation and Recycling , Vol. 94 , pp. 157 - 168 .

Lozano , R. , Lozano , F.J. , Mulder , K. , Huisingh , D. and Waas , T. ( 2013a ), “ Advancing higher education for sustainable development: international insights and critical reflections ”, Journal of Cleaner Production , Vol. 48 , pp. 3 - 9 .

Lozano , R. , Lukman , R. , Lozano , F.J. , Huisingh , D. and Lambrechts , W. ( 2013b ), “ Declarations for sustainability in higher education: becoming better leaders, through addressing the university system ”, Journal of Cleaner Production , Vol. 48 , pp. 10 - 19 .

Lozano , R. , Ceulemans , K. , Alonso-Almeida , M. , Huisingh , D. , Lozano , F.J. , Waas , T. , Lambrechts , W. , Lukman , R. and Hugé , J. ( 2015 ), “ A review of commitment and implementation of sustainable development in higher education: results from a worldwide survey ”, Journal of Cleaner Production , Vol. 108 , pp. 1 - 18 .

Lynch , M. , Zovinka , E.P. , Zhang , L. , Hruska , J.L. and Lee , A. ( 2005 ), “ Rural outreach chemistry for kids (R.O.C.K.): the program and its evaluation ”, Journal of Higher Education Outreach and Engagement , Vol. 10 No. 3 , pp. 125 - 141 .

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Corresponding author

About the authors.

Florian Findler is a Teaching and Research Associate at the Institute for Managing Sustainability ( www.sustainability.eu ) at the Vienna University of Economics and Business. He studied management at the University of Marburg, the University of Hohenheim, and at the BI Norwegian Business School in Oslo. Prior to his work at the institute, Florian gained working experience in the IT and automotive sector and as a Research Assistant at the Chair for Marketing and Business Development at the University of Hohenheim. His main research interests are sustainability in higher education, corporate social responsibility and impact assessment.

Norma Schönherr is a Research Fellow and Project Manager at the Institute for Managing Sustainability ( www.sustainability.eu ) at the Vienna University of Economics and Business. Before joining the institute, she held positions in an international environmental NGO, a development agency and a free research institute. She is an expert in impact measurement and management. Her main areas of expertise are corporate social responsibility, international sustainability governance and corporate impacts on global sustainable development.

Rodrigo Lozano is a Professor (full) at the University of Gävle, Sweden and former Editor-in-Chief for the Journal of Cleaner Production. He was previously an Assistant Professor at the Copernicus Institute of Sustainable Development, Utrecht University, the Netherlands, and a Program Leader of the BA Environment and Business at the Sustainability Research Institute, University of Leeds, UK. For over 20 years, Rodrigo has been working toward sustainability in NGOs, universities and corporations. His projects have ranged from chemical leasing, indoor-air quality and energy efficiency, to sustainability assessment and reporting and to organizational change management.

Daniela Reider is a graduate of the master’s program “Supply Chain Management” at the Vienna University of Economics and Business. In addition, she also studied at LUISS Guido Carlì, Rome and the City University of Hong Kong. Besides her studies, she worked at the Institute for Managing Sustainability as a Research Assistant. In this function, her main focus was on a project concerning the impact of higher education institutions. Furthermore, she participated in the preparation of an EU research proposal (Horizon 2020) on Responsible Research and Innovation in the ICT sector.

André Martinuzzi is the Founding Director of the Institute for Managing Sustainability ( www.sustainability.eu ) and an Associate Professor at the Vienna University of Economics and Business. His areas of research are sustainable development, corporate social responsibility, and knowledge management. For 20 years, he has co-ordinated projects and networks funded by the EU Framework Programmes, on behalf of six different EU Directorates General, Eurostat, UN organizations and for several national ministries. He currently carries out research on how corporations manage their impacts on the sustainable development goals and on responsible research and innovation in the areas of smart homes and smart health.

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Correction: Role of AI chatbots in education: systematic literature review

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“To improve the clarity of the discussion section, we employed Large Language Model (LLM) for stylistic suggestions.”

