conclusion of literature review in research

ON YOUR 1ST ORDER

How to Conclude a Literature Review

By Laura Brown on 6th March 2019

The conclusion of the dissertation literature review focuses on a few critical points,

Highlight the essential parts of the existing body of literature in a concise way.
Next, you should analyse the current state of the reviewed literature .
Explain the research gap for your chosen topic/existing knowledge.
Now, outline the areas for future study by mentioning main agreements and disagreements in the literature.
Finally, link the research to existing knowledge .

Now, any of you who have been into research would agree that literature review is a very exhausting process and may stress you during your academic career. It is tougher because it requires you to be organised. We have seen many students asking does a literature review need a conclusion.

Well, the answer is simple, a good literature review will always have a proper ending. But there is nothing to worry about how to write a conclusion for a literature review. Here is a complete guide for you in “four” simple yet convenient steps. These steps can really be valuable in providing an excellent presentation to your literature review help . Furthermore, you can ask us for literature review conclusion examples anytime using our live chat or email option.

Now, without further ado, let’s move towards the steps.

How To Write A Literature Review Conclusion

Simple Steps To Conclude A Literature Review

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Here are four major steps which can help you with how to conclude a literature review with ease.

1. Enlist Key Points

The conclusion can also be said as judgement because it gives a clear view of your work, whether you achieved your targeted objectives or not. Typically, it is not too difficult to conclude a review, but it can be challenging as well if not carried out properly.

It is crucial to find key features which should be engaging and useful as well for a reader. So at first, draft or enlist key factors before moving forward towards initialising your summary.

2. Summarise The Key Features Briefly

This is a most sensitive and important step of a dissertation literature review conclusion, where you should stick to the following things to get the job done efficiently.

Once you are done drafting the important points , here you should mention them briefly.
You can also take the liberty to agree or disagree with whatever literature you have gone through.
Make sure you don’t drag your arguments while counter-arguing. Keeping your points specific is key.
Describe, in one to two lines, how you addressed the previously identified gap .
It is also important to point out the lapses you have noticed in previous authors’ work. Those lapses could be a misquotation of figures, a wrong pattern of research and so on.
Alongside this, discuss existing theories and methods to build a framework for your research.

3. Educational Implications Of The Reviewed Literature

After mentioning the key factors, it is suggested to put implications to the already reviewed research. Like, as identifying problems in the already done research and giving recommendations on how these problems can be resolved.

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4. Indicating Room For Future Research

After completing the whole analysis of the particular research, you will be capable of identifying the work which can be done in future. You can also leave some gaps for future researchers so others can extend your work. This will be the final step, and this is how to end a literature review.

Tips That Can Enlighten Your Conclusion

Tips That Can Make A Good Literature Review Conclusion

We hope that things are very clear to you on how to write a conclusion for a literature review. If you want it to be even better and more meaningful, then you should keep the below points in mind.

It should not be burdened with an unnecessary chain of details.
It should be as precise and easy to understand as possible.
You should mention important key points and findings .
Make sure to put all points in a flow so the reader can understand your research in one go.
Do not add anything from your own.

“Simply put, touch the prominent factors and leave them unexplained here”.

Get Help to Conclude Your Literature Review

If you are able to keep your focus around these steps and mentioned points, believe us, you will never ask anyone how to conclude literature review.

Looking At Literature Review Conclusion Example

Below are three examples which will help you understand how to conclude a literature review.

1. Firstly, you should summarise the important aspects and evaluate the current state of the existing literature.

Overall, the findings from this literature review highlight the need for further research to address the gaps in knowledge on the effectiveness of mindfulness-based interventions for reducing symptoms of anxiety and depression in college students.

2. Now, along with mentioning the gaps, come up with your approach to future study.

Therefore, to address this gap in the literature, we incorporated larger and more diverse samples, used standardised measures of mindfulness and mental health outcomes, and included longer follow-up periods to assess the long-term effects of mindfulness-based interventions on anxiety and depression.

3. Now summarise on how your findings will contribute to the particular field by linking it to the existing knowledge.

The findings from the study will provide important insights for researchers, clinicians, and educators interested in developing and implementing effective interventions to promote mental health and well-being among college students, and highlight the need for further research to establish the effectiveness of mindfulness-based interventions in this population.

We hope that these examples will bring in more clarification and you can have a better idea about the literature review conclusion.

What basically is a literature review?

What are the 3 primary parts of a literature review, what are the goals of writing a literature review.

There are four primary objectives of writing a literature review:

1. Determining the background from the previous scholarly literature related to the topic.

2. Identifying the gaps between literature to boost further research.

3. Analysing if the theory is applicable and associating a suitable methodology.

Why is a literature review conclusion necessary?

https://azhin.org/cummings/basiclitreview/conclusions
https://www.citewrite.qut.edu.au/write/writing-well/litreview.html
https://psychology.ucsd.edu/undergraduate-program/undergraduate-resources/academic-writing-resources/writing-research-papers/writing-lit-review.html
https://students.unimelb.edu.au/academic-skills/resources/report-writing/reviewing-the-literature

Laura Brown, a senior content writer who writes actionable blogs at Crowd Writer.

Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

An introductory paragraph that explains what your working topic and thesis is
A forecast of key topics or texts that will appear in the review
Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
Critically Evaluate: Mention the strengths and weaknesses of your sources
Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

Summarize the key findings you have taken from the literature and emphasize their significance
Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
Qualitative versus quantitative research
Empirical versus theoretical scholarship
Divide the research by sociological, historical, or cultural sources
Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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Literature Review: Conducting & Writing

Sample Literature Reviews
Steps for Conducting a Lit Review
Finding "The Literature"
Organizing/Writing
Chicago: Notes Bibliography

Sample Lit Reviews from Communication Arts

Have an exemplary literature review.

Literature Review Sample 1
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How do I Write a Literature Review?: #5 Writing the Review

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

WRITING THE REVIEW

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

The actual review generally has 5 components:

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

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

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

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

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

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

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

Conclusion : In the conclusion, you should:

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

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

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Literature Review: Edith Cowan University
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conclusion of literature review in research

The Writing Center • University of North Carolina at Chapel Hill

Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

Roughly how many sources should you include?
What types of sources (books, journal articles, websites)?
Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
Should you evaluate your sources?
Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
By publication: Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

Sometimes, though, you might need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. Put in only what is necessary. Here are a few other sections you might want to consider:

Current Situation: Information necessary to understand the topic or focus of the literature review.
History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

Questions for Further Research: What questions about the field has the review sparked? How will you further your research as a result of the review?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author’s information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

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How to Write a Literature Review

What is a literature review.

What Is the Literature
Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts.

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly.

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences.

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

Abstract - Brief summary of the contents of the article
Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
Results - What was found in the course of the study
Discussion - What do the results mean
Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

Introduction
Literature Review
Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

Next: What Is the Literature >>
Last Updated: Mar 2, 2023 9:33 AM
URL: https://libguides.wesleyan.edu/litreview

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Literature Review Guide

The Literature Review

What is a Literature Review?
Plan Your Literature Review
Define Your Research Question
Search the Literature
Analyze Your Research Results
Manage Research Results
Write the Literature Review

What is a Literature Review? What is its purpose?

The purpose of a literature review is to offer a comprehensive review of scholarly literature on a specific topic along with an evaluation of the strengths and weaknesses of authors' arguments . In other words, you are summarizing research available on a certain topic and then drawing conclusions about researchers' findings. To make gathering research easier, be sure to start with a narrow/specific topic and then widen your topic if necessary.

A thorough literature review provides an accurate description of current knowledge on a topic and identifies areas for future research. Are there gaps or areas that require further study and exploration? What opportunities are there for further research? What is missing from my collection of resources? Are more resources needed?

It is important to note that conclusions described in the literature you gather may contradict each other completely or in part. Recognize that knowledge creation is collective and cumulative. Current research is built upon past research findings and discoveries. Research may bring previously accepted conclusions into question. A literature review presents current knowledge on a topic and may point out various academic arguments within the discipline.

What a Literature Review is not

A literature review is not an annotated bibliography . An annotated bibliography provides a brief summary, analysis, and reflection of resources included in the bibliography. Often it is not a systematic review of existing research on a specific subject. That said, creating an annotated bibliography throughout your research process may be helpful in managing the resources discovered through your research.
A literature review is not a research paper . A research paper explores a topic and uses resources discovered through the research process to support a position on the topic. In other words, research papers present one side of an issue. A literature review explores all sides of the research topic and evaluates all positions and conclusions achieved through the scientific research process even though some conclusions may conflict partially or completely.

From the Online Library

SAGE Research Methods This link opens in a new window SAGE Research Methods is a web-based research methods tool that covers quantitative, qualitative and mixed methods. Researchers can explore methods and concepts to help design research projects, understand a particular method or identify a new method, and write up research. Sage Research Methods focuses on methodology rather than disciplines, and is of potential use to researchers from the social sciences, health sciences and other research areas.
Sage Research Methods Project Planner - Reviewing the Literature View the resources and videos for a step-by-step guide to performing a literature review.

The Literature Review: Step by Step

Follow this step-by-step process by using the related tabs in this Guide.

Define your Research question
Analyze the material you’ve found
Manage the results of your research
Write your Review

Getting Started

Consider the following questions as you develop your research topic, conduct your research, and begin evaluating the resources discovered in the research process:

What is known about the subject?
Are there any gaps in the knowledge of the subject?
Have areas of further study been identified by other researchers that you may want to consider?
Who are the significant research personalities in this area?
Is there consensus about the topic?
What aspects have generated significant debate on the topic?
What methods or problems were identified by others studying in the field and how might they impact your research?
What is the most productive methodology for your research based on the literature you have reviewed?
What is the current status of research in this area?
What sources of information or data were identified that might be useful to you?
How detailed? Will it be a review of ALL relevant material or will the scope be limited to more recent material, e.g., the last five years.
Are you focusing on methodological approaches; on theoretical issues; on qualitative or quantitative research?

What is Academic Literature?

What is the difference between popular and scholarly literature?

To better understand the differences between popular and scholarly articles, comparing characteristics and purpose of the publications where these articles appear is helpful.

Database Search Tips

Boolean Operators
Keywords vs. Subjects
Creating a Search String
Library databases are collections of resources that are searchable, including full-text articles, books, and encyclopedias.
Searching library databases is different than searching Google. Best results are achieved when using Keywords linked with Boolean Operators .
Applying Limiters such as full-text, publication date, resource type, language, geographic location, and subject help to refine search results.
Utilizing Phrases or Fields , in addition to an awareness of Stop Words , can focus your search and retrieve more useful results.
Have questions? Ask a Librarian

Boolean Operators connect keywords or concepts logically to retrieve relevant articles, books, and other resources. There are three Boolean Operators:

Using AND

Narrows search results
Connects two or more keywords/concepts
All keywords/concepts connected with "and" must be in an article or resource to appear in the search results list

Venn diagram of the AND connector

Example: The result list will include resources that include both keywords -- "distracted driving" and "texting" -- in the same article or resource, represented in the shaded area where the circles intersect (area shaded in purple).

Broadens search results ("OR means more!")
Connects two or more synonyms or related keywords/concepts
Resources appearing in the results list will include any of the terms connected with the OR connector

Venn diagram of the OR connector

Example: The result list will include resources that include the keyword "texting" OR the keyword "cell phone" (entire area shaded in blue); either is acceptable.

Excludes keywords or concepts from the search
Narrows results by removing resources that contain the keyword or term connected with the NOT connector
Use sparingly

Venn diagram of the NOT connector

Example: The result list will include all resources that include the term "car" (green area) but will exclude any resource that includes the term "motorcycle" (purple area) even though the term car may be present in the resource.

A library database searches for keywords throughout the entire resource record including the full-text of the resource, subject headings, tags, bibliographic information, etc.

Natural language words or short phrases that describe a concept or idea
Can retrieve too few or irrelevant results due to full-text searching (What words would an author use to write about this topic?)
Provide flexibility in a search
Must consider synonyms or related terms to improve search results
TIP: Build a Keyword List

Example: The keyword list above was developed to find resources that discuss how texting while driving results in accidents. Notice that there are synonyms (texting and "text messaging"), related terms ("cell phones" and texting), and spelling variations ("cell phone" and cellphone). Using keywords when searching full text requires consideration of various words that express an idea or concept.

Subject Headings
Predetermined "controlled vocabulary" database editors apply to resources to describe topical coverage of content
Can retrieve more precise search results because every article assigned that subject heading will be retrieved.
Provide less flexibility in a search
Can be combined with a keyword search to focus search results.
TIP: Consult database subject heading list or subject headings assigned to relevant resources

Example 1: In EBSCO's Academic Search Complete, clicking on the "Subject Terms" tab provides access to the entire subject heading list used in the database. It also allows a search for specific subject terms.

Example 2: A subject term can be incorporated into a keyword search by clicking on the down arrow next to "Select a Field" and selecting "Subject Terms" from the dropdown list. Also, notice how subject headings are listed below the resource title, providing another strategy for discovering subject headings used in the database.

When a search term is more than one word, enclose the phrase in quotation marks to retrieve more precise and accurate results. Using quotation marks around a term will search it as a "chunk," searching for those particular words together in that order within the text of a resource.

"cell phone"

"distracted driving"

"car accident"

TIP: In some databases, neglecting to enclose phrases in quotation marks will insert the AND Boolean connector between each word resulting in unintended search results.

Truncation provides an option to search for a root of a keyword in order to retrieve resources that include variations of that word. This feature can be used to broaden search results, although some results may not be relevant. To truncate a keyword, type an asterisk (*) following the root of the word.

For example:

Library databases provide a variety of tools to limit and refine search results. Limiters provide the ability to limit search results to resources having specified characteristics including:

Resource type
Publication date
Geographic location

In both the EBSCO and ProQuest databases, the limiting tools are located in the left panel of the results page.

EBSCO ProQuest

The short video below provides a demonstration of how to use limiters to refine a list of search results.

Each resource in a library database is stored in a record. In addition to the full-text of the resources, searchable Fields are attached that typically include:

Journal title
Date of Publication

Incorporating Fields into your search can assist in focusing and refining search results by limiting the results to those resources that include specific information in a particular field.

In both EBSCO and ProQuest databases, selecting the Advanced Search option will allow Fields to be included in a search.

For example, in the Advanced Search option in EBSCO's Academic Search Complete database, clicking on the down arrow next to "Select a Field" provides a list of fields that can be searched within that database. Select the field and enter the information in the text box to the left to use this feature.

Stop words are short, commonly used words--articles, prepositions, and pronouns-- that are automatically dropped from a search. Typical stop words include:

In library databases, a stop word will not be searched even if it is included in a phrase enclosed in quotation marks. In some instances, a word will be substituted for the stop word to allow for the other words in the phrase to be searched in proximity to one another within the text of the resource.

For example, if you searched company of America, your result list will include these variatons:

company in America
company of America
company for America

Creating an Search String

This short video demonstrates how to create a search string -- keywords connected with Boolean operators -- to use in a library database search to retrieve relevant resources for any research assignment.

Database Search Menu Template Use this search menu template to plan a database search.
Last Updated: Sep 29, 2023 11:02 AM
URL: https://guides.rasmussen.edu/LitReview

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Research Guides

Organizing Your Social Sciences Research Paper

9. The Conclusion
Purpose of Guide
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Independent and Dependent Variables
Glossary of Research Terms
Reading Research Effectively
Narrowing a Topic Idea
Broadening a Topic Idea
Extending the Timeliness of a Topic Idea
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The conclusion is intended to help the reader understand why your research should matter to them after they have finished reading the paper. A conclusion is not merely a summary of the main topics covered or a re-statement of your research problem, but a synthesis of key points and, if applicable, where you recommend new areas for future research. For most college-level research papers, one or two well-developed paragraphs is sufficient for a conclusion, although in some cases, more paragraphs may be required in summarizing key findings and their significance.

Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University.

Importance of a Good Conclusion

A well-written conclusion provides you with important opportunities to demonstrate to the reader your understanding of the research problem. These include:

Presenting the last word on the issues you raised in your paper . Just as the introduction gives a first impression to your reader, the conclusion offers a chance to leave a lasting impression. Do this, for example, by highlighting key findings in your analysis that advance new understanding about the research problem, that are unusual or unexpected, or that have important implications applied to practice.
Summarizing your thoughts and conveying the larger significance of your study . The conclusion is an opportunity to succinctly re-emphasize the "So What?" question by placing the study within the context of how your research advances past research about the topic.
Identifying how a gap in the literature has been addressed . The conclusion can be where you describe how a previously identified gap in the literature [described in your literature review section] has been filled by your research.
Demonstrating the importance of your ideas . Don't be shy. The conclusion offers you the opportunity to elaborate on the impact and significance of your findings. This is particularly important if your study approached examining the research problem from an unusual or innovative perspective.
Introducing possible new or expanded ways of thinking about the research problem . This does not refer to introducing new information [which should be avoided], but to offer new insight and creative approaches for framing or contextualizing the research problem based on the results of your study.

Bunton, David. “The Structure of PhD Conclusion Chapters.” Journal of English for Academic Purposes 4 (July 2005): 207–224; Conclusions. The Writing Center. University of North Carolina; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Conclusions. The Writing Lab and The OWL. Purdue University; Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Structure and Writing Style

I. General Rules

The function of your paper's conclusion is to restate the main argument . It reminds the reader of the strengths of your main argument(s) and reiterates the most important evidence supporting those argument(s). Do this by stating clearly the context, background, and necessity of pursuing the research problem you investigated in relation to an issue, controversy, or a gap found in the literature. Make sure, however, that your conclusion is not simply a repetitive summary of the findings. This reduces the impact of the argument(s) you have developed in your essay.

When writing the conclusion to your paper, follow these general rules:

Present your conclusions in clear, simple language. Re-state the purpose of your study, then describe how your findings differ or support those of other studies and why [i.e., what were the unique or new contributions your study made to the overall research about your topic?].
Do not simply reiterate your findings or the discussion of your results. Provide a synthesis of arguments presented in the paper to show how these converge to address the research problem and the overall objectives of your study.
Indicate opportunities for future research if you haven't already done so in the discussion section of your paper. Highlighting the need for further research provides the reader with evidence that you have an in-depth awareness of the research problem and that further investigations should take place.

Consider the following points to help ensure your conclusion is presented well:

If the argument or purpose of your paper is complex, you may need to summarize the argument for your reader.
If, prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the end of your paper to describe your main points and explain their significance.
Move from a detailed to a general level of consideration that returns the topic to the context provided by the introduction or within a new context that emerges from the data.

The conclusion also provides a place for you to persuasively and succinctly restate the research problem, given that the reader has now been presented with all the information about the topic . Depending on the discipline you are writing in, the concluding paragraph may contain your reflections on the evidence presented. However, the nature of being introspective about the research you have conducted will depend on the topic and whether your professor wants you to express your observations in this way.

NOTE : If asked to think introspectively about the topics, do not delve into idle speculation. Being introspective means looking within yourself as an author to try and understand an issue more deeply, not to guess at possible outcomes or make up scenarios not supported by the evidence.

II. Developing a Compelling Conclusion

Although an effective conclusion needs to be clear and succinct, it does not need to be written passively or lack a compelling narrative. Strategies to help you move beyond merely summarizing the key points of your research paper may include any of the following strategies:

If your essay deals with a critical, contemporary problem, warn readers of the possible consequences of not attending to the problem proactively.
Recommend a specific course or courses of action that, if adopted, could address a specific problem in practice or in the development of new knowledge.
Cite a relevant quotation or expert opinion already noted in your paper in order to lend authority and support to the conclusion(s) you have reached [a good place to look is research from your literature review].
Explain the consequences of your research in a way that elicits action or demonstrates urgency in seeking change.
Restate a key statistic, fact, or visual image to emphasize the most important finding of your paper.
If your discipline encourages personal reflection, illustrate your concluding point by drawing from your own life experiences.
Return to an anecdote, an example, or a quotation that you presented in your introduction, but add further insight derived from the findings of your study; use your interpretation of results to recast it in new or important ways.
Provide a "take-home" message in the form of a succinct, declarative statement that you want the reader to remember about your study.

III. Problems to Avoid

Failure to be concise Your conclusion section should be concise and to the point. Conclusions that are too lengthy often have unnecessary information in them. The conclusion is not the place for details about your methodology or results. Although you should give a summary of what was learned from your research, this summary should be relatively brief, since the emphasis in the conclusion is on the implications, evaluations, insights, and other forms of analysis that you make. Strategies for writing concisely can be found here .

Failure to comment on larger, more significant issues In the introduction, your task was to move from the general [the field of study] to the specific [the research problem]. However, in the conclusion, your task is to move from a specific discussion [your research problem] back to a general discussion [i.e., how your research contributes new understanding or fills an important gap in the literature]. In short, the conclusion is where you should place your research within a larger context [visualize your paper as an hourglass--start with a broad introduction and review of the literature, move to the specific analysis and discussion, conclude with a broad summary of the study's implications and significance].

Failure to reveal problems and negative results Negative aspects of the research process should never be ignored. These are problems, deficiencies, or challenges encountered during your study should be summarized as a way of qualifying your overall conclusions. If you encountered negative or unintended results [i.e., findings that are validated outside the research context in which they were generated], you must report them in the results section and discuss their implications in the discussion section of your paper. In the conclusion, use your summary of the negative results as an opportunity to explain their possible significance and/or how they may form the basis for future research.

Failure to provide a clear summary of what was learned In order to be able to discuss how your research fits within your field of study [and possibly the world at large], you need to summarize briefly and succinctly how it contributes to new knowledge or a new understanding about the research problem. This element of your conclusion may be only a few sentences long.

Failure to match the objectives of your research Often research objectives in the social sciences change while the research is being carried out. This is not a problem unless you forget to go back and refine the original objectives in your introduction. As these changes emerge they must be documented so that they accurately reflect what you were trying to accomplish in your research [not what you thought you might accomplish when you began].

Resist the urge to apologize If you've immersed yourself in studying the research problem, you presumably should know a good deal about it [perhaps even more than your professor!]. Nevertheless, by the time you have finished writing, you may be having some doubts about what you have produced. Repress those doubts! Don't undermine your authority by saying something like, "This is just one approach to examining this problem; there may be other, much better approaches that...." The overall tone of your conclusion should convey confidence to the reader.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Concluding Paragraphs. College Writing Center at Meramec. St. Louis Community College; Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University; Freedman, Leora and Jerry Plotnick. Introductions and Conclusions. The Lab Report. University College Writing Centre. University of Toronto; Leibensperger, Summer. Draft Your Conclusion. Academic Center, the University of Houston-Victoria, 2003; Make Your Last Words Count. The Writer’s Handbook. Writing Center. University of Wisconsin Madison; Miquel, Fuster-Marquez and Carmen Gregori-Signes. “Chapter Six: ‘Last but Not Least:’ Writing the Conclusion of Your Paper.” In Writing an Applied Linguistics Thesis or Dissertation: A Guide to Presenting Empirical Research . John Bitchener, editor. (Basingstoke,UK: Palgrave Macmillan, 2010), pp. 93-105; Tips for Writing a Good Conclusion. Writing@CSU. Colorado State University; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Writing Conclusions. Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Writing: Considering Structure and Organization. Institute for Writing Rhetoric. Dartmouth College.

