literature review in a qualitative study

Archer Library

Qualitative research: literature review .

• Archer Library This link opens in a new window
• Schedule a Reference Appointment This link opens in a new window
• Qualitative Research Handout This link opens in a new window
• Locating Books
• ebook Collections This link opens in a new window
• A to Z Database List This link opens in a new window
• Research & Stats
• Literature Review Resources
• Citation & Reference

Exploring the literature review 

Literature review model: 6 steps.

Adapted from The Literature Review , Machi & McEvoy (2009, p. 13).

Your Literature Review

Step 2: search, boolean search strategies, search limiters, ★ ebsco & google drive.

1. Select a Topic

"All research begins with curiosity" (Machi & McEvoy, 2009, p. 14)

Selection of a topic, and fully defined research interest and question, is supervised (and approved) by your professor. Tips for crafting your topic include:

• Be specific. Take time to define your interest.
• Topic Focus. Fully describe and sufficiently narrow the focus for research.
• Academic Discipline. Learn more about your area of research & refine the scope.
• Avoid Bias. Be aware of bias that you (as a researcher) may have.
• Document your research. Use Google Docs to track your research process.
• Research apps. Consider using Evernote or Zotero to track your research.

Consider Purpose

What will your topic and research address?

In The Literature Review: A Step-by-Step Guide for Students , Ridley presents that literature reviews serve several purposes (2008, p. 16-17).  Included are the following points:

• Historical background for the research;
• Overview of current field provided by "contemporary debates, issues, and questions;"
• Theories and concepts related to your research;
• Introduce "relevant terminology" - or academic language - being used it the field;
• Connect to existing research - does your work "extend or challenge [this] or address a gap;" 
• Provide "supporting evidence for a practical problem or issue" that your research addresses.

★ Schedule a research appointment

At this point in your literature review, take time to meet with a librarian. Why? Understanding the subject terminology used in databases can be challenging. Archer Librarians can help you structure a search, preparing you for step two. How? Contact a librarian directly or use the online form to schedule an appointment. Details are provided in the adjacent Schedule an Appointment box.

2. Search the Literature

Collect & Select Data: Preview, select, and organize

AU Library is your go-to resource for this step in your literature review process. The literature search will include books and ebooks, scholarly and practitioner journals, theses and dissertations, and indexes. You may also choose to include web sites, blogs, open access resources, and newspapers. This library guide provides access to resources needed to complete a literature review.

Books & eBooks: Archer Library & OhioLINK

Databases: scholarly & practitioner journals.

Review the Library Databases tab on this library guide, it provides links to recommended databases for Education & Psychology, Business, and General & Social Sciences.

Expand your journal search; a complete listing of available AU Library and OhioLINK databases is available on the Databases  A to Z list . Search the database by subject, type, name, or do use the search box for a general title search. The A to Z list also includes open access resources and select internet sites.

Databases: Theses & Dissertations

Review the Library Databases tab on this guide, it includes Theses & Dissertation resources. AU library also has AU student authored theses and dissertations available in print, search the library catalog for these titles.

Did you know? If you are looking for particular chapters within a dissertation that is not fully available online, it is possible to submit an ILL article request . Do this instead of requesting the entire dissertation.

Newspapers:  Databases & Internet

Consider current literature in your academic field. AU Library's database collection includes The Chronicle of Higher Education and The Wall Street Journal .  The Internet Resources tab in this guide provides links to newspapers and online journals such as Inside Higher Ed , COABE Journal , and Education Week .

Search Strategies & Boolean Operators

There are three basic boolean operators:  AND, OR, and NOT.

Used with your search terms, boolean operators will either expand or limit results. What purpose do they serve? They help to define the relationship between your search terms. For example, using the operator AND will combine the terms expanding the search. When searching some databases, and Google, the operator AND may be implied.

Overview of boolean terms

About the example: Boolean searches were conducted on November 4, 2019; result numbers may vary at a later date. No additional database limiters were set to further narrow search returns.

Database Search Limiters

Database strategies for targeted search results.

Most databases include limiters, or additional parameters, you may use to strategically focus search results.  EBSCO databases, such as Education Research Complete & Academic Search Complete provide options to:

• Limit results to full text;
• Limit results to scholarly journals, and reference available;
• Select results source type to journals, magazines, conference papers, reviews, and newspapers
• Publication date

Keep in mind that these tools are defined as limiters for a reason; adding them to a search will limit the number of results returned.  This can be a double-edged sword.  How? 

• If limiting results to full-text only, you may miss an important piece of research that could change the direction of your research. Interlibrary loan is available to students, free of charge. Request articles that are not available in full-text; they will be sent to you via email.
• If narrowing publication date, you may eliminate significant historical - or recent - research conducted on your topic.
• Limiting resource type to a specific type of material may cause bias in the research results.

Use limiters with care. When starting a search, consider opting out of limiters until the initial literature screening is complete. The second or third time through your research may be the ideal time to focus on specific time periods or material (scholarly vs newspaper).

★ Truncating Search Terms

Expanding your search term at the root.

Truncating is often referred to as 'wildcard' searching. Databases may have their own specific wildcard elements however, the most commonly used are the asterisk (*) or question mark (?).  When used within your search. they will expand returned results.

Asterisk (*) Wildcard

Using the asterisk wildcard will return varied spellings of the truncated word. In the following example, the search term education was truncated after the letter "t."

Explore these database help pages for additional information on crafting search terms.

• EBSCO Connect: Searching with Wildcards and Truncation Symbols
• EBSCO Connect: Searching with Boolean Operators
• EBSCO Connect: EBSCOhost Search Tips
• EBSCO Connect: Basic Searching with EBSCO
• ProQuest Help: Search Tips
• ERIC: How does ERIC search work?

★ EBSCO Databases & Google Drive

Tips for saving research directly to Google drive.

Researching in an EBSCO database?

It is possible to save articles (PDF and HTML) and abstracts in EBSCOhost databases directly to Google drive. Select the Google Drive icon, authenticate using a Google account, and an EBSCO folder will be created in your account. This is a great option for managing your research. If documenting your research in a Google Doc, consider linking the information to actual articles saved in drive.

EBSCO Databases & Google Drive

EBSCOHost Databases & Google Drive: Managing your Research

This video features an overview of how to use Google Drive with EBSCO databases to help manage your research. It presents information for connecting an active Google account to EBSCO and steps needed to provide permission for EBSCO to manage a folder in Drive.

About the Video:  Closed captioning is available, select CC from the video menu.  If you need to review a specific area on the video, view on YouTube and expand the video description for access to topic time stamps.  A video transcript is provided below.

• EBSCOhost Databases & Google Scholar

Defining Literature Review

What is a literature review.

A definition from the Online Dictionary for Library and Information Sciences .

A 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" (Reitz, 2014). 

A systemic review is "a literature review focused on a specific research question, which uses explicit methods to minimize bias in the identification, appraisal, selection, and synthesis of all the high-quality evidence pertinent to the question" (Reitz, 2014).

Recommended Reading

About this page

EBSCO Connect [Discovery and Search]. (2022). Searching with boolean operators. Retrieved May, 3, 2022 from https://connect.ebsco.com/s/?language=en_US

EBSCO Connect [Discover and Search]. (2022). Searching with wildcards and truncation symbols. Retrieved May 3, 2022; https://connect.ebsco.com/s/?language=en_US

Machi, L.A. & McEvoy, B.T. (2009). The literature review . Thousand Oaks, CA: Corwin Press: 

Reitz, J.M. (2014). Online dictionary for library and information science. ABC-CLIO, Libraries Unlimited . Retrieved from https://www.abc-clio.com/ODLIS/odlis_A.aspx

Ridley, D. (2008). The literature review: A step-by-step guide for students . Thousand Oaks, CA: Sage Publications, Inc.

Archer Librarians

Schedule an appointment.

Contact a librarian directly (email), or submit a request form. If you have worked with someone before, you can request them on the form.

• ★ Archer Library Help • Online Reqest Form
• Carrie Halquist • Reference & Instruction
• Jessica Byers • Reference & Curation
• Don Reams • Corrections Education & Reference
• Diane Schrecker • Education & Head of the IRC
• Tanaya Silcox • Technical Services & Business
• Sarah Thomas • Acquisitions & ATS Librarian
• << Previous: Research & Stats
• Next: Literature Review Resources >>
• Last Updated: Nov 17, 2023 7:46 AM
• URL: https://libguides.ashland.edu/qualitative

Archer Library • Ashland University © Copyright 2023. An Equal Opportunity/Equal Access Institution.

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

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

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

Instantly correct all language mistakes in your text

Upload your document to correct all your mistakes in minutes

Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

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

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

You can also use boolean operators to help narrow down your search.

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

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

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

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

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

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

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

The only proofreading tool specialized in correcting academic writing - try for free!

The academic proofreading tool has been trained on 1000s of academic texts and by native English editors. Making it the most accurate and reliable proofreading tool for students.

Try for free

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

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

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

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

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

• 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 sentences to draw connections, comparisons and contrasts

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

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

Open Google Slides Download PowerPoint

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

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

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

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

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

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

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

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved April 9, 2024, from https://www.scribbr.com/dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, what is a theoretical framework | guide to organizing, what is a research methodology | steps & tips, how to write a research proposal | examples & templates, unlimited academic ai-proofreading.

✔ Document error-free in 5minutes ✔ Unlimited document corrections ✔ Specialized in correcting academic texts

Chapter 9. Reviewing the Literature

What is a “literature review”.

No researcher ever comes up with a research question that is wholly novel. Someone, somewhere, has asked the same thing. Academic research is part of a larger community of researchers, and it is your responsibility, as a member of this community, to acknowledge others who have asked similar questions and to put your particular research into this greater context. It is not simply a convention or custom to begin your study with a review of previous literature (the “ lit review ”) but an important responsibility you owe the scholarly community.

Too often, new researchers pursue a topic to study and then write something like, “No one has ever studied this before” or “This area is underresearched.” It may be that no one has studied this particular group or setting, but it is highly unlikely no one has studied the foundational phenomenon of interest. And that comment about an area being underresearched? Be careful. The statement may simply signal to others that you haven’t done your homework. Rubin ( 2021 ) refers to this as “free soloing,” and it is not appreciated in academic work:

The truth of the matter is, academics don’t really like when people free solo. It’s really bad form to omit talking about the other people who are doing or have done research in your area. Partly, I mean we need to cite their work, but I also mean we need to respond to it—agree or disagree, clarify for extend. It’s also really bad form to talk about your research in a way that does not make it understandable to other academics.…You have to explain to your readers what your story is really about in terms they care about . This means using certain terminology, referencing debates in the literature, and citing relevant works—that is, in connecting your work to something else. ( 51–52 )

A literature review is a comprehensive summary of previous research on a topic. It includes both articles and books—and in some cases reports—relevant to a particular area of research. Ideally, one’s research question follows from the reading of what has already been produced. For example, you are interested in studying sports injuries related to female gymnasts. You read everything you can find on sports injuries related to female gymnasts, and you begin to get a sense of what questions remain open. You find that there is a lot of research on how coaches manage sports injuries and much about cultures of silence around treating injuries, but you don’t know what the gymnasts themselves are thinking about these issues. You look specifically for studies about this and find several, which then pushes you to narrow the question further. Your literature review then provides the road map of how you came to your very specific question, and it puts your study in the context of studies of sports injuries. What you eventually find can “speak to” all the related questions as well as your particular one.

In practice, the process is often a bit messier. Many researchers, and not simply those starting out, begin with a particular question and have a clear idea of who they want to study and where they want to conduct their study but don’t really know much about other studies at all. Although backward, we need to recognize this is pretty common. Telling students to “find literature” after the fact can seem like a purposeless task or just another hurdle for completing a thesis or dissertation. It is not! Even if you were not motivated by the literature in the first place, acknowledging similar studies and connecting your own research to those studies are important parts of building knowledge. Acknowledgment of past research is a responsibility you owe the discipline to which you belong.

Literature reviews can also signal theoretical approaches and particular concepts that you will incorporate into your own study. For example, let us say you are doing a study of how people find their first jobs after college, and you want to use the concept of social capital . There are competing definitions of social capital out there (e.g., Bourdieu vs. Burt vs. Putnam). Bourdieu’s notion is of one form of capital, or durable asset, of a “network of more or less institutionalized relationships of mutual acquaintance or recognition” ( 1984:248 ). Burt emphasizes the “brokerage opportunities” in a social network as social capital ( 1997:355 ). Putnam’s social capital is all about “facilitating coordination and cooperation for mutual benefit” ( 2001:67 ). Your literature review can adjudicate among these three approaches, or it can simply refer to the one that is animating your own research. If you include Bourdieu in your literature review, readers will know “what kind” of social capital you are talking about as well as what kind of social scientist you yourself are. They will likely understand that you are interested more in how some people are advantaged by their social capital relative to others rather than being interested in the mechanics of how social networks operate.

The literature review thus does two important things for you: firstly, it allows you to acknowledge previous research in your area of interest, thereby situating you within a discipline or body of scholars, and, secondly, it demonstrates that you know what you are talking about. If you present the findings of your research study without including a literature review, it can be like singing into the wind. It sounds nice, but no one really hears it, or if they do catch snippets, they don’t know where it is coming from.

Examples of Literature Reviews

To help you get a grasp of what a good literature review looks like and how it can advance your study, let’s take a look at a few examples.