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Employment of patients with rheumatoid arthritis - a systematic review and meta-analysis

• Lilli Kirkeskov 1 , 2 &
• Katerina Bray 1 , 3  

BMC Rheumatology volume  7 , Article number:  41 ( 2023 ) Cite this article

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Patients with rheumatoid arthritis (RA) have difficulties maintaining employment due to the impact of the disease on their work ability. This review aims to investigate the employment rates at different stages of disease and to identify predictors of employment among individuals with RA.

The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines focusing on studies reporting employment rate in adults with diagnosed RA. The literature review included cross-sectional and cohort studies published in the English language between January 1966 and January 2023 in the PubMed, Embase and Cochrane Library databases. Data encompassing employment rates, study demographics (age, gender, educational level), disease-related parameters (disease activity, disease duration, treatment), occupational factors, and comorbidities were extracted. Quality assessment was performed employing Newcastle–Ottawa Scale. Meta-analysis was conducted to ascertain predictors for employment with odds ratios and confidence intervals, and test for heterogeneity, using chi-square and I 2 -statistics were calculated. This review was registered with PROSPERO (CRD42020189057).

Ninety-one studies, comprising of a total of 101,831 participants, were included in the analyses. The mean age of participants was 51 years and 75.9% were women. Disease duration varied between less than one year to more than 18 years on average. Employment rates were 78.8% (weighted mean, range 45.4–100) at disease onset; 47.0% (range 18.5–100) at study entry, and 40.0% (range 4–88.2) at follow-up. Employment rates showed limited variations across continents and over time. Predictors for sustained employment included younger age, male gender, higher education, low disease activity, shorter disease duration, absence of medical treatment, and the absence of comorbidities.

Notably, only some of the studies in this review met the requirements for high quality studies. Both older and newer studies had methodological deficiencies in the study design, analysis, and results reporting.

Conclusions

The findings in this review highlight the prevalence of low employment rates among patients with RA, which increases with prolonged disease duration and higher disease activity. A comprehensive approach combining clinical and social interventions is imperative, particularly in early stages of the disease, to facilitate sustained employment among this patient cohort.

Peer Review reports

Rheumatoid arthritis (RA) is a chronic, inflammatory joint disease that can lead to joint destruction. RA particularly attacks peripheral joints and joint tissue, gradually resulting in bone erosion, destruction of cartilage, and, ultimately, loss of joint integrity. The prevalence of RA varies globally, ranging from 0.1- 2.0% of the population worldwide [ 1 , 2 ]. RA significantly reduces functional capacity, quality of life, and results in an increase in sick leave, unemployment, and early retirement [ 3 , 4 , 5 ]. The loss of productivity due to RA is substantial [ 2 , 5 , 6 , 7 ]. A 2015 American study estimated the cost of over $250 million annually from RA-related absenteeism in United States alone [ 8 ].

Research has highlighted the importance of maintaining a connection to the labour market [ 3 , 9 ], Even a short cessation from work entails a pronounced risk of enduring work exclusion [ 10 ]. In Denmark merely 55% on sick leave for 13 weeks succeeded in re-joining the workforce within one year. Among those on sick leave for 26 weeks, only 40% returned to work within the same timeframe [ 11 ]. Sustained employment is associated with an improved health-related quality of life [ 12 , 13 ]. Early and aggressive treatment of RA is crucial for importance in achieving remission and a favourable prognosis reducing the impact of the disease [ 2 , 14 , 15 , 16 ]. Therefore, initiating treatment in a timely manner and supporting patients with RA in maintaining their jobs with inclusive and flexible workplaces if needed is critical [ 3 , 17 ].

International studies have indicated, that many patients with RA are not employed [ 18 ]. In 2020, the average employment rate across Organization for Economic Co-operation and Development (OECD) countries was 69% in the general population (15 to 64 years of age), exhibiting variations among countries, ranging from 46–47% in South Africa and India to 85% in Iceland [ 19 ]. Employment rates were lower for individuals with educational levels below upper secondary level compared to those with upper secondary level or higher education [ 19 ]. For individuals suffering with chronic diseases, the employment rates tend to be lower. Prognostic determinants for employment in the context of other chronic diseases encompasses the disease’s severity, employment status prior to getting a chronic disease, and baseline educational level [ 20 , 21 , 22 ]. These somatic and social factors may similarly influence employment status of patients with RA. Several factors, including the type of job (especially physically demanding occupations), support from employers and co-workers, social safety net, and disease factors such as duration and severity, could have an impact on whether patients with RA are employed [ 17 , 23 , 24 ]. Over the years, politicians and social welfare systems have tried to improve the employment rates for patients with chronic diseases. In some countries, rehabilitation clinics have been instrumental in supporting patients to remain in paid work. Healthcare professionals who care for patients with RA occupy a pivotal role in preventing work-related disability and support the patients to remain in work. Consequently, knowledge of the factors that contribute to retention of patients with RA at work is imperative [ 17 , 25 ].