Writing Tip

Don't Belabor the Obvious!

Avoid phrases like "in conclusion...," "in summary...," or "in closing...." These phrases can be useful, even welcome, in oral presentations. But readers can see by the tell-tale section heading and number of pages remaining to read, when an essay is about to end. You'll irritate your readers if you belabor the obvious.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Another Writing Tip

New Insight, Not New Information!

Don't surprise the reader with new information in your conclusion that was never referenced anywhere else in the paper and, as such, the conclusion rarely has citations to sources. If you have new information to present, add it to the discussion or other appropriate section of the paper. Note that, although no actual new information is introduced, the conclusion, along with the discussion section, is where you offer your most "original" contributions in the paper; the conclusion is where you describe the value of your research, demonstrate that you understand the material that you’ve presented, and locate your findings within the larger context of scholarship on the topic, including describing how your research contributes new insights or valuable insight to that scholarship.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Conclusions. The Writing Center. University of North Carolina.

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Next: Appendices >>
Last Updated: Oct 10, 2023 1:30 PM
URL: https://libguides.usc.edu/writingguide

How to Write a Literature Review

Preparing for a literature review, what is a literature review, literature review purpose, how to develop a literature review for theses and dissertations, literature review length, introduction to the literature review, body of the literature review, conclusion of the literature review.

Clearly define the topic of your research, this is the basis of picking what articles you'll be reading, analyzing and summarizing, and subsequently including in your research topic. Narrowing down the topic allows you to have a more specific base of literature to read, analyze, and review.

A literature review is a portion of a research paper that compiles, describes, and analyzes different sources of information relevant to a given research topic, and then draws connections between each source to one another and the research of the author writing the review. Rather than simply describing each of the sources, critical reviews of the sources should be made.

A literature review is important for a variety of reasons, beyond just providing a background for your research topic. The purpose of the literature review is to:

Discuss current questions and debates that exist in the research topic
Provide a summary of the relevant aspects of the sources reviewed
Show how your research paper is placed chronologically in the research topic
Provide an overall understanding and introduction to the topic, building credibility
Prevent the author from researching a topic or area that has already been done

The first step in developing the literature review for theses and dissertations is to collect information and sources that are related to the topic area you are researching.

1. Keyword search

There are a variety of different places to find relevant further research for your topic. University or public library catalogs are a good place to search, as well as online databases such as Google Scholar. When searching for relevant sources, try to use keywords that are related to your topic. When you find a few really good sources, look at their literature reviews and bibliographies to find other literature in the field.

2. Snowballing

Read as many sources in your field as possible to fully understand what work has been done in the past and where the current status of the topic lies. This could be journal articles, publications, books, and interviews, to name just a few.

Take notes as you are reading the different sources. I personally like to download my sources in my theses as pdfs and then highlight relevant information and annotate in the margins, using Adobe Acrobat Reader.

Once you have read and annotated bibliography of the relevant sources, then analyze the collected works and categorize them from most and least relevant to the subject you are discussing. One effective method for doing this is by utilizing a reading grid.

A reading grid can be broken down by source information individually for each source included in the theses or dissertation literature review, such as the research question, methodology, findings, limitations, and areas for future research. This allows you to easily see the most relevant information within each piece of literature. An example of this can be seen below, provided by OpenAcademics and adapted from Auckland University of Technology.

Reading grid by OpenAcademics adapted from Auckland University of Technology.

View this example in greater detail here .

3. Citations

Citing a source means giving the credit for the source used in your research paper. This includes the information that you get from books or scholarly articles, and even pictures, charts or graphs. It is essential to give credit where it is due, so that you do not plagiarize another person's work.

You will need to include citations when you are using specific information from a single source, or when you are paraphrasing an idea from a single source. Citations can help avoid any confusion that would arise if someone else reads your work, and they can help direct readers to further resources on your topic.

When writing a literature review it is essential to keep track of all of the sources that you use. You should compile all of the sources into one document so that you can refer back to them easily and know what information came from which source. This will make it easier for you when you are ready to write your paper and insert citations.

There is a citation style that is specific to each discipline, and you should always follow the standards for your field. Check with your instructor or supervisor if you have any questions about the citation style you should use.

How to format citations

To make sure your paper is as perfect as it can be, let's take a look at how to format citations. If you're using Microsoft Word to write your literature review, you can use the "References" tab to organize your citations. If you want more control over the formatting, or if you're using another type of word processing program, you can do it manually.

Starting with a few basics

Double space everything, including block quotes and bibliography entries. If you're using a citation tool like Zotero or EndNote, make sure the formatting preferences are set for double spacing.For citations, you can use a standard font (like Times New Roman or Arial) in size 12. Using 1-inch margins all around for citations is common practice. To make sure your citations look good, indenting each new citation by half an inch is a good practice. (if you press Tab at the beginning of a paragraph, that should work).

The number of concepts explored and the number of sources incorporated into the literature review will determine its length. The number of sources included depend on how narrow or broad the topic is, the level of agreement among researchers in the topic, and the desired depth of analysis.

If the topic of your research is incredibly specific, there may only be a limited number of sources to choose from for your review, whereas if it is a really broad topic, you may need to include a variety of sources to paint a full picture of the topic background. Additionally, if there is a lot of disagreement within the research topic, you may need to include more sources to show the varying opinion that exists.

This section should describe how your research topic is placed in the context of the existing literature in the field, and provide a reasoning for reviewing the literature that has been selected. Additionally the methodology for finding these sources should be discussed, and the order of the selected literature should be explained — whether it is running chronologically, based on theme of sources, or some other methodological manner.

The best approach for the body of the literature review is to break it down into sections or paragraphs for each of the sources reviewed. Within each literature source discussion, there should be the following components:

Description of the context of the literature and a summary of the most important concepts and aspects
Explanations of theories, equations, and terminology, relevant to the topic
Discussion of aspects of the literature that connect to your research topic

Within the conclusion of the literature review, the entire section should be summarized and connected together in a methodical manner. To achieve this, the conclusion should provide the following:

A summarized overview of the important concepts, flaws, and gaps in each of the reviewed sources.
A description of how the literature is tied together, and a discussion of how the topic being written about also contributes to the overall field of knowledge.

You should show that the sources provided in the literature review relate to the work that is to be discussed in your research topic. Directly discuss different aspects of the literature review that contributed to the concepts, ideas, methodology, results, and conclusions in your research. If your research addresses potential gaps in past literature, you can also highlight this here.

An effective method for meeting this conclusion is to first synthesize the works with a brief introduction, a comparison of agreeing and disagreeing points of view, and stating the research findings impact. Then finalize the conclusion by pointing out the limitations of the topic, its impact, and discussing the contribution of your own work to this field.

An example of this synthesis and contribution discussion can be seen below, provided by OpenAcademics and adapted from Auckland University of Technology.

Synthesis of Literature Review done by OpenAcademics adapted from Auckland University of Technology.

You can view this example in greater detail here .

If you need additional insight into creating a literature review, I highly recommend checking out this video created by Wordvice Editing Service, which provides a detailed explanation of what to include, what not to include, how to structure, and how to compose a literature review from start to finish.

Thank you for reading!

If you’re looking for a tool to aid in your literature review, check out Scrintal — a web application designed to gather, organize & visually connect your thoughts, files & insights.

Too many people struggle with visualising how their thoughts connect to each other . Scrintal is a web app that combines mind mapping with the power of networked note-taking . So you get crystal clear in your thinking, write creatively and share your findings easily.

Comparisons

With 💛 from Stockholm.

Research Methods

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

Literature Review

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

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

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

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

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

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

A literature review is important because it:

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

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

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

Not an essay

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

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

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

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

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

Systematic review or meta-analysis?

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

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

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

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

Not all systematic reviews contain meta-analysis.

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

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

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

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

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Last Updated: Aug 21, 2023 4:07 PM
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UConn Library
Literature Review: The What, Why and How-to Guide
Introduction

Literature Review: The What, Why and How-to Guide — Introduction

Getting Started
How to Pick a Topic
Strategies to Find Sources
Evaluating Sources & Lit. Reviews
Tips for Writing Literature Reviews
Writing Literature Review: Useful Sites
Citation Resources
Other Academic Writings

What are Literature Reviews?

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

Goals of Literature Reviews

What are the goals of creating a Literature Review? A literature could be written to accomplish different aims:

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

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

What kinds of sources require a Literature Review?

A research paper assigned in a course
A thesis or dissertation
A grant proposal
An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework: 10.1177/08948453211037398

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

Example : The effect of leave policies on increasing fertility: a systematic review: 10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

Example : Employment Instability and Fertility in Europe: A Meta-Analysis: 10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts . Journal of Advanced Nursing , 53 (3), 311-318.

Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis: 10.1177/05390184221113735

Literature Reviews in the Health Sciences

UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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Types of Review Articles and Brief Illustrations
Concluding Remarks

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Writing: Literature Review Basics

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The Job of the Conclusion

The job of the conclusion is, quite literally, to conclude ... or to wrap things up so the reader feels a sense of closure. It accomplishes this by stepping back from the specifics in order to view the bigger picture of the document. In other words, it is reminding the reader of the main argument.

Whereas an introduction started out generally and moved towards discussion of a specific focus, the conclusion takes the opposite approach. It starts by reminding the reader of the contents and importance of your findings and then moves out gradually to more general topics.

For most written assignments, the conclusion is a single paragraph. It does not introduce any new information; rather, it succinctly restates your chief conclusions and places the importance of your findings within your field. Depending upon the purpose of the literature review, you may also include a brief statement of future directions or self-reflection.

Here is an easy checklist for writing a conclusion:

Is the main argument of the paper accurately restated as the first sentence (but is not copied verbatim?

In a literature review, you basicaly want to answer the question, "What did I find out? What conclusions did I come to?" Giving the reader a one-sentence answer to this question that provides a summary of your findings is a solid way to begin a conclusion.

What recommendations do you have?

Here you may offer the reader your suggestions on what you think should happen next. You can make recommendations that are specific to the evidence you have uncovered, or you can make recommendations for future research. When this area is well done, it links to previous conclusions you have already made and gives the conclusion a finished feeling.

Did you remind the reader of the importance of the topic and how it can contribute to the knowledge in the field?

Make sure that the paper places its findings in the context of some kind of needed change, relevance, or solution. If you addressed why the topic was interesting, important, or relevant in your introduction, you can loop back to that here. Other ways that can be done are to remind the reader of other research you have discussed and how your work builds upon theirs, or what gaps there may yet be to explore.

Keep these items in mind as "what not to do":

Is there a sense of closure without using words such as "In conclusion?"

If you have to use the words "In conclusion" or similar ones to launch your conclusion so the reader knows the end is near, you've got a problem. Make sure the reader has a distinct sense that the paper has come to an end without telling them it is ending. It is important to not leave the reader hanging.

Did you avoid presenting any new information?

No new ideas should be introduced in the conclusion. It is simply a review of the material that is already present in the paper. The only new idea would be the suggesting of a direction for future research.

Stigmatization of the mentally ill is caused by the public’s belief in myths about the dangerousness of the mentally ill and exposing those myths can reduce stigmatization. At least one-third of the people sampled in one study said that they would both reject socially and fear violence from someone displaying behaviors associated with different mentally illnesses. Other research discovered that this rejection is associated to lack of contact with the mentally ill and that as contact increased, fear of the mentally ill decreased. The direction of the relationship between fear and rejection seems to be that fear (possibly based upon myths about mental illness) causes rejection. Taken as a whole, it appears that exposing these myths as myths increases the acceptance of the mentally ill and that staged contact with a mentally person to expose myths has an even more powerful effect. Caution must be advised, though; Martin et al.’s (2002) and Alexander and Link’s (2003) studies and the first study of Corrigan et al. (2002) were based upon paper and pencil methodologies. And while Corrigan et al.’s (2002) second study involved staged Myths of violence 6 presentations, it was conducted in a college setting with a college sample. Future research should replicate these findings in more natural settings with different populations.

Now let's break that down.

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Writing a Research Paper Conclusion | Step-by-Step Guide

Published on October 30, 2022 by Jack Caulfield . Revised on April 13, 2023.

Restate the problem statement addressed in the paper
Summarize your overall arguments or findings
Suggest the key takeaways from your paper

The content of the conclusion varies depending on whether your paper presents the results of original empirical research or constructs an argument through engagement with sources .

Step 1: restate the problem, step 2: sum up the paper, step 3: discuss the implications, research paper conclusion examples, frequently asked questions about research paper conclusions.

The first task of your conclusion is to remind the reader of your research problem . You will have discussed this problem in depth throughout the body, but now the point is to zoom back out from the details to the bigger picture.

While you are restating a problem you’ve already introduced, you should avoid phrasing it identically to how it appeared in the introduction . Ideally, you’ll find a novel way to circle back to the problem from the more detailed ideas discussed in the body.

For example, an argumentative paper advocating new measures to reduce the environmental impact of agriculture might restate its problem as follows:

Meanwhile, an empirical paper studying the relationship of Instagram use with body image issues might present its problem like this:

“In conclusion …”

Avoid starting your conclusion with phrases like “In conclusion” or “To conclude,” as this can come across as too obvious and make your writing seem unsophisticated. The content and placement of your conclusion should make its function clear without the need for additional signposting.

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Having zoomed back in on the problem, it’s time to summarize how the body of the paper went about addressing it, and what conclusions this approach led to.

Depending on the nature of your research paper, this might mean restating your thesis and arguments, or summarizing your overall findings.

Argumentative paper: Restate your thesis and arguments

In an argumentative paper, you will have presented a thesis statement in your introduction, expressing the overall claim your paper argues for. In the conclusion, you should restate the thesis and show how it has been developed through the body of the paper.

Briefly summarize the key arguments made in the body, showing how each of them contributes to proving your thesis. You may also mention any counterarguments you addressed, emphasizing why your thesis holds up against them, particularly if your argument is a controversial one.

Don’t go into the details of your evidence or present new ideas; focus on outlining in broad strokes the argument you have made.

Empirical paper: Summarize your findings

In an empirical paper, this is the time to summarize your key findings. Don’t go into great detail here (you will have presented your in-depth results and discussion already), but do clearly express the answers to the research questions you investigated.

Describe your main findings, even if they weren’t necessarily the ones you expected or hoped for, and explain the overall conclusion they led you to.

Having summed up your key arguments or findings, the conclusion ends by considering the broader implications of your research. This means expressing the key takeaways, practical or theoretical, from your paper—often in the form of a call for action or suggestions for future research.

Argumentative paper: Strong closing statement

An argumentative paper generally ends with a strong closing statement. In the case of a practical argument, make a call for action: What actions do you think should be taken by the people or organizations concerned in response to your argument?

If your topic is more theoretical and unsuitable for a call for action, your closing statement should express the significance of your argument—for example, in proposing a new understanding of a topic or laying the groundwork for future research.

Empirical paper: Future research directions

In a more empirical paper, you can close by either making recommendations for practice (for example, in clinical or policy papers), or suggesting directions for future research.

Whatever the scope of your own research, there will always be room for further investigation of related topics, and you’ll often discover new questions and problems during the research process .

Finish your paper on a forward-looking note by suggesting how you or other researchers might build on this topic in the future and address any limitations of the current paper.

Full examples of research paper conclusions are shown in the tabs below: one for an argumentative paper, the other for an empirical paper.

Argumentative paper
Empirical paper

While the role of cattle in climate change is by now common knowledge, countries like the Netherlands continually fail to confront this issue with the urgency it deserves. The evidence is clear: To create a truly futureproof agricultural sector, Dutch farmers must be incentivized to transition from livestock farming to sustainable vegetable farming. As well as dramatically lowering emissions, plant-based agriculture, if approached in the right way, can produce more food with less land, providing opportunities for nature regeneration areas that will themselves contribute to climate targets. Although this approach would have economic ramifications, from a long-term perspective, it would represent a significant step towards a more sustainable and resilient national economy. Transitioning to sustainable vegetable farming will make the Netherlands greener and healthier, setting an example for other European governments. Farmers, policymakers, and consumers must focus on the future, not just on their own short-term interests, and work to implement this transition now.

As social media becomes increasingly central to young people’s everyday lives, it is important to understand how different platforms affect their developing self-conception. By testing the effect of daily Instagram use among teenage girls, this study established that highly visual social media does indeed have a significant effect on body image concerns, with a strong correlation between the amount of time spent on the platform and participants’ self-reported dissatisfaction with their appearance. However, the strength of this effect was moderated by pre-test self-esteem ratings: Participants with higher self-esteem were less likely to experience an increase in body image concerns after using Instagram. This suggests that, while Instagram does impact body image, it is also important to consider the wider social and psychological context in which this usage occurs: Teenagers who are already predisposed to self-esteem issues may be at greater risk of experiencing negative effects. Future research into Instagram and other highly visual social media should focus on establishing a clearer picture of how self-esteem and related constructs influence young people’s experiences of these platforms. Furthermore, while this experiment measured Instagram usage in terms of time spent on the platform, observational studies are required to gain more insight into different patterns of usage—to investigate, for instance, whether active posting is associated with different effects than passive consumption of social media content.

If you’re unsure about the conclusion, it can be helpful to ask a friend or fellow student to read your conclusion and summarize the main takeaways.

Do they understand from your conclusion what your research was about?
Are they able to summarize the implications of your findings?
Can they answer your research question based on your conclusion?

You can also get an expert to proofread and feedback your paper with a paper editing service .

Prevent plagiarism. Run a free check.

The conclusion of a research paper has several key elements you should make sure to include:

A restatement of the research problem
A summary of your key arguments and/or findings
A short discussion of the implications of your research

No, it’s not appropriate to present new arguments or evidence in the conclusion . While you might be tempted to save a striking argument for last, research papers follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the results and discussion sections if you are following a scientific structure). The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

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Concluding Your Literature Review

In the previous blogs, we talked about searching and assessing reference papers for your literature review , and shared tips on organising and writing the content . Let’s look now at how to conclude your literature review.

One of the aims of writing the literature review is to define the purpose and contribution of your own study. Your review should therefore cover the points listed below to provide the rationale or justification for your study:

⦁ gaps in the research

⦁ limitations of previous studies

⦁ weaknesses or lack of support for existing theories

Quick Takeaways:

et al.' means 'and others'.
Use 'et al.' to cite works with three or more authors.
The presentation (et al., et al., or rarely et al) depends on the style guide or journal guidelines

The English language has a rich history of borrowing words from other languages, especially from Latin. Latin abbreviations such as ‘a.m.’, ‘p.m.’ and ‘CV’ have become part of our everyday vocabulary. Such abbreviations are also frequently used in academic writing, from the ‘Ph.D.’ in the affiliation section to the ‘i.e.’, ‘e.g.’, ‘et al.’, and ‘QED’ in the rest of the paper.

This guide explains when and how to correctly use ‘et al.’ in a research paper.

In this guide:

1) Meaning of ‘et al.’
a) Table: Correct use of ‘et al.’ by style guide
b) Unusual scenarios

Filling a Gap is Not a Rationale in itself

You need to state clearly what your study intends to achieve and why it is important.

It is not sufficient to simply say something like, “there is a gap in the research or literature”. Your readers might think that the gap exists only because there is no reason to fill such gap.

Then what should you consider including in the conclusion of your literature review?

1. Purpose or Objective of Your Study

First, you must be clear about what the purpose or objective of your study is. For example, you need to make it clear whether your study:

⦁ is designed to answer a specific question or solve a specific problem

⦁ is an experimental study looking for a cause and effect relationship

⦁ is a correlational study looking for relationships between variables

⦁ compares different clinical or psychological treatments or interventions

⦁ presents a new technique or an adaptation of an existing one

⦁ is a meta-analysis or review of previous studies

2. Significance of your Study

Try to be specific about the significance of your study and have a clear idea about what or who will benefit from it.

To give you some examples, a benefit might include:

⦁ advancing an existing theory or developing a new one

⦁ providing a new technique that will benefit future researchers

⦁ presenting a new material or product, or refining an existing one that will benefit industry

⦁ proposing a treatment or intervention that will aid clinicians and patients

⦁ providing evidence that can be used to improve government policy-making

Steps to Writing your Literature Review Conclusion

It is important to remember that the conclusion only needs to be a few sentences long. So, do not write too much.

You can follow the steps and adapt the sample expressions listed below:

Step #1: Start with a sentence to highlight the research gap

You may consider using one of these examples:

Despite the aforementioned theoretical inferences, no study to date has provided empirical support for the hypothesized effects

Step #2: State what you did to address the problem

Try using a sentence similar to one of these:

Therefore, in a series of experiments, we explored the direct effects of a on b and c, and tested whether m had a moderating influence on these effects

Step #3: Summarise how the findings will contribute to theory and/or practice

You may consider writing in one of these ways:

The results not only provide support for the theory, but also have practical implications for industry and government decision makers

Confirmation of the suitability of the intervention in this population will provide an alternative choice of treatment for this condition, which will benefit both patients and clinicians.

Putting those sample expressions together, we have the following example literature review conclusions.

“Given the lack of evidence for the applicability of this psychological intervention in Asian populations, we conducted a randomised control trial with a sample of patients who attended the clinic at ABC Hospital. Confirmation of the suitability of the intervention in this population will provide an alternative choice of treatment for this condition, which will benefit both patients and clinicians.”

But, always remember that the wording you use will differ depending on the nature of your study.

And no matter how different the wording you use is, the fundamental elements of this summary should not change, you must cover the following:

⦁ make clear the research gap

⦁ explain how you set out to address the problem

⦁ and why it was important to do so

QUICK ASIDE

Wondering why some abbreviations such as ‘et al.’ and ‘e.g.’ use periods, whereas others such as CV and AD don’t? Periods are typically used if the abbreviations include lowercase or mixed-case letters. They’re usually not used with abbreviations containing only uppercase letters.