Reader-Friendly Example: The Power of Peers

The first is by Janice McCabe ( 2016 ) and is from an article on peer networks in the journal Contexts . Contexts presents articles in a relatively reader-friendly format, with the goal of reaching a large audience for interesting sociological research. Read this example carefully and note how easily McCabe is able to convey the relevance of her own work by situating it in the context of previous studies:

Scholars who study education have long acknowledged the importance of peers for students’ well-being and academic achievement. For example, in 1961, James Coleman argued that peer culture within high schools shapes students’ social and academic aspirations and successes. More recently, Judith Rich Harris has drawn on research in a range of areas—from sociological studies of preschool children to primatologists’ studies of chimpanzees and criminologists’ studies of neighborhoods—to argue that peers matter much more than parents in how children “turn out.” Researchers have explored students’ social lives in rich detail, as in Murray Milner’s book about high school students, Freaks, Geeks, and Cool Kids , and Elizabeth Armstrong and Laura Hamilton’s look at college students, Paying for the Party . These works consistently show that peers play a very important role in most students’ lives. They tend, however, to prioritize social over academic influence and to use a fuzzy conception of peers rather than focusing directly on friends—the relationships that should matter most for student success. Social scientists have also studied the power of peers through network analysis, which is based on uncovering the web of connections between people. Network analysis involves visually mapping networks and mathematically comparing their structures (such as the density of ties) and the positions of individuals within them (such as how central a given person is within the network). As Nicholas Christakis and James Fowler point out in their book Connected , network structure influences a range of outcomes, including health, happiness, wealth, weight, and emotions. Given that sociologists have long considered network explanations for social phenomena, it’s surprising that we know little about how college students’ friends impact their experiences. In line with this network tradition, I focus on the structure of friendship networks, constructing network maps so that the differences we see across participants are due to the underlying structure, including each participant’s centrality in their friendship group and the density of ties among their friends. ( 23 )

What did you notice? In her very second sentence, McCabe uses “for example” to introduce a study by Coleman, thereby indicating that she is not going to tell you every single study in this area but is going to tell you that (1) there is a lot of research in this area, (2) it has been going on since at least 1961, and (3) it is still relevant (i.e., recent studies are still being done now). She ends her first paragraph by summarizing the body of literature in this area (after giving you a few examples) and then telling you what may have been (so far) left out of this research. In the second paragraph, she shifts to a separate interesting focus that is related to the first but is also quite distinct. Lit reviews very often include two (or three) distinct strands of literature, the combination of which nicely backgrounds this particular study . In the case of our female gymnast study (above), those two strands might be (1) cultures of silence around sports injuries and (2) the importance of coaches. McCabe concludes her short and sweet literature review with one sentence explaining how she is drawing from both strands of the literature she has succinctly presented for her particular study. This example should show you that literature reviews can be readable, helpful, and powerful additions to your final presentation.

Authoritative Academic Journal Example: Working Class Students’ College Expectations

The second example is more typical of academic journal writing. It is an article published in the British Journal of Sociology of Education by Wolfgang Lehmann ( 2009 ):

Although this increase in post-secondary enrolment and the push for university is evident across gender, race, ethnicity, and social class categories, access to university in Canada continues to be significantly constrained for those from lower socio-economic backgrounds (Finnie, Lascelles, and Sweetman 2005). Rising tuition fees coupled with an overestimation of the cost and an underestimation of the benefits of higher education has put university out of reach for many young people from low-income families (Usher 2005). Financial constraints aside, empirical studies in Canada have shown that the most important predictor of university access is parental educational attainment. Having at least one parent with a university degree significantly increases the likelihood of a young person to attend academic-track courses in high school, have high educational and career aspirations, and ultimately attend university (Andres et al. 1999, 2000; Lehmann 2007a). Drawing on Bourdieu’s various writing on habitus and class-based dispositions (see, for example, Bourdieu 1977, 1990), Hodkinson and Sparkes (1997) explain career decisions as neither determined nor completely rational. Instead, they are based on personal experiences (e.g., through employment or other exposure to occupations) and advice from others. Furthermore, they argue that we have to understand these decisions as pragmatic, rather than rational. They are pragmatic in that they are based on incomplete and filtered information, because of the social context in which the information is obtained and processed. New experiences and information can, however, also be allowed into one’s world, where they gradually or radically transform habitus, which in turn creates the possibility for the formation of new and different dispositions. Encountering a supportive teacher in elementary or secondary school, having ambitious friends, or chance encounters can spark such transformations. Transformations can be confirming or contradictory, they can be evolutionary or dislocating. Working-class students who enter university most certainly encounter such potentially transformative situations. Granfield (1991) has shown how initially dislocating feelings of inadequacy and inferiority of working-class students at an elite US law school were eventually replaced by an evolutionary transformation, in which the students came to dress, speak and act more like their middle-class and upper-class peers. In contrast, Lehmann (2007b) showed how persistent habitus dislocation led working-class university students to drop out of university. Foskett and Hemsley-Brown (1999) argue that young people’s perceptions of careers are a complex mix of their own experiences, images conveyed through adults, and derived images conveyed by the media. Media images of careers, perhaps, are even more important for working-class youth with high ambitions as they offer (generally distorted) windows into a world of professional employment to which they have few other sources of access. It has also been argued that working-class youth who do continue to university still face unique, class-specific challenges, evident in higher levels of uncertainty (Baxter and Britton 2001; Lehmann 2004, 2007a; Quinn 2004), their higher education choices (Ball et al. 2002; Brooks 2003; Reay et al. 2001) and fears of inadequacy because of their cultural outsider status (Aries and Seider 2005; Granfield 1991). Although the number of working-class university students in Canada has slowly increased, that of middle-class students at university has risen far more steeply (Knighton and Mizra 2002). These different enrolment trajectories have actually widened the participation gap, which in tum explains our continued concerns with the potential outsider status Indeed, in a study comparing first-generation working-class and traditional students who left university without graduating, Lehmann (2007b) found that first-generation working-class students were more likely to leave university very early in some cases within the first two months of enrollment. They were also more likely to leave university despite solid academic performance. Not “fitting in,” not “feeling university,” and not being able to “relate to these people” were key reasons for eventually withdrawing from university. From the preceding review of the literature, a number of key research questions arise: How do working-class university students frame their decision to attend university? How do they defy the considerable odds documented in the literature to attend university? What are the sources of information and various images that create dispositions to study at university? What role does their social-class background- or habitus play in their transition dispositions and how does this translate into expectations for university? ( 139 )

What did you notice here? How is this different from (and similar to) the first example? Note that rather than provide you with one or two illustrative examples of similar types of research, Lehmann provides abundant source citations throughout. He includes theory and concepts too. Like McCabe, Lehmann is weaving through multiple literature strands: the class gap in higher education participation in Canada, class-based dispositions, and obstacles facing working-class college students. Note how he concludes the literature review by placing his research questions in context.

Find other articles of interest and read their literature reviews carefully. I’ve included two more for you at the end of this chapter . As you learned how to diagram a sentence in elementary school (hopefully!), try diagramming the literature reviews. What are the “different strands” of research being discussed? How does the author connect these strands to their own research questions? Where is theory in the lit review, and how is it incorporated (e.g., Is it a separate strand of its own or is it inextricably linked with previous research in this area)?

One model of how to structure your literature review can be found in table 9.1. More tips, hints, and practices will be discussed later in the chapter.

Table 9.1. Model of Literature Review, Adopted from Calarco (2020:166)

Embracing Theory

A good research study will, in some form or another, use theory. Depending on your particular study (and possibly the preferences of the members of your committee), theory may be built into your literature review. Or it may form its own section in your research proposal/design (e.g., “literature review” followed by “theoretical framework”). In my own experience, I see a lot of graduate students grappling with the requirement to “include theory” in their research proposals. Things get a little squiggly here because there are different ways of incorporating theory into a study (Are you testing a theory? Are you generating a theory?), and based on these differences, your literature review proper may include works that describe, explain, and otherwise set forth theories, concepts, or frameworks you are interested in, or it may not do this at all. Sometimes a literature review sets forth what we know about a particular group or culture totally independent of what kinds of theoretical framework or particular concepts you want to explore. Indeed, the big point of your study might be to bring together a body of work with a theory that has never been applied to it previously. All this is to say that there is no one correct way to approach the use of theory and the writing about theory in your research proposal.

Students are often scared of embracing theory because they do not exactly understand what it is. Sometimes, it seems like an arbitrary requirement. You’re interested in a topic; maybe you’ve even done some research in the area and you have findings you want to report. And then a committee member reads over what you have and asks, “So what?” This question is a good clue that you are missing theory, the part that connects what you have done to what other researchers have done and are doing. You might stumble upon this rather accidentally and not know you are embracing theory, as in a case where you seek to replicate a prior study under new circumstances and end up finding that a particular correlation between behaviors only happens when mediated by something else. There’s theory in there, if you can pull it out and articulate it. Or it might be that you are motivated to do more research on racial microaggressions because you want to document their frequency in a particular setting, taking for granted the kind of critical race theoretical framework that has done the hard work of defining and conceptualizing “microaggressions” in the first place. In that case, your literature review could be a review of Critical Race Theory, specifically related to this one important concept. That’s the way to bring your study into a broader conversation while also acknowledging (and honoring) the hard work that has preceded you.

Rubin ( 2021 ) classifies ways of incorporating theory into case study research into four categories, each of which might be discussed somewhat differently in a literature review or theoretical framework section. The first, the least theoretical, is where you set out to study a “configurative idiographic case” ( 70 ) This is where you set out to describe a particular case, leaving yourself pretty much open to whatever you find. You are not expecting anything based on previous literature. This is actually pretty weak as far as research design goes, but it is probably the default for novice researchers. Your committee members should probably help you situate this in previous literature in some way or another. If they cannot, and it really does appear you are looking at something fairly new that no one else has bothered to research before, and you really are completely open to discovery, you might try using a Grounded Theory approach, which is a methodological approach that foregrounds the generation of theory. In that case, your “theory” section can be a discussion of “Grounded Theory” methodology (confusing, yes, but if you take some time to ponder, you will see how this works). You will still need a literature review, though. Ideally one that describes other studies that have ever looked at anything remotely like what you are looking at—parallel cases that have been researched.

The second approach is the “disciplined configurative case,” in which theory is applied to explain a particular case or topic. You are not trying to test the theory but rather assuming the theory is correct, as in the case of exploring microaggressions in a particular setting. In this case, you really do need to have a separate theory section in addition to the literature review, one in which you clearly define the theoretical framework, including any of its important concepts. You can use this section to discuss how other researchers have used the concepts and note any discrepancies in definitions or operationalization of those concepts. This way you will be sure to design your study so that it speaks to and with other researchers. If everyone who is writing about microaggressions has a different definition of them, it is hard for others to compare findings or make any judgments about their prevalence (or any number of other important characteristics). Your literature review section may then stand alone and describe previous research in the particular area or setting, irrespective of the kinds of theory underlying those studies.

The third approach is “heuristic,” one in which you seek to identify new variables, hypotheses, mechanisms, or paths not yet explained by a theory or theoretical framework. In a way, you are generating new theory, but it is probably more accurate to say that you are extending or deepening preexisting theory. In this case, having a single literature review that is focused on the theory and the ways the theory has been applied and understood (with all its various mechanisms and pathways) is probably your best option. The focus of the literature reviewed is less on the case and more on the theory you are seeking to extend.

The final approach is “theory testing,” which is much rarer in qualitative studies than in quantitative, where this is the default approach. Theory-testing cases are those where a particular case is used to see if an existing theory is accurate or accurate under particular circumstances. As with the heuristic approach, your literature review will probably draw heavily on previous uses of the theory, but you may end up having a special section specifically about cases very close to your own . In other words, the more your study approaches theory testing, the more likely there is to be a set of similar studies to draw on or even one important key study that you are setting your own study up in parallel to in order to find out if the theory generated there operates here.

If we wanted to get very technical, it might be useful to distinguish theoretical frameworks properly from conceptual frameworks. The latter are a bit looser and, given the nature of qualitative research, often fit exploratory studies. Theoretical frameworks rely on specific theories and are essential for theory-testing studies. Conceptual frameworks can pull in specific concepts or ideas that may or may not be linked to particular theories. Think about it this way: A theory is a story of how the world works. Concepts don’t presume to explain the whole world but instead are ways to approach phenomena to help make sense of them. Microaggressions are concepts that are linked to Critical Race Theory. One could contextualize one’s study within Critical Race Theory and then draw various concepts, such as that of microaggressions from the overall theoretical framework. Or one could bracket out the master theory or framework and employ the concept of microaggression more opportunistically as a phenomenon of interest. If you are unsure of what theory you are using, you might want to frame a more practical conceptual framework in your review of the literature.

Helpful Tips

How to maintain good notes for what your read.

Over the years, I have developed various ways of organizing notes on what I read. At first, I used a single sheet of full-size paper with a preprinted list of questions and points clearly addressed on the front side, leaving the second side for more reflective comments and free-form musings about what I read, why it mattered, and how it might be useful for my research. Later, I developed a system in which I use a single 4″ × 6″ note card for each book I read. I try only to use the front side (and write very small), leaving the back for comments that are about not just this reading but things to do or examine or consider based on the reading. These notes often mean nothing to anyone else picking up the card, but they make sense to me. I encourage you to find an organizing system that works for you. Then when you set out to compose a literature review, instead of staring at five to ten books or a dozen articles, you will have ten neatly printed pages or notecards or files that have distilled what is important to know about your reading.

It is also a good idea to store this data digitally, perhaps through a reference manager. I use RefWorks, but I also recommend EndNote or any other system that allows you to search institutional databases. Your campus library will probably provide access to one of these or another system. Most systems will allow you to export references from another manager if and when you decide to move to another system. Reference managers allow you to sort through all your literature by descriptor, author, year, and so on. Even so, I personally like to have the ability to manually sort through my index cards, recategorizing things I have read as I go. I use RefWorks to keep a record of what I have read, with proper citations, so I can create bibliographies more easily, and I do add in a few “notes” there, but the bulk of my notes are kept in longhand.