The aim of this study is therefore to conduct a systematic review, with a primary focus on examining employment rates among patients with RA at the onset of the disease, at study entry, and throughout follow-up. Additionally, this study intends to identify predictors of employment. The predefined predictors, informed by the author’s comprehensive understanding of the field and specific to RA, encompass socioeconomic factors such as age, gender, level of education, employment status prior to the disease, disease stage and duration, treatment modalities, and comorbidities, including depression, which are relevant both to RA and other chronic conditions [ 26 ].

This systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) for studies that included employment rate in patients with rheumatoid arthritis [ 27 ]. PROSPERO registration number: CRD42020189057.

Selection criteria and search strategies

A comprehensive literature search was conducted, covering the period from January 1966 to January 2023 across the PubMed, Embase, and Cochrane Library databases using the following search terms: (Rheumatoid arthritis OR RA) AND (employment OR return to work). Only studies featuring a minimum cohort size of thirty patients and articles in the English language were deemed eligible for inclusion.

The initial screening of articles was based on the titles and abstracts. Studies comprising a working-age population, with current or former employment status, and with no limitations to gender, demographics, or ethnicity were included in this review. Articles addressing topics of employment, work ability or disability, return to work or disability pension were encompassed within the scope of this review. Full-time and part-time employment, but not ‘working as housewives’ was included in this review’s definition of employment. Studies involving other inflammatory diseases than RA were excluded. Reference lists in the selected articles were reviewed, and more articles were included if relevant. A review of the reference lists in the initially selected articles was conducted, with additional articles incorporated if they proved relevant to the research objectives. The eligible study designs encompassed cohort studies, case–control studies, and cross-sectional studies. All other study designs, including reviews, case series/case reports, in vitro studies, qualitative studies, and studies based on health economics were systematically excluded from the review.

Data extraction, quality assessment and risk-of-bias

The data extraction from the selected articles included author names, year of publication, study design, date for data collection, employment rate, study population, age, gender, educational level, ethnicity, disease duration, and pharmacological treatment. To ensure comprehensive evaluation of study quality and potential bias, quality assessment was independently assessed by two reviewers (LK and KB) using the Newcastle–Ottawa Scale (NOS) for cross-sectional and cohort studies [ 28 ]. Any disparities in the assessment were resolved by discussion until consensus was reached. For cross-sectional studies the quality assessment included: 1) Selection (maximum 5 points): representativeness of the sample, sample size, non-respondents, ascertainment of the risk factor; 2) Comparability (maximum 2 points); study controls for the most important, and any additional factor; 3) Outcome (maximum 3 points): assessment of outcome, and statistical testing. For cohort studies the assessment included: 1) Selection (maximum 4 points): representativeness of the exposed cohort, selection of the non-exposed cohort, ascertainment of exposure, demonstration that the outcome of interest was not present at start of study; 2) Comparability (maximum 2 points): comparability of cohorts on the basis of the design or analysis; 3) Outcome (maximum 3 points): assessment of outcome, was the follow-up long enough for outcomes to occur, and adequacy of follow up of cohorts. The rating scale was based on 9–10 items dividing the studies into high (7–9/10), moderate (4–6) or low (0–3) quality. A low NOS score (range 0–3) indicated a high risk of bias, and a high NOS score (range 7–9/10) indicated a lower risk of bias.