Unusual Scenarios

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The response to our workshop, which included a constructive and insightful Q&A session, was very positive.Drawing on our extensive experience working with hundreds of Hong Kong researchers targeting the GRF and ECS every year, we used examples of poor and subsequently improved proposals to show the attendees how they can make their applications stand out. The response to our workshop, which included a constructive and insightful Q&A session, was very positive.Drawing on our extensive experience working with hundreds of Hong Kong researchers targeting the GRF and ECS every year, we used examples of poor and subsequently improved proposals to show the attendees how they can make their applications stand out. The response to our workshop, which included a constructive and insightful Q&A session, was very positive.Drawing on our extensive experience working with hundreds of Hong Kong researchers targeting the GRF and ECS every year, we used examples of poor and subsequently improved proposals to show the attendees how they can make their applications stand out.

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How to Write a Literature Review: Conclusion Prompts

A literature review is a particular type of academically written paper that gives an overview about a published material. This published material can be any source like a book, a dissertation, thesis or a research paper. It is done as a first step while conducting a research on the particular subject. It is an honest, objective and precise critique of the literature under concern.

In order to write a conclusion of a literature review we must first understand the basic format and structure of the conclusion.

You might be in a hurry by the end of the paper and would want to finish it as soon as possible. However you must not compromise on the conclusion. It is the last and most critical part of your review. This is where the reader gets a final extract of your literature review. A conclusion must be very well thought out and composed to give the reader a reminder of the whole review as well as an effective ending. A good conclusion must be able to:

The conclusion must be able to give a fine finishing to your paper. This is the final impression the reader will carry with him. It must be able to wrap up everything you have already mentioned. There is generally no typical format for a conclusion and can be written in any way the author considers the most suitable. However it is important to keep a few things in your mind while writing one.

Blend –this does not mean that you repeat the things that you have already stated in the body. Create a blend that shows how effectively you have managed to explain the ideas, examples and references and how well they contribute in supporting your stance.
State the areas that need further future research
Focus on the introduction and now with a better developed understanding, identify the key points.
State how your ideas will contribute in application of the theory.
Never end on an ambiguous or unclear note. Be bold, clear and straight in the conclusion.
You may raise questions and ask the reader to ponder deep into the topic. But do not sound as if you left any area unattended. Your conclusion should have a feel that is complete and concise.
Read the conclusion twice or thrice before considering it final. Make sure there is no area where you might leave the reader wandering between two opinions.

The Importance of Corporate Reputation for Sustainable Supply Chains: A Systematic Literature Review, Bibliometric Mapping, and Research Agenda

Original Paper
Open access
Published: 13 October 2022

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David von Berlepsch ORCID: orcid.org/0000-0001-8690-7014 1 , 2 ,
Fred Lemke 2 , 4 &
Matthew Gorton 3

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Corporate Reputation (CR) is essential to value generation and is co-created between a company and its stakeholders, including supply chain actors. Consequently, CR is a critical and valuable resource that should be managed carefully along supply chains. However, the current CR literature is fragmented, and a general definition of CR is elusive. Besides, the academic CR debate largely lacks a supply chain perspective. This is not surprising, as it is very difficult to collect reliable data along supply chains. When supply chains span the globe, data collection is especially challenging, as the chain consists of multiple suppliers and subcontractors, positioned at different tier levels. Recognizing this, the paper examines firstly the current state of CR research through a systematic literature review from a business perspective. The review is combined with a bibliometric mapping approach to show the most influential research clusters, representative of CR research streams and their contributors. This process highlights that the connection between CR and supply chain issues represents a major research gap. Consequently, this paper introduces a research agenda connecting these the two traditionally separated research fields.

Avoid common mistakes on your manuscript.

Introduction

Corporate Reputation (CR) is an intangible and critical asset in sustaining business operations. Despite many years of efforts and initiatives in the private sector, politics, and academic research, addressing the importance of reputation, reputational risks, and reputation management along entire supply chains, the management of CR has not yet become established as an important part of strategic management decisions in practice. Although the many advantages that a positive CR brings to individual organizations (improving the bottom line, being a decisive factor in some customers’ choices, buffering for risks, etc.), CR cannot be seen in isolation (Dhingra & Krishnan, 2021 ). The shaping of stakeholders’ CR perceptions occurs through the interaction of stakeholders, especially business partners that make up the supply chain (Mani & Gunasekaran, 2021 ; Nguyen & Phan, 2021 ) Thus, a corporation’s overall reputation is influenced by the actions and behavior of its supply chain partners (Saleheen & Habib, 2022 ). Over time, however, a better understanding of the important role CR plays in the successful and sustainable development of companies emerged. Consequently, the CR topic has been discussed via a strategic management lens, over the past two decades. However, supply chains represent a nascent topic in CR debates, given that CR is an important dimension of supplier relationships with wider implications in chain settings (Fan et al., 2021 ).

This paper addresses two major research gaps regarding the interplay between supply chain management (SCM) and CR research. The first gap originates from the traditionally separated fields of CR and supply chain research, which have been treated as two different units of analysis, often in isolation and without understanding the linkages between them (Blom & Niemann, 2022 ). The second gap concerns the absence of a research agenda connecting these two fields of research, including the most pressing topics to be explored. Consequently, this paper aims to provide an agenda for future research on the combination of CR and in supply chains, derived from a systematic literature review.

As argued by Hoejmose et al. ( 2014 ), only a few studies consider the issue of CR across the supply chain context, with many only drawing on narrowly focused data or observations (Rajagopal et al., 2021 ). Wolf ( 2014 ) echoed this point and highlighted that more research should explore reputation and supply chains in combination to understand the linkages between them. At present, the academic literature provides interesting discussions, highlighting the overarching role of CR for business studies. However, there is a need to develop a theoretical foundation that will guide future research. Therefore, we undertake a literature review to address the following research goals:

Provide a state-of-the-art literature review, highlighting the historical development of the research field of CR.

Identify the most influential journals and authors which have shaped CR research.

Develop a current and consolidated definition of CR.

Highlight the importance of CR and its connection to the supply chain environment.

Outline an agenda for future CR research, relevant for supply chain topics.

For tackling the research goals, we divide this article into four parts. We begin with outlining CR and its connection to supply chain aspects, continue with the methodology section, before moving on to the evolution of CR as a research field and a conceptualization of CR. This provides the basis for a consolidated definition of CR. Then, we address the connection between CR and supply chain issues and highlight the importance of CR in a supply chain context. We conclude with a research agenda that can guide future CR researchers and practitioners to embark on their explorations in a targeted and structured approach.

CR and Its Connection to Supply Chain Aspects

The market offerings, communications, and actions of a company’s supply chain partners pose a reputational risk, particularly for those operating in large supply networks as well as those involved in chains that span multiple countries where poor transparency, corruption, and human rights records are common. Thus, it is difficult to mitigate reputational risks in supply chains that are globally dispersed. Rajagopal et al. ( 2021 ) and Rajagopal et al. ( 2017 ) introduced the idea of looking at risk drivers from upstream and downstream supply chain partners, arguing that reputational risk is clearly overlooked in the supply chain literature. In addition, Dhingra and Krishnan ( 2021 ) explored social and environmental reputation costs along the supply chain and identified the importance of reputational risk sharing between supply chain partners. They highlight the lack of research in a supply chain context regarding reputation risk management and call for research to identify ways of substantially reducing reputational risks in supply chain settings. Mani and Gunasekaran ( 2018 ) echo these concerns, exploring how ethical behaviors and actions along global supply chains affect firm reputation. Their research highlights a need for further investigation of the role of reputation mechanisms in supply chain networks, influencing ethical and social actions, upwards and downwards the supply chain. Fan et al. ( 2021 ) document the risk of reputational spillover effects between supply chain partners. They recommend adopting a sustainability perspective when studying supply chains’ reputational risk. Likewise, Nguyen and Phan ( 2021 ) conclude that additional research is needed to explain reputational effects throughout supply chains and how to minimize reputational risks. Taking this further, Blom and Niemann ( 2022 ) argue that reputational risks along the supply chain have a predominant influence on a firm’s CR. However, despite the importance of this topic for practitioners and academics, the above authors found little literature on the topic. Reflecting on recent calls, further research is necessary to explore the topic of reputation in a supply chain context more holistically, including Corporate Social Responsibility (CSR) and environmental risks as influencing factors.

Dahlmann and Roehrich ( 2019 ) highlight that the engagement of an organization with its supply chain partners is crucial for the development of sustainable supply chains. This research field is complex because changes in a firm’s CR, resulting from the actions of one or more of its partners, can alter profoundly its relationships with other stakeholders. For example, during the Covid-19 pandemic, sales of internet-based fast fashion retailer Boohoo.com surged. However, in July 2020, newspaper reports identified that some of Boohoo’s suppliers paid employees below the minimum wage, and failed to follow appropriate social distancing guidelines (Thomond, 2020 ). An independent report, commissioned by Boohoo, found that the allegations were ‘substantially true’ (Levitt, 2020 ). In the wake of the controversy, several institutional investors sold their shares, denting Boohoo’s share price. PricewaterhouseCoopers (PwC) quit as its auditor and other leading accountancy firms ruled out working with the retailer.

A corporation’s reputation, as the Boohoo.com vignette illustrates, is co-created by organizations and their stakeholders. Therefore, CR is a dynamic construct, subject to external influences (e.g., customer perceptions) and is, thus, in a constant state of flux and development. Consequently, it varies in value over time (Veh et al., 2019 ). Hence, in this paper, we argue that CR matters in a supply chain context—a notion that has recently been heightened by developments in the EU. Specifically, EU businesses are facing increasing regulations concerning ethical sourcing and mandatory supply chain due diligence, forcing them to pay greater attention to the practices of their supply chain partners (European Parliament, 2021 ). Namely, the draft EU Directive on Mandatory Human Rights, Environmental and Good Governance Due Diligence envisages that companies falling within its scope will have to make appropriate efforts to identify their suppliers and subcontractors and implement actions to ensure that their business partners’ act in accordance with the company’s due diligence strategy. This includes measures relating to workload, occupational safety, working hours, exploitation, occupational health, fair trade, social compatibility, child labor, production of waste, and the sustainable use of natural resources (European Parliament, 2021 ). Other states and international organizations are also seeking to improve transparency in supply chains, especially in efforts to combat modern slavery (Australian Government, 2018 ; UK Parliament, 2015 ). The focus of CR is, thus, moving beyond the corporation’s own actions to also include those of their supply chain partners, posing the question as to how to manage CR within a supply chain context?

As the Boohoo.com case demonstrates, end-customers may not be the only actors shaping CR but it could be any stakeholder along the chain (Dewalska-Opitek & Bilińska-Reformat, 2021 ). Despite the current literature’s focus on the customer’s perspective, the scientific paradigm is highly likely to shift its focus toward a more comprehensive perspective (Bendixen & Abratt, 2007 ; Dahlmann & Roehrich, 2019 ; Jelinkova & Lostakova, 2016 ; Martin-de Castro, 2021 ; Panzone et al., 2016 ). This change is helpful when examining reputational spillover effects in a supply chain context. Following the argument of Petersen and Lemke ( 2015 ), one actor can utilize reputational triggers (i.e., offering, communication, and action) which may cause reputational aspects of the initiating actor to spill to others. For instance, ‘being innovative’ may spill from the supplier to the manufacturer when working with this supplier. These receiving organizations are CR borrowers , and the spill can happen willingly or unwillingly.

Between both owner and borrower are stakeholders that care about what is happening; they mediate the process. For instance, a supplier may employ children in the production process. As soon as the caring stakeholder is aware and perceives this action to be relevant (e.g., customers), it ‘reflects’ CR aspects directly from the owner to the borrower (e.g., from the supplier that employs children to the manufacturer that integrates this part in a wider system). This is a CR spillover, and the caring CR reflector is almost exclusively assumed to be the customer. However, the CR reflector could be any stakeholder who cares about what companies design and create, say, and how they behave (e.g., investors, policy makers, assessors, industry experts, communities, societies).

Recent global crisis heightened strains on supply chains, affecting CR. For instance, the Covid-19 pandemic placed enormous pressure on reputation management within global supply networks (Blom & Niemann, 2022 ). Many companies worldwide ran into difficulties, due to supply chain bottlenecks, as experienced, for example, at seaports, trade centers, and entire specialized economic zones (Phillips et al., 2022 ). Supply chains without any resource buffers, that were purposely designed for lean management, just-in-time, and cost optimization, showed little resilience during the Covid-19 pandemic (Phillips et al., 2022 ). Supply chain disruptions apparent during the pandemic were further exacerbated by the war in Ukraine. In the wake of such crises, many supply chains experienced domino and butterfly effects where small alterations caused large effects in complex systems (Hosseini & Ivanov, 2022 ; Yu et al., 2022 ). In response, many corporations sought to reintegrate sourcing and production into national and local regions.

In such an environment, reputation and supply chain management must be flexible and resilient enough to respond to global crises in real time. Consequently, corporations will need to continuously reassess their engagement with supply chain partners to assess and reduce risks. For mastering the risk challenge, an understanding of CR mechanisms is critical for supply chains and its corresponding stakeholders, as discussed earlier. However, literature on this topic is limited, in part because of CR and supply chains have been traditional regarded as separate ‘silos’ and due to data availability. Based on the high complexity of supply chain networks, companies do not always have a complete picture of their suppliers and sub-suppliers. Moreover, even if they possess the data, their willingness to share with the public (including research institutions) is limited, to preserve competitive advantage (Aamer et al., 2020 ; Quintana-García et al., 2021 ; Shaikh et al., 2020 ). Thus, empirical studies based on supply chain data are scarce. Nevertheless, understanding the mechanisms that co-create, transfer, and destroy CR along the supply chain is recognized as an important research topic (Marketing Science Institute, 2018; Syed Alwi et al., 2020 ). However, research on CR is fragmented across several disciplines and lacks a concerted supply chain perspective. To address this deficiency as well as to respond to recent calls for advancing CR research (Pérez-Cornejo et al., 2019 ; Veh et al., 2019 ), we conduct a Systematic Literature Review (SLR). When working with companies in CR, we recognize that the following areas are currently concerned with managing this topic: marketing, finance and accounting, general management, strategy, organizational studies, and supply chain management. The idea of this research paper originated from a business perspective, on the meso level (i.e., supply chain). To contribute to the currently underrepresented literature, due to data availability, practitioners’ insights offer new perspectives and knowledge in the field (Aguinis et al., 2022 ; Schön, 2017 ; Stokes, 2011 ). During the development of this research project, and acknowledging its relevance for supply chain topics, we realized that CR is not very well featured in the supply chain literature domain. Therefore, before discussing CR in relation to supply chain aspects, it is important to have a clear view of the CR literature. In this article, we continue with the methodology of our SLR and bibliometric mapping. This leads us to a consolidation of existing CR definitions.

Systematic Literature Review (SLR)

To provide an overview of the literature and develop a consolidated definition of CR, we carried out a SLR of CR research. A SLR is a powerful means for detecting and making sense of conceptual as well as methodological issues (Boell & Cecez-Kecmanovic, 2015 ; Crossan & Apaydin, 2010 ; Grewal et al., 2018 ; Sarmento & Simões, 2018 ; Veh et al., 2019 ). It is also suitable for identifying critical areas for further research and informing theory development (Köhler et al., 2017 ; Kohtamäki et al., 2018 ). Hulland et al. ( 2018 ) highlight the demand for empirical studies to systematically detect and better understand specific research areas and their gaps, as well as their future research potential. The aggregation of studies from different disciplines allows us to attain a comprehensive overview of the body of knowledge, and to highlight the inter-relationships of various constructs, research areas, and broader literature fields (Bier et al., 2020 ; Burgers et al., 2019 ).

The literature review process began with a planning phase, including the development of inclusion/exclusion criteria for the selection of published materials (Grewal et al., 2018 ; Kohtamäki et al., 2018 ). The study focuses solely on scientific peer-reviewed articles in top tier journals. We only reviewed English contributions, published in journals listed in the ABS Ranking (that also includes FT50 journals). Specifically, we took the ABS ranking as a guidance framework and limited inclusion to papers published in journals ranked ABS2 to ABS4*. Our intention is not to downplay non-English or low/unranked articles. We rather sought to identify a literature pool that has greater potential to be highly cited. Setting a recent timeframe is recommended by Hox et al. ( 2017 ), to reveal the current state of the art and research directions within a field. Our data set includes articles published between 1996 and 2021. Prior to 1996, the CR literature was limited and the number of publications on CR substantially increased from less than 2 to over 40 per year (see Fig. 1 ).

Key events of corporate reputation and related publications per year (1975–2021)

The SLR followed the procedures recommended by Sarmento and Simões ( 2018 ). In the first stage, robust citation index services were identified. Scopus, produced by Elsevier, allows a subject search with citation tracking in the sciences and social sciences with over 69 million records (Scopus, accessed on 17.04.2021). This, in combination with Web of Science, generated more than 90 million records (Web of Science, accessed on 17.04.2021). The overall number of publications on Google Scholar containing the exact phrase ‘corporate reputation’ in the title, abstract, or keywords is approximately 72,500 (date: 17.04.2021). Besides Google Scholar, the search was also conducted in the Web of Science, EBSCO, Social Science Research Network (SSRN), and Scopus databases for identifying articles dedicated to ‘corporate reputation.’ There is a noticeable publication uptake in 2011 (Fig. 1 ), which served as a suitable starting point for further assessment. Working with the literature of the past ten years ensured that we capture the current understanding of CR. This initial sample contained 1922 articles, suitable for our bibliometric mapping analysis. For the SLR, the titles, abstracts, and key words of the 1922 relevant articles were examined for relevance to the topic ‘corporate reputation.’ This was the second stage. In some cases, although the title and key words appeared promising, the content of the abstract was of little relevance for our SLR. These articles were discounted, following Kohtamäki et al. ( 2018 ), who argued that generic articles with no particular contribution to the research question should be excluded. This filtering reduced the dataset from 1922 peer-reviewed articles to 235 scientific papers relevant for the study.

In the third stage, coders searched for the phrase ‘corporate reputation’ in every article, using the electronic search function. Two coders worked through the 235 articles independently. The content of the 235 articles relating to CR was selected by the coders and then transferred to an Excel spreadsheet. Each coder indicated whether they regarded the content as relevant or not. Discrepancies between markers, based on their individual assessments, were discussed and agreement reached. Two weeks later, this procedure was repeated. Only those articles regarded as relevant on both occasions by both coders proceeded to the next coding phase. This process ensured consistency in the classification of articles, suitable for further analysis.

In the third stage of coding, the content of the articles where CR was explained, defined, or distinguished from other concepts was highlighted. Coded sentences or paragraphs were transferred into a new Excel sheet. The extracted sections and definitions identified by both coders were then compared. For 37 text phrases where the two coders disagreed, they reached agreement through a negotiation process. In eight cases, the two could not come to an agreement, so these text passages were discarded and not considered further in the process. Overall, the two coders identified and agreed on over 583 text passages suitable for the next stage of coding.

In the fourth stage of coding, within the selected text blocks, words and short text phrases that dealt directly with CR were identified. We adopted ‘descriptive coding’ to develop “an inventory of topics for indexing and categorizing” (Miles et al., 2019 , p. 65). In the initial coding of the text block data, highlighted text chunks represented distinct meanings, which is typical in ‘first cycle coding’ (Saldaña, 2016 ). The text passages were printed twice on separate cards. Each coder worked separately with the identical card set, allocating the highlighted text chunks to meaningful categories. In the ‘second cycle coding’ step, the coding material was then categorized, following the principles of ‘pattern coding’ (Saldaña, 2016 ). Cards containing more than one code were categorized in multiple ways, a process known as ‘simultaneous coding’ or ‘double coding’ (Saldaña, 2016 ). The two coders’ classification of manually categorized cards (i.e., highlighted text chunks) were copied into an Excel spreadsheet, and an inter-coder reliability index computed. The two coders discussed any disagreements, as part of the negotiation process.

In qualitative research that explores rich interview data, inter-coder reliability tests could be repeated multiple times, resulting in an eventually high level of agreement between coders (e.g., Campbell et al., 2013 ; Lemke et al., 2011 ; MacPhail et al., 2016 ). In our study, the inter-coder agreement was 94.3% after just one coding round. Agreement by chance is eliminated by a Cohen’s Kappa of 91.3%, which exceeds substantially the recommended threshold (88.4%), as suggested in the literature (Cohen, 1968 ; Lombard et al., 2002 ; Perreault Jr & Leigh, 1989 ). Both results may not be surprising, given that the coded text were existing definitions and CR descriptions in academic publications, which were intended to be clear and precise, leaving little room for ambiguity and subjective interpretation. The resulting words and text passages and content gathered in this analytical stage provided the basis for formulating a holistic definition of CR. Although CR has been a research topic for over four decades, the understanding of the term has evolved in different sub-disciplines, resulting in fragmented perspectives (Gomez-Trujillo et al., 2020 ; Khan & Digout, 2018 ).

Corporate Reputation as a Research Field

The origins of research on CR are mostly USA-based, with the stock market crash of 1929 laying the foundations for an awareness of CR on a broader scale (Jones et al., 2000 ; O'Neill, 1977 ; Stevens, 1975 ). During the following decade, due to several corporate scandals based on discrimination against women, Jews, African Americans, and other minorities, the US government began to curtail unethical behavior and to restrain the power of corporations (O'Neill, 1984 ). Consequently, in the 1930s, a new system of regulations and regulating institutions emerged in the US. Following US military occupation after World War II, several regulatory standards were transposed and influenced standards for transnational companies across Western Europe (Maier, 1977 ; Majone, 2002 ). From the mid-1960s onwards, a slowly increasing number of publications on the topic indicate a rising awareness in academia—CR turned into a public issue. Figure 1 shows the distribution of peer-reviewed publications on the topic of CR, from 1975 until 2021. Given that the number of publications continues to rise, it seems unlikely that the research field has yet reached a peak, especially given the growing public awareness about CR and its media coverage (Fragouli, 2020 ; Gatzert, 2015 ; Money et al., 2017 ; Veh et al., 2019 ).

The mid-1970s witnessed a heightened interest in CR among academics, as the post-war consensus on business-state relationships in western societies dissolved. Specifically, Friedman ( 1970 ) and other Chicago School economists prompted debate on whether businesses were over-regulated to the detriment of macroeconomic performance. They argued that a company’s only responsibility was to its shareholders, while adhering to the legal system in which they operated. In the 1980s, the development of CR as a scientific topic began, utilizing theoretical approaches from business economics. In this context, CR theory was founded on game, signaling, and stakeholder theories (Weigelt & Camerer, 1988 ). In the 1990s, sociological perspectives informed academic perspectives on CR, drawing on organizational and social identity theories (Walker, 2010 ).