What kinds of information should you include from your reading? Here are some bulleted suggestions from Calarco ( 2020:113–114 ), with my own emendations:

• Citation . If you are using a reference manager, you can import the citation and then, when you are ready to create a bibliography, you can use a provided menu of citation styles, which saves a lot of time. If you’ve originally formatted in Chicago Style but the journal you are writing for wants APA style, you can change your entire bibliography in less than a minute. When using a notecard for a book, I include author, title, date as well as the library call number (since most of what I read I pull from the library). This is something RefWorks is not able to do, and it helps when I categorize.

I begin each notecard with an “intro” section, where I record the aims, goals, and general point of the book/article as explained in the introductory sections (which might be the preface, the acknowledgments, or the first two chapters). I then draw a bold line underneath this part of the notecard. Everything after that should be chapter specific. Included in this intro section are things such as the following, recommended by Calarco ( 2020 ):

• Key background . “Two to three short bullet points identifying the theory/prior research on which the authors are building and defining key terms.”
• Data/methods . “One or two short bullet points with information about the source of the data and the method of analysis, with a note if this is a novel or particularly effective example of that method.” I use [M] to signal methodology on my notecard, which might read, “[M] Int[erview]s (n-35), B[lack]/W[hite] voters” (I need shorthand to fit on my notecard!).
• Research question . “Stated as briefly as possible.” I always provide page numbers so I can go back and see exactly how this was stated (sometimes, in qualitative research, there are multiple research questions, and they cannot be stated simply).
• Argument/contributions . “Two to three short bullet points briefly describing the authors’ answer to the central research question and its implication for research, theory, and practice.” I use [ARG] for argument to signify the argument, and I make sure this is prominently visible on my notecard. I also provide page numbers here.

For me, all of this fits in the “intro” section, which, if this is a theoretically rich, methodologically sound book, might take up a third or even half of the front page of my notecard. Beneath the bold underline, I report specific findings or particulars of the book as they emerge chapter by chapter. Calarco’s ( 2020 ) next step is the following:

• Key findings . “Three to four short bullet points identifying key patterns in the data that support the authors’ argument.”

All that remains is writing down thoughts that occur upon finishing the article/book. I use the back of the notecard for these kinds of notes. Often, they reach out to other things I have read (e.g., “Robinson reminds me of Crusoe here in that both are looking at the effects of social isolation, but I think Robinson makes a stronger argument”). Calarco ( 2020 ) concludes similarly with the following:

• Unanswered questions . “Two to three short bullet points that identify key limitations of the research and/or questions the research did not answer that could be answered in future research.”

As I mentioned, when I first began taking notes like this, I preprinted pages with prompts for “research question,” “argument,” and so on. This was a great way to remind myself to look for these things in particular. You can do the same, adding whatever preprinted sections make sense to you, given what you are studying and the important aspects of your discipline. The other nice thing about the preprinted forms is that it keeps your writing to a minimum—you cannot write more than the allotted space, even if you might want to, preventing your notes from spiraling out of control. This can be helpful when we are new to a subject and everything seems worth recording!

After years of discipline, I have finally settled on my notecard approach. I have thousands of notecards, organized in several index card filing boxes stacked in my office. On the top right of each card is a note of the month/day I finished reading the item. I can remind myself what I read in the summer of 2010 if the need or desire ever arose to do so…those invaluable notecards are like a memento of what my brain has been up to!

Where to Start Looking for Literature

Your university library should provide access to one of several searchable databases for academic books and articles. My own preference is JSTOR, a service of ITHAKA, a not-for-profit organization that works to advance and preserve knowledge and to improve teaching and learning through the use of digital technologies. JSTOR allows you to search by several keywords and to narrow your search by type of material (articles or books). For many disciplines, the “literature” of the literature review is expected to be peer-reviewed “articles,” but some disciplines will also value books and book chapters. JSTOR is particularly useful for article searching. You can submit several keywords and see what is returned, and you can also narrow your search by a particular journal or discipline. If your discipline has one or two key journals (e.g., the American Journal of Sociology and the American Sociological Review are key for sociology), you might want to go directly to those journals’ websites and search for your topic area. There is an art to when to cast your net widely and when to refine your search, and you may have to tack back and forth to ensure that you are getting all that is relevant but not getting bogged down in all studies that might have some marginal relevance.

Some articles will carry more weight than others, and you can use applications like Google Scholar to see which articles have made and are continuing to make larger impacts on your discipline. Find these articles and read them carefully; use their literature review and the sources cited in those articles to make sure you are capturing what is relevant. This is actually a really good way of finding relevant books—only the most impactful will make it into the citations of journals. Over time, you will notice that a handful of articles (or books) are cited so often that when you see, say, Armstrong and Hamilton ( 2015 ), you know exactly what book this is without looking at the full cite. This is when you know you are in the conversation.

You might also approach a professor whose work is broadly in the area of your interest and ask them to recommend one or two “important” foundational articles or books. You can then use the references cited in those recommendations to build up your literature. Just be careful: some older professors’ knowledge of the literature (and I reluctantly add myself here) may be a bit outdated! It is best that the article or book whose references and sources you use to build your body of literature be relatively current.

Keep a List of Your Keywords

When using searchable databases, it is a good idea to keep a list of all the keywords you use as you go along so that (1) you do not needlessly duplicate your efforts and (2) you can more easily adjust your search as you get a better sense of what you are looking for. I suggest you keep a separate file or even a small notebook for this and you date your search efforts.

Here’s an example:

Table 9.2. Keep a List of Your Keywords

Think Laterally

How to find the various strands of literature to combine? Don’t get stuck on finding the exact same research topic you think you are interested in. In the female gymnast example, I recommended that my student consider looking for studies of ballerinas, who also suffer sports injuries and around whom there is a similar culture of silence. It turned out that there was in fact research about my student’s particular questions, just not about the subjects she was interested in. You might do something similar. Don’t get stuck looking for too direct literature but think about the broader phenomenon of interest or analogous cases.

Read Outside the Canon

Some scholars’ work gets cited by everyone all the time. To some extent, this is a very good thing, as it helps establish the discipline. For example, there are a lot of “Bourdieu scholars” out there (myself included) who draw ideas, concepts, and quoted passages from Bourdieu. This makes us recognizable to one another and is a way of sharing a common language (e.g., where “cultural capital” has a particular meaning to those versed in Bourdieusian theory). There are empirical studies that get cited over and over again because they are excellent studies but also because there is an “echo chamber effect” going on, where knowing to cite this study marks you as part of the club, in the know, and so on. But here’s the problem with this: there are hundreds if not thousands of excellent studies out there that fail to get appreciated because they are crowded out by the canon. Sometimes this happens because they are published in “lower-ranked” journals and are never read by a lot of scholars who don’t have time to read anything other than the “big three” in their field. Other times this happens because the author falls outside of the dominant social networks in the field and thus is unmentored and fails to get noticed by those who publish a lot in those highly ranked and visible spaces. Scholars who fall outside the dominant social networks and who publish outside of the top-ranked journals are in no way less insightful than their peers, and their studies may be just as rigorous and relevant to your work, so it is important for you to take some time to read outside the canon. Due to how a person’s race, gender, and class operate in the academy, there is also a matter of social justice and ethical responsibility involved here: “When you focus on the most-cited research, you’re more likely to miss relevant research by women and especially women of color, whose research tends to be under-cited in most fields. You’re also more likely to miss new research, research by junior scholars, and research in other disciplines that could inform your work. Essentially, it is important to read and cite responsibly, which means checking that you’re not just reading and citing the same white men and the same old studies that everyone has cited before you” ( Calarco 2020:112 ).

Consider Multiple Uses for Literature

Throughout this chapter, I’ve referred to the literature of interest in a rather abstract way, as what is relevant to your study. But there are many different ways previous research can be relevant to your study. The most basic use of the literature is the “findings”—for example, “So-and-so found that Canadian working-class students were concerned about ‘fitting in’ to the culture of college, and I am going to look at a similar question here in the US.” But the literature may be of interest not for its findings but theoretically—for example, employing concepts that you want to employ in your own study. Bourdieu’s definition of social capital may have emerged in a study of French professors, but it can still be relevant in a study of, say, how parents make choices about what preschools to send their kids to (also a good example of lateral thinking!).

If you are engaged in some novel methodological form of data collection or analysis, you might look for previous literature that has attempted that. I would not recommend this for undergraduate research projects, but for graduate students who are considering “breaking the mold,” find out if anyone has been there before you. Even if their study has absolutely nothing else in common with yours, it is important to acknowledge that previous work.

Describing Gaps in the Literature

First, be careful! Although it is common to explain how your research adds to, builds upon, and fills in gaps in the previous research (see all four literature review examples in this chapter for this), there is a fine line between describing the gaps and misrepresenting previous literature by failing to conduct a thorough review of the literature. A little humility can make a big difference in your presentation. Instead of “This is the first study that has looked at how firefighters juggle childcare during forest fire season,” say, “I use the previous literature on how working parents juggling childcare and the previous ethnographic studies of firefighters to explore how firefighters juggle childcare during forest fire season.” You can even add, “To my knowledge, no one has conducted an ethnographic study in this specific area, although what we have learned from X about childcare and from Y about firefighters would lead us to expect Z here.” Read more literature review sections to see how others have described the “gaps” they are filling.

Use Concept Mapping

Concept mapping is a helpful tool for getting your thoughts in order and is particularly helpful when thinking about the “literature” foundational to your particular study. Concept maps are also known as mind maps, which is a delightful way to think about them. Your brain is probably abuzz with competing ideas in the early stages of your research design. Write/draw them on paper, and then try to categorize and move the pieces around into “clusters” that make sense to you. Going back to the gymnasts example, my student might have begun by jotting down random words of interest: gymnasts * sports * coaches * female gymnasts * stress * injury * don’t complain * women in sports * bad coaching * anxiety/stress * careers in sports * pain. She could then have begun clustering these into relational categories (bad coaching, don’t complain culture) and simple “event” categories (injury, stress). This might have led her to think about reviewing literature in these two separate aspects and then literature that put them together. There is no correct way to draw a concept map, as they are wonderfully specific to your mind. There are many examples you can find online.

Ask Yourself, “How Is This Sociology (or Political Science or Public Policy, Etc.)?”

Rubin ( 2021:82 ) offers this suggestion instead of asking yourself the “So what?” question to get you thinking about what bridges there are between your study and the body of research in your particular discipline. This is particularly helpful for thinking about theory. Rubin further suggests that if you are really stumped, ask yourself, “What is the really big question that all [fill in your discipline here] care about?” For sociology, it might be “inequality,” which would then help you think about theories of inequality that might be helpful in framing your study on whatever it is you are studying—OnlyFans? Childcare during COVID? Aging in America? I can think of some interesting ways to frame questions about inequality for any of those topics. You can further narrow it by focusing on particular aspects of inequality (Gender oppression? Racial exclusion? Heteronormativity?). If your discipline is public policy, the big questions there might be, How does policy get enacted, and what makes a policy effective? You can then take whatever your particular policy interest is—tax reform, student debt relief, cap-and-trade regulations—and apply those big questions. Doing so would give you a handle on what is otherwise an intolerably vague subject (e.g., What about student debt relief?).

Sometimes finding you are in new territory means you’ve hit the jackpot, and sometimes it means you’ve traveled out of bounds for your discipline. The jackpot scenario is wonderful. You are doing truly innovative research that is combining multiple literatures or is addressing a new or under-examined phenomenon of interest, and your research has the potential to be groundbreaking. Congrats! But that’s really hard to do, and it might be more likely that you’ve traveled out of bounds, by which I mean, you are no longer in your discipline . It might be that no one has written about this thing—at least within your field— because no one in your field actually cares about this topic . ( Rubin 2021:83 ; emphases added)

Don’t Treat This as a Chore

Don’t treat the literature review as a chore that has to be completed, but see it for what it really is—you are building connections to other researchers out there. You want to represent your discipline or area of study fairly and adequately. Demonstrate humility and your knowledge of previous research. Be part of the conversation.

Supplement: Two More Literature Review Examples

Elites by harvey ( 2011 ).

In the last two decades, there has been a small but growing literature on elites. In part, this has been a result of the resurgence of ethnographic research such as interviews, focus groups, case studies, and participant observation but also because scholars have become increasingly interested in understanding the perspectives and behaviors of leaders in business, politics, and society as a whole. Yet until recently, our understanding of some of the methodological challenges of researching elites has lagged behind our rush to interview them.

There is no clear-cut definition of the term elite, and given its broad understanding across the social sciences, scholars have tended to adopt different approaches. Zuckerman (1972) uses the term ultraelites to describe individuals who hold a significant amount of power within a group that is already considered elite. She argues, for example, that US senators constitute part of the country’s political elite but that among them are the ultraelites: a “subset of particularly powerful or prestigious influentials” (160). She suggests that there is a hierarchy of status within elite groups. McDowell (1998) analyses a broader group of “professional elites” who are employees working at different levels for merchant and investment banks in London. She classifies this group as elite because they are “highly skilled, professionally competent, and class-specific” (2135). Parry (1998:2148) uses the term hybrid elites in the context of the international trade of genetic material because she argues that critical knowledge exists not in traditional institutions “but rather as increasingly informal, hybridised, spatially fragmented, and hence largely ‘invisible,’ networks of elite actors.” Given the undertheorization of the term elite, Smith (2006) recognizes why scholars have shaped their definitions to match their respondents . However, she is rightly critical of the underlying assumption that those who hold professional positions necessarily exert as much influence as initially perceived. Indeed, job titles can entirely misrepresent the role of workers and therefore are by no means an indicator of elite status (Harvey 2010).