Analytical approach

For outcomes reported in numerical values or percentages, the odds ratio along with their 95% confidence intervals (CI) were calculated, whenever feasible. Weighted means were calculated, and comparisons between these were conducted using t-test for unpaired data. Furthermore, meta-analysis concerning the pre-determined and potentially pivotal predictors for employment status, both at disease onset, study entry, and follow-up was undertaken. The predictors included age, gender, ethnicity, level of education, duration of disease, treatment, and the presence of comorbities, contingent upon the availability of the adequate data. Additionally, attempts have been made to find information regarding on job categorizations, disease activity (quantified through DAS28; disease activity score for number of swollen joints), and quality of life (SF-36 scores ranging from 0 (worst) to 100 (best)). Age was defined as (< = 50/ > 50 years), gender (male/female), educational level college education or more/no college education), race (Caucasian/not Caucasian), job type (non-manual/manual), comorbidities (not present/present), MTX ever (no/yes), biological treatment ever (no/yes), prednisolone ever (no/yes), disease duration, HAQ score (from 0–3)), joint pain (VAS from 1–10), and DAS28 score. Age, disease duration, HAQ score, VAS score, SF36 and DAS28 were in the studies reported by mean values and standard deviations (SD). Challenges were encountered during attempts to find data which could be used for analysing predictors of employment status before disease onset, and at follow-up, as well as factors related to treatments beyond MTX, prednisolone, and biological as predictors for being employed after disease onset. Test for heterogeneity was done using Chi-squared statistics and I 2 , where I 2 below 40% might not be important; 30–60% may represent moderate heterogeneity; 50–90% substantial heterogeneity; and 75–100% considerable heterogeneity. Meta-analysis for predictors for employment and odds ratio; confidence intervals; and test for heterogeneity were calculated using the software Review Manager (RevMan, version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).

General description of included studies

The search yielded a total of 2277 references addressing RA its association with employment. Following the initial title screen, 199 studies were considered relevant for further evaluation. Of those, 91 studies ultimately met the inclusion criteria. Figure  1 shows the results of the systematic search strategy.

Flow chart illustrating the systematic search for studies examining employment outcome in patients with rheumatoid arthritis

Table 1 summarizes the general characteristics of the included studies. The publication year of the included studies ranged from 1971 to 2022. Among the studies, 60 (66%) adopted a cross-sectional research design [ 13 , 18 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 129 ] with a total of 41,857 participants analysing data at a specific point in time. Concurrently, 31 studies (34%) adopted a cohort design [ 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 130 ] with a total of 59,974 participants. Most of these studies exhibited a small to moderate sample size, with a median of 652 participants. Additionally, single centre studies and studies from high-income countries were predominant. Study details are shown in Table 1 .

General description of study participants

On average, patients with RA were 51 years old, with an age range spanning from 42 to 64 years. Furthermore, the female population accounted for 75.9% of the patient cohort, with a range from 41 to 92%. The duration of the disease at study entry exhibited significant variability, ranging from less than one year up to more than 18 years on average.

• Employment rate

At disease onset, the employment rate was 78.8% (weighted mean, range 45.4–100), at study entry 47.0% (range 18.5–100), and during the follow-up period 40.0% (range 4–88.2), as shown in Table 2 . Notably, a comparative analysis of the employment rates between Europe and North America indicated no substantial difference ( p  = 0.93). However, the comparison between Europe, North America and ‘other continents’ did yield significant differences (or nearly differences) with p -values of 0.003 and 0.08, respectively.

The employment rate exhibited no change, when comparing studies from the 1980s through to 2022. Specifically, the weighted mean for the years 1981–2000 was 49.2%, aligning closely with the corresponding figures for the years 2001–2010 (49.2%) and 2011–2022 43.6%. These findings were statistically non-significant, with p -values of 0.80 for comparison between year 1981–2000 and 2001–2010; 0.66 for 2001–2010 and 2011–2022, and 0.94 for 1981–2000 and 2011–2022, shown in Figure S 1 , see Additional file.

Among the studies included in the analysis, nineteen studies included data of employment at follow-up, with durations ranging from 1 to 20 years, Table 2 . For instance, Jäntti, 1999 [ 97 ] reported an employment rate 69% one year after disease onset, which gradually declined to 50% after 15 years and further to 20% after 20 years. Similarly, Mäkisara, 1982 [ 63 ] demonstrated that 60% of the patients were employed 5 years after disease onset, 50% after 10 years, and 33% after 15 years. Nikiphorou, 2012 [ 101 ] reported an employment rate of 67% at study entry, which decreased to 43% after 10 years.