The origins of CR as a research subject are multi-theoretical. Historically, many prominent theoretical contributions come from game and signaling theory (Fombrun & Shanley, 1990 ; Rindova et al., 2005 ; Veh et al., 2018 ). This emphasizes that CR serves as a signal of a firm’s credibility attributes, products, or services (Saxton, 1998 ; Shapiro, 1983 ). In addition, Weigelt and Camerer ( 1988 ) connect game and signaling theory and outline how reputation can emerge from the past actions and behaviors of a firm. Turban and Greening ( 1997 ) combine the concepts of social identity and signaling theories to develop the concept of social performance as an aspect of CR. Johnson and Greening ( 1999 ) elaborate on this with the idea that good social performance enhances a firm’s overall reputation. Thus, proactive CSR creates a reputation that a firm is reliable and honest, and signals to customers (Sethi et al., 2016 ) that the corporation offers a superior product and service quality (Mishra et al., 1998 ; Purohit & Srivastava, 2001 ; Rao et al., 1999 ). Fombrun ( 2005 ) argues that the problem of a concrete definition regarding the concept of CR stems from diverse studies, which examine the construct of CR from different disciplinary perspectives. Both highlight the need for an integrated view. Thus, the Integrative School of Thought was born. Figure 2 provides a snapshot of the theoretical foundation.

Theoretical Foundation of Corporate Reputation Research in the 1980s and 1990s

Barney ( 1986 ) and Dierickx and Cool ( 1989 ) developed CR theory from a Resource-Based-View (RBV) perspective. Accordingly, CR is used for developing an advantage over competitors, and Hall ( 1992 ) emphasizes that CR can differentiate a company from its competitors. Shielding reputational barriers can hinder competitors’ entry to a market or an industry where an existing company’s reputation is strong. Overall, organizational strategists consider CR a competitive and, thus, strategic asset to distinguish a company from its competitors (Rindova & Fombrun, 1999 ).

DiMaggio and Powell ( 1983 ) and Meyer and Rowan ( 1977 ) use institutional theory to inform their stream of CR research. This influenced the work of Staw and Epstein ( 2000 ) on how CR emerges in organizational interactions. Rindova et al. ( 2005 ) redefined the idea of CR as a social construct derived from the collective awareness and acceptance of an organization in its stakeholder environment. Referring to the theoretical concept of CR, CSR, and stakeholder theory, Mitchell et al. ( 1997 ) mapped out the connection between CR and CSR. Considering these findings, a conceptual basis for empirical studies was formed. The aim was to demonstrate how corporate social performance is linked to different corporate performance indicators, i.e., CR (Brammer & Pavelin, 2006 ; Turban & Greening, 1997 ).

Fombrun and Van Riel ( 1997 ) draw on sociological perspectives and stakeholder theory. They explored the connection between social constructs, such as rankings and reviews, and considered their influence on relationships between organizations and their stakeholders. Granovetter ( 1985 ) and White ( 1981 ) point out how social rankings and reviews strongly influence stakeholders’ perceptions of CR. Thus, CR represents an aggregated assessment of a firm from the perspective of both its stakeholders and their peer groups. Consequently, although CR is difficult to imitate for other companies (Fombrun & Zajac, 1987 ), it essentially is a perception that is largely outside the direct control of the organization.

Analogous School of Thought

The theory of reputation and its definition derives from psychology. The concept of self-identity thus informed the creation of reputation as a research field. Martineau ( 1958 ) defines corporate image as a sum of functional qualities and psychological attributes that exist in the mind of the consumer. This view is mainly influenced by the idea of reputation as a behavioral construct as part of self-identity theory. However, Kennedy ( 1990 ) argues that corporate image is synonymous with CR. Early studies stemming from the Analogous School of Thought focused on the concept of corporate image rather than on CR. The choice of terminology was a child of its time. In the 1960s and 1970s, corporate image research was very fashionable, while the term CR had not yet been established. Rindova ( 1997 ) notes that those authors from the Analogous School of Thought largely have a background in public relations and have, therefore, focused on the concept of corporate image rather than CR. As a result of the research undertaken by this school of thought, many regard the terms corporate image and CR as identical. Hence, ambiguity about the conceptualization of CR persists.

Differentiated School of Thought

Authors from the Differentiated School of Thought consider CR and corporate image as two different but interrelated theoretical concepts. This approach generated two ideas. Firstly, a firm’s reputation is one layer of a corporate image. While, secondly, CR is influenced by multiple images perceived by a company’s stakeholders. Many authors of this school (Bromley, 2001 ; Fombrun, 1996 ; Fombrun & Shanley, 1990 ; Gray & Balmer, 1998 ; Rindova, 1997 ; Saxton, 1998 ) argue that CR reflects a firm’s image over time perceived by its stakeholders. It is shaped by the thoughts and words of its stakeholders. In addition, Fombrun ( 1996 ) suggests that CR is essentially backwards looking, characterized by customers experiences created in the past.

Integrative School of Thought

Authors from this school argue that a bilateral dynamic relationship between a firm's reputation and its projected corporate images build the foundation of a company’s reputation. Thus, CR is not static and needs to be constantly managed with planned, formal, sensitive, and target-oriented communication activities. They define CR as an umbrella construct which includes different layers: corporate image, organizational identity, organizational culture, and stakeholder perceptions of past behavior and action (Cian & Cervai, 2014 ). Thereby, CR is rooted in both internal and external stakeholder groups which are influenced in their perception of CR by the company’s image, identity, culture, and communication activities. However, the conceptualization of CR remains debatable, and Walker ( 2010 ) argues that researchers across disciplines need to be open to new concepts and definitions. The historical development of CR is outlined in Fig. 3 a.

Source : Adapted from 1. (Singh & Lumsden, 1 990 ), 2. (Whetten, 1 987 ), 3. (Gotsi & Wilson, 2 001 ). b : Consolidated School of Thought

a School of Thoughts in corporate reputation research history.

Consolidated School of Thought

The integrative school of thought regards CR as the expectation of stakeholders toward the company’s future actions to secure CSR aspects as well as to show true engagement in sustainability along their corporate value chain system. In this sense, CR is not merely backwards oriented—it is rather the trust that stakeholders place in companies when it comes to fulfilling their promises and adhering to the values they communicate. This includes the traceability and transparency of their value chains. Since the late 2000s, climate, environmental, and sustainability factors have increased the pressure for companies to focus more on conservation aspects of their CR. Additionally, Dahlmann and Roehrich ( 2019 ) point out that the engagement of an organization with its partners along its supply chains is crucial for the development of long-term sustainability and to ensure green and sustainable supply chains in the future.

The prevailing view in the contemporary CR literature derives from a focus on end-consumers (Dijkmans et al., 2015 ; Kiessling et al., 2016 ; Quintana-García et al., 2021 ; Walsh et al., 2014 ; Wies et al., 2015 ), which continues to endure (Brønn & Brønn, 2017 ; Camilleri, 2017 ; Walsh et al., 2018 ). It is surprising to see that the end-consumer perspective still serves as a reference point for directing and guiding the reputational debate, given that CR is created, shaped, interpreted, and is meaningful throughout the entire chain of business’s operations (Guo et al., 2020 ; Quintana-García et al., 2021 ).

Consolidated Definition of CR

Definitions providing new insights and contemporary knowledge were coded manually before we entered them into Excel. At first, we searched the entire paper, using our search term, ‘corporate reputation.’ In doing so, we identified the relevant paragraphs in which definitions appeared and read these carefully. In the analysis, we did not work with a pre-defined list of codes that has the risk of losing important information. Rather, two independent researchers coded the definitions stemming from the research papers and compared them. They then ranked the grouped content of the CR definitions according to frequency, identifying the most important and most frequently mentioned terms and incorporating them into the definition. The goal was not to go into as much detail as possible and to characterize the individual underlying foundations of CR, but to look for definitions that had a high degree of similarity with each other and could, thus, be consolidated. Our synthesized definition of CR derives from the 235 coded articles, of which 183 or 77.87% have been incorporated or reflected in the consolidated CR definition proposed in this paper. We, thus, have a solid basis that offers a contemporary definition of CR to provide researchers and practitioners with common ground for conceptualizing CR.

Corporate reputation is a unique, intangible, status-based asset, emerging from the stakeholders’ perception of the firm’s future commitments and how closely it previously acted within the overall expectations of its stakeholders, based on their beliefs and values. This is judged by their evaluation of future commitments and past experience with the company (i.e., prior actions, performance, and behavior). The perception represents the aggregated opinion of the stakeholder community and is co-created by the interplay of organizations, their stakeholders, and the competitive environment.

Bibliometric Mapping—Identifying Key Clusters in the Current CR Literature

In order to identify the most important journals and influential CR authors, as well as to identify the key dimensions of CR, we undertook a bibliometric analysis (Singh & Dhir, 2019 ). This analysis includes a variety of techniques that are used to support a SLR (Fellnhofer, 2019 ; Gurzki & Woisetschlaeger, 2017 ; Samiee & Chabowski, 2012 ; Vogel, 2012 ). Bibliometric visualization is a comprehensive method to identify the most influential authors in a research domain along with the most important topics associated with it (Fellnhofer, 2019 ; Ji et al., 2020 ; Leydesdorff et al., 2016 ; van Eck & Waltman, 2017 ). Small ( 1973 ) introduced co-citation analysis as an effective tool to highlight the interlinkages between different knowledge fields and their underlying intellectual structure. The VOSviewer mapping technique works with co-citation linkages between authors and key words (Meng et al., 2020 ; Van Eck et al., 2010 ). This allows for plotting networks and citation maps to visualize the relationships between diverse topics, publications, authors, or other items of interest.

For defining CR, we worked with our smaller set of 235 articles (Table 1 ). For creating a bibliometric map, however, we wanted to display a more holistic view that displays the connections between networks of CR studies. For the latter, the dataset of 1922 suitable articles was merged into a comma-separated value file (CSV) and imported as tabulated data into Microsoft Excel. In a second step, network maps were generated to visualize the co-citation analysis and highlight the most influential authors in the CR field. We used the visualization program VOSviewer, version 1.6.14 (VOSviewer, accessed on 17.04.2021), to perform this analysis. The input file was used by the VOSviewer algorithm to locate items in a low-dimensional space. This was necessary to define the distance between sets of items as an indicator of their relatedness. Publications are concentrated in the following journals: Corporate Reputation Review, Journal of Marketing, Journal of Business Ethics and Strategic Management Journal (Fig. 4 ). Based on the total number of 1922 publications in high impact journals, CR developed from a niche topic into one that is of general interest. The specialized Corporate Reputation Review is the dominant publication outlet and is placed at the center of the bibliometric map. Its aim is to be the main communication platform for CR research (Fombrun & Van Riel, 1997 ).

Bibliometric mapping of journals for the topic corporate reputation (1975–2021)

In the network analysis, a dot represents a journal and dot sizes indicate the volume of publications on the CR topic. The analysis also illustrates the proximity of journals, based on co-referencing frequency. When working with the 1922 publications, we identified the most cited CR authors between 1975 and 2021, grouping authors with fifty or more citations, and plotted co-citation maps (Fig. 5 ).

Co-citation map of the research field corporate reputation between 1975 and 2021

The dotted lines demarcate four clusters, each with a center point indicating the leading author. This author has been cited most often by related authors in the cluster space, signaling the lead author’s influence—or contribution—to the work of others. The clusters are clearly distinguishable while still being visually interconnected. The four clusters capture influential researchers in the field of CR and different research directions. The typology can provide researchers with an orientation to the CR topic. Consequently, it can thus help researchers plan their own future investigations.

Cluster 1—Organizational Perspective

Researchers from this cluster connect CR with relationship marketing and CSR (Hildebrand et al., 2011 ). Most publications appeared between the years 2000 and 2015 and their geographical setting is principally Germany, USA, and Australia. Most authors in this cluster come from the fields of marketing and organizational studies. Against this background, the research cluster typically has the customer-company relationship as a dyadic focus and explores how sustainability, social, and ethical aspects influence CR in a diverse stakeholder environment (Bhattacharya et al., 2010 ; Brammer & Pavelin, 2005 , 2006 ; Greening, 1995 ). The research design of papers often follows those employed in organizational theory and organizational psychology (Cable & Turban, 2003 ; Einwiller et al., 2010 ). Consequently, multiple researchers specializing in human resources contribute to this cluster and studies are usually conducted from the perspective of employees (Cable & Turban, 2003 ; Greening & Turban, 2000 ). Surveys, event studies, and experiments are preferred for empirical analysis.

Cluster 2—Empirical Perspective

CR research in Cluster 2 consists of papers mostly by German marketing academics. Research forming this cluster is typically data driven and part of performance marketing (Raithel & Schwaiger, 2015 ). Studies often draw on German or European samples of respondents and companies (Schwaiger et al., 2010 ). Since 2000, the researchers have used Structure Equation Modeling in customer-based reputation research (Schloderer et al., 2014 ) to understand how CR is associated with customer satisfaction, loyalty, and trust (Walsh et al., 2014 ). Researchers from this cluster are also interested in the development and utilization of other regression-based statistical methods in marketing research (Schwaiger, 2004 ; Wilczynski et al., 2009 ).

Cluster 3—Individualistic Perspective

CR researchers in Cluster 3 were most active in the years 2000 to 2010. The majority are UK-based academics, and their research relates to the fields of marketing and consumer behavior. They sought to explain CR with findings from organizational research, drawing on concepts from social identity and corporate branding theories (Balmer, 2008 ; Balmer & Greyser, 2006 ; Melewar, 2003 ). These scholars wrote seminal papers, separating the concepts of corporate identity, corporate image, corporate branding, and CR (Abratt & Kleyn, 2012 ). Increasingly, topics from the field of social media marketing and digital marketing attracted attention, such as a consideration of e-reputation (Chun & Davies, 2001 ). Overall, this cluster focuses on CR as a customer-centric concept (Walsh et al., 2015 ).

Cluster 4—Conceptual Perspective

Cluster 4 is almost exclusively dominated by US-based scholars, active since the 1990s (Abratt & Kleyn, 2012 ; Barney, 1991 ; Deephouse & Carter, 2005 ; Fombrun & Shanley, 1990 ; Fombrun & Van Riel, 1997 ). Articles explore the topic of CR often on a sectoral basis, beginning with the fashion industry and the banking sector (Fombrun, 1995 ; Preece et al., 1995 ). Based on the findings generated from these industries, the first empirical studies attempting to estimate the effects of CR on financial performance emerged in the early 2000s (Barnett et al., 2006 ; Roberts & Dowling, 2002 ). Later, additional dimensions were added such as product and service quality, leadership performance, and CSR (Barnett, 2007 ). The authors in this cluster laid the foundations for CR as a distinctive field of research. They developed measures of CR which have since been adapted and further refined (Fombrun et al., 2000 , 2015 ; Ponzi et al., 2011 ). In terms of theory, most of the initial published research is based on signaling and stakeholder theories (Baumgartner et al., 2020 ), as well as those related to crisis and communication management (Coombs, 2020 ). The table below contrasts and compares the theories applied in the four clusters, listed in order of popularity:

As Table 2 shows, Cluster 1 has a greater CSR focus which we also find in the theories applied. Cluster 2 is almost exclusively concerned with the end-consumer which explains the preference from working with theories stemming predominantly from marketing. Cluster 3 adopts an individualistic perspective and works with the theories that shed light on individual actors and their identities. Cluster 4 typically explores questions around theory development and methods of measurement (Table 2 ).

The Importance of CR in the Supply Chain

As witnessed in the Boohoo.com case, the CR of firms in a supply chain is interconnected. Often, suppliers must adjust their own strategies to fit with the business concept (and thus, intended CR) of manufacturers or retailers (Hoejmose et al., 2014 ; Petersen & Lemke, 2015 ; Quintana-García et al., 2021 ). Thereby, CR frames the process of how stakeholders obtain superior value from their supply chain partners.

Within the supply chain context, CR has the potential to strengthen stakeholder attachment and commitment to a corporation. For example, suppliers adjust their behavior and management ethics toward their downstream customers to ensure that they are in the position to make the value proposition for their buyers stronger. Consequently, CR parallels the flow of micro-interactions and exchanges of offerings serve like a tier-to-tier baton that contributes to the competitive advantage of an entire supply chain. When the offering is ‘in use’ (e.g., a tier 1 supplier obtains raw material), a new offering becomes created (e.g., for the manufacturer). At the risk of simplification, Fig. 6 introduces the concept in a generalized supply chain setting.

Source : Based on Lemke and Petersen ( 2013 )

Corporate reputation in a simplified supply chain context.

Figure 6 presents a linear input-through-output process of a supply chain, where CR is formed along the supply chain. Resource integration happens at each stage of the chain and the smaller squares on the left symbolize the beginning at the raw material stage. Consequently, CR becomes part of designing a new offering for the next chain member, which becomes larger, more substantial, complete, and tailored toward the needs of the end-consumer market. We indicate this in the form of the increasing ‘competitive advantage’ that all supply chain members co-create.

The analysis of the literature resulted in the identification of twelve dimensions of CR, and Table 3 provides an overview in alphabetical order:

The dimensions of CR displayed in Table 3 represent an additional pillar of CR that must be included in a holistic discussion of CR today. Regarding the dimensions, we further developed an idea of a Consolidated School of Thought from our historical analysis of CR (see Fig. 3 b). This school views CR on a broader canvas—one that is embedded in the stakeholder environment, framed by the dimensions derived from our research. We believe that this understanding must be included in a modern and consolidated version of CR. Thus, a theoretical model should reflect the dimensions of CR to meet the requirements of contemporary and preventive reputation management in the stakeholder environment of any business organization.

We aim to identify the emerging research gaps relevant in the current literature, formulating a CR agenda that can guide future CR research. In doing so, it is critical to identify how important the supply chain topic is for strategic decision making when it comes to CR, especially with all its complexity added by hundreds or even thousands of different chain members, resulting in a global network from which reputational damage can arise very quickly via spillover effects, as the Boohoo case shows. To ensure a sustainable supply chain, all stakeholders of a company will increasingly demand information, transparency, and traceability, seeking greater control. In a chain setting, managing these demands is challenging with IT advancements, such as cloud solutions for mitigating risk during global crises, becoming increasingly prevalent. Specifically, companies are moving applications and parts of their IT infrastructure to the cloud to simplify data management to minimize risks, including reputational risks, along the supply chain (Colicchia et al., 2018 ; Singh, 2021 ). A traceable and transparent information management system is critical, especially when deliveries of important components for production are delayed or not delivered at all (Colicchia et al., 2018 ; Golan et al., 2020 ).

When it comes to information management, transparency and traceability, cyber-attacks can significantly damage and compromise a company’s reputation and, thus, create new risk factors. Similarly, companies along the supply chain can jeopardize CR if they do not perform due diligence or do not comply with the legal regulations that are in place for the enforcement of human rights and sustainability. The primary focus of companies is understandably often on their customers, but given the interlinked nature of CR, they also need to understand their suppliers’ behavior just as well. The pressure on companies to create more transparency regarding the origin of raw materials and the nature of production processes is, therefore, increasingly substantial (Gualandris et al., 2021 ; Mollenkopf et al., 2022 ; Roy, 2021 ).

To capture and manage CR, all stakeholders of a corporate environment should be considered. Looking at the CR concept holistically, it is only possible to manage it along the entire supply chain with all parties actively engaged. The bibliometric mapping shows the multiple fields that connect with CR. It remains, therefore, challenging to capture or explain every detail about the meaning of reputation in a single model. This is particularly important in the supply chain setting, as the Covid-19 pandemic brought to light (Gereffi et al., 2022 ; Panwar et al., 2022 ; Phillips et al., 2022 ), resulting in interdependencies and associated risks of being dependent, when looking at global chains (Alexander et al., 2022 ; Sauer et al., 2022 ; Seuring et al., 2022 ).

Theoretical advancements in CR are needed to offer recommendations for responding to the changing conditions. Those maintaining their CR in the long term will have to do more than ‘communication’ in the future. It will take a great deal of effort, especially in the changing demands on supply chain issues, that requires that all CR dimensions are utilized (see Fig. 3 b).

The figure shows the fourth cycle of the scientific path, and it is, thus, a continuation of the first three modes of thinking, indicated in Fig. 3 a. Overall, the school of thoughts have the stakeholder approach in common, which is the unifying theoretical foundation over the course of time. This becomes particularly noticeable, since the 2000s. Researchers agree that the topic of CR must be covered from a broader stakeholder perspective, which renders a single-dimensional approach insufficient. It is necessary to go a step further and consider a holistic assessment of CR, including not only financial aspects, but also environmental, ethical, social, cultural, legal, and technical dimensions, which we tried to achieve by identifying and exploring the different dimensions of CR (Baldarelli & Gigli, 2014 ; De Castro et al., 2006 ; Singh & Misra, 2021 ). These are currently manifested in the literature and allow for a forward-looking school that consolidates the insights made thus far.

Recommendations for Future CR Research in the Supply Chain Context and Beyond

The research questions listed in Table 4 were extracted from the pool of SLR articles dating from 2018 onwards. In the time span considered, we identified a total of 172 questions for further research. To avoid repetition, we summarized and thematically clustered these into 52 questions. Based on our literature assessment, we added 13 CR questions that are specifically relevant for supply chains, resulting in 65 research questions that await empirical treatment to advance theory. On this basis, the implications for further research were assigned to the clusters identified in the bibliometric mapping (right-hand side of Table 4 ).

We divide the research questions into ten different themes, indicating distinct research directions. The supply chain section, for example, focuses on how CR originates and develops along the chain and, thus, affects the reputation of individual chain members (Manello & Calabrese, 2019 ). In addition, questions arise as to what extent reputational effects result from a crisis in the supply chain and how the CR of other chain members could be affected (Lemke & Petersen, 2018 ; Tannous & Yoon, 2018 ).

Quite visibly, yet surprisingly, CR academic research in a supply chain context is noticeably underrepresented, and specific CR questions in this area are listed in Table 4 (highlighted in gray). Furthermore, we continued with the ranking of questions beginning with the ones that are currently critical to move the field forward and others that are suitable for subsequent exploration. We encourage future researchers to adopt a supply chain perspective in their CR investigations. The chain setting adds complexity, but it is important to recognize the impact that this research stream can make on supply chain theory development and practice.

Researchers from Cluster 1 — Organizational Perspectives note the possibility that the reputation of one company can override that of another (Burke et al., 2018 ; Cooper et al., 2018 ; Park et al., 2020 ). This work recognizes the importance of understanding how to prevent the transfer of a negative reputation during a crisis. In a similar vein, it is also interesting to learn how to make use of a positive reputation of one supply chain partner to add reputational value to others. This requires further study of spillover effects (Lemke & Petersen, 2018 ). While it is recognized that CR spills over from one actor to another, it is not known how this occurs in practice. Some CR dimensions may spill directly, while others can spill in an indirect fashion. Some may not spill at all, as they are heavily tied to a single actor (Petersen & Lemke, 2015 ). Some may spill immediately, while others spill much more slowly. For future research, this raises the questions of which CR dimensions (e.g., innovativeness, working environment, etc.) spill, how far they spill, and what determines the magnitude of the spill. It would be fruitful to explore also which dimensions have the tendency to re-spill from one actor to another and, subsequently, to other actors—like skimming stones on a lake’s surface. Finally, the effect of reputation spills on actors in other supply chains and associated networks is another promising avenue for research.