Many scholars have used the term elite in a relational sense, defining them either in terms of their social position compared to the researcher or compared to the average person in society (Stephens 2007). The problem with this definition is there is no guarantee that an elite subject will necessarily translate this power and authority in an interview setting. Indeed, Smith (2006) found that on the few occasions she experienced respondents wanting to exert their authority over her, it was not from elites but from relatively less senior workers. Furthermore, although business and political elites often receive extensive media training, they are often scrutinized by television and radio journalists and therefore can also feel threatened in an interview, particularly in contexts that are less straightforward to prepare for such as academic interviews. On several occasions, for instance, I have been asked by elite respondents or their personal assistants what they need to prepare for before the interview, which suggests that they consider the interview as some form of challenge or justification for what they do.

In many cases, it is not necessarily the figureheads or leaders of organizations and institutions who have the greatest claim to elite status but those who hold important social networks, social capital, and strategic positions within social structures because they are better able to exert influence (Burt 1992; Parry 1998; Smith 2005; Woods 1998). An elite status can also change, with people both gaining and losing theirs over time. In addition, it is geographically specific, with people holding elite status in some but not all locations. In short, it is clear that the term elite can mean many things in different contexts, which explains the range of definitions. The purpose here is not to critique these other definitions but rather to highlight the variety of perspectives.

When referring to my research, I define elites as those who occupy senior-management- and board-level positions within organizations. This is a similar scope of definition to Zuckerman’s (1972) but focuses on a level immediately below her ultraelite subjects. My definition is narrower than McDowell’s (1998) because it is clear in the context of my research that these people have significant decision-making influence within and outside of the firm and therefore present a unique challenge to interview. I deliberately use the term elite more broadly when drawing on examples from the theoretical literature in order to compare my experiences with those who have researched similar groups.

”Changing Dispositions among the Upwardly Mobile” by Curl, Lareau, and Wu ( 2018 )

There is growing interest in the role of cultural practices in undergirding the social stratification system. For example, Lamont et al. (2014) critically assess the preoccupation with economic dimensions of social stratification and call for more developed cultural models of the transmission of inequality. The importance of cultural factors in the maintenance of social inequality has also received empirical attention from some younger scholars, including Calarco (2011, 2014) and Streib (2015). Yet questions remain regarding the degree to which economic position is tied to cultural sensibilities and the ways in which these cultural sensibilities are imprinted on the self or are subject to change. Although habitus is a core concept in Bourdieu’s theory of social reproduction, there is limited empirical attention to the precise areas of the habitus that can be subject to change during upward mobility as well as the ramifications of these changes for family life.

In Bourdieu’s (1984) highly influential work on the importance of class-based cultural dispositions, habitus is defined as a “durable system of dispositions” created in childhood. The habitus provides a “matrix of perceptions” that seems natural while also structuring future actions and pathways. In many of his writings, Bourdieu emphasized the durability of cultural tastes and dispositions and did not consider empirically whether these dispositions might be changed or altered throughout one’s life (Swartz 1997). His theoretical work does permit the possibility of upward mobility and transformation, however, through the ability of the habitus to “improvise” or “change” due to “new experiences” (Friedman 2016:131). Researchers have differed in opinion on the durability of the habitus and its ability to change (King 2000). Based on marital conflict in cross-class marriages, for instance, Streib (2015) argues that cultural dispositions of individuals raised in working-class families are deeply embedded and largely unchanging. In a somewhat different vein, Horvat and Davis (2011:152) argue that young adults enrolled in an alternative educational program undergo important shifts in their self-perception, such as “self-esteem” and their “ability to accomplish something of value.” Others argue there is variability in the degree to which habitus changes dependent on life experience and personality (Christodoulou and Spyridakis 2016). Recently, additional studies have investigated the habitus as it intersects with lifestyle through the lens of meaning making (Ambrasat et al. 2016). There is, therefore, ample discussion of class-based cultural practices in self-perception (Horvat and Davis 2011), lifestyle (Ambrasat et al. 2016), and other forms of taste (Andrews 2012; Bourdieu 1984), yet researchers have not sufficiently delineated which aspects of the habitus might change through upward mobility or which specific dimensions of life prompt moments of class-based conflict.

Bourdieu (1999:511; 2004) acknowledged simmering tensions between the durable aspects of habitus and those aspects that have been transformed—that is, a “fractured” or “cleft” habitus. Others have explored these tensions as a “divided” or “fragmented” habitus (Baxter and Britton 2001; Lee and Kramer 2013). Each of these conceptions of the habitus implies that changes in cultural dispositions are possible but come with costs. Exploration of the specific aspects of one’s habitus that can change and generate conflict contributes to this literature.

Scholars have also studied the costs associated with academic success for working-class undergraduates (Hurst 2010; Lee and Kramer 2013; London 1989; Reay 2017; Rondini 2016; Stuber 2011), but we know little about the lasting effects on adults. For instance, Lee and Kramer (2013) point to cross-class tensions as family and friends criticize upwardly mobile individuals for their newly acquired cultural dispositions. Documenting the tension many working-class students experience with their friends and families of origin, they find that the source of their pain or struggle is “shaped not only by their interactions with non-mobile family and friends but also within their own minds, by their own assessments of their social positions, and by how those positions are interpreted by others” (Lee and Kramer 2013:29). Hurst (2010) also explores the experiences of undergraduates who have been academically successful and the costs associated with that success. She finds that decisions about “class allegiance and identity” are required aspects of what it means to “becom[e] educated” (4) and that working-class students deal with these cultural changes differently. Jack (2014, 2016) also argues that there is diversity among lower-income students, which yields varied college experiences. Naming two groups, the “doubly disadvantaged” and the “privileged poor,” he argues that previous experience with “elite environments” (2014:456) prior to college informs students’ ability to take on dominant cultural practices, particularly around engagement, such as help seeking or meeting with professors (2016). These studies shed light on the role college might play as a “lever for mobility” (2016:15) and discuss the pain and difficulty associated with upward mobility among undergraduates, but the studies do not illuminate how these tensions unfold in adulthood. Neither have they sufficiently addressed potential enduring tensions with extended family members as well as the specific nature of the difficulties.

Some scholars point to the positive outcomes upwardly mobile youth (Lehmann 2009) and adults (Stuber 2005) experience when they maintain a different habitus than their newly acquired class position, although, as Jack (2014, 2016) shows, those experiences may vary depending on one’s experience with elite environments in their youth. Researchers have not sufficiently explored the specific aspects of the habitus that upwardly mobile adults change or the conflicts that emerge with family and childhood friends as they reach adulthood and experience colliding social worlds. We contribute to this scholarship with clear examples of self-reported changes to one’s cultural dispositions in three specific areas: “horizons,” food and health, and communication. We link these changes to enduring tension with family members, friends, and colleagues and explore varied responses to this tension based on race.

Further Readings

Bloomberg, Linda Dale, and Marie F. Volpe. 2012. Completing Your Qualitative Dissertation: A Road Map from Beginning to End . 2nd ed. Thousand Oaks, CA: SAGE. In keeping with its general approach to qualitative research, includes a “road map” for conducting a literature review.

Hart, Chris. 1998. Doing a Literature Review: Releasing the Social Science Research Imagination . London: SAGE. A how-to book dedicated entirely to conducting a literature review from a British perspective. Useful for both undergraduate and graduate students.

Machi, Lawrence A., and Brenda T. McEvoy. 2022. The Literature Review: Six Steps to Success . 4th ed. Newbury Park, CA: Corwin. A well-organized guidebook complete with reflection sections to prompt successful thinking about your literature review.

Ridley, Diana. 2008. The Literature Review: A Step-by-Step Guide for Students . London: SAGE. A highly recommended companion to conducting a literature review for doctoral-level students.

The process of systematically searching through pre-existing studies (“literature”) on the subject of research; also, the section of a presentation in which the pre-existing literature is discussed.

Follow-up questions used in a semi-structured interview  to elicit further elaboration.  Suggested prompts can be included in the interview guide  to be used/deployed depending on how the initial question was answered or if the topic of the prompt does not emerge spontaneously.

A tool for identifying relationships among ideas by visually representing them on paper.  Most concept maps depict ideas as boxes or circles (also called nodes), which are structured hierarchically and connected with lines or arrows (also called arcs). These lines are labeled with linking words and phrases to help explain the connections between concepts.  Also known as mind mapping.

The people who are the subjects of an interview-based qualitative study. In general, they are also known as the participants, and for purposes of IRBs they are often referred to as the human subjects of the research.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

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.

The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Introduction

What is a literature review?

What does a literature review look like, how can i conduct a literature review, how do i analyze a literature review, how do i write a literature review.

• Research question
• Conceptual framework
• Conceptual vs. theoretical framework
• Data collection
• Qualitative research methods
• Focus groups
• Observational research
• Case studies
• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Literature reviews

The literature review might be among the least romantic parts of research. However, the importance of understanding and synthesizing relevant literature in helping establish the research question for your study cannot be overstated.

To emphasize the importance of a literature review, writing a literature review, and incorporating literature reviews in research, let's examine its place in scholarly inquiry.

Foundations of scholarly literature

In mainstream research, a researcher shares their research in a paper that appears in a journal article, book chapter, thesis, or dissertation. Novel and interesting research is more likely to be published as peer-reviewed articles .

A researcher needs to be able to write a literature review that persuades scholars that their work is original and important. Put differently, a literature review is how researchers familiarize themselves with current conversation concerning their research topic and demonstrate that they are contributing something new and interesting to this conversation.

What is the purpose of a literature review?

A good literature review can help you critically evaluate current knowledge and key concepts around current knowledge and key concepts within a particular topic. A researcher should provide an overview of relevant research and demonstrate they understand the knowledge surrounding their inquiry to generate new understanding.

Identifying a research gap

Literature reviews can identify which developments occurred and where a gap or puzzle remains that can be informed by further inquiry. For example, current research may assert that a sufficient amount of sleep benefits athletes in sports like basketball and soccer. At the same time, other researchers have reached the same conclusion in tennis and golf. However, if a researcher believes rugby players might have different sleep needs, there is a gap in the literature if no one has conducted a study specific to rugby.

Various gaps can be uncovered in a literature review. Examples include:

• A lack of research in a particular context that cannot be explained by existing theory, such as an unexamined geographical area or group of people
• A focus on certain theories or methodologies while overlooking others that can explain an unresolved puzzle
• An absence of studies after a certain time period or the occurrence of a significant event that challenges existing assumptions or understanding

Summarizing themes and patterns

Literature reviews can help develop theory by synthesizing and building on existing knowledge. This is an approach to knowledge called synthesis. A literature review helps draw connections across various studies and brings insights that individual papers may not be able to provide.

Writing for your audience

To publish in a peer-reviewed journal, you should also consider how reviewers and readers will see your work to ensure your research gets accepted for publication and is read widely by your target audience.

Reviewers for an academic journal want to know if the author of a paper understands the theories and work in his or her field. Thus, a researcher must summarize the key ideas, theories, and knowledge relevant to the theories or knowledge under discussion. A reviewer may not find the author credible if they do not demonstrate a comprehensive understanding of certain developments central to the research area.

Students may also be asked to report on relevant literature to demonstrate knowledge of the field and critical analysis skills. Well-structured paragraphs and sections convey that you understand your topic and that your approach makes sense. These skills are fundamental in a thesis or dissertation. Students are often expected to write an entire dissertation chapter providing a summary of the existing research and different aspects that can inform further research.

ATLAS.ti helps you make sense of research.

Download a free trial of our qualitative data analysis software to see how it can work for you.

The shape of your literature review will depend on your research objectives. A written literature review can either be part of a larger research paper or stand alone as its own study.

A literature review section

A typical, original research paper begins with reviewing the literature to justify the novelty and importance of the inquiry being undertaken. For example, imagine that the author wants to examine the study habits of university students heavily engaged in social media. How does the author know other researchers haven't already explored the topic? And if they did, how can the author contribute new and interesting insights to move understanding further?

A background section in a larger paper should summarize the relevant, existing research to answer these questions. By examining studies on study habits and social media use, the author can demonstrate they have thoroughly surveyed the field to determine if and how further research can meaningfully expand understanding.

A stand-alone literature review

A review can also be a full-length paper. As stand-alone papers, they present a secondary analysis of a series of discrete but related studies in which the researcher provides their own interpretations on the overarching topic.

Remember that writing this type of paper is similar to writing a full paper on your own research project, and peer reviewers will evaluate it as such. A full research paper typically requires a description of the research methodology and the author's specific theoretical approach to analyzing the studies . A clear account of how the author conducted the analysis makes the key findings more credible.

You need not read all of the available theoretical and empirical scholarship to identify recurring central themes or important trends. A review merely samples the most relevant studies to generate key insights after summarizing sources.

Put simply, the researcher needs to collect written studies. There is no minimum number of required studies that constitute a good literature search, as it varies depending on the topic, the research question , and the amount of discussion that already exists on your subject.

In general, relevant sources include academic journals and monographs. Journals are easily searchable via library databases and online search engines like Google Scholar, which may even lead you to downloadable PDFs of full articles. Scholars may also make their papers available on websites like Academia.edu and ResearchGate.

Look for scholars who are well-known in their field. One quick way to identify key experts in your area is to search for highly cited papers and researchers. They can provide fundamental theories and findings critical to your review and link to previous, useful literature.

It's also important to emphasize recent studies in your collection. Especially in the social sciences, developments within the last five years may have opened up new insights or approaches that are important to consider. Later studies may have already challenged or refuted older papers, diminishing their potential contribution to your inquiry.

Other sources of research can include conference proceedings, university bulletins, unpublished theses, and any other publication available for other scholars to read. You may also incorporate records from cultural sources, theoretical discussions in presentations, or newspaper articles.

Keep in mind, however, that scholars take peer-reviewed publications like journal articles more seriously. On the other hand, if you are studying an underdeveloped topic with few published studies, you can consider other information sources to demonstrate a need for further research and discussion on your specific topic.

Organize your data all in one place.

Text files, PDFs, videos, and pictures. ATLAS.ti helps you analyze them all. See how with a free trial.