In addition, seven studies included data of employment rate among patients comparing different medical treatments [ 18 , 44 , 56 , 91 , 105 , 110 , 119 ]. These studies indicated that, on average, 55.0% (weighted mean) of the patients were employed after receiving treatment with MTX, while 42.8% after undergoing treatment with a combination of MTX + Adalimumab (all patients were employed at disease onset in these specific studies).

Predictors for employment

Information of normative comparison data to use for meta-analysis of predictors for employment at study entry was available for age, gender, educational level, race, job type, comorbidities, MTX at any time, biological treatment at any time, prednisolone at any time, disease duration, HAQ score, joint pain (VAS-score), and disease activity (DAS28 score). Predictors for employment at study entry was being younger /age below 50 years, being a male, higher educational level (college or more), non-manual work, having no comorbidities, no medical treatment, short disease duration, and low HAQ score, VAS-score, or DAS28 score. Heterogeneity was small for age, gender, medical treatment, and moderate for educational level, and job type as indicted by the I 2 values, Table  3 , and shown in detail in Figures S 2 , S 3 , S 4 , S 5 , S 6 , S 7 , S 8 , S 9 , S 10 , S 11 , S 12 , S 13 , S 14 , S 15 and S 16 , see Additional file.

Assessment of quality of included studies

All studies were subject to rigorous quality assessment. These assessments resulted in categorisation of either medium quality ( n  = 64; 70%) or high-quality studies ( n  = 27; 30%), with no studies falling into the low-quality category. The quality assessment is shown in Tables  4 and 5 .

Notably, many studies were characterised by several common attributes, including cross-sectional study design, single-centre-settings, relatively small sample sizes, and the reliance on self-reported patient data. When including only the high-quality studies in the analyses, the employment rates at study entry changed from 47% (weighted mean, all studies) to 50% (weighted mean, high quality studies).

Key findings

This systematic review has identified a decline in the employment rate among patients with RA, with a notable decrease from disease onset during the study entry to follow-up, where only half of the patients were employed. These findings corroborate earlier research that indicated a substantial decline in employment rates among patients with RA over time. Notably, previous studies have reported that approximately one third of patients with RA stopped working within 2 to 3 years after disease onset, and more than half was unable to work after 10 to 15 years [ 23 , 63 , 93 , 97 , 101 ]. Only few studies have included data from the general population, comparing the employment rates with the rates for patients with RA [ 89 , 90 ]. Comparisons with the general population further underscored the challenges faced by RA patients, as their employment rates were consistently lower.

Despite changes in medical treatment, social security systems, and societal norms over the past decades, there was no significant improvement in the employment for patients with RA. This pattern aligns with data from the Global Burden of Disease studies, highlighting the persistent need for novel approaches and dedicated efforts to support patients with RA in sustaining employment [ 2 , 123 ]. Recent recommendations from EULAR (European Alliance of Associations for Rheumatology) and ACR (American College of Rheumatology) have emphasized the importance of enabling individuals with rheumatic and musculoskeletal diseases to engage in healthy and sustainable work [ 17 , 124 , 125 ].

While different countries possess different social laws and health care systems for supporting patients with chronic diseases, the variations in the weighted mean of employment rates across countries were relatively minor.

In the meta-analysis, one of the strongest predictors for maintaining employment was younger age at disease onset [ 43 , 51 , 101 , 116 ]. Verstappen, 2004 found that older patients with RA had an increased risk of becoming work disabled, potentially caused by the cumulative effects of long-standing RA, joint damage, and diminished coping mechanisms, compared to younger patients [ 23 ].

More women than men develop RA, however this study showed that a higher proportion of men managed to remain employed compared to women [ 18 , 36 , 42 , 43 , 46 , 62 , 71 , 89 , 101 , 116 ]. Previous studies have shown inconsistent results in this regard. Eberhart, 2007 found that a significantly higher number of men with RA worked even though there was no difference in any disease state between the sexes [ 93 ]. De Roos,1999 showed that work-disabled women were less likely to be well-educated and more likely to be in a nonprofessional occupation than working women. Interestingly, there was no association of these variables among men. Type of work and disease activity may influence work capacity more in women than in men [ 46 ]. Sokka, 2010 demonstrated a lower DAS28 and HAQ-score in men compared to women among the still working patients with RA, which indicated that women continued working at higher disability and disease activity levels compared with men [ 18 ].