Within this cluster, organizational authenticity and its influence on corporate purpose as well as CR has been a key area in recent research. One strand of literature seeks to understand the future of work and its influence on organizations (Jiang et al., 2022 ; Valdés et al., 2022 ). According to this line of argumentation, the working environment impacts on the overall attractiveness of a firm and, thus, influences its CR. Adding to this, the influence of social regulation (especially CSR) and its regulatory effect on organizations is regarded as an important area for future research. Specifically, work is warranted regarding how CSR leads to spillovers of reputational risks between chain members and ultimately influences stakeholders’ perceptions. This research cluster also identifies a need to address shortcomings in our understanding of how transformative technologies—such as social media—influence the process of reputational spillovers and reputational damage (Nardella et al., 2022 ). Similarly, the complex role of the state in the formation and evolution of CR is similarly regarded as insufficiently researched. Thus, insights into regulatory efficacy, as well as alternative social regulatory mechanisms effectively shaping CR in the organizational context are called for.

Researchers from Cluster 2 — Empirical Perspective emphasize that the development of reputation in the supply chain warrants further investigation (Karamchandani et al., 2021 ; Mani & Gunasekaran, 2021 ; Nurchayati et al., 2020 ). Specifically, questions arise regarding the impact of crises on CR and on the supply chain (Coombs & Laufer, 2018 ; Gomez-Trujillo et al., 2020 ). In this context, there are also considerations in how far reputational crises affect business partners. Extant research stemming from Cluster 2 recognizes that CR is transmitted throughout a supply chain. However, how such a transfer works and what dimensions of reputation can be transferred remains unclear (Cole & Aitken, 2020 ; Dhingra & Krishnan, 2021 ; Wang & Franke, 2020 ). Hence, research on reputational owners and reputational borrowers is recommended (Petersen & Lemke, 2015 ).

Current research from this cluster deals mostly with quantifying the relationship between CSR and CR. It calls for more longitudinal, in-depth assessments (McWilliams et al., 2019 ). A broader range of methods, including ethnomethodological ones and experiments are needed to provide better evidence of causality, and overcome the limitations of cross-sectional survey-based research. Regarding topic focus, this cluster does not pay particular attention to the supply chain context but perceives a need for greater research regarding how to defend and enhance CR in a digital environment (Ertz et al., 2022 ; Syed Alwi et al., 2020 ). This involves testing whether digitization is inevitably accompanied by greater customer integration, making the customer an even more integral part of the formation of CR (Morgeson III et al., 2020 ; Schaarschmidt et al., 2021 ). For instance, in a social media environment, do company’s customers become more visible, so that its CR becomes more dependent on how others perceive their customers?

Research from Cluster 3 — Individualistic Perspective considers the impact of reputational crises on a company’s market offering and the value co-creation process. Here, researchers call for further attention to be paid to risk management strategies (Arora et al., 2021 ; Dhingra & Krishnan, 2020; Pérez-Cornejo et al., 2019 ). Specifically, this should involve preventing reputation loss and restoring lost reputation in a context where supply chains are becoming increasingly complex, globalized, and highly digitalized (Lemke & Petersen, 2018 ; Quintana-García et al., 2021 ; Rajagopal et al., 2021 ; Walsh et al., 2015 ). Communication styles, company actions, and strategies in such a context also warrant further research (Ajayi & Mmutle, 2021 ; Busse et al., 2017 ; Ingenhoff et al., 2018 ; Singh & Misra, 2021 ). A blind spot in the assessed literature is the lack of studies considering CR in a multinational context, along truly global supply chains (Abugre & Anlesinya, 2020 ; Aguilera-Caracuel et al., 2017 ; Swoboda & Hirschmann, 2017 ). An accurate examination of the influence of cultural dimensions on the generation and transfer of CR is warranted (Swoboda & Hirschmann, 2017 ). For instance, the effects of cultural dimensions could be conceptualized and measured based on cultural dimension theory and cultural context theory (Hofstede, 1980 ).

Recent research within Cluster 3 focuses on the impact of corporate marketing on corporate brand orientation, corporate brand image, and corporate brand reputation as well as on organization’s stakeholders (Balmer & Podnar, 2021 ; Melewar et al., 2021 ). This assesses the degree to which, and how best, a corporation can control its image. Part of this research agenda addresses the importance of integration of communications across a corporation (Chun et al., 2019 ) and its supply chain. It identifies that further research regarding the influence of departmental reputation or a single employee’s actions on overall CR is warranted (Brown et al., 2022 ). For instance, if an employee commits a crime or behaves antisocially, what is the effect on CR? Consequently, the relationships between CR and stakeholders’ individual reputations should be investigated further. Finally, research on the role of social media on an individual’s perception of a corporation’s reputation remains limited and the potential mechanisms explaining such relationships are poorly understood (Rutter et al., 2021 ).

Authors from Cluster 4 — Conceptual Perspectives rely on financial data. The impact of CR on financial performance is often examined in terms of sales and stock market prices (Fasaei et al., 2018 ; Fombrun et al., 2015 ; Love & Kraatz, 2017 ; Zhelyazkov & Gulati, 2016 ). Moreover, the influence of CR on risk management has increased in importance in the academic literature (del Brío & Lizarzaburu, 2017 ; Eckert, 2017 ), especially in the aftermath of the 2007/08 financial crisis (Fourati & Dammak, 2021 ; Gangi et al., 2020 ; Sethuraman, 2018 ; Shim & Yang, 2016 ; Thakor, 2015 ).

Recent research from authors within Cluster 4 seeks to understand the effect of CR on buyers’ intentions. They identify that CR is of special importance in an e-commerce environment because of the typically trust boosting effects of face-to-face encounters, which are absent in an online setting (Fombrun et al., 2022 ). Consequently, in a digital environment, other strategies for augmenting CR should be identified (Fombrun et al., 2020 ). In response, many researchers focus on the social and ethical values of the corporation (Bundy et al., 2022 ). As an outcome, researchers call for further research on the topic of responsible leadership and CR, including the impact of social and ecological responsibility on stakeholder perceptions (Freeman & Auster, 2021 ). This dovetails with a need for work on how stakeholders’ judge the sincerity of a corporation’s social and ethical pronouncements.

Stakeholder theory remains at the center of Cluster 4’s research, which continues to address the influence of stakeholders on the overall reputation of a company (Baah et al., 2021 ; Barnett & Leih, 2018 ; Fombrun et al., 2015 ; Ghadge et al., 2020 ; Waldner & Willems, 2020 ). From this perspective, future research should investigate the level of influence individual stakeholder groups have on a company’s reputation. Furthermore, the question of suitable methods and metrics for CR remains a key consideration. It is recommended to continue researching the composite elements of CR to determine how stakeholders and supply chain partners affect the company’s reputation (Baah et al., 2020 , 2021 ; Fombrun et al., 2015 ; Walsh et al., 2015 ). Stakeholder-based perspectives should recognize the growing importance of online and social media environments. Specifically, studies should seek to understand social media’s role in the context of CR formation (Dijkmans et al., 2015 ; Hartmann, 2021 ; Ott & Theunissen, 2015 ; Waldner & Willems, 2020 ; Zheng et al., 2018 ). To date, the literature on this remains nascent with only a few articles directly considering the influence of digital media on the development of CR (Mingione & Abratt, 2020 ; Schaarschmidt & Walsh, 2020 ). Key questions for further research include how communication channels affect the nature of information exchange between stakeholders (Gomez-Trujillo et al., 2020 ; Quintana-García et al., 2021 ; Syed Alwi et al., 2020 ) and how the nature of the media affects the degree to which CR is transferred from one supply chain partner to another (Azadegan et al., 2020 ; Hartmann, 2021 ; Mihardjo et al., 2020 ).

The four clusters show substantial room for further exploration. However, none of the clusters directly addresses sustainability aspects. In the SLR, we recognize the lack of attention placed on topics such as green, responsible, and sustainable supply chains, when it comes to the CR debate. This is a vital area for exploration. Consequently, future research should understand the effects of CR on corporations’ sustainability actions and their responsiveness to societal developments. This could include an assessment of how CR activities differ in international versus national supply chains and how CR affects assessments of whether a particular supply chain is regarded as sustainable or not.

Practical Implications

In the SLR, the impact that others have on CR is particularly noticeable in the supply chain context. Managers should understand and use reputational mechanisms to their advantage. Either their company has built up a certain reputation and can spread reputational dimensions to others or they are in the position of the reputational borrower, that benefits from or is damaged by reputational triggers (e.g., offer, communication, action) of others (Lemke & Petersen, 2018 ). Managers also must pay attention to the ‘ones that care.’ These stakeholders are reputational reflectors (e.g., customers), whose awareness and relevance cause spillovers to occur. Relationships with these stakeholders should be managed well, so that spillovers can be controlled to a greater extent.

Companies can no longer manage supply chains like in the pre-COVID-19 era. Transparency, sustainability, and security of supply are essential for mitigating reputational risks along the supply chain (Gereffi et al., 2022 ; Phillips et al., 2022 ; Seuring et al., 2022 ). Transparency must also exist when it comes to information flows, as clear and direct communication, as a reputational trigger, is a fundamental part of reputation management within supply chains (Lemke & Petersen, 2013 ; Panwar et al., 2022 ).

Finally, managers should carefully consider the importance of sustainability criteria and social standards as part of CR because modern customers are increasingly critical and less forgiving (Yang et al., 2021 ). SCM is currently troubled by a lack of visibility throughout extended supply chains, as corporations often have complex supplier networks operating at multiple tiers (Panwar et al., 2022 ). Consequently, to minimize reputational risks, it could be useful integrating advanced information technologies to significantly improve visibility and, thereby, become more responsive to major disruption and variability within supply chains (Phillips et al., 2022 ; Sauer et al., 2022 ).

Limitations

While this paper provides a research agenda for future CR topics, based on a SLR, we acknowledge that this study has several limitations. We explored the topic of CR from a business perspective which might be a limitation of this paper. Aguinis et al. ( 2022 ) recently suggested to integrate more practitioner insights into academic research, which is also supported by other scholars (Schön, 1995 ; Stokes, 1997 ; Thompson & Thompson, 2008 ). With respect to our review, we excluded non-peer-reviewed publications such as books, conference papers, white and gray literature as well as non-English publications. Including papers published in only ABS 2 to 4* ranked journals also limited the scope but maintained a focus on the research frontier. We did not specifically capture the broader societal themes (macro) that are relevant, regarding political, technological, environmental, and economic global debates. In our SLR, we identified the most popular theories applied in the four research clusters. We did not capture how studies relate to each other and the methods they used for their investigations in great depth. More fine-grained work understanding the dynamics of each cluster is warranted.

CR is an important concept, affecting value creation and destruction along supply chains. Whereas early work on value co-creation focused on seller-customer dyads, this article introduces and advocates a supply chain perspective. This recognizes the potential for reputational spillover effects in a supply chain, as witnessed in the case of Boohoo.com (Levitt, 2020 ), and recently proposed legislative changes that widen the remit of due diligence to include supply chain partners (Australian Government, 2018 ; European Parliament, 2021 ; UK Parliament, 2015 ). Consequently, CR should be studied within a holistic SCM context. However, as demonstrated by the SLR, a supply chain perspective is typically lacking within the CR literature while the supply chain literature falls short on its treatment of CR.

In addition to CR, we acknowledge that other intangible assets are strongly relevant in a supply chain context too, such as relational capital, collaboration skills, and network capabilities, among others. It is important to differentiate intangible assets in a supply chain context, study their connections as well as their effects on the supply chain. However, we firstly need to provide foundational research on CR before investigating the interplay between different intangible assets in a SCM context. This paper, thus, represents a starting point for further research on CR and its connection with SCM and potential reputational risks. The latter includes reputational spillovers. It is an attempt to rectify an existing bias and provide a basis for future studies in this vital area. For this purpose, the SLR allows us to define CR more comprehensively and the subsequent bibliometric mapping provides strategic research directions that are rooted in four literature clusters. Based on the analysis, we identify and map out future directions for the academic study of CR with a supply chain focus, linked to recent articles in each of the four CR research clusters. We hope that our assessment will motivate researchers to consider how CR is created, maintained, and destroyed in a wider supply chain context.

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von Berlepsch, D., Lemke, F. & Gorton, M. The Importance of Corporate Reputation for Sustainable Supply Chains: A Systematic Literature Review, Bibliometric Mapping, and Research Agenda. J Bus Ethics (2022). https://doi.org/10.1007/s10551-022-05268-x

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Published: 07 November 2023

A comparative evaluation of child health care in China using multicriteria decision analysis methods

Miao Wu 1 ,
Qian Liu 2 &
Zhengye Wang 1

BMC Health Services Research volume 23 , Article number: 1217 ( 2023 ) Cite this article

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Child health is an important public health issue in China and the Chinese government always attached great importance to child health care. With the implementation of a series of medical and health reforms in China in recent decades, the status of child health improved year by year.

Objectives This study aims to comprehensively evaluate if the measures implemented in the medical and health reforms effectively promoted the development of Chinese child health care in recent years and provide theoretical support for future decision-making on the policies of child health care in China.

Methods A total of six indicators were selected from the China Health Statistics Yearbook. Based on the multi-criteria decision analysis (MCDA) algorithm, three different evaluation methods were applied in the study, which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS) method, the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE). Each indicator's weight was calculated by the entropy weight methods objectively. The sensitivity analysis was conducted to validate the stability and accuracy of the rank results.

Results The results indicated that the rank values of each year’s child health care calculated by the different evaluation methods were not exactly the same, but the overall trend is consistent which is that child health care in China improved year by year from 2000 to 2020. The top 5 were ranked from 2016-2020 and the bottom 5 were ranked from 2000-2004.

Conclusions The results indicated that the policies and measures implemented in the medical and health reforms, as well as improved sanitation conditions, availability of healthy food and water, etc., have jointly promoted the development of child health care in China in the past 20 years, providing a scientific theoretical basis for future policy-making to promote child health care.

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Introduction

Child health care (CHC) is one of the most important factors for the growth of the child and is always a top priority issue in people’s health care because children are the future of a nation and their health is vital to a nation’s future development [ 1 , 2 ]. As the most populous nation in the world, China always attaches great importance to maternal and CHC. Since the People’s Republic of China was founded in 1949, the central government not only mandated the development of the gynecology and pediatric department in general hospitals but also established an independent maternal and child healthcare (MCH) institution system to implement public health duties while at the same time carrying out basic medical services that are closely related to the health of women and children [ 3 ]. With the efforts of several generations, China has established a large sound MCH system with improved service delivery and health status, benefiting over 2/3 of the total population and beyond. In particular, the under-five mortality rate dropped from 210.7 to 7.8 deaths per 1,000 live births during the past 70 years. And the maternal mortality rate dropped from 1500 to 17.8 over the same period [ 4 , 5 ].

In September 2000, global leaders, including Chinese leaders, gathered at the United Nations assembly and adopted a resolution on the Millennium Development Goals (MDG) which were 8 goals that United Nations Member States tried to achieve before 2015. Among the main objectives are a 2/3 reduction in child mortality in the under-fives (MDG 4) and a 3/4 reduction in maternal mortality (MDG 5) [ 6 ]. Remarkable progress in achieving the MDG has been made during this period [ 7 ]. In 2009, China launched a comprehensive health reform, as part of the central government’s plan to improve its healthcare system, aiming to provide universal coverage of essential health services for all Chinese citizens by 2020 [ 8 ]. This health reform can be broadly classified into 2 phases: the first one was from 2009 to 2011, and the other was from 2012 onward [ 9 ]. The first phase emphasized financial investment and focused on increasing financial investment to expand insurance coverage and build infrastructure [ 9 ]. As a consequence, the proportion of total health expenditure to gross domestic product (GDP) increased from 4.55 in 2008 to 6.64 in 2019 [ 10 ]. The second phase prioritized the transformation of resources into effective services through systemic healthcare delivery reform [ 9 ]. Recognizing the inadequacies of the first phase, the government moved to address the systemic causes of the inefficient healthcare delivery system, including altering provider payment and pricing incentives, restructuring macro-governance, and reforming the health delivery system. Public hospital reform and a primary-healthcare-based integrated delivery system consisted of China’s healthcare delivery transformation. Recognizing the complexity of delivery reform, the central government issued general guidelines and, except for the Zero-Markup Drup Policy, encouraged local governments to innovate and experiment with models within their institutional context [ 9 ]. With the past decade’s effort, China has made substantial progress in improving equal access to care and enhancing financial protection, especially for people of a lower socioeconomic status [ 9 ]. In 2019, China also issued the Healthy China Action Plan (HCAP) which is a new guideline to implement the country’s initiative to improve health throughout the lifespan. Given the particular importance of childhood and adolescence for overall lifelong health, the HCAP aims to foster child and adolescent health and well-being through a series of steps and programs [ 11 ]. Furthermore, To arrest the falling birth rate, in recent years, the Chinese government has ramped up efforts to encourage families to have more children with the implementation of the policy on encouraging childbirth in China [ 12 ]. As a consequence, the child population in China might become larger than before, and any improvement in CHC services or policies will benefit hundreds of millions of children in China. The policies implemented in China may have little bias in different regions due to the different conditions and environments, however, the overall direction of policies is consistent.

Under the above background, we try to use multi-criteria decision-making (MCDM) methods to scientifically evaluate if the measures of China’s medical and health reform promoted the CHC status in recent years and provide theoretical support for future decision-making on the policies of CHC. MCDM is a method to support decision-making, by exploring the balance between the pros and cons of different alternatives [ 13 ]. And it was used widely in many fields which will be discussed in the Literature review part. In this study, 3 methods of MCDM which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS), the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE) method, have been applied to comprehensively evaluate the status of CHC in China during 2000-2020. A total of 6 evaluation indicators and corresponding values were selected from the China Health Statistic Yearbook. To the best of our knowledge, few studies focused on the evaluation of the Chinese child healthcare state in recent years.

The remaining part of this paper consists of the following 5 parts: Literature Review, Data and Methods, Results, Discussion, and Conclusions.

Literature review

MCDM, also known as Multi-Criteria Decision Analysis the method that supports decision-makers faced with evaluating alternatives by taking into account multiple criteria in an explicit manner [ 14 , 15 ]. It has been widely applied in the public sector as well as in private-sector decisions on agriculture resource management, immigration, education, transport, investment, environment, defense, health care, etc. [ 16 ]. The application in the medicine and healthcare field has been booming since the 2000s [ 17 ]. MCDM approaches can be classified broadly into 3 categories: value measurement models, outranking models, and goal, aspiration, or reference-level models [ 18 ]. Inspired by the previous study [ 19 ], we use outranking models to rank the CHC state of each year in China from 2000 to 2020. The common ranking methods of MCDA include TOPSIS [ 20 ], RSR [ 21 ], weighted sum method (WSM) [ 22 ], Vsekriterijumsko Kompromisno Rangiranje (VIKOR) [ 23 ], Elimination et Choice Translating Reality (ELECTRE) [ 24 ], Analytic Hierarchy Process (AHP) [ 25 ], etc.

The TOPSIS is a classical and simple method in MCDA that was first introduced by Hwang & Yoon in 1981 [ 26 ], then a series of improvements of the method has been developed and applied in the various MCDA issues [ 27 , 28 , 29 ]. These studies indicated that though the traditional TOPSIS method could be used in many MCDA issues, it was not sufficient to solve some sophisticated cases in real-world situations which are involved uncertainty, subjectivity, and incomplete information [ 30 ]. Cioca, et al. [ 31 ] suggest that the combined approach relying upon TOPSIS and other MCDA methods such as AHP could be more reliable and effective in solving the problem. Cao, et al. [ 32 ] objectively evaluated the conditions for scale management suitability by applying the entropy-TOPSIS method. The research gave a scientific reference for the rational utilization of land resources and land use policymaking. Jyotdeep Singh, et al. [ 33 ] applied a hybrid approach of fuzzy TOPSIS and grey relation analysis (GRA) method to strategically rank store location based on the multi-criteria. Yu, et al. [ 34 ] proposed an integrated evaluation approach to select the best suppliers by incorporating decision makers’ risk attitudes using the ANN, AHP, and TOPSIS methods. The results show that the proposed integrated method is effective and efficient.

RSR is another common evaluation method in MCDA, which was originally proposed by a Chinese professor named Tian Fengdiao in 1993 [ 35 ]. It integrates the strongpoints of classical parametric estimations and modern nonparametric estimations [ 36 ]. Due to its flexibility and outstanding performance, RSR has been widely used in the medical health field and others in recent years. Wang, et al. [ 37 ] applied RSR to the evaluation of feeding practices behaviors, and their association with infant health risks in rural Lhasa, Tibet. Wu, et al. [ 38 ] applied RSR and the data envelopment method to evaluate the medical service efficiency in Traditional Chinese Medicine (TCM) hospitals and provide references for making relevant policies scientifically. Tian, et al. [ 39 ] evaluated the overall indoor air quality by integrating air change effectiveness and contaminant removal effectiveness by using multi-indicator methods, including RSR, TOPSIS, and Z-score methods. Zhu, et al. [ 40 ] used RSR to determine the optimal parameters in their study of a biclustering algorithm in the spontaneous reporting system of China.

Previous studies indicated a variety of techniques could be used for calculating criteria’ weights in MCDA. Some require the decision-makers to participate in the weighting procedure and the values of the weights are fully dependent on their opinion. These methods belong to subjective weighting techniques characterized by uncertainty due to varying interpretations of the decision problem by different decision-makers [ 41 ]., i.e., AHP, Simultaneous Evaluation of Criteria and Alternatives (SECA) [ 42 ], Simple Multi-Attribute Rating Techniques (SMART) [ 43 ], etc. To overcome the disadvantages of subjective weighting techniques, various objective weighting techniques were proposed and widely used because they do not need expert knowledge of the problem anymore and are readily applied. The weight value calculated by the objective weighting techniques is only dependent on the inherent information and the mathematical equations. The objective weighting techniques include the entropy method, standard deviation method, statistical variance method, mean method, etc. [ 44 ]. As suggested by Duan, et al. [ 45 ], we use the entropy method to calculate the weight of each index, which effectively eliminates the influence of manual intervention and makes the results of the evaluation more objective and accurate.