A good analysis should have a deliberate methodological approach. In other words, a review is more than just a report of relevant research from scholarly articles. A researcher writing a literature review needs to synthesize the existing knowledge and key debates from the collected studies.

Thematic review

Simply put, a thematic literature review aims to identify key themes or concepts that frequently appear in the collected studies. If your inquiry revolves around study tools, for example, what tools appear to be studied more often than others? Perhaps technology like computers and tablets appear often in studies, while newer devices such as virtual reality headsets and other wearable technology are given less focus.

Understanding what topics have already been studied in abundance can help you make an argument about what researchers should explore next. Prominent themes provide a helpful guide for identifying important trends and turning points in research.

As a result, your literature review can benefit from an annotated bibliography , which is a systematic organization of the research papers in your analysis. Many bibliographies include summaries of each study and a checklist of data points (e.g., does the study mention computers, handheld devices, or wearable technology?) to provide a visualization of your analysis.

Quantitative analysis

As mentioned earlier, identifying gaps or unresolved puzzles is a common rationale for writing a literature review. Examples of knowledge gaps include underexplored aspects of theory, lack of discussion in particular contexts, and underutilized research methods.

A quantitative analysis of the literature can help illustrate these gaps. For example, you can argue for a methodological gap among your collected studies. In a set of 40 papers, if 25 involve studies based on interviews and another 10 are based on surveys , you can argue that further observational research is necessary.

Writing a literature review involves discussing your collected studies by describing prominent themes, theoretical or empirical aspects that are missing or underexplored, or a combination of both. Remember that a key goal is to demonstrate your knowledge of the most recent and important developments in the field.

Examine the thematic codes in your project to determine which themes are most apparent and which elements remain underexamined. You can use these code frequencies in your written report to explain the extent or absence of theoretical development in the field (e.g., "Bus transportation is mentioned in only 7% (14 times) of the collected literature, demonstrating a lack of research on what people think about using buses for commuting.").

The goal of the writing process is not to exhaustively detail every study but to describe the most apparent trends or missing information. Select 3-5 themes that arise from the codes and describe each in detail, citing studies from the collected literature as key examples.

From a presentation of these themes, you can make an assertion about the need for novel research inquiry. Using the identified themes to represent a coherent whole, analyze and identify the overlooked areas of research that your own work can address.

Ultimately, most scholarly research is published based on whether that research contributes something novel and interesting to the current conversation around the topic. As a result, a rigorous literature review presents multiple sources of significant studies revolving around the same research topic. It presents a compelling argument about what such studies have yet to explore.

From research question to findings, make it happen with ATLAS.ti.

All the tools you need at every step of the research process. Try ATLAS.ti with a free trial.

How to Operate Literature Review Through Qualitative and Quantitative Analysis Integration?

• Conference paper
• First Online: 05 May 2022
• Cite this conference paper

• Eduardo Amadeu Dutra Moresi   ORCID: orcid.org/0000-0001-6058-3883 13 ,
• Isabel Pinho   ORCID: orcid.org/0000-0003-1714-8979 14 &
• António Pedro Costa   ORCID: orcid.org/0000-0002-4644-5879 14  

Part of the book series: Lecture Notes in Networks and Systems ((LNNS,volume 466))

Included in the following conference series:

• World Conference on Qualitative Research

453 Accesses

2 Citations

Usually, a literature review takes time and becomes a demanding step in any research project. The proposal presented in this article intends to structure this work in an organised and transparent way for all project participants and the structured elaboration of its report. Integrating qualitative and quantitative analysis provides opportunities to carry out a solid, practical, and in-depth literature review. The purpose of this article is to present a guide that explores the potentials of qualitative and quantitative analysis integration to develop a solid and replicable literature review. The paper proposes an integrative approach comprising six steps: 1) research design; 2) Data Collection for bibliometric analysis; 3) Search string refinement; 4) Bibliometric analysis; 5) qualitative analysis; and 6) report and dissemination of research results. These guidelines can facilitate the bibliographic analysis process and relevant article sample selection. Once the sample of publications is defined, it is possible to conduct a deep analysis through Content Analysis. Software tools, such as R Bibliometrix, VOSviewer, Gephi, yEd and webQDA, can be used for practical work during all collection, analysis, and reporting processes. From a large amount of data, selecting a sample of relevant literature is facilitated by interpreting bibliometric results. The specification of the methodology allows the replication and updating of the literature review in an interactive, systematic, and collaborative way giving a more transparent and organised approach to improving the literature review.

• Quantitative analysis
• Qualitative analysis
• Bibliometric analysis
• Science mapping

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Pritchard, A.: Statistical bibliography or bibliometrics? J. Doc. 25 (4), 348–349 (1969)

Google Scholar  

Nalimov, V., Mulcjenko, B.: Measurement of Science: Study of the Development of Science as an Information Process. Foreign Technology Division, Washington DC (1971)

Hugar, J.G., Bachlapur, M.M., Gavisiddappa, A.: Research contribution of bibliometric studies as reflected in web of science from 2013 to 2017. Libr. Philos. Pract. (e-journal), 1–13 (2019). https://digitalcommons.unl.edu/libphilprac/2319

Verma, M.K., Shukla, R.: Library herald-2008–2017: a bibliometric study. Libr. Philos. Pract. (e-journal), 2–12 (2018). https://digitalcommons.unl.edu/libphilprac/1762

Pandita, R.: Annals of library and information studies (ALIS) journal: a bibliometric study (2002–2012). DESIDOC J. Libr. Inf. Technol. 33 (6), 493–497 (2013)

Article   Google Scholar  

Kannan, P., Thanuskodi, S.: Bibliometric analysis of library philosophy and practice: a study based on scopus database. Libr. Philos. Pract. (e-journal), 1–13 (2019). https://digitalcommons.unl.edu/libphilprac/2300/

Marín-Marín, J.-A., Moreno-Guerrero, A.-J., Dúo-Terrón, P., López-Belmonte, J.: STEAM in education: a bibliometric analysis of performance and co-words in Web of Science. Int. J. STEM Educ. 8 (1) (2021). Article number 41

Khalife, M.A., Dunay, A., Illés, C.B.: Bibliometric analysis of articles on project management research. Periodica Polytechnica Soc. Manag. Sci. 29 (1), 70–83 (2021)

Pech, G., Delgado, C.: Screening the most highly cited papers in longitudinal bibliometric studies and systematic literature reviews of a research field or journal: widespread used metrics vs a percentile citation-based approach. J. Informet. 15 (3), 101161 (2021)

Das, D.: Journal of informetrics: a bibliometric study. Libr. Philos. Pract. (e-journal), 1–15 (2021). https://digitalcommons.unl.edu/libphilprac/5495/

Schmidt, F.: Meta-analysis: a constantly evolving research integration tool. Organ. Res. Methods 11 (1), 96–113 (2008)

Zupic, I., Cater, T.: Bibliometric methods in management organisation. Organ. Res. Methods 18 (3), 429–472 (2014)

Noyons, E., Moed, H., Luwel, M.: Combining mapping and citation analysis for evaluative bibliometric purposes: a bibliometric study. J. Am. Soc. Inf. Sci. 50 , 115–131 (1999)

van Rann, A.: Measuring science. Capita selecta of current main issues. In: Moed, H., Glänzel, W., Schmoch, U. (eds.) Handbook of Quantitative Science and Technology Research, pp. 19–50. Kluwer Academic, Dordrecht (2004)

Chapter   Google Scholar  

Garfield, E.: Citation analysis as a tool in journal evaluation. Science 178 , 417–479 (1972)

Hirsch, J.: An index to quantify an individuals scientific research output. In: Proceedings of the National Academy of Sciences, vol. 102, pp. 16569–1657. National Academy of Sciences, Washington DC (2005)

Cobo, M., López-Herrera, A., Herrera-Viedma, E., Herrera, F.: Science mapping software tools: review, analysis and cooperative study among tools. J. Am. Soc. Inform. Sci. Technol. 62 , 1382–1402 (2011)

Noyons, E., Moed, H., van Rann, A.: Integrating research perfomance analysis and science mapping. Scientometrics 46 , 591–604 (1999)

Donthu, N., Kumar, S., Mukherjee, D., Pandey, N., Lim, W.M.: How to conduct a bibliometric analysis: an overview and guidelines. J. Bus. Res. 133 , 285–296 (2021)

Aria, M., Cuccurullo, C.: Bibliometrix: an R-tool for comprehensive science mapping analysis. J. Informet. 11 (4), 959–975 (2017)

Aria, M., Cuccurullo, C.: Package ‘bibliometrix’. https://cran.r-project.org/web/packages/bibliometrix/bibliometrix.pdf . Accessed 10 July 2021

Börner, K., Chen, C., Boyack, K.: Visualisingg knowledge domains. Ann. Rev. Inf. Sci. Technol. 37 , 179–255 (2003)

Morris, S., van der Veer Martens, B.: Mapping research specialities. Ann. Rev. Inf. Sci. Technol. 42 , 213–295 (2008)

Zitt, M., Ramanana-Rahary, S., Bassecoulard, E.: Relativity of citation performance and excellence measures: from cross-field to cross-scale effects of field-normalisation. Scientometrics 63 (2), 373–401 (2005)

Li, L.L., Ding, G., Feng, N., Wang, M.-H., Ho, Y.-S.: Global stem cell research trend: bibliometric analysis as a tool for mapping trends from 1991 to 2006. Scientometrics 80 (1), 9–58 (2009)

Ebrahim, A.N., Salehi, H., Embi, M.A., Tanha, F.H., Gholizadeh, H., Motahar, S.M.: Visibility and citation impact. Int. Educ. Stud. 7 (4), 120–125 (2014)

Canas-Guerrero, I., Mazarrón, F.R., Calleja-Perucho, C., Pou-Merina, A.: Bibliometric analysis in the international context of the “construction & building technology” category from the web of science database. Constr. Build. Mater. 53 , 13–25 (2014)

Gaviria-Marin, M., Merigó, J.M., Baier-Fuentes, H.: Knowledge management: a global examination based on bibliometric analysis. Technol. Forecast. Soc. Chang. 140 , 194–220 (2019)

Heradio, R., Perez-Morago, H., Fernandez-Amoros, D., Javier Cabrerizo, F., Herrera-Viedma, E.: A bibliometric analysis of 20 years of research on software product lines. Inf. Softw. Technol. 72 , 1–15 (2016)

Furstenau, L.B., et al.: Link between sustainability and industry 4.0: trends, challenges and new perspectives. IEEE Access 8 , 140079–140096 (2020). Article 9151934

van Eck, N.J., Waltman, L.: VOSviewer manual. Universiteit Leiden, Leiden (2021)

Bastian, M., Heymann, S., Jacomy, M.: Gephi: an open source software for exploring and manipulating networks. In: Proceedings of the Third International ICWSM Conference, pp. 361–362. Association for the Advancement of Artificial Intelligence, San Jose CA (2009)

Chen, C.: How to use CiteSpace. Leanpub, Victoria, British Columbia, CA (2019)

yWorks.: yEd Graph Editor Manual. https://yed.yworks.com/support/manual/index.html . Accessed 13 July 2020

Moresi, E.A.D., Pierozzi Júnior, I.: Representação do conhecimento para ciência e tecnologia: construindo uma sistematização metodológica. In: 16th International Conference on Information Systems and Technology Management, TECSI, São Paulo SP (2019). Article 6275

Moresi, E.A.D., Pinho, I.: Proposta de abordagem para refinamento de pesquisa bibliográfica. New Trends Qual. Res. 9 , 11–20 (2021)

Moresi, E.A.D., Pinho, I.: Como identificar os tópicos emergentes de um tema de investigação? New Trends Qual. Res. 9 , 46–55 (2021)

Chen, Y.H., Chen, C.Y., Lee, S.C.: Technology forecasting of new clean energy: the example of hydrogen energy and fuel cell. Afr. J. Bus. Manag. 4 (7), 1372–1380 (2010)

Ernst, H.: The use of patent data for technological forecasting: the diffusion of CNC-technology in the machine tool industry. Small Bus. Econ. 9 (4), 361–381 (1997)

Chen, C.: Science mapping: a systematic review of the literature. J. Data Inf. Sci. 2 (2), 1–40 (2017)

Prabhakaran, T., Lathabai, H.H., Changat, M.: Detection of paradigm shifts and emerging fields using scientific network: a case study of information technology for engineering. Technol. Forecast. Soc. Change 91 , 124–145 (2015)

Klavans, R., Boyack, K.W.: Identifying a better measure of relatedness for mapping science. J. Am. Soc. Inf. Sci. 57 (2), 251–263 (2006)

Kauffman, J., Kittas, A., Bennett, L., Tsoka, S.: DyCoNet: a Gephi plugin for community detection in dynamic complex networks. PLoS ONE 9 (7), e101357 (2014)

Grant, M.J., Booth, A.: A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info. Libr. J. 26 (2), 91–108 (2009)

Costa, A.P., Soares, C.B., Fornari, L., Pinho, I.: Revisão da Literatura com Apoio de Software - Contribuição da Pesquisa Qualitativa. Ludomedia, Aveiro Portugal (2019)

Tranfield, D., Denyer, D., Smart, P.: Towards a methodology for developing evidence-informed management knowledge by means of systematic review. Br. J. Manag. 14 (3), 207–222 (2003)

Costa, A.P., Amado, J.: Content Analysis Supported by Software. Ludomedia, Oliveira de Azeméis - Aveiro - Portugal (2018)

Pinho, I., Leite, D.: Doing a literature review using content analysis - research networks review. In: Atas CIAIQ 2014 - Investigação Qualitativa em Ciências Sociais, vol. 3, pp. 377–378. Ludomedia, Aveiro Portugal (2014)

White, M.D., Marsh, E.E.: Content analysis: a flexible methodology. Libr. Trends 55 (1), 22–45 (2006)

Souza, F.N., Neri, D., Costa, A.P.: Asking questions in the qualitative research context. Qual. Rep. 21 (13), 6–18 (2016)

Pinho, I., Pinho, C., Rosa, M.J.: Research evaluation: mapping the field structure. Avaliação: Revista da Avaliação da Educação Superior (Campinas) 25 , 546–574 (2020)

Costa, A., Moreira, A. de Souza, F.: webQDA - Qualitative Data Analysis (2019). www.webqda.net

Download references

Author information

Authors and affiliations.