Disease duration also played a significant role as a predictor of employment outcomes [ 33 , 36 , 45 , 71 , 77 , 86 , 102 , 111 ]. Longer disease duration correlate with decreased employment likelihood, which could be attributed to older age and increased joint damage and disability in patients with longer-standing RA.

Higher educational levels were associated with a greater possibility of employment [ 30 , 43 , 45 , 46 , 51 , 62 , 86 ]. This is probably due to enhanced job opportunities, flexibility, lower physical workload, better insurance coverage, and improved health care for well-educated individuals. This is further supported by the fact that having a manual work was a predictor for not being employed [ 30 , 39 , 43 , 44 , 45 ].

Furthermore, health-related quality of life, as measured by SF 36, lower disease activity (DAS28 scores), reduced joint pain (VAS-score), and lower disability (HAQ score) were additionally predictors for being employed [ 33 , 35 , 36 , 45 , 71 , 86 ]. This support the statement that the fewer symptoms from RA, the greater the possibility of being able to work.

The results showed that the presence of comorbidity was a predictor for not being employed, aligning with findings from previous studies that chronic diseases such as cardiovascular disease, lung disease, diabetes, cancer, and depression reduced the chances of being employed [ 126 ]. Moreover, the risk of exiting paid work increased with multimorbidity [ 127 ].

While limited data were available for assessing the impact of treatment on employment, indications suggested that patients with RA were receiving medical treatments, such as MTX or biological medicine, were more likely to be unemployed. One possible explanation for this phenomenon could be that patients with RA, who were receiving medical treatment, had a more severe and a longer duration of RA compared to those, who had never been on medical treatment. However, the scarcity of relevant studies necessitates caution when drawing definitive conclusions in this regard.

Therefore, the predictors for employment found in this review were being younger, being a male, having higher education, low disease activity, low disease duration, and being without comorbidities. This is supported by previous studies [ 93 , 116 ]

In summary, this review underscores the importance of managing disease activity, offering early support to patients upon diagnosis, and reducing physically demanding work to maintain employment among patients with RA. Achieving success in this endeavour requires close cooperation among healthcare professionals, rehabilitation institutions, companies, and employers. Furthermore, it is important that these efforts are underpinned by robust social policies that ensure favourable working conditions and provide financial support for individuals with physical disabilities, enabling them to remain active in the labour market.

Strengths and limitations

The strength of this review and meta-analysis lies in the inclusion of a large number of articles originating from various countries. Furthermore, the data showed a consistent employment rate in high quality studies compared to all studies. However, there are some limitations to this review. No librarian was used to define search terms and only three databases were searched. Furthermore, the initial search, selection of articles, data extraction, and analysis was undertaken only by one author, potentially leading to the omission of relevant literature and data. The review also extended back to 1966, with some articles from the 1970s and 1980s included. Given the significant changes in medical treatment, social security systems, and society over the past decades, the generalizability of the findings may be limited.

Moreover, the majority of studies did not include a control group from the general population, which limited the ability to compare employment rates with the general population in the respective countries. Many studies were cross-sectional in design, which limits the evidence of causality between employment rate and having RA. However, the employment rate was approximately the same in high quality studies compared to all studies, which supports an association. A substantial number of studies relied on self-reported employment rates, introducing the potential for recall bias. Additionally, many studies did not account for all relevant risk factors for unemployment failing to control for all relevant confounders.

EULAR have made recommendation for point to consider when designing, analysing, and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis. These recommendations include study design, study duration, and the choice of work participation outcome domains (e.g., job type, social security system) and measurement instruments, the power to detect meaningful effects, interdependence among different work participation outcome domains (e.g., between absenteeism and presentism), the populations included in the analysis of each work participation outcome domain and relevant characteristics should be described. In longitudinal studies work-status should be regularly assessed and changes reported, and both aggregated results and proportions of predefined meaningful categories should be considered [ 128 ]. Only some of the studies in this review met the requirements for high quality studies. In both older and newer studies methodological deficiencies persisted in study design, analysis, and reporting of results, as recommended by EULAR.