Fuzzy set theory has been approved to be an effective approach to deal with uncertainty and ambiguity in MCDA [ 46 , 47 , 48 ]. Therefore, the integration of fuzzy set theory and MCDA methods would perfectly solve the ambiguous group decision problems. Previous studies have shown that the Fuzzy TOPSIS was widely used in various issues in recent decades. Bae, et al. [ 49 ] evaluated the health vulnerability caused by climate and air pollution in Korea by using the fuzzy TOPSIS. Rahim, et al. [ 50 ] showed the possibility of fuzzy logic utilization in assessing safety, health, and environmental risk and proposed a methodology based on the fuzzy-TOPSIS MCDA model for material selection suitable for the manufacturing sector. Milad Shafii, et al. [ 51 ] used fuzzy TOPSIS and fuzzy AHP methods to assess the performance of hospital managers in the hospitals owned by the Iranian Ministry of Health. Zhao, et al. [ 52 ] applied the fuzzy TOPSIS approach to evaluate the performance of Strong Smart Grid in China. From the above-mentioned studies, we can see that the method of fuzzy TOPSIS was more applicable and reliable than the traditional TOPSIS method in MCDA.

Data and methods

Figure 1 shows the MCDA problem-solving flowchart of this study.

The flowcharts in this study

Patient and public involvement

No patient was involved in this study since it’s a kind of research on the statistical analysis of data, and all the data used in the study was publicly available in the China Health Statistics Yearbook.

The data construction and collection in the China Health Statics Yearbook is mainly responsed by the National Health Commission of the People’s Republic of China. And China Health Statistics Yearbook is publicly released by National Health Commission of the People’s Republic of China every year. Each Yearbook records the latest 10 years of CHC data. The data for this study (2000-2020 CHC data ) was sourced from the China Health Statistics Yearbook 2010-2021. According to the Yearbook’s guidance and relevant studies from Chinese researchers, a total of 6 criteria I 1 ~I 6 that directly reflect the work quality of CHC were selected as evaluation indicators to comprehensively evaluate the status of CHC in China from the year 2011 to 2020, which are I 1 : the percentage of low birthweight newborns (less than 2,500 gram, %), I 2 : perinatal mortality (‰), I 3 : the prevalence of low weight in children under 5 years old (%), I 4 : Neonatal visit rate (%), I 5 : systematic management rate of children under 3 years old (%), I 6 : systematic management rate of children under 7 years old (%). Table 1 shows the original data of CHC in China from 2000 to 2020.

Using the entropy weight method to determine each indicator’s weight

The entropy weight method, a method to determine the weights of indicators by evaluating the values of indicators under objective conditions [ 53 ], was recommended in our study to calculate each indicator’s weight according to the following 4 steps.

Step 1: Establishing the judgment matrix

According to Table 1 , we establish the following judgment matrix A :

In which m=21, n =6, \(\mathrm{and\;}{a}_{ij}\) represent the j -th indicator’s value in the i -th year.

Step 2: Normalize the judgment matrix.

The criteria are generally classified into 2 types: benefit and cost. The benefit criteria mean that the higher the value it is the better the result would be, while the cost criteria is valid the opposite. In our study, I 1 , I 2, and I 3 are cost criteria, while others are benefit criteria. Because the higher the value of indicator I 1 (the percentage of low birthweight newborns), indicator I 2 (perinatal mortality), and indicator I 3 (the prevalence of low weight in children under 5 years old), the worse the CHC status. Meanwhile, the higher the value of indicator I 4 ( Neonatal visit rate), I 5 ( systematic management rate of children under 3 years old), I 6 ( systematic management rate of children under 7 years old), the worse the CHC status. We use Equations ( 1 ) and ( 2 ) to normalize the benefit criteria and cost criteria values, respectively.

Step 3: Calculating the indicator’s entropy

In an evaluation problem that has m evaluated object with n indicators, the entropy for the j- th indicator is calculated as the equation ( 3 ):

Where, \({f}_{ij}=\frac{{S}_{ij}}{\sum_{i=1}^{m}Sij}\) , \(\mathrm{k}=\frac{1}{\mathrm{ln}m}\) .

Among them, \({f}_{ij}\) is the characteristic proportion of the i -th object.

Step 4: Calculating the entropy weight

The j th indicator’s entropy weight \(({w}_{j})\) was then calculated based on the Equation ( 3 )

Entropy-weighted TOPSIS evaluation method

The entropy-weighted TOPSIS evaluation model has been widely used in MCDA applications due to its objectiveness, rationality, and effectiveness. It is an effective MCDA method to evaluate the performance of alternatives through similarity with the ideal solution [ 54 ]. Its basic concept is that the chosen alternative should have the shortest distance from the ideal solution and the farthest from the negative-ideal solution [ 55 ]. The detailed processes of applying the entropy-weighted TOPSIS method are given below:

Step 1: Build the co-trending decision matrix

TOPSIS method requires all the criteria should have the same type, which is benefit type or cost type, in other words, the decision matrix must be the co-trending matrix. Thus, we first convert all the cost indicators (I 1 , I 2, and I 3 ) in Table 1 into the benefit indicators by replacing each cost indicator’s value with 100 minus it, respectively.

Step 2: Normalize the co-trending matrix

The co-trending matrix was then normalized by Equation ( 5 ), which eliminated the influence of the different measurement units. Then, a normalized matrix R was established.

Where \({r}_{ij}\) represent the normalized value of j - th indicator’s value in the i - th year.

Step 3: Build the normalized matrix of weight

We built the normalized matrix of weight X by Equation ( 6 ).

Where i=1, 2,...,21, and j=1,2,...6.

Namely, each index \({r}_{ij}\) multiply its the corresponding weight \({w}_{j}\) which is calculated by the entropy weight method mentioned above. Then, a normalized matrix of weight X was obtained as below:

Step 4: Identify the ideal solution A + and negative-ideal solution A -

The positive-ideal solutional X + and negative-ideal solution X - were determined by matrix X as follows:

Where max{ \({x}_{ij}\) } and min{ \({x}_{ij}\) } means the max and min value in the j-th column, respectively.

Step 5: Calculate Euclidean distance

We calculated Euclidean distance from X + and X - for each alternative \({x}_{i}\) , respectively as follows:

Where \({D}_{i}^{+}\) are Euclidean distances between i-th objective and positive-ideal solution, and \({D}_{i}^{-}\) are Euclidean distances between i-th objective and negative-ideal solution.

Step 6: Calculate the relative closeness coefficient

The relative closeness coefficient of i-th objective is calculated by using Equation ( 11 ) :

Where 0 \(\le {C}_{i}\le 1\) , and the larger the \({C}_{i}\) value, the better the performance of CHC in that year. Then, we ranked all the objectives according to their \({C}_{i}\) values.

Entropy-weighted RSR evaluation method

Entropy-weighted RSR (WRSR) is another comprehensive evaluation method that uses a rank transformation to calculate dimensionless statistical indexes from the matrix. The distribution of WRSR can be explored by the parameter statistical method. Generally, the WRSR indicators range from 0 (worst) to 1 (best), which was used to assess the state of the subjective [ 56 ]. The detailed processes are given below:

Step 1: Rank the indicators

We first rank all the indicators in Table 1 based on the rules that indicators of benefit type are ranked in ascending order while indicators of cost type are ranked in descending order.

Step 2: Calculate the WRSR

We then calculate the WRSR of each evaluation object (i.e work quality of the CHC in a year) by equation ( 12 ).

Where \({S}_{ij}\) is the rank of CHC indicators in China from 2000 to 2021, i=1, 2, ...,21; m=6, which is the index number of CHC, and \({w}_{j}\) is the weight of j-th indicator.

Step 3: Sort the objectives

The last step is sorting the objective according to the WRSR values. The greater the value of WRSR i , the better the performance of CHC.

Fuzzy comprehensive evaluation method

The FCE method is an application of the fuzzy set theory to make a synthetic assessment in a fuzzy decision environment with multiple criteria [ 57 ]. The FCE method used in our study is given below:

Step 1: Calculate the coefficient C i and WRSR i

The coefficient C i and WRSR i of each alternative can be obtained by using the entropy-weighted TOPSIS and weighted RSR method, respectively.

Step 2: Calculate the rank of each alternative based on the Fuzzy Set theory

The coefficient C i and WRSR i were substituted to the following formula:

Where W 1 : W 2 is the weight ratio for C i and WRSR i , respectively. According to the previous study applying fuzzy set theory to a comprehensive evaluation work [ 58 ], the weight ratio W 1 : W 2 is set to 0.1:0.9, 0.5:0.5, and 0.9:0.1, respectively.

Step 3: Rank the alternative comprehensively

Since the weight ratio has 3 sets of values (i.e., 0.1:0.9, 0.5:0.5, and 0.9:0.1), we ranked all the alternatives 3 times based on the result calculated by the formula ( 13 ), respectively. Correspondingly, each alternative has 3 orders and we selected the order that appeared most frequently as the comprehensive order of the alternative. The greater the value, the better the performance of CHC.

Sensitivity analysis through criteria weight change

Sensitivity analysis is an effective method to observe variations in the final result that was caused by the changes in the model’s parameters. In our study, sensitivity analysis was conducted by changing each criterion’s weight according to the changing rate \({\delta }_{k}\) . The designed scheme was also applied in the previous study [ 19 ]. Specially, supposing W i changes to \({W}_{i}^{*}\) , i=1,2,...,6 and \({W}_{i}^{*} is\) calculated by the Equations ( 14 ) and ( 15 ).

Where k =1,2,...n ( n =6), \({\gamma }_{k}\) =0.01, 0.03, 0.06, 0.1, 0.2, 0.5, 0.8,1.0, 1.3, 1.8, 2.1, 2.5, 3, 3.5,4 and 4.5. \({\delta }_{k}\) is the changing rate of \({W}_{k}\) . The variable \({\gamma }_{k}\) is defined as the unitary variation rate of the variation of \({W}_{k}\) .

Since the sum of the 6 indicator’s weights should be equal to 1 when W k changes \({W}_{k}^{*}\) , other weights will also change, which was calculated as Equation ( 16 ).

Where \({W}_{k}{\prime}\) is the k-th indicator’s weight after changing.

Taking W 1 as an example, because the unit change rate \({\gamma }_{1}\) was designed to 16 different values, a total of 16 sets of changed weights \({W}_{k}^{*} and {W}_{k}{\prime}\) can be derived from the above formulas \(.\) Correspondingly, C i also has 16 changed values which will be analyzed further. These changes were all based on the variation of W 1. With the same algorithms, the recalculated C i based on the variation of other weights (i.e., W 2 , W 3 , W 4 , W 5 , W 6 ) can be obtained. All the calculations in our study were implemented in Matlab 2019b and Microsoft Excel 2010.

The entropy weight for each indicator

Table 2 shows each indicator’s entropy weight values, which shows I 1 has the maximum weight value of 0.1962, and I 3 has the minimum weight value of 0.1448.

Evaluation results of CHC in China from 2000 to 2020 based on the entropy-weighted TOPSIS method

The work quality of CHC in China from 2000 to 2020 was ranked based on the value of relative closeness coefficient C i calculated by the entropy-weighted TOPSIS methods, the results are shown in Table 3 and Fig. 2 a. The positive-ideal solutional X + and negative-ideal solution X - in this study were (0.0425, 0.0324, 0.0312, 0.0357, 0.0340, 0.0286) and (0.0429,0.0361,0.0318,0.0402,0.0433, 0.0371), respectively.

The ranks of child heal care in China from 2000 to 2020 with different methods. a the ranks calculated by the weighted TOPSIS method ( b ) the ranks calculated by the weighted RSR method ( c ) the ranks calculated by the Fuzzy comprehensive evaluation method ( d ) A comparison of the ranks calculated by the weighted TOPSIS method, weighted RSR method, and Fuzzy comprehensive evaluation method

Evaluation results of CHC in China from 2000 to 2020 based on the weighted RSR evaluation method

Then, we ranked the work quality of CHC in China from 2000 to 2020 based on the WRSR i value calculated by the weighted RSR evaluation methods, the results are shown in Table 4 and Fig. 2 b.

Evaluation results of CHC in China from 2000 to 2020 based on the FCE method

Table 5 and Fig. 2 c shows the detailed evaluation results of CHC in China from 2000 to 2020 based on the FCE method.

The results indicate that all 3 evaluation methods above have approximately similar results which are that the top 5 performances of CHC were achieved in the latest 5 years (2016-2020) and the bottom 5 performances of CHC were achieved in the first 5 years (2000-2004). Figure 2 d indicates that the trend of CHC performance in recent years is consistent. Generally, CHC in China improved year by year after 2000.

Correlation analysis

The correlation of different evaluation results (i.e., weighted TOPSIS method, WRSR, and FCE) was then analyzed by Spearman’s rank correlation coefficient. Figure 3 a-c shows the correlation between C i and WRSR i , the correlation between C i and 0.5 C i +0.5 WRSR i , and the correlation between WRSR i and 0.5 C i +0.5 WRSR i, respectively. The calculated coefficients of Spearman’s rank correlation indicate all these correlations are significantly positively correlated.

Spearman rank correlation analysis for the results calculated by the different methods. a Correlation between C i and WRSR ( b ) orrelation between C i and 0.5 C i + 0.5 WRSR ( c ) Correlation between WRSR and 0.5 C i + 0.5 WRSR. WRSR is the Entropy-weighted rank-sum ratio of the CHC performance in i-th year, C i is the relative closeness coefficient of the CHC performance in i-th year, where i=2000,2001,...2020

Sensitivity analysis

Table 6 and Fig. 4 a show the changing weights of each indicator under the different unitary variation ratio \({\gamma }_{1}\) for W1. With the same method, the changing weights under different unitary variation ratio \({\gamma }_{k}\) for W 2 , W 3 , W 4 , W 5 , and W 6 can be obtained, which are shown in Fig. 4 b-f. The original ranking calculated by entropy-weight TOPSIS for each year’s CHC performance is the ranking when \({\gamma }_{k}=1\) .

Weight of C i sensitivity analysis. C i is the relative closeness coefficient of i-th year CHC performance, where i= 2000, 2001, 2020. a - f is the C i value under different unitary variation ratio γγ kk for W1 - W6, respectively, where k=1,2,. 16

Evaluation methods

Three different methods of weighted TOPSIS, weighted RSR, and FCE were applied in this study to evaluate the CHC work in China from 2000 to 2020. Each of them has its characteristics. The advantages of the weighted TOPSIS method are ease of application, universality, and consideration of distances to an ideal solution. Its disadvantages are low sensitivity and sensitivity to the interference of outliers [ 59 ]. A significant advantage of the weighted RSR method is that the interference of outliers is limited because the rank of original data has been used. Meanwhile, the disadvantage is that some potentially useful information is lost [ 60 ]. To overcome the disadvantages of weighted TOPSIS method and weighted RSR method, the FCE method has been used in this study, making the results more effective and reliable. The final evaluation result of FCE is determined by the most frequently appearing results in the designed schemes, reflecting the overall changing trend of the results [ 58 ]. Due to the above reasons, we recommend the FCE method to synthetically evaluate the CHC in China from 2000 to 2020.

Evaluation results analysis

The results of the weighted TOPSIS method based on C i value show that CHC in China improved year by year from 2003 to 2016 and a small downward trend appeared during 2001- 2003 (Fig. 2 a, Table 3 ) which also appeared in the results of the weighted RSR method and FCE method, indicating the CHC in China from 2001 to 2003 maybe not as well as other years’ performance. Besides, slight declines appeared in 2005 and 2006, 2007 and 2008, 2013, and 2014 in the results of the weighted RSRS method, shown in Fig. 2 b and Table 4 . As for the results of FCE (Fig. 2 c, Table 5 ), a slight decline appeared in 2007 and 2008. However, though some slight declines appeared, the overall trend of CHC in China from 2000 to 2020 is upward steadily without changing, as shown in Fig. 2 d.

The weights used in the weighted TOPSIS method and weighted RSR methods were the entropy weights. It has the advantage of objectivity, making the results more objective and reliable. The entropy weights listed in Table 2 showed that the indicator of I 1 (the percentage of low birthweight newborns) has a maximum weight value of 0.1962 and the minimum weight value of 0.1448 is for I 3 (the prevalence of low weight in children under 5 years old). To observe the impact of weight variation on the final results, we performed the sensitivity analysis in the study, and the results are shown in Fig. 4 . From Fig. 4 a we can see that the C i values gradually decrease when \({\gamma }_{k}\) > 1.3 for the ranking of 2014-2020, and gradually increase when \({\gamma }_{k}\) > 1.3 for the ranking of 2000-2009. The original ranking was disordered when \({\gamma }_{k}\) > 3.5. Figure 4 b shows that the ranking of each year’s CHC performance is not sensitive to the variation of W 2 except for the year 2003. Figure 4 c shows that the impact of W 3 variation is limited on the ranking of each year’s CHC performance. Figure 4 d shows that the variation of W 4 has a certain impact on the ranking results in 2019, 2018, 2008,2007, 2001, and 2000. Figure 4 e and f also show that each year’s CHC performance is not sensitive to the variation of W 5 and W 6. Besides, the results of Spearman rank correlation analysis indicated that the rank results of the weighted TOPSIS, the weighted RSR, and FCE are significantly positively correlated. In summary, the CHC in China from 2000 to 2020 improved year by year. This is inseparable from the efforts of all Chinese people and China's medical and health reform in recent decades.

Effective policy

As early as 1992, the State Council of China issued the Planning Outline of Child Development in China in the 1990s, which was a national action plan for children to achieve their developmental potential, followed by the Child Development Outline of China (2001-2010) and Child Development Outline of China (2011-2020), which present national goals and strategies of 10-years plan for child development across health, child protection, education, environment, and social protection sectors [ 61 ]. The Chinese government made great progress in improving CHC work through legislation and investment. In 1994, the Law of the People’s Republic of China (PRC) on Maternal and Infant Health Care was enacted to guarantee the smooth implementation of policies for maternal and child health care [ 62 ]. Up to 2008, maternal and child health care hospitals or service centers have been established in every province, city, and county in China. Even township clinics have employed maternal and child health care staff [ 63 ]. The data of the China Health Statistic Yearbook 2003 and 2019 indicates that from 2003 to 2020 the numbers of health technicians, licensed physicians, and registered nurses in maternal and child health institutions in China have greatly increased from 145,610 to 428,809, from 59,340 to 136,820, from 40,476 to 196,000, with an average annual growth rate of 3.99%, 1.58%, and 8.24%, respectively. In 2009, the Chinese government launched an ambitious plan of health care system reform with the goal of providing universal coverage of essential health services for all Chinese citizens by 2020 and achieved substantial positive results that have even overtaken many developing countries [ 64 ]. The Chinese government also cooperated with international organizations to improve the CHC, such as World Health Organization (WHO), United Nations International Children's Fund (UNICEF), World Bank, etc. Such international conventions provided China with opportunities to develop a policy framework aimed at improving maternal and child health care work in China [ 65 ]. The China-UNICEF Integrated Early Child Development (IECD) in Poo Rural Regions Project was launched by the Government of China under support from UNICEF in 2013 [ 66 ]. Since the deepening of medical reform, China comprehensively implemented national basic public health service programs to freely provide 12 kinds of items including maternal and child health care services. The Chinese government announced the Health China 2030 blueprint in 2016, which aims to provide universal health security for all citizens by 2030 [ 67 ]. Besides, programs such as China’s Family Plan, Reinforcing Maternal and Child Health Care, Reinforcing Essential Health Service in Poor Rural Arear, Eliminating Newborn Tetanus in 1000 Counties in Midwestern Regions, etc, have been implemented successfully and achieved great success. The policies implemented in China may have little bias in different regions due to the different conditions and environments, however, the overall direction of policies is consistent. All in all, with the implementation of a series of effective policies and great efforts of Chinese people, the CHC in China improved year by year.

This article only applied 3 evaluation methods on CHC in China, i.e. weighted TOPSIS, weighted RSR, and FCE methods. However, other classical evaluation methods, such as Grey Relational Analysis(GRE), Analytic Hierarchy Process(AHP), Data Envelopment Analysis (DEA), etc., were not applied. The evaluation methods in this article are not comprehensive enough. Meanwhile, due to the authors’ limited understanding and knowledge, some analyses in this article may be inaccurate and subjective. However, scientific methods for evaluating the CHC performance in China and theoretical support for future decision-makers are provided.

In this study, we applied methods of the weighted TOPSIS, weighted RSR, and FCE methods to comprehensively evaluate the CHC status in China from 2000 to 2020. A total of 6 indicators were selected and each indicator’s weight was calculated by the entropy weight method objectively. FCE method, based on fuzzy theory and combining the results of the weighted TOPSIS methods and weighted RSR methods, was recommended since it effectively overcomes the disadvantages of a single evaluation method and the result is more reliable. Though the 3 rank results calculated by the different methods are not exactly the same, the overall trend was consistent, namely the CHC in China from 2000 to 2020 improved year by year, and the best CHC performance was achieved in 2020.

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Acknowledgments

Thanks are given to all the authors for their active cooperation. Besides, special thanks are given to my mother Chunyan Wang, my father Zhimin Wu, my mother-in-law Jinping Fen, father-in-law Shibing Liu, this paper can never be finished without your help. Last but not least, I would like to tell my 2 kids, GuoGuo and MaoMao, no one can stop you from moving forward to success but yourself. Strong internal spirit and willing can overcome unfavorable external factors, promoting the thing's development and eventrally achieving the goals. No matter what happens, do remember never stop your steps moving forward, and never give up your dream in your heart, coz that’s the real meaning of one’s life.

Sponsored by the Natural Science Foundation of Xinjiang Uygur Autonomous Region (2022D01C436).

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Wu, M., Liu, Q. & Wang, Z. A comparative evaluation of child health care in China using multicriteria decision analysis methods. BMC Health Serv Res 23 , 1217 (2023). https://doi.org/10.1186/s12913-023-10204-4

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Published: 08 November 2023

Policies to prevent zoonotic spillover: a systematic scoping review of evaluative evidence

Chloe Clifford Astbury 1 , 2 , 3 ,
Kirsten M. Lee 1 , 2 ,
Ryan Mcleod 1 ,
Raphael Aguiar 2 ,
Asma Atique 1 ,
Marilen Balolong 4 ,
Janielle Clarke 1 ,
Anastassia Demeshko 1 ,
Ronald Labonté 5 ,
Arne Ruckert 5 ,
Priyanka Sibal 6 ,
Kathleen Chelsea Togño 4 ,
A. M. Viens 1 , 3 ,
Mary Wiktorowicz 1 , 2 ,
Marc K. Yambayamba 7 ,
Amy Yau 8 &
Tarra L. Penney 1 , 2 , 3

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Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more difficult to contain, there is a need for effective preventive interventions that reduce the risk of zoonotic spillover events. Public policies can play a key role in preventing spillover events. The aim of this review is to identify and describe evaluations of public policies that target the determinants of zoonotic spillover. Our approach is informed by a One Health perspective, acknowledging the inter-connectedness of human, animal and environmental health.