Catholic University of Brasília, Brasília, DF, 71966-700, Brazil

Eduardo Amadeu Dutra Moresi

University of Aveiro, 3810-193, Aveiro, Portugal

Isabel Pinho & António Pedro Costa

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Eduardo Amadeu Dutra Moresi .

Editor information

Editors and affiliations.

Department of Education and Psychology, University of Aveiro, Aveiro, Portugal

António Pedro Costa

António Moreira

Department Didactics, Organization and Research Methods, University of Salamanca, Salamanca, Salamanca, Spain

Maria Cruz Sánchez‑Gómez

Adventist University of Africa, Nairobi, Kenya

Safary Wa-Mbaleka

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this paper

Cite this paper.

Moresi, E.A.D., Pinho, I., Costa, A.P. (2022). How to Operate Literature Review Through Qualitative and Quantitative Analysis Integration?. In: Costa, A.P., Moreira, A., Sánchez‑Gómez, M.C., Wa-Mbaleka, S. (eds) Computer Supported Qualitative Research. WCQR 2022. Lecture Notes in Networks and Systems, vol 466. Springer, Cham. https://doi.org/10.1007/978-3-031-04680-3_13

Download citation

DOI : https://doi.org/10.1007/978-3-031-04680-3_13

Published : 05 May 2022

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-04679-7

Online ISBN : 978-3-031-04680-3

eBook Packages : Intelligent Technologies and Robotics Intelligent Technologies and Robotics (R0)

Share this paper

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Literature Review

Literature review is important because it:

• Provides ideas about what should be studied;
• Helps us conduct inquires that have not already been done
• Connects our research to existing studies

But…doing a literature review is not simply summarizing (or copying) what you think is related and useful to your work. BEING CRITICAL AND CAREFUL IS A MUST !

In reviewing existing literature, you may try to look for gaps in the field and rework your study in a different setting or with different people. Nonetheless, literature review is a continuous sense-making process -- you need to review the literature continuously in order to organize your thoughts and refine your analysis.

A good literature review should be able to:  

• Connect to your research questions
• Connect to your choice of methods and research design
• Support your data analysis
• Help you draw conclusions and make claims about your research.

Selecting your literature with a purpose

It is impossible to read everything, so when selecting literature  for reviewing, consider these:

• Is it relevant to your topic/field of study?
• Is it a primary source from the researcher(s) or secondary source (e.g. a summary you read in a book about someone’s research)?
• Is it updated?

Nature of literatures:

Your literature review can be of different dimensions. Each has its foci and purposes

An official website of the United States government

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

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

• Publications
• Account settings

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

• Advanced Search
• Journal List
• v.9(1); 2015 Feb

Qualitative systematic reviews: their importance for our understanding of research relevant to pain

This article outlines what a qualitative systematic review is and explores what it can contribute to our understanding of pain. Many of us use evidence of effectiveness for various interventions when working with people in pain. A good systematic review can be invaluable in bringing together research evidence to help inform our practice and help us understand what works. In addition to evidence of effectiveness, understanding how people with pain experience both their pain and their care can help us when we are working with them to provide care that meets their needs. A rigorous qualitative systematic review can also uncover new understandings, often helping illuminate ‘why’ and can help build theory. Such a review can answer the question ‘What is it like to have chronic pain?’ This article presents the different stages of meta-ethnography, which is the most common methodology used for qualitative systematic reviews. It presents evidence from four meta-ethnographies relevant to pain to illustrate the types of findings that can emerge from this approach. It shows how new understandings may emerge and gives an example of chronic musculoskeletal pain being experienced as ‘an adversarial struggle’ across many aspects of the person’s life. This article concludes that evidence from qualitative systematic reviews has its place alongside or integrated with evidence from more quantitative approaches.

Many of us use evidence of effectiveness for various interventions when working with people in pain. A good systematic review can be invaluable in bringing together research evidence to help inform our practice and help us understand what works. In addition to evidence of effectiveness, understanding how people with pain experience both their pain and their care can help us when we are working with them to provide care that meets their needs. A high-quality qualitative systematic review can also uncover new understandings, often helping illuminate ‘why’ and can help build theory. A qualitative systematic review could answer the question ‘What is it like to have chronic non-malignant pain?’

The purpose of this article is to outline what a qualitative systematic review is and explore what it can contribute to our understanding of pain. A qualitative systematic review brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together. There is a debate over whether the search needs to be exhaustive. 1 , 2 Methods for systematic reviews of quantitative research are well established and explicit and have been pioneered through the Cochrane Collaboration. Methods for qualitative systematic reviews have been developed more recently and are still evolving. The Cochrane Collaboration now has a Qualitative and Implementation Methods Group, including a register of protocols, illustrating the recognition of the importance of qualitative research within the Cochrane Collaboration. In November 2013, an editorial described the Cochrane Collaboration’s first publication of a qualitative systematic review as ‘a new milestone’ for Cochrane. 3 Other editorials have raised awareness of qualitative systematic reviews in health. 4

Noblit and Hare 5 were pioneers in the area of synthesising qualitative data. They describe such reviews as aggregated or as interpretative. The aggregated review summarises the data, and Hannes and Pearson 6 provide a worked example of an aggregation approach. Interpretative approaches, as the name suggests, interpret the data, and from that interpretation, new understandings can develop that may lead to development of a theory that helps us to understand or predict behaviour. Types of interpretative qualitative systematic reviews include meta-ethnography, critical interpretative synthesis, realist synthesis and narrative synthesis. More details about these and other approaches can be found in other papers and books. 1 , 5 , 7 – 11 This article will describe one approach, meta-ethnography, as it was identified as the most frequently used approach, 1 and there are some examples using meta-ethnography that focus on pain. A meta-ethnographic approach can be used with a variety of qualitative methodologies, not only ethnography. The data for a meta-ethnography are the concepts or themes described by the authors of the primary studies.

Noblit and Hare 5 outlined the seven steps of a meta-ethnography: (1) getting started, (2) deciding what is relevant, (3) reading the studies, (4) determining how studies are related to each other, (5) translating studies into each other, (6) synthesising translations and (7) expressing the synthesis.

The first three might seem relatively straightforward, although Lee et al. 12 emphasised both the importance and nuances of the reading stage, and Toye et al. 13 discuss the complexities of making quality assessments of qualitative papers and searching for this type of study. You need to understand what data to extract from the papers and how you are going to do this.

You have to first identify what is a concept and what is purely descriptive. Toye et al. 2 describe a process for collaboratively identifying concepts. In determining how studies are related to each other and translating them into each other, the meta-ethnographer compares the concepts found in each study with each other and then groups similar concepts into conceptual themes. Translating studies into each other involves looking at where concepts between studies agree (reciprocal synthesis) and where they do not agree (refutational synthesis). Developing conceptual categories can be challenging as you need to judge the extent to which a concept from one study adequately reflects concepts from other studies and choose one that seems to fit best. This is discussed in more detail in Toye et al. 2 , 13

To synthesise the translation, a line of argument is then developed from the conceptual categories. How the concepts group and relate to each other are developed. This provides an overall interpretation of the findings, ensuring this is grounded in the data from the primary studies. You are aiming to explain, and new concepts and understandings may emerge, which can then go on to underpin development of theory. For example, a qualitative systematic review that explored medicine taking found that ‘resistance’ was a new concept, revealed through meta-ethnography, and this helped understanding of lay responses to medicine taking. 1 Hannes and Macaitis, 14 in a review of published papers, reported that over time, authors have become more transparent about searching and critical appraisal, but that the synthesis element of reviews is often not well described. Being transparent about decisions that are interpretative has its own challenges. Working collaboratively to challenge interpretations and assumptions can be helpful. 2 , 12 The next section will use examples of qualitative systematic reviews from the pain field to illuminate what this type of review can contribute to our understanding of pain.

What can a qualitative systematic review contribute to the field of pain – some examples

Toye et al. 2 , 15 undertook a meta-ethnography to look at patients’ experiences of chronic non-malignant musculoskeletal pain. At the time of this research, no other qualitative systematic reviews had been published in this area. Their review included 77 papers reporting 60 individual studies, resulting from searches of six electronic bibliographic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and HMIC) from inception until February 2012 and hand-searching key journals from 2001 to 2012.

They developed a new concept which they identified as an ‘adversarial struggle’. This struggle took place across five main dimensions: (1) there was a struggle to affirm themselves, where there was a tension between the ‘real me’ (without pain) and ‘not real me’ (me with pain). (2) The present and future were often unpredictable, and construction of time was altered and they struggled to reconstruct themselves in time. (3) People struggled to find an acceptable explanation for their pain and suffering. (4) There was a struggle to negotiate the healthcare system and (5) a struggle for pain to be seen as legitimate, including the need to be believed, and a struggle to know whether to show or hide their pain. Some people were able to move forward with pain. They saw their body as more integrated, they re-defined what was normal, they told people about their pain, they were part of a community of people with pain and they felt more expert on how their pain affected them and what they could do about it.

So, this meta-ethnography highlighted the adversarial nature of having chronic musculoskeletal pain and how this struggle pervaded many different areas of their life. It also illustrated how by showing patients their pain is understood and being alongside the person in pain, they can start to move forward. A short film based on the 77 papers in this meta-ethnography has been made and is available on YouTube. 16 This film was made as an attempt to disseminate the findings of a meta-ethnography in a way that is accessible to a range of people.

Snelgrove and Liossi 17 undertook a meta-ethnography of qualitative research in chronic low back pain (CLBP) using meta-ethnography. They included 33 papers of 28 studies published between 2000 and 2012. They identified three overarching themes of (1) the impact of CLBP on self, (2) relationships with others (health professionals and family and friends) and (3) coping with CLBP. They found that very few successful coping strategies were reported. Like Toye et al., 2 , 15 they also reported disruption to self, distancing their valued self from their painful self, legitimising pain, the struggle to manage daily living and the importance of social relationships alongside negotiation of their care in the health system.

MacNeela et al. 18 also undertook a meta-ethnography of experiences of CLBP. They included 38 articles published between 1994 and 2012 representing 28 studies. They identified four themes: (1) the undermining influence of pain, (2) the disempowering impact on all levels, (3) unsatisfying relationships with healthcare professionals and (4) learning to live with the pain. They reported the findings being dominated by ‘wide-ranging distress and loss’. They discussed the disempowering consequences of pain and a search for help. However, they also highlighted self-determination and resilience and suggested these could offer ‘pathways to endurance’. They emphasised self-management and adaptation, which resonates with the moving forward category reported by Toye et al. 2 , 15

Froud et al. 19 looked at the impact of low back pain on people’s lives. They describe their approach as meta-ethnographic and meta-narrative. They included 49 papers of about 42 studies from inception of databases searched until July 2011. They described five themes: activities, relationships, work, stigma and changing outlook, which they derived from ‘participant-level data’. They described their findings as showing patients wanted to be believed. They highlighted the importance of social factors when developing relevant outcome measures. There are other examples of qualitative systematic reviews relevant to pain. 20 – 23

Different qualitative systematic reviews on a similar subject may come up with overlapping but also some different findings. This could be, for example, because different search periods or different inclusion criteria are used, so different primary studies may be included in different reviews. In addition, undertaking a qualitative systematic review requires researchers to interpret concepts. This interpretation does not need to be a limitation. For example, to ensure rigour and transparency, Toye et al. 24 report a process of collaborative interpretation of concepts among a team of experienced qualitative researchers to ensure individual interpretations were challenged and remained grounded in the original studies. They also published a detailed audit trail of the processes and decisions made. 2 Campbell et al. 1 argue ‘Meta-ethnography is a highly interpretative method requiring considerable immersion in the individual studies to achieve a synthesis. It places substantial demands upon the synthesiser and requires a high degree of qualitative research skill’. It is important to be able to think conceptually when undertaking a meta-ethnography, and it can be a time-consuming process. However, the ability of a meta-ethnography to synthesise a large number of primary research studies, generate new conceptual understandings and thus increase our understanding of patients’ experiences of pain makes it a very useful resource for our evidence-based practice.

The way forward

A register of qualitative systematic reviews would be useful for researchers and clinicians, so there was a clear way of identifying existing qualitative reviews or reviews that are planned or underway. The Cochrane Collaboration does now have a register for protocols of qualitative systematic reviews being undertaken under the aegis of the Cochrane Qualitative and Implementation Methods Group. It would help those wanting to undertake qualitative systematic reviews if reviews that were underway were registered and described more clearly to prevent duplication of effort, for example, using ‘qualitative systematic review’ and the methodological approach used (such as meta-ethnography) in the title and/or abstract. The Toye et al. 2 protocol 25 was accessible on the National Institutes for Health website from 2010. The Snelgrove and Liossi 17 study was done without external funding, so it would be difficult to pick up that it was underway. The MacNeela et al. 18 study was listed on the Irish Research Council for the Humanities and Social Sciences under their Research Development Initiative 2008–2009, but was described as ‘Motivation and Beliefs among People Experiencing Chronic Low Back Pain’, so it was not clearly identified at that stage as a qualitative systematic review. Finally, the Froud et al. 19 award details 26 do not mention qualitative systematic reviews or meta-ethnography. This highlights the difficulty of finding some of these reviews and the importance of a register of both completed and ongoing reviews.