Perspectives for future studies

Future research in this area should focus on developing and evaluating new strategies to address the ongoing challenges faced by patients with RA in maintaining employment. Despite many initiatives over the years, there has been no success in increasing employment rates for patients with RA in many countries. Therefore, there is a pressing need for controlled studies that investigated the effectiveness of interventions such as education, social support, and workplace adaptations in improving employment outcomes for these individuals.

This systematic review underscores the low employment rate among patients with RA. Key predictors of sustained employment include being younger, having higher educational level, short disease duration, and lower disease activity, along with fewer comorbidities. Importantly, the review reveals that the employment rate has not changed significantly across different time periods. To support patients with RA in maintaining their employment, a comprehensive approach that combines early clinical treatment with social support is crucial. This approach can play a pivotal role in helping patients with RA stay connected to the labour market.

Availability of data and materials

The datasets used and/or analyzed during the current study are available in the supplementary file.

Abbreviations

• Rheumatoid arthritis

Methotrexate

Newcastle Ottawa Quality Assessment Scale

Standard deviation

Not analyzed

Not relevant

Disease activity

Health Assessment Questionnaire

Visual analog scale for pain

European Alliance of Associations for Rheumatology

American College of Rheumatology

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Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark

Lilli Kirkeskov & Katerina Bray

Department of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark

Lilli Kirkeskov

Department of Occupational and Social Medicine, Holbaek Hospital, Holbaek, Denmark

Katerina Bray

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LK performed the systematic research, including reading articles, performed the blinded quality assessment and the meta-analysis, and drafted and revised the article. KM performed the blinded quality assessment and the discussion afterwards of articles to be included in the research and the scores, and drafted and revised the article.

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Correspondence to Lilli Kirkeskov .

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Not applicable as this is a systematic review. All the studies that are included have obtained ethical approval and consent as appreciated by the journal in which they have been published.

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Supplementary Information

Additional file 1: figure s1..

Employment; year of investigation.

Additional file 2: Figure S2.

Forest Plot of Comparison: Predictors for employment. Outcome: Younger or older age.

Additional file 3: Figure S3.

Forest Plot of Comparison: Predictors for employment. Outcome: >50 yr or <50 yr of age.

Additional file 4: Figure S4.

Forest Plot of Comparison: Predictors for employment. Outcome: Gender: Male or Female.

Additional file 5: Figure S5.

Forest Plot of Comparison: Predictors for employment. Outcome: Educational level: no college education or college education or higher.

Additional file 6: Figure S6.

Forest Plot of Comparison: Predictors for employment. Outcome: no comorbidities present or one or more comorbidities present.

Additional file 7: Figure S7.

Forest Plot of Comparison: Predictors for employment. Outcome: Ethnicity: Caucasian or other than Caucasian.

Additional file 8: Figure S8.

Forest Plot of Comparison: Predictors for employment. Outcome: Short or long disease duration.

Additional file 9: Figure S9.

Forest Plot of Comparison: Predictors for employment. Outcome: Low or high Health Assessment Questionnaire, HAQ-score.

Additional file 10: Figure S10.

Forest Plot of Comparison: Predictors for employment. Outcome: Low or high VAS-score.

Additional file 11: Figure S11.

Forest Plot of Comparison: Predictors for employment. Outcome: Job type: blue collar workers or other job types.

Additional file 12: Figure S12.

Forest Plot of Comparison: Predictors for employment. Outcome: No MTX or MTX.

Additional file 13: Figure S13.

Forest Plot of Comparison: Predictors for employment. Outcome: No biological or biological.

Additional file 14: Figure S14.

Forest Plot of Comparison: Predictors for employment. Outcome: No prednisolone or prednisolone.

Additional file 15: Figure S15.

Forest Plot of Comparison: Predictors for employment. Outcome: Low or high DAS score.

Additional file 16: Figure S16.

Forest Plot of Comparison: Predictors for employment. Outcome: Low or high SF 36-score.

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Kirkeskov, L., Bray, K. Employment of patients with rheumatoid arthritis - a systematic review and meta-analysis. BMC Rheumatol 7 , 41 (2023). https://doi.org/10.1186/s41927-023-00365-4

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Received : 07 June 2023

Accepted : 20 October 2023

Published : 14 November 2023

DOI : https://doi.org/10.1186/s41927-023-00365-4

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