In this systematic scoping review, we searched Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal-human interface, public policy, prevention and zoonoses. We screened titles and abstracts, extracted data and reported our process in line with PRISMA-ScR guidelines. We also searched relevant organisations’ websites for evaluations published in the grey literature. All evaluations of public policies aiming to prevent zoonotic spillover events were eligible for inclusion. We summarised key data from each study, mapping policies along the spillover pathway.

Our review found 95 publications evaluating 111 policies. We identified 27 unique policy options including habitat protection; trade regulations; border control and quarantine procedures; farm and market biosecurity measures; public information campaigns; and vaccination programmes, as well as multi-component programmes. These were implemented by many sectors, highlighting the cross-sectoral nature of zoonotic spillover prevention. Reports emphasised the importance of surveillance data in both guiding prevention efforts and enabling policy evaluation, as well as the importance of industry and private sector actors in implementing many of these policies. Thoughtful engagement with stakeholders ranging from subsistence hunters and farmers to industrial animal agriculture operations is key for policy success in this area.

This review outlines the state of the evaluative evidence around policies to prevent zoonotic spillover in order to guide policy decision-making and focus research efforts. Since we found that most of the existing policy evaluations target ‘downstream’ determinants, additional research could focus on evaluating policies targeting ‘upstream’ determinants of zoonotic spillover, such as land use change, and policies impacting infection intensity and pathogen shedding in animal populations, such as those targeting animal welfare.

The increasing incidence of zoonotic emerging infectious diseases (EIDs) has been attributed to behavioural practices and ecological and socioeconomic change, and is predicted to continue in the coming years [ 1 ]. Higher levels of anthropogenic activity, including agricultural intensification, urbanisation and other forms of land use change, have led to increased interactions between wildlife, humans and livestock, increasing the risk of cross-species transmission [ 2 , 3 , 4 ]. Meanwhile, accelerating rates of globalisation and urbanisation, leading to increased global movement of people and goods and more dense human settlements, have made outbreaks of disease in human populations more difficult to contain [ 5 ]. In response, a call has been issued by leading organisations and experts, including the United Nations Environment Programme, the International Livestock Research Institute and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, to complement reactive policy responses with policies that prevent zoonotic EIDs [ 1 , 6 , 7 , 8 , 9 , 10 ]. This approach, sometimes called deep prevention, would need to target upstream drivers to reduce the risk of outbreaks occuring [ 11 ].

Zoonotic spillover, defined as the transmission of a pathogen from an animal to a human, depends on the alignment of ecological, epidemiological and behavioural factors [ 12 ]. Zoonotic pathogens must be transmitted across a spillover pathway (Fig. 1 ) in order to induce infections in humans [ 12 , 13 ]. This involves meeting a series of conditions including appropriate density and distribution of reservoir hosts, pathogen prevalence, infection intensity and human exposure [ 12 ]. Across this pathway, a number of drivers of zoonotic spillover have been identified, including changes in wildlife and livestock populations [ 14 ]; deforestation, urbanisation and other forms of land use change [ 15 , 16 ]; bushmeat consumption [ 17 , 18 , 19 ]; and a variety of human practices including hunting, farming, animal husbandry, mining, keeping of exotic pets and trade [ 8 , 9 , 20 , 21 , 22 ]. These large-scale changes have repeatedly given rise to spillover events [ 2 , 15 , 23 ], sometimes involving pathogens with epidemic or pandemic potential [ 24 ].

Spillover pathway adapted from Plowright et al. [ 12 , 13 ]

The responsibility for addressing zoonotic disease frequently spans multiple sectors of governance due to its relevance for both animals and humans. A One Health perspective, which recognises the health of humans, animals and the environment as being closely linked and inter-dependent [ 25 ], can be useful in understanding the spillover pathway and drivers of spillover events, as well as informing policy and governance approaches to address this cross-sectoral problem. At the international level, the World Health Organization, the Food and Agriculture Organization, the World Organisation for Animal Health and the United Nations Environment Programme have endorsed a One Health approach to policymaking to respond to zoonotic infectious diseases, emphasising collaboration between agencies [ 26 ].

Operationalising a One Health approach to policy

While One Health is a promising approach to preventing zoonotic EIDs, operationalising this concept remains a challenge. Evaluative evidence exists around the effectiveness of interventions to prevent spillover events [ 13 , 27 , 28 , 29 ], however these have often been implemented as short- to medium-term programmes or academic investigations [ 8 ]. In some cases, zoonoses have re-emerged after successful programmes have ended [ 29 ]. As a result, experts have argued for the incorporation of successful interventions into policy frameworks, providing interventions with the sustainability required for long-term disease control [ 8 , 10 ].

Operationalising a One Health approach to policy involves understanding the policy options, identifying the stakeholders involved and developing insights into how to successfully implement and evaluate these policies. Although the longevity and scope of government actions may make policy an effective vehicle for prevention of emerging diseases, implementing policy is a complex process involving numerous actors with competing views and interests [ 30 ]. This context presents challenges for policy development and implementation. Where relevant policies are designed and implemented in isolation, opportunities for co-benefits may be missed and interventions may produce unintended consequences [ 31 ]. Finally, while evaluative evidence is key to informing future policy decisions, the complex systems in which policies are often implemented make evaluation challenging [ 32 ].

Aims and scope

To provide insights around how to use policy to successfully prevent zoonotic spillover events, it is necessary to synthesise the available evaluative evidence. A One Health perspective allows this evidence synthesis to incorporate a wide range of policy instruments and actors and to identify approaches to successfully implementing and evaluating policies in this complex, multi-sectoral context.

Approaches to managing epidemic and pandemic infectious pathogens when they have entered human populations have been systematically catalogued in the medical literature [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. These measures include hand washing, face masks, school closures, contact tracing, vaccination and case isolation. Further upstream, systematic reviews of interventions targeting the spillover pathway have predominantly focused on programmes rather than policies, and have been restricted by various characteristics such as geographic region [ 28 ] or pathogen type [ 29 ], or focused on programmes with an explicit endorsement of a One Health approach [ 27 ]. In consequence, a comprehensive understanding of what policies to prevent zoonotic spillover have been evaluated, what actors are involved, and how to successfully implement and evaluate them, is lacking. To address these research gaps, our objective was to synthesise the existing evaluative evidence around policies that target the determinants of zoonotic spillover.

Our approach to identifying and analysing this literature was informed by a One Health perspective, acknowledging the inter-connectedness of human, animal and environmental health.

We conducted a systematic scoping review of evaluations of policies aimed at preventing zoonotic spillover events, based on a previously published protocol [ 40 ]. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews [ 41 ]. The scoping review was conducted in line with guidelines published by Arksey and O’Malley and refined by Levac and colleagues [ 42 , 43 , 44 ], which emphasise an iterative approach suited to an exploratory research question.

The One Health perspective guided the development of the review methodology. This included the search strategy and inclusion criteria, which allow for the inclusion of policies focused on human, animal or environmental health (or any combination of these areas) and with leadership from one or more of these sectors, and the research questions, which seek to outline the policies and the range of sectors involved in implementation. While our focus on the spillover pathway meant we only included policies that had been evaluated in terms of their impacts on animal and human population distributions, health and interactions, we explicitly searched for environment-focused policies (e.g., protection of wetlands and other wildlife habitats) that might have been evaluated from this perspective. We also aimed to interrogate the One Health approach to governance, by assessing to what extent cross-sectoral collaboration – a key tenet of One Health practice [ 25 ] – emerged as a reason for policy success.

Stage 1: identifying the research question

Informed by our research objective, our research questions were:

What policies aimed at preventing zoonotic spillover (i.e., policies that target the determinants of zoonotic spillover included in the spillover pathway [ 12 ]: population distribution, health and interactions) have been evaluated?

What are the types of policies?

Which policy actors (single department, multi-sectoral, whole of government) are involved?

What are the reasons for policy success and failure, and the unintended consequences of implementing these policies?

How has evaluation of these policies been approached in the literature?

What are the methods or study designs used?

What are the outcomes?

What are the opportunities and challenges for evaluation?

Stage 2: identifying relevant studies

We systematically searched four electronic databases (Medline, Scopus, Web of Science, Global Health) in May 2021. The search strategy was organized by the main concepts in our research question: the spillover pathway; public policy; prevention; and zoonotic pathogens. The search strategy was developed iteratively, informed by existing systematic reviews focused on related concepts [ 28 , 45 , 46 , 47 , 48 , 49 ] and known indicator papers meeting inclusion criteria. We also searched the websites of 18 organisations involved in the prevention of zoonotic spillover to identify relevant grey literature. The choice of organisations was informed by an actor mapping exercise in which we identified key international organisations working on the prevention of emerging zoonoses using network sampling [ 50 ]. We searched the websites of a subset of these organisations, focusing on inter-governmental organisations and organisations whose main focus was zoonotic disease. See Supplementary File 1 for details of academic database and grey literature search strategies.

Stage 3: study selection

Studies were included if they met the following criteria:

Primary empirical study with an English-language abstract from any country or region (reviews were excluded);

Study reporting empirical findings from an evaluation of any sort; and.

Study focused on a policy implemented by government that targets the determinants of zoonotic spillover.

Academic records identified through the searches were collated and double screened using the online platform Covidence [ 51 ]. Two researchers (CCA and KML) initially screened titles and abstracts. Title and abstract screening of an initial set of 100 papers was undertaken by both researchers independently. Results were compared to ensure consistency in decisions around study eligibility, and discrepancies were resolved through consensus. This process was repeated until an acceptable level of agreement (> 90%) was reached. The remaining papers were then screened by one of the two reviewers. Full-text screening was undertaken by two independent researchers and discrepancies were resolved by consensus. Studies with full-texts in any language were eligible for inclusion if they include an English-language abstract. Full-text studies published in French, Spanish or Chinese were single-screened by a member of the research team fluent in that language (CCA or AY). Studies published in other languages were translated as necessary.

Grey literature was screened by one researcher (CCA) to determine whether it met the inclusion criteria. Publications were initially screened by looking at titles, tables of contents and executive summaries. Where these indicated that the publication might be eligible, documents were read in full to determine if inclusion criteria were met.

In line with published guidelines, the approach to study selection was refined iteratively when reviewing articles for inclusion [ 42 , 43 , 44 ].

Stage 4: charting the data

Data charting was conducted using a form designed to identify the information required to answer the research question and sub-research questions (see Supplementary File 2). Data charting focused on characteristics of the study, the policy, and the evaluation. For each policy, this included identifying which determinant of zoonotic spillover situated along the spillover pathway was being targeted. For the purpose of this study, we used a model of the spillover pathway adapted from Plowright et al.’s work [ 12 , 13 ], in which we differentiated between wildlife and domesticated animals (Fig. 1 ). This differentiation is important in the policy context, as the wildlife-domesticated animal interface is an important site for intervention, as well as the human-animal interface.

The data charting form was piloted with ten records to ensure that it was consistent with the research question, and revised iteratively [ 42 , 43 , 44 ]. Data charting was conducted by one researcher (CCA, RM, JC, AD or PS) and checked by a second researcher (CCA or KML). Discrepancies were resolved by consensus.

Stage 5: collating, summarising and reporting the results

Our protocol stated that we would use the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project [ 52 ] to assess study quality [ 40 ]. However, on reviewing the included studies we selected two tools that were more appropriate to their characteristics: (1) ROBINS-I [ 53 ] for quantitative outcome evaluations and (2) a tool developed by the authors of a previous review [ 54 ] – based on Dixon-Woods et al.’s approach to assessing study credibility and contribution [ 55 ] – for all other study types. Two researchers (CCA and KML) assessed study quality independently for an initial set of 10 studies, before comparing assessments and reaching agreement where discrepancies occurred. This process was repeated until an adequate level of agreement was reached (> 90%). The remaining studies were assessed by a single researcher (CCA or KML). Records were not excluded based on quality assessment. Instead, assessments were primarily used to help synthesize the literature on how policies were evaluated. Quality assessment was not performed on grey literature due to the wide variability in the format and comprehensiveness of included publications.

We analysed the charted data, presenting a numerical summary of the included studies in table form, allowing us to describe the range of policy interventions that have been evaluated, aspects of policy implementation and approaches to evaluation. Based on the charted data, we inductively grouped evaluated policies with similar characteristics into policy types and assigned a policy instrument to each policy type: communication/marketing, guidelines, fiscal, regulation, legislation, environmental/social planning or service provision. We mapped policy types onto the spillover pathway shown in Fig. 1 to outline the policies that have been used to target each of these determinants. Thematic analysis was conducted using the approach described by Braun and Clarke where the focus is guided by the researcher’s analytic interests [ 56 ], with five overarching themes chosen as an a priori coding framework: (1) reasons for policy success; (2) reasons for policy failure; (3) unintended consequences of policy implementation; (4) opportunities for policy evaluation; and (5) challenges for policy evaluation. We selected these themes based on our research questions and previous familiarisation with the included articles during the process of article selection, data extraction and quality assessment. Sub-themes were subsequently identified through close reading and coding of the included articles. Thematic analysis was conducted by one researcher (RM) using the qualitative data analysis software Dedoose [ 57 ] and reviewed by the lead author (CCA).

Study characteristics

After removing duplicates, our searches identified a total of 5064 academic records. After screening titles and abstracts, we considered 330 records for full-text review. We also identified 11 relevant publications through our grey literature search. Grey literature reports were published by five organisations: four organisations focused on health and disease, including an intergovernmental organisation (the World Organisation for Animal Health) and three non-governmental organisations (the One Health Commission, the Global Alliance for Rabies Control and EcoHealth Alliance); and one non-governmental organisation focused on wildlife trade (TRAFFIC). In total, we included 95 publications in this review (PRISMA diagram in Fig. 2 ) [ 58 ].

We excluded studies which assessed the unintended consequences of policies to prevent zoonotic spillover without evaluating their effectiveness. This included studies that looked exclusively at the mental health impacts of mandatory livestock culls on farm workers [ 59 ]; studies which focused on potentially relevant factors, such as the wildlife trade, but with no consideration of outcomes situated on the spillover pathway [ 60 ]; and studies which assessed the detection power of surveillance systems without assessing the impact of associated policy interventions [ 61 , 62 , 63 ].

Policy characteristics

The characteristics of the policies evaluated in the included studies are presented in Supplementary File 3 and summarised in Table 1 . Some studies evaluated more than one policy, particularly modelling studies which compared the impacts of several policy options and process evaluations focused on a range of activities undertaken by a single government. Therefore, the number of evaluated policies (n = 111) is greater than the number of included studies (n = 95).

Most policies were evaluated for their impact on human exposure (21%), pathogen prevalence in domesticated animals (18%), barriers within domesticated animals (15%), and pathogen survival and spread in domesticated animals (9%). There were also a number of multi-component policies studies across multiple stages of the spillover pathway (18%). Fewer studies focused on wildlife health and populations, and none of the included studies evaluated policies for their impact on infection intensity and pathogen release in either domesticated animals or wildlife.

Where the government department responsible for implementing a policy was identified in the paper, most policies were implemented by a single department (35%), although there were a number of multi-sectoral efforts (24%). The range of government sectors responsible for implementing policies to prevent zoonotic spillover included human health, animal health, food safety, agriculture, conservation, national parks, forestry, fisheries, environmental protection, border control and foreign affairs. Policies were predominantly intended to be implemented by private sector actors, including individuals and organisations working in trade, retail, hunting and animal agriculture. However, some policies were also implemented by public sector actors working in public health, veterinary public health and environmental conservation.

Most policies were situated in high-income (49%) and upper middle-income (28%) countries, with studies from East Asia and the Pacific (43%) and Europe and Central Asia (19%) dominating. Publications focused on policies targeting various zoonotic diseases, with the most common being avian influenza (50%), rabies (19%), brucellosis (11%) and Hendra virus (4%).

Most policies were evaluated using process (38%) or outcome (31%) evaluation. The most frequently used policy instrument was legislation (59%), particularly for managing pathogen spread in domesticated animals through measures such as mandatory vaccination, culls or disinfection protocols. Meanwhile, communication and marketing or service provision was more typically used to reduce risk in wildlife and human populations, for example by providing guidance around recommended hygiene protocol, by distributing oral vaccination in wildlife habitat or by offering vaccination to human populations.

PRISMA 2020 diagram [ 58 ]

What policies aimed at preventing zoonotic spillover have been evaluated?

Policy types targeted different determinants across the pathway to zoonotic spillover and used various approaches with different evidence of success (Table 2 ). We identified policy options including culling – both general and targeted – of wild and domesticated animals; habitat protection (limiting activities such as agriculture and animal husbandry in wildlife habitats); supplemental feeding to control wildlife movements; vaccination of both wildlife, domesticated animals and human populations with occupational exposure to animals; policies to improve biosecurity in sites where animals are kept, slaughtered and sold, including mandates and information campaigns; live animal market closures; and bans on hunting and selling wildlife. Where outcomes or impacts were evaluated, most policies saw some level of success (i.e., outcome measures were found to vary in a direction that indicated policy success), though relative effectiveness was not assessed due to variation in study design and outcome measure. Policies with consistent evidence of effectiveness – where outcome measures varied in a direction that indicated policy success in all studies included in the review – included culling and sterilisation of wildlife populations, habitat protection, vaccination in wildlife and domesticated animal populations and mandated disinfection protocols. Policies with equivocal evidence of success (i.e., outcome measures varied in different directions or studies had different findings, some indicating success and some indicating failure) included supplemental feeding of wildlife, pre-emptive livestock culls, live animal market closures and bans on wildlife hunting, trade and consumption. For many policies, there were no impact or outcome evaluations identified in this review.

What are the reasons for policy success?

The evidence from the identified impact and outcome evaluations suggests that most of the policies succeeded to some extent. A range of factors contributed to policy success. First, studies emphasized the importance of effective collaboration and coordination between various agencies, disciplines, and levels of government in the execution of policy directives [ 114 , 115 ], in line with a One Health approach to policy and governance. Policy success was attributed, in part, to strong working relationships that encouraged effective communication between various government agencies, and facilitated timely and appropriate policy responses [ 115 ]. Synergy between agencies responsible for surveillance and the execution of control strategies was also reported to be beneficial. For example, prompt communication and effective collaboration between laboratories testing samples and agencies implementing culls in the field was seen as important in the control of highly pathogenic avian influenza in Nigeria [ 116 ]. Similarly, authors also identified the importance of private-public relations and private sector contributions to implementing policies to prevent zoonotic spillover [ 112 ]. This included stronger government engagement with private veterinarians as a factor for success in reducing the spillover of Hendra virus in Queensland [ 109 ], and with farmers, poultry companies and national farming and poultry processing associations in Ghana as part of a successful campaign to reduce risk from highly pathogenic avian influenza [ 112 ]. Studies suggest that the inclusion of private sector stakeholders in the policy process has the potential to improve compliance through transparent dialogue around disease ecology, risk and risk mitigation [ 90 , 91 , 103 , 117 ]; and highlight the utility of participatory approaches in prompting behaviour changes [ 91 ].

Second, authors emphasised the significance of economic incentives, suggesting that policy impact is dependent on private actors’ appraisal of costs and benefits. Studies illustrated how incentives, including compensation, subsidies, rebates, and fines, have had varying degrees of success [ 91 , 97 , 112 , 115 ]. Compensation levels [ 104 , 114 ] and enforcement practices [ 92 ] were identified as salient factors for compliance and adherence. For example, fear of sanctions for bushmeat hunting while a ban was in place in some parts of West Africa were identified as a stronger incentive to avoid bushmeat hunting than the fear of contracting Ebola virus [ 97 ]. Culls were seen as particularly challenging in this regard: while the long-term benefits for farmers may outweigh the financial loss [ 104 ], authorities need to be conscientious of the substantial economic impacts when considering policies that mandate culling or safe disposal [ 95 ]. The direct losses related to compliance (time, labour and expenses) and indirect losses due to price fluctuations and decreases in trade volume, as well as losses to associated industries, are substantial [ 88 , 96 , 113 , 118 ].

Third, trust in government and public support for implemented policy were specified as critical factors influencing the effectiveness of disease control strategies, and research suggests that strategic engagement to facilitate compliance is a necessary step in the policy process [ 97 ]. Participatory approaches that attempt to identify and understand factors influencing compliance have been consistently used to overcome resistance to policy, as insights from engagement and consultation can lead to solutions that facilitate behaviour change at the population level [ 91 , 103 ]. For example, a World Health Organization initiative to reduce avian influenza transmission in poultry markets in Indonesia worked alongside market vendors to achieve its aims, carrying out repeated consultations with the vendors and implementing market infrastructure (such as energy and running water in the market) in collaboration with local authorities to support vendor behaviour change [ 91 ].

Fourth, studies also demonstrated the importance of public communication. The quality of information, as well as the volume, complexity and delivery of public health messages, were key factors [ 75 , 114 ]. Authors contend that communication strategies must understand the target audience and how they interpret and engage with messages [ 97 ], for example by building on relationships where there is exiting trust, such as between veterinarians advising animal vaccination and animal owners [ 117 ]. Homogenously delivered communication strategies were ineffectual: they limited opportunities for open discourse; discounted contradictory lived experiences and expressions of uncertainty; and ultimately contributed to scepticism surrounding implemented policies [ 97 , 117 ].

Finally, studies underscored the importance of surveillance infrastructure to inform intervention strategies. Surveillance programs with the ability to collect and operationalize relevant data were essential to the development of appropriate interventions that are responsive to each unique context [ 115 , 119 ]. Implementing effective surveillance programmes requires the appropriate evaluation tools [ 120 ] and trained personnel [ 81 ].

What are the reasons for policy failure?

Studies showed that perceptions of acceptability and appropriateness were crucial to the effectiveness of implemented policies [ 101 , 104 ]. Several factors were identified that negatively affected acceptability and appropriateness, including: additional expenses for private sector actors without sufficient support [ 75 , 100 , 104 , 112 , 114 ], particularly were culls were demanded but reimbursement for farmers was slow and inadequate, as in a brucellosis eradication campaign in Macedonia [ 81 ]; lack of affordable alternatives [ 97 ]; impracticality of implemented strategies [ 75 , 101 ]; lack of cultural understanding in designing policy interventions [ 97 , 100 ], for example the distribution of footwear to pig farmers in a Polynesian context where footwear was not traditionally worn [ 100 ]; lack of understanding of viral ecology [ 100 ]; as well as public scepticism and distrust [ 97 , 114 ].