This article has argued that qualitative systematic reviews have their place alongside or integrated with more quantitative approaches. There is an increasing body of evidence from qualitative systematic reviews. They can synthesise primary research, and this can be helpful for the busy practitioner. The methods for these approaches are still developing, and attention to rigour at each stage is crucial. It is important that each stage of the synthesis is reported transparently and that the researchers’ stance is clearly reported. 27 Meta-ethnographies published over the last year 2 , 15 , 17 – 19 have drawn together a wide range of primary studies and shown that people’s lives can be markedly changed by their pain across multiple dimensions of their life.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

• Locations and Hours
• UCLA Library
• Research Guides
• Biomedical Library Guides

Systematic Reviews

• Types of Literature Reviews

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

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

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

• << Previous: Home
• Next: Planning Your Systematic Review >>
• Last Updated: Mar 1, 2024 10:55 AM
• URL: https://guides.library.ucla.edu/systematicreviews

A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence-Based Practice in Nursing and Health Care

Affiliations.

• 1 PhD candidate, School of Nursing and Midwifey, Monash University, and Clinical Nurse Specialist, Adult and Pediatric Intensive Care Unit, Monash Health, Melbourne, Victoria, Australia.
• 2 Lecturer, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
• 3 Senior Lecturer, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
• PMID: 26790142
• DOI: 10.1111/wvn.12134

Background: The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. Although there are a number of resources available to guide researchers in developing a quantitative review protocol, very few resources exist for qualitative reviews.

Aims: To guide researchers through the process of developing a qualitative systematic review protocol, using an example review question.

Methodology: The key elements required in a systematic review protocol are discussed, with a focus on application to qualitative reviews: Development of a research question; formulation of key search terms and strategies; designing a multistage review process; critical appraisal of qualitative literature; development of data extraction techniques; and data synthesis. The paper highlights important considerations during the protocol development process, and uses a previously developed review question as a working example.

Implications for research: This paper will assist novice researchers in developing a qualitative systematic review protocol. By providing a worked example of a protocol, the paper encourages the development of review protocols, enhancing the trustworthiness and value of the completed qualitative systematic review findings.

Linking evidence to action: Qualitative systematic reviews should be based on well planned, peer reviewed protocols to enhance the trustworthiness of results and thus their usefulness in clinical practice. Protocols should outline, in detail, the processes which will be used to undertake the review, including key search terms, inclusion and exclusion criteria, and the methods used for critical appraisal, data extraction and data analysis to facilitate transparency of the review process. Additionally, journals should encourage and support the publication of review protocols, and should require reference to a protocol prior to publication of the review results.

Keywords: guidelines; meta synthesis; qualitative; systematic review protocol.

© 2016 Sigma Theta Tau International.

• Evidence-Based Practice / standards*
• Information Seeking Behavior
• Nursing / methods
• Qualitative Research*
• Research Design / standards*
• Systematic Reviews as Topic*
• Writing / standards*

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• Write for Us
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 24, Issue 2
• Five tips for developing useful literature summary tables for writing review articles
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 1 , 2 ,
• http://orcid.org/0000-0002-7839-8130 Parveen Ali 3 , 4
• 1 Memorial University of Newfoundland , St John's , Newfoundland , Canada
• 2 Swat College of Nursing , Pakistan
• 3 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
• 4 Sheffield University Interpersonal Violence Research Group , Sheffield University , Sheffield , UK
• Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St John's, NL A1C 5C4, Canada; ay6133{at}mun.ca

https://doi.org/10.1136/ebnurs-2021-103417

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Introduction

Literature reviews offer a critical synthesis of empirical and theoretical literature to assess the strength of evidence, develop guidelines for practice and policymaking, and identify areas for future research. 1 It is often essential and usually the first task in any research endeavour, particularly in masters or doctoral level education. For effective data extraction and rigorous synthesis in reviews, the use of literature summary tables is of utmost importance. A literature summary table provides a synopsis of an included article. It succinctly presents its purpose, methods, findings and other relevant information pertinent to the review. The aim of developing these literature summary tables is to provide the reader with the information at one glance. Since there are multiple types of reviews (eg, systematic, integrative, scoping, critical and mixed methods) with distinct purposes and techniques, 2 there could be various approaches for developing literature summary tables making it a complex task specialty for the novice researchers or reviewers. Here, we offer five tips for authors of the review articles, relevant to all types of reviews, for creating useful and relevant literature summary tables. We also provide examples from our published reviews to illustrate how useful literature summary tables can be developed and what sort of information should be provided.

Tip 1: provide detailed information about frameworks and methods

• Download figure
• Open in new tab
• Download powerpoint

Tabular literature summaries from a scoping review. Source: Rasheed et al . 3

The provision of information about conceptual and theoretical frameworks and methods is useful for several reasons. First, in quantitative (reviews synthesising the results of quantitative studies) and mixed reviews (reviews synthesising the results of both qualitative and quantitative studies to address a mixed review question), it allows the readers to assess the congruence of the core findings and methods with the adapted framework and tested assumptions. In qualitative reviews (reviews synthesising results of qualitative studies), this information is beneficial for readers to recognise the underlying philosophical and paradigmatic stance of the authors of the included articles. For example, imagine the authors of an article, included in a review, used phenomenological inquiry for their research. In that case, the review authors and the readers of the review need to know what kind of (transcendental or hermeneutic) philosophical stance guided the inquiry. Review authors should, therefore, include the philosophical stance in their literature summary for the particular article. Second, information about frameworks and methods enables review authors and readers to judge the quality of the research, which allows for discerning the strengths and limitations of the article. For example, if authors of an included article intended to develop a new scale and test its psychometric properties. To achieve this aim, they used a convenience sample of 150 participants and performed exploratory (EFA) and confirmatory factor analysis (CFA) on the same sample. Such an approach would indicate a flawed methodology because EFA and CFA should not be conducted on the same sample. The review authors must include this information in their summary table. Omitting this information from a summary could lead to the inclusion of a flawed article in the review, thereby jeopardising the review’s rigour.

Tip 2: include strengths and limitations for each article

Critical appraisal of individual articles included in a review is crucial for increasing the rigour of the review. Despite using various templates for critical appraisal, authors often do not provide detailed information about each reviewed article’s strengths and limitations. Merely noting the quality score based on standardised critical appraisal templates is not adequate because the readers should be able to identify the reasons for assigning a weak or moderate rating. Many recent critical appraisal checklists (eg, Mixed Methods Appraisal Tool) discourage review authors from assigning a quality score and recommend noting the main strengths and limitations of included studies. It is also vital that methodological and conceptual limitations and strengths of the articles included in the review are provided because not all review articles include empirical research papers. Rather some review synthesises the theoretical aspects of articles. Providing information about conceptual limitations is also important for readers to judge the quality of foundations of the research. For example, if you included a mixed-methods study in the review, reporting the methodological and conceptual limitations about ‘integration’ is critical for evaluating the study’s strength. Suppose the authors only collected qualitative and quantitative data and did not state the intent and timing of integration. In that case, the strength of the study is weak. Integration only occurred at the levels of data collection. However, integration may not have occurred at the analysis, interpretation and reporting levels.

Tip 3: write conceptual contribution of each reviewed article

While reading and evaluating review papers, we have observed that many review authors only provide core results of the article included in a review and do not explain the conceptual contribution offered by the included article. We refer to conceptual contribution as a description of how the article’s key results contribute towards the development of potential codes, themes or subthemes, or emerging patterns that are reported as the review findings. For example, the authors of a review article noted that one of the research articles included in their review demonstrated the usefulness of case studies and reflective logs as strategies for fostering compassion in nursing students. The conceptual contribution of this research article could be that experiential learning is one way to teach compassion to nursing students, as supported by case studies and reflective logs. This conceptual contribution of the article should be mentioned in the literature summary table. Delineating each reviewed article’s conceptual contribution is particularly beneficial in qualitative reviews, mixed-methods reviews, and critical reviews that often focus on developing models and describing or explaining various phenomena. Figure 2 offers an example of a literature summary table. 4

Tabular literature summaries from a critical review. Source: Younas and Maddigan. 4

Tip 4: compose potential themes from each article during summary writing

While developing literature summary tables, many authors use themes or subthemes reported in the given articles as the key results of their own review. Such an approach prevents the review authors from understanding the article’s conceptual contribution, developing rigorous synthesis and drawing reasonable interpretations of results from an individual article. Ultimately, it affects the generation of novel review findings. For example, one of the articles about women’s healthcare-seeking behaviours in developing countries reported a theme ‘social-cultural determinants of health as precursors of delays’. Instead of using this theme as one of the review findings, the reviewers should read and interpret beyond the given description in an article, compare and contrast themes, findings from one article with findings and themes from another article to find similarities and differences and to understand and explain bigger picture for their readers. Therefore, while developing literature summary tables, think twice before using the predeveloped themes. Including your themes in the summary tables (see figure 1 ) demonstrates to the readers that a robust method of data extraction and synthesis has been followed.

Tip 5: create your personalised template for literature summaries

Often templates are available for data extraction and development of literature summary tables. The available templates may be in the form of a table, chart or a structured framework that extracts some essential information about every article. The commonly used information may include authors, purpose, methods, key results and quality scores. While extracting all relevant information is important, such templates should be tailored to meet the needs of the individuals’ review. For example, for a review about the effectiveness of healthcare interventions, a literature summary table must include information about the intervention, its type, content timing, duration, setting, effectiveness, negative consequences, and receivers and implementers’ experiences of its usage. Similarly, literature summary tables for articles included in a meta-synthesis must include information about the participants’ characteristics, research context and conceptual contribution of each reviewed article so as to help the reader make an informed decision about the usefulness or lack of usefulness of the individual article in the review and the whole review.

In conclusion, narrative or systematic reviews are almost always conducted as a part of any educational project (thesis or dissertation) or academic or clinical research. Literature reviews are the foundation of research on a given topic. Robust and high-quality reviews play an instrumental role in guiding research, practice and policymaking. However, the quality of reviews is also contingent on rigorous data extraction and synthesis, which require developing literature summaries. We have outlined five tips that could enhance the quality of the data extraction and synthesis process by developing useful literature summaries.

• Aromataris E ,
• Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

• Open access
• Published: 02 April 2022

A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access

• Nicholas C. Coombs 1 ,
• Duncan G. Campbell 2 &
• James Caringi 1  

BMC Health Services Research volume  22 , Article number:  438 ( 2022 ) Cite this article

22k Accesses

19 Citations

10 Altmetric

Metrics details

Ensuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient’s acceptance of services that they are to receive and ensuring appropriate fit between services and a patient’s specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution.

We used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients’ treatment plans. Semi-structured interviews and content analysis were used to explore barriers–appropriateness and acceptability–to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings.

Five key themes emerged from analysis: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US.

Conclusions

Inadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems’ ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.

Peer Review reports

Unequal access to healthcare services is an important element of health disparities in the United States [ 1 ], and there remains much about access that is not fully understood. The lack of understanding is attributable, in part, to the lack of uniformity in how access is defined and evaluated, and the extent to which access is often oversimplified in research [ 2 ]. Subsequently, attempts to address population-level barriers to healthcare access are insufficient, and access remains an unresolved, complex health challenge [ 3 , 4 , 5 ]. This paper presents a study that aims to explore some of the less well studied barriers to healthcare access, particularly those that influence healthcare acceptability and appropriateness.

In truth, healthcare access entails a complicated calculus that combines characteristics of individuals, their households, and their social and physical environments with characteristics of healthcare delivery systems, organizations, and healthcare providers. For one to fully ‘access’ healthcare, they must have the means to identify their healthcare needs and have available to them care providers and the facilities where they work. Further, patients must then reach, obtain, and use the healthcare services in order to have their healthcare needs fulfilled. Levesque and colleagues critically examined access conceptualizations in 2013 and synthesized all ways in which access to healthcare was previously characterized; Levesque et al. proposed five dimensions of access: approachability, acceptability, availability, affordability and appropriateness [ 2 ]. These refer to the ability to perceive, seek, reach, pay for, and engage in services, respectively.

According to Levesque et al.’s framework, the five dimensions combine to facilitate access to care or serve as barriers. Approachability indicates that people facing health needs understand that healthcare services exist and might be helpful. Acceptability represents whether patients see healthcare services as consistent or inconsistent with their own social and cultural values and worldviews. Availability indicates that healthcare services are reached both physically and in a timely manner. Affordability simplifies one’s capacity to pay for healthcare services without compromising basic necessities, and finally, appropriateness represents the fit between healthcare services and a patient’s specific healthcare needs [ 2 ]. This study focused on the acceptability and appropriateness dimensions of access.

Before the novel coronavirus (SARS-CoV-2; COVID-19) pandemic, approximately 13.3% of adults in the US did not have a usual source of healthcare [ 6 ]. Millions more did not utilize services regularly, and close to two-thirds reported that they would be debilitated by an unexpected medical bill [ 7 , 8 , 9 ]. Findings like these emphasized a fragility in the financial security of the American population [ 10 ]. These concerns were exacerbated by the pandemic when a sudden surge in unemployment increased un- and under-insurance rates [ 11 ]. Indeed, employer-sponsored insurance covers close to half of Americans’ total cost of illness [ 12 ]. Unemployment linked to COVID-19 cut off the lone outlet to healthcare access for many. Health-related financial concerns expanded beyond individuals, as healthcare organizations were unequipped to manage a simultaneous increase in demand for specialized healthcare services and a steep drop off for routine revenue-generating healthcare services [ 13 ]. These consequences of the COVID-19 pandemic all put additional, unexpected pressure on an already fragmented US healthcare system.