Additionally, policy ineffectiveness was associated with poor planning and execution of intervention strategies, including lack of clear direction [ 114 ]; incomplete or inconsistent implementation of control measures (17); limited scope of intervention [ 114 ]; and poor enforcement [ 92 ]. A lack of adequate resources to implement strategies also contributed to policy failure [ 81 ]. Adequate financial resources were necessary to hire and train staff to run surveillance and control operations [ 81 ]. Financial resources were also necessary to fund compensation mechanisms that facilitate compliance. Willingness to adopt policy-prescribed disposal practices was found to be associated with compensation levels (incentives) as a proportion of production price, dependency on income from activities driving zoonotic risk, and contact with prevention staff [ 92 ].

What are the unintended consequences of implementing policies to prevent zoonotic spillover?

A small number of the included studies collected data on the unintended consequences of policies to prevent zoonotic spillover (n = 18). In some instances, unintended consequences were due to disease ecology or human behaviour as a result of policy failure. For example, a study assessing the impacts of the closure of a live poultry market found that, following the closure, vendors travelled to neighbouring markets to sell their animals [ 94 ]. As a result, while cases of avian influenza decreased in the area surrounding the closed market, cases increased in these neighbouring markets, leading to the wider geographic spread of the disease. In another study, elk were provided with supplementary feeding grounds to discourage them from coming into contact with the livestock who shared their range [ 65 ]. While this intervention had the intended consequence of reducing the transmission of brucellosis between elk and livestock, the spread of brucellosis between the elk using the supplementary feeding grounds – who were gathering in larger, tighter groups for longer periods, resulting in higher within-herd transmission – and other elk populations in the area increased. This resulted in an increasing prevalence of brucellosis among the elk, potentially increasing the risk of spillover to livestock. These examples illustrate the complexity of the social and ecological systems in which these policies are implemented, further suggesting the need for a One Health approach to policies to prevent zoonotic spillover.

A key unintended consequence can be attributed to the loss of profits and livelihoods sometimes associated with policies to prevent zoonotic spillover, as described above. The losses incurred by complying with regulations made farmers, hunters and other private sector actors reluctant to report potential infections, contributing to increased unauthorized or illegal activity, and unrestrained spread of disease [ 90 , 92 , 94 , 98 , 112 , 114 ]. Studies investigated the creative ways policy enforcement was circumvented, including hiding hunting equipment on the outskirts of towns or developing informal trade markets and networks [ 97 , 98 ]. Unintended consequences identified in the included evaluations emphasize an opportunity for policymakers to improve sector compliance through public education, levying the influence of consumer attitudes on industry standards [ 104 , 113 ].

A range of study designs were used to evaluate policies. Outcome evaluations (n = 33) used time series or repeat cross-sectional data to conduct evaluations of natural experiments, though most studies did not include a control group for comparison. Outcome evaluations also used case-control and modelling approaches to assess policy impact on an outcome of interest. Process evaluations (n = 30) used cross-sectional and qualitative approaches, as well as study designs combining multiple sources of data, to understand aspects of policy implementation such as the extent to which the policy was being implemented as designed, and the responses and attitudes of stakeholders involved in policy implementation. Economic evaluations (n = 11) included cost-benefit analyses, risk-benefit analyses and modelling studies. Formative evaluations (n = 17) used modelling approaches to estimate what the impacts of a proposed policy option would be in a specific context.

Outcome variables interpreted as indicators of policy success were also numerous and represented determinants along the spillover pathway. As expected, many studies assessed impact on disease transmission, including disease prevalence and incidence, disease eradication, case numbers, and basic reproduction number in human and animal populations, as well as evidence of disease in environmental samples, such as in live animal markets or at carcass disposal sites. Studies also assessed impacts on intermediate factors indicative of successful implementation of specific policies, such as the availability of wild species in markets where a trade ban had been implemented, or knowledge and practices of stakeholders in response to an educational or information campaign.

While most studies found a reduced risk of zoonotic spillover following policy implementation, comparing the magnitude of these impacts was challenging due to the variety of study designs and outcome measures used in the included studies. However, we identified several studies which used modelling to directly compare the impacts of policy options. These studies evaluated various policy scenarios: different combinations within multi-component policy interventions [ 121 ]; culling versus vaccinating wildlife [ 122 ] and livestock [ 84 , 85 ] populations; targeting strategies to humans exclusively versus targeting humans and livestock [ 108 ]; and altering the parameters for culling and vaccination strategies, for example by modelling different ranges for culling and vaccination near infected farms [ 85 ]. These studies often highlighted trade-offs between the effectiveness of policy measures and their cost. For example, estimates of the number of infected flocks were lower when incorporating a ring cull (cull of animals on farms surrounding an outbreak) into a multi-component control strategy for highly pathogenic avian influenza [ 121 ]. However, livestock vaccination was estimated to be a highly effective strategy, with one study findings livestock vaccination to be as or more effective than a pre-emptive cull for outbreak control purposes (depending on the extent of vaccination coverage), while minimising the number of animals culled [ 85 ]. One study jointly modelled costs and benefits of strategies, and found that livestock vaccination had a higher cost-benefit ratio than a wildlife cull [ 122 ]. A final study highlighted the potential of holistic approaches, with drug administration in humans and livestock having a lower cost per disability-adjusted life year averted than intervention in humans alone [ 108 ].

Study authors noted a number of challenges encountered while evaluating policies to prevent zoonotic spillover. One study noted the difficulty of determining the impact of policies aiming to reduce spillover events between wildlife, livestock and humans, as the number of spillover events is often relatively small [ 65 ]. This highlights the importance of considering upstream determinants and risk factors as outcome measures in attempting to evaluate these policies, particularly where spillover events may happen infrequently or not at all during the period of observation. Studying changes in risk factors for spillover can provide insight on the effectiveness of different policies in tackling spillover risk.

Lack of suitable data was a frequently cited barrier to policy evaluation. As policies to prevent zoonotic spillover are often reactive, being implemented in response to an outbreak in animal populations, accessing data from before a policy was implemented was challenging. Studies highlighted the value of routinely collected data, which was often the only data available and was frequently used for policy evaluation [ 65 , 66 , 94 , 115 , 119 , 123 ]. However, in many contexts routine data on animal health is not collected [ 80 ]. Routine testing data from livestock can sometimes be used for evaluation where it exists, but it does not always provide sufficient detail for examining the potential for a policy to prevent zoonotic spillover. For example, some tests do not differentiate between current and past infection, making it difficult to identify where and when spillover occurred [ 65 ], and animal health data may not be granular enough for policy evaluation, particularly in terms of evaluating local policies [ 94 ]. Studies also highlighted instances where the private sector may own data sets reporting disease prevalence and transmission, but may be reluctant to share the data for evaluation purposes [ 121 ]. In such instances, open communication and good relationships with the private sector may be facilitators to evaluation.

Beyond the lack of baseline data, studies highlighted the difficulty in collecting information about policy compliance. As failing to comply often puts farmers and hunters at risk of fines or imprisonment, they were reluctant to disclose information about non-compliance or participation in illegal trade and sale of animals [ 86 , 92 , 97 , 112 ]. This made it difficult to determine policy effectiveness.

Quality assessment

Of the 44 quantitative evaluations, 37 were evaluated as being at moderate or higher risk of bias (see Supplementary File 4), given the possibility of bias in the assessment of intervention impact due to the presence of confounding effects. A small number of studies were determined to be at serious (n = 6) or critical (n = 1) risk of bias, for two main reasons: only having data from after the intervention was implemented; or using a case-control study model without measuring and adjusting for important potential confounders, such as the prevalence of a targeted disease prior to policy implementation. These limitations may reflect the nature of zoonotic spillover events and policy responses, which can happen quickly and leave little time for baseline data collection. Many of the included studies relied on surveillance data, but where such data sets are not available, post-test and case-control study designs may be the only options.

The quality of studies assessed with the tool developed based on Dixon-Woods’ approach [ 55 ] was high overall (n = 41, see Supplementary file 5). Most studies were rated as high in terms of clearly and comprehensively presenting their results (n = 37), analysis (n = 34), research design (n = 33), aims (n = 32) and research process (n = 28). Most studies also had a high relevance to the research question (n = 31), indicating that the research was embedded in policy, being commissioned, co-designed or conducted in partnership with government stakeholders.

We identified a range of policies targeting different parts of the spillover pathway implemented by various policy and governance sectors, including some multi-sectoral initiatives. Policies tended to rely heavily on private sector actors (including actors ranging from small-scale farmers and hunters to larger commercial operations) for implementation, suggesting that open communication and collaboration with these actors was essential for successful policy implementation. Policy success was undermined by lack of collaboration between government agencies; lack of communication between surveillance and control operations; poor understanding of the context in which policies were implemented; and inadequate financial compensation for private sector actors who lost profits and incurred additional costs by complying with policies. Where policies were ineffective, this tended to be due to unintended consequences relating to complex dynamics within the social and ecological systems where policies were implemented. Lack of appropriate data was a key obstacle to policy evaluation, and studies emphasised the importance of robust surveillance infrastructure in evaluating policies that tended to be implemented reactively, in response to an outbreak of zoonotic disease in animal or human populations.

Implications for policy and practice

The key role that the private sector and industry actors play in implementing policies to prevent zoonotic spillover is an important consideration for policymakers. Our findings suggest that many of these policies must be complied with by farmers – from subsistence and smallholder farmers to large corporations – as well as by other actors, such as hunters. Lack of awareness as well as financial costs of compliance among these groups present key barriers to policy success in this area. This set of stakeholders is complex as some may make very marginal profits, if any, and may struggle to afford the additional costs of implementing preventive policies. However, powerful actors and profitable industries are also involved, including large-scale farms and primary resource extraction enterprises [ 22 ]. Acknowledging the differences across these stakeholder groups, and in particular assessing their capacity to bear some of the costs related to prevention, emerges as crucial in successful policy implementation.

Finally, our findings highlight the importance of disease surveillance in efforts to reduce the risk of spillover events. As well as acting as an early warning system, surveillance provides a source of data to evaluate the impact of preventive policies. We found the availability of surveillance data to be a key enabling factor in evaluating policies. In addition, close collaboration between agencies responsible for disease surveillance and control efforts was key to policy success. National surveillance efforts, as well as cross-country collaboration to support global efforts, such as the United States Agency for International Development’s PREDICT program supporting surveillance in areas at high risk for zoonotic disease outbreaks [ 124 ], must be sustained and expanded. In complex areas such as the prevention of zoonotic spillover, approaches to surveillance which encompass risk factors and transmission pathways [ 125 ], as well as One Health surveillance systems which harmonise and integrate data collection and analysis from across human, animal and environmental sectors [ 126 ], are promising approaches to developing surveillance systems that support risk. This context also involves a need to strengthen surveillance capacity in remote and rural locations, as communities living in these contexts may have exposure to numerous pathogens of wildlife origin. This will require strengthening clinical and diagnostic capacity in these settings, as well as engaging with stakeholders such as community human and animal health workers and wildlife or national park rangers [ 127 ].

Comparison with existing literature

This review sought to map the range of policies implemented to reduce the risk of zoonotic spillover, and the various approaches taken to evaluation, and identify factors behind the success and failure of policy implementation and evaluation. Due to this broad scope, comparing relative effectiveness of policy interventions was challenging. Existing systematic reviews with a more specific focus could apply meta-analysis to determine which interventions were most effective. For example, a review of market-level biosecurity measures aiming to reduce the transmission of avian influenza found that reducing market size, separating poultry species, cleaning and disinfecting premises, closing markets and banning overnight storage were highly effective interventions [ 45 ]. However, our findings suggest that studies focused on the control of avian influenza dominate the literature in this space (55 out of 111 evaluated policies), and many of these are focused on market-level measures. Systematic reviews focused on other approaches to reduce spillover risk, such as on-farm biosecurity [ 47 ]; biosecurity for backyard poultry rearing [ 46 ]; and community-based interventions [ 28 ] comment on the paucity of high-quality evidence around the impacts of such approaches. By taking a broad perspective, we hope our findings will provide policy options for consideration in a number of contexts, and guide researchers in focusing their efforts on areas where evidence is lacking.

Strengths and weaknesses of the study

To our knowledge, this is the first attempt to systematically identify and document evaluations of policies aiming to prevent the spillover of zoonotic pathogens into human populations. However, because of the complex drivers of spillover events, some potentially relevant policy evaluations may be excluded where their outcome measures are too far removed from zoonotic spillover. While relevant, such evaluations will be difficult to systematically identify as they make no reference to zoonotic disease.

In addition, this review focused on policy evaluations that have been reported in the peer-reviewed literature and the grey literature published by international agencies and organisations working on these topics. Policies that have been implemented but not evaluated, or evaluated but not published in these literatures, will therefore be excluded from this review. As a result, potentially effective and important policies in the prevention of zoonotic spillover events may not have been identified. However, we hope that the findings from this review will highlight these gaps in the evaluative evidence. We also hope that this review, by extracting practical dimensions, such as study design, outcome measures and the challenges encountered in the evaluation process, will support policymakers and researchers in carrying out further policy evaluations in this space.

Unanswered questions and future research

Our findings highlight several important gaps in the evidence. First, while observational evidence emphasises the importance of upstream determinants such as environmental and ecosystem health in the increasing rate of zoonotic spillover [ 1 , 15 ], we only identified a single evaluation of a policy attempting to target one of these upstream determinants: an evaluation carried out in China to assess the impact of the Ramstar wetland protection program on avian influenza in migratory waterfowl [ 66 ]. This study found that proximity to protected wetlands reduced outbreak risk. Authors hypothesised that this effect was due to the separation of wild waterfowl and poultry populations and the diversion of wild waterfowl away from human-dominated landscapes and toward protected natural habitats. Our findings support existing calls for more quantitative and mechanistic studies of the impact of interventions supporting environmental and ecosystem health on zoonotic spillover risk [ 128 ], as well as calls for greater integration of the environment into One Health research, policy and practice [ 31 ]. Further evaluations of environment and habitat protection policies would strengthen our understanding of this area. In addition, the impact of policies to reduce deforestation or expand forest coverage, such as China’s Grain-to-Green program [ 129 ], on the spillover pathway could be evaluated. Such evaluations might consider potential unintended consequences, as these policies could promote healthier wildlife populations with better disease resistance, but may also facilitate wildlife population growth and higher rates of wildlife-human encounters [ 130 ].

There is also a lack of evaluation of policies targeting infection intensity and pathogen release in either wildlife or domesticated animals. These could include approaches such as improving animal health and welfare to make these populations more resistant to disease [ 13 ]. While arguments have been made for strengthening legal structures supporting animal welfare in order to reduce the risk of zoonotic pathogen transmission [ 131 ], there is a need to evaluate policies that take this approach.

Our review found publications evaluating a wide range of policy interventions spanning the spillover pathway, including habitat protection; trade regulations; border control and quarantine procedures; farm and market biosecurity measures; public information campaigns; and vaccination programmes for wildlife and domesticated animals, as well as human populations with occupational exposure to animals. A wide range of governance sectors implemented these policies, highlighting the prevention of zoonotic spillover as a cross-sectoral issue, though most policies were implemented by a single sector. Our findings highlight the importance of industry and private actors in implementing policies to prevent zoonotic spillover, and the need for thoughtful and effective engagement with this wide range of actors, from subsistence hunters and farmers through to industrial animal agriculture operations to address their concerns through a range of incentives. We also identified the centrality of surveillance data in evaluating policies that are often implemented reactively, and effective collaboration between surveillance and control operations as a central factor in successful policy implementation.

Data Availability

All data generated or analysed during this study are included in this published article and its supplementary information files. Analysis code for descriptive characteristics of included policies is available on GitHub.

Abbreviations

Emerging infectious disease

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CCA, JC and TLP acknowledge internal research support from York University. MW and CCA acknowledge internal research support from the Dahdaleh Institute for Global Health Research. KML acknowledges funding from the Canadian Institutes of Health Research through a Health System Impact Fellowship. AY is funded by the BBSRC through the Mandala project (grant number BB/V004832/1). AMV acknowledges support from York University through a York Research Chair in Population Health Ethics & Law. This review was undertaken as part of a project funded by the Canadian Institutes of Health Research, Grant Reference Number VR5-172686. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Clifford Astbury, C., Lee, K.M., Mcleod, R. et al. Policies to prevent zoonotic spillover: a systematic scoping review of evaluative evidence. Global Health 19 , 82 (2023). https://doi.org/10.1186/s12992-023-00986-x

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How to Conclude a Literature Review
The conclusion of the dissertation literature review focuses on a few critical points, Highlight the essential parts of the existing body of literature in a concise way. Next, you should analyse the current state of the reviewed literature. Explain the research gap for your chosen topic/existing knowledge.
Writing a Literature Review
Conclusion: Summarize the key findings you have taken from the literature and emphasize their significance Connect it back to your primary research question How should I organize my lit review?
How to Write a Literature Review
Step 1 - Search for relevant literature Step 2 - Evaluate and select sources Step 3 - Identify themes, debates, and gaps Step 4 - Outline your literature review's structure Step 5 - Write your literature review Free lecture slides Other interesting articles Frequently asked questions Introduction Quick Run-through Step 1 & 2 Step 3 Step 4 Step 5
How to Write a Strong Conclusion for Your Literature Review
The first step to conclude your literature review is to restate your research question and objectives. This helps you to remind the reader of the purpose and scope of your literature...
Literature Review: Conducting & Writing
This guide will provide research and writing tips to help students complete a literature review assignment.
How do I Write a Literature Review?: #5 Writing the Review
A descriptive statement about the types of literature used in the review; Summarize your findings; Conclusion(s) based upon your findings; Introduction: Like a typical research paper introduction, provide the reader with a quick idea of the topic of the literature review: Define or identify the general topic, issue, or area of concern. This ...
5. The Literature Review
Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date. Given this, the purpose of a literature review is to: Place each work in the context of its contribution to understanding the research problem being studied.
Literature Reviews
A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period. A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis.
How to Write a Literature Review
Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work. A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision.
Literature Review Guide
The purpose of a literature review is to offer a comprehensive review of scholarly literature on a specific topic along with an evaluation of the strengths and weaknesses of authors' arguments. In other words, you are summarizing research available on a certain topic and then drawing conclusions about researchers' findings.
9. The Conclusion
The conclusion can be where you describe how a previously identified gap in the literature [described in your literature review section] has been filled by your research. Demonstrating the importance of your ideas. Don't be shy. The conclusion offers you the opportunity to elaborate on the impact and significance of your findings.
Literature review as a research methodology: An ...
In addition, a literature review is an excellent way of synthesizing research findings to show evidence on a meta-level and to uncover areas in which more research is needed, which is a critical component of creating theoretical frameworks and building conceptual models.
Guidance on Conducting a Systematic Literature Review
Literature review is an essential feature of academic research. Fundamentally, knowledge advancement must be built on prior existing work. To push the knowledge frontier, we must know where the frontier is. By reviewing relevant literature, we understand the breadth and depth of the existing body of work and identify gaps to explore.
How to Write a Literature Review
Conclusion of the Literature Review ‍ Preparing for a Literature Review Clearly define the topic of your research, this is the basis of picking what articles you'll be reading, analyzing and summarizing, and subsequently including in your research topic.
Literature Review Research
Literature Review is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.
Literature Review: The What, Why and How-to Guide
Example: Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework: 10.1177/08948453211037398 ; Systematic review: "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139).
How to Write a Literature Review: Six Steps to Get You from ...
A literature review I am currently working on, for example, explores barriers to higher education for undocumented students. Step Two: Search for the literature: Conduct a comprehensive bibliographic search of books and articles in your area.
Chapter 9 Methods for Literature Reviews
9.3. Types of Review Articles and Brief Illustrations. EHealth researchers have at their disposal a number of approaches and methods for making sense out of existing literature, all with the purpose of casting current research findings into historical contexts or explaining contradictions that might exist among a set of primary research studies conducted on a particular topic.
AZHIN: Writing: Literature Review Basics: Conclusions
For most written assignments, the conclusion is a single paragraph. It does not introduce any new information; rather, it succinctly restates your chief conclusions and places the importance of your findings within your field.
Writing a Research Paper Conclusion
The conclusion of a research paper is where you wrap up your ideas and leave the reader with a strong final impression. It has several key goals: Restate the problem statement addressed in the paper Summarize your overall arguments or findings Suggest the key takeaways from your paper
Concluding Your Literature Review
Concluding Your Literature Review 06 February 2020 In the previous blogs, we talked about searching and assessing reference papers for your literature review, and shared tips on organising and writing the content. Let's look now at how to conclude your literature review.
Conclusions from the Literature Review
Conclusions from the Literature Review Authors: Claudia Krille Institut für Qualitätsentwicklung an Schulen Schleswig-Holstein Abstract This chapter summarizes the results from the systematic...
Helpful Tips On Writing A Literature Review Conclusion
How to Write a Literature Review: Conclusion Prompts. A literature review is a particular type of academically written paper that gives an overview about a published material. This published material can be any source like a book, a dissertation, thesis or a research paper. It is done as a first step while conducting a research on the ...
Guidelines for virtual early childhood and family learning: An equity
Our review identified numerous findings concerning digital tools. The literature relates that a variety of multimedia tools are needed for educators to be responsive to the funds of knowledge of children and families (Goulding et al., 2018). Technology should be in place for educators to use for programing, interaction, and community building.
The Importance of Corporate Reputation for Sustainable ...
However, there is a need to develop a theoretical foundation that will guide future research. Therefore, we undertake a literature review to address the following research goals: 1. Provide a state-of-the-art literature review, highlighting the historical development of the research field of CR. 2.
A comparative evaluation of child health care in China using
The remaining part of this paper consists of the following 5 parts: Literature Review, Data and Methods, Results, Discussion, and Conclusions. Literature review MCDM, also known as Multi-Criteria Decision Analysis the method that supports decision-makers faced with evaluating alternatives by taking into account multiple criteria in an explicit ...
How educational psychologists use cognitive behavioural therapy
This systematic literature review explored how educational psychologists (EPs) use cognitive behavioural therapy (CBT) interventions within school settings, with whom and to what effect. ... it is difficult to draw conclusions about long-term impact due to limited follow-up or longitudinal research within this review. This highlights the ...
Policies to prevent zoonotic spillover: a systematic scoping review of
We conducted a systematic scoping review of evaluations of policies aimed at preventing zoonotic spillover events, based on a previously published protocol [].Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews [].The scoping review was conducted in line with guidelines published by Arksey and O'Malley ...