Other structural barriers to healthcare access exist in relation to the rural–urban divide. Less than 10% of US healthcare resources are located in rural areas where approximately 20% of the American population resides [ 14 ]. In a country with substantially fewer providers per capita compared to many other developed countries, persons in rural areas experience uniquely pressing healthcare provider shortages [ 15 , 16 ]. Rural inhabitants also tend to have lower household income, higher rates of un- or under-insurance, and more difficulty with travel to healthcare clinics than urban dwellers [ 17 ]. Subsequently, persons in rural communities use healthcare services at lower rates, and potentially preventable hospitalizations are more prevalent [ 18 ]. This disparity often leads rural residents to use services primarily for more urgent needs and less so for routine care [ 19 , 20 , 21 ].

The differences in how rural and urban healthcare systems function warranted a federal initiative to focus exclusively on rural health priorities and serve as counterpart to Healthy People objectives [ 22 ]. The rural determinants of health, a more specific expression of general social determinants, add issues of geography and topography to the well-documented social, economic and political factors that influence all Americans’ access to healthcare [ 23 ]. As a result, access is consistently regarded as a top priority in rural areas, and many research efforts have explored the intersection between access and rurality, namely within its less understood dimensions (acceptability and appropriateness) [ 22 ].

Acceptability-related barriers to care

Acceptability represents the dimension of healthcare access that affects a patient’s ability to seek healthcare, particularly linked to one’s professional values, norms and culture [ 2 ]. Access to health information is an influential factor for acceptable healthcare and is essential to promote and maintain a healthy population [ 24 ]. According to the Centers for Disease Control and Prevention, health literacy or a high ‘health IQ’ is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, which impacts healthcare use and system navigation [ 25 ]. The literature indicates that lower levels of health literacy contribute to health disparities among rural populations [ 26 , 27 , 28 ]. Evidence points to a need for effective health communication between healthcare organizations and patients to improve health literacy [ 24 ]. However, little research has been done in this area, particularly as it relates to technologically-based interventions to disseminate health information [ 29 ].

Stigma, an undesirable position of perceived diminished status in an individual’s social position, is another challenge that influences healthcare acceptability [ 30 ]. Those who may experience stigma fear negative social consequences in relation to care seeking. They are more likely to delay seeking care, especially among ethnic minority populations [ 31 , 32 ]. Social media presents opportunities for the dissemination of misleading medical information; this runs further risk for stigma [ 33 ]. Stigma is difficult to undo, but research has shown that developing a positive relationship with a healthcare provider or organization can work to reduce stigma among patients, thus promoting healthcare acceptability [ 34 ].

A provider’s attempts to engage patients and empower them to be active decision-makers regarding their treatment has also been shown to improve healthcare acceptability. One study found that patients with heart disease who completed a daily diary of weight and self-assessment of symptoms, per correspondence with their provider, had better care outcomes than those who did not [ 35 ]. Engaging with household family members and involved community healers also mitigates barriers to care, emphasizing the importance of a team-based approach that extends beyond those who typically provide healthcare services [ 36 , 37 ]. One study, for instance, explored how individuals closest to a pregnant woman affect the woman’s decision to seek maternity care; partners, female relatives, and community health-workers were among the most influential in promoting negative views, all of which reduced a woman’s likelihood to access care [ 38 ].

Appropriateness-related barriers to care

Appropriateness marks the dimension of healthcare access that affects a patient’s ability to engage, and according to Levesque et al., is of relevance once all other dimensions (the ability to perceive, seek, reach and pay for) are achieved [ 2 ]. The ability to engage in healthcare is influenced by a patient’s level of empowerment, adherence to information, and support received by their healthcare provider. Thus, barriers to healthcare access that relate to appropriateness are often those that indicate a breakdown in communication between a patient with their healthcare provider. Such breakdown can involve a patient experiencing miscommunication, confrontation, and/or a discrepancy between their provider’s goals and their own goals for healthcare. Appropriateness represents a dimension of healthcare access that is widely acknowledged as an area in need of improvement, which indicates a need to rethink how healthcare providers and organizations can adapt to serve the healthcare needs of their communities [ 39 ]. This is especially true for rural, ethnic minority populations, which disproportionately experience an abundance of other barriers to healthcare access. Culturally appropriate care is especially important for members of minority populations [ 40 , 41 , 42 ]. Ultimately, patients value a patient-provider relationship characterized by a welcoming, non-judgmental atmosphere [ 43 , 44 ]. In rural settings especially, level of trust and familiarity are common factors that affect service utilization [ 45 ]. Evidence suggests that kind treatment by a healthcare provider who promotes patient-centered care can have a greater overall effect on a patient’s experience than a provider’s degree of medical knowledge or use of modern equipment [ 46 ]. Of course, investing the time needed to nurture close and caring interpersonal connections is particularly difficult in under-resourced, time-pressured rural health systems [ 47 , 48 ].

The most effective way to evaluate access to healthcare largely depends on which dimensions are explored. For instance, a population-based survey can be used to measure the barrier of healthcare affordability. Survey questions can inquire directly about health insurance coverage, care-related financial burden, concern about healthcare costs, and the feared financial impacts of illness and/or disability. Many national organizations have employed such surveys to measure affordability-related barriers to healthcare. For example, a question may ask explicitly about financial concerns: ‘If you get sick or have an accident, how worried are you that you will not be able to pay your medical bills?’ [ 49 ]. Approachability and availability dimensions of access are also studied using quantitative analysis of survey questions, such as ‘Is there a place that you usually go to when you are sick or need advice about your health?’ or ‘Have you ever delayed getting medical care because you couldn’t get through on the telephone?’ In contrast, the remaining two dimensions–acceptability and appropriateness–require a qualitative approach, as the social and cultural factors that determine a patient’s likelihood of accepting aspects of the services that are to be received (acceptability) and the fit between those services and the patient’s specific healthcare needs (appropriateness) can be more abstract [ 50 , 51 ]. In social science, qualitative methods are appropriate to generate knowledge of what social events mean to individuals and how those individuals interact within them; these methods allow for an exploration of depth rather than breadth [ 52 , 53 ]. Qualitative methods, therefore, are appropriate tools for understanding the depth of healthcare providers’ experiences in the inherently social context of seeking and engaging in healthcare.

In sum, acceptability- and appropriateness-related barriers to healthcare access are multi-layered, complex and abundant. Ensuring access becomes even more challenging if structural barriers to access are factored in. In this study, we aimed to explore barriers to healthcare access among persons in Montana, a historically underserved, under-resourced, rural region of the US. Montana is the fourth largest and third least densely populated state in the country; more than 80% of Montana counties are classified as non-core (the lowest level of urban/rural classification), and over 90% are designated as health professional shortage areas [ 54 , 55 ]. Qualitative methods supported our inquiry to explore barriers to healthcare access related to acceptability and appropriateness.

Participants

Qualitative methods were utilized for this interpretive, exploratory study because knowledge regarding barriers to healthcare access within Montana’s rural health systems is limited. We chose Montana healthcare providers, rather than patients, as the population of interest so we may explore barriers to healthcare access from the perspective of those who serve many persons in rural settings. Inclusion criteria required study participants to provide direct healthcare to patients at least one-half of their time. We defined ‘provider’ as a healthcare organization employee with clinical decision-making power and the qualifications to develop or revise patients’ treatment plans. In an attempt to capture a group of providers with diverse experience, we included providers across several types and specialties. These included advanced practice registered nurses (APRNs), physicians (MDs and DOs), and physician assistants (PAs) who worked in critical care medicine, emergency medicine, family medicine, hospital medicine, internal medicine, pain medicine, palliative medicine, pediatrics, psychiatry, and urgent care medicine. We also included licensed clinical social workers (LCSWs) and clinical psychologists who specialize in behavioral healthcare provision.

Recruitment and Data Collection

We recruited participants via email using a snowball sampling approach [ 56 ]. We opted for this approach because of its effectiveness in time-pressured contexts, such as the COVID-19 pandemic, which has made healthcare provider populations hard to reach [ 57 ]. Considering additional constraints with the pandemic and the rural nature of Montana, interviews were administered virtually via Zoom video or telephone conferencing with Zoom’s audio recording function enabled. All interviews were conducted by the first author between January and September 2021. The average length of interviews was 50 min, ranging from 35 to 70 min. There were occasional challenges experienced during interviews (poor cell phone reception from participants, dropped calls), in which case the interviewer remained on the line until adequate communication was resumed. All interviews were included for analysis and transcribed verbatim into NVivo Version 12 software. All qualitative data were saved and stored on a password-protected University of Montana server. Hard-copy field notes were securely stored in a locked office on the university’s main campus.

Data analysis included a deductive followed by an inductive approach. This dual analysis adheres to Levesque’s framework for qualitative methods, which is discussed in the Definition of Analytic Domains sub-section below. Original synthesis of the literature informed the development of our initial deductive codebook. The deductive approach was derived from a theory-driven hypothesis, which consisted of synthesizing previous research findings regarding acceptability- and appropriateness-related barriers to care. Although the locations, patient populations and specific type of healthcare services varied by study in the existing literature, several recurring barriers to healthcare access were identified. We then operationalized three analytic domains based on these findings: cultural considerations, patient-provider communication, and provider-provider communication. These domains were chosen for two reasons: 1) the terms ‘culture’ and ‘communication’ were the most frequently documented characteristics across the studies examined, and 2) they each align closely with the acceptability and appropriateness dimensions of access to healthcare, respectively. In addition, ‘culture’ is included in the definition of acceptability and ‘communication’ is a quintessential aspect of appropriateness. These domains guided the deductive portion of our analysis, which facilitated the development of an interview guide used for this study.

Interviews were semi-structured to allow broad interpretations from participants and expand the open-ended characterization of study findings. Data were analyzed through a flexible coding approach proposed by Deterding and Waters [ 58 ]. Qualitative content analysis was used, a method particularly beneficial for analyzing large amounts of qualitative data collected through interviews that offers possibility of quantifying categories to identify emerging themes [ 52 , 59 ]. After fifty percent of data were analyzed, we used an inductive approach as a formative check and repeated until data saturation, or the point at which no new information was gathered in interviews [ 60 ]. At each point of inductive analysis, interview questions were added, removed, or revised in consideration of findings gathered [ 61 ]. The Standards for Reporting Qualitative Research (SRQR) was used for reporting all qualitative data for this study [ 62 ]. The first and third authors served as primary and secondary analysts of the qualitative data and collaborated to triangulate these findings. An audit approach was employed, which consisted of coding completed by the first author and then reviewed by the third author. After analyses were complete, member checks ensured credibility and trustworthiness of findings [ 63 ]. Member checks consisted of contacting each study participant to explain the study’s findings; one-third of participants responded and confirmed all findings. All study procedures were reviewed and approved by the Human Subjects Committee of the authors’ institution’s Institutional Review Board.

Definitions of Analytic Domains

Cultural considerations.

Western health systems often fail to consider aspects of patients’ cultural perspectives and histories. This can manifest in the form of a providers’ lack of cultural humility. Cultural humility is a process of preventing imposition of one’s worldview and cultural beliefs on others and recognizing that everyone’s conception of the world is valid. Humility cultivates sensitive approaches in treating patients [ 64 ]. A lack of cultural humility impedes the delivery of acceptable and appropriate healthcare [ 65 ], which can involve low empathy or respect for patients, or dismissal of culture and traditions as superstitions that interfere with standard treatments [ 66 , 67 ]. Ensuring cultural humility among all healthcare employees is a step toward optimal healthcare delivery. Cultural humility is often accomplished through training that can be tailored to particular cultural- or gender-specific populations [ 68 , 69 ]. Since cultural identities and humility have been marked as factors that can heavily influence patients’ access to care, cultural considerations composed our first analytic domain. To assess this domain, we asked participants how they address the unique needs of their patients, how they react when they observe a cultural behavior or attitude from a patient that may not directly align with their treatment plan, and if they have received any multicultural training or training on cultural considerations in their current role.

Patient-provider communication

Other barriers to healthcare access can be linked to ineffective patient-provider communication. Patients who do not feel involved in healthcare decisions are less likely to adhere to treatment recommendations [ 70 ]. Patients who experience communication difficulties with providers may feel coerced, which generates disempowerment and leads patients to employ more covert ways of engagement [ 71 , 72 ]. Language barriers can further compromise communication and hinder outcomes or patient progress [ 73 , 74 ]. Any miscommunication between a patient and provider can affect one’s access to healthcare, namely affecting appropriateness-related barriers. For these reasons, patient-provider communication composed our second analytic domain. We asked participants to highlight the challenges they experience when communicating with their patients, how those complications are addressed, and how communication strategies inform confidentiality in their practice. Confidentiality is a core ethical principle in healthcare, especially in rural areas that have smaller, interconnected patient populations [ 75 ].

Provider-Provider Communication

A patient’s journey through the healthcare system necessitates sufficient correspondence between patients, primary, and secondary providers after discharge and care encounters [ 76 ]. Inter-provider and patient-provider communication are areas of healthcare that are acknowledged to have some gaps. Inconsistent mechanisms for follow up communication with patients in primary care have been documented and emphasized as a concern among those with chronic illness who require close monitoring [ 68 , 77 ]. Similar inconsistencies exist between providers, which can lead to unclear care goals, extended hospital stays, and increased medical costs [ 78 ]. For these reasons, provider-provider communication composed our third analytic domain. We asked participants to describe the approaches they take to streamline communication after a patient’s hospital visit, the methods they use to ensure collaborative communication between primary or secondary providers, and where communication challenges exist.

Healthcare provider characteristics

Our sample included 12 providers: four in family medicine (1 MD, 1 DO, 1 PA & 1 APRN), three in pediatrics (2 MD with specialty in hospital medicine & 1 DO), three in palliative medicine (2 MDs & 1 APRN with specialty in wound care), one in critical care medicine (DO with specialty in pediatric pulmonology) and one in behavioral health (1 LCSW with specialty in trauma). Our participants averaged 9 years (range 2–15) as a healthcare provider; most reported more than 5 years in their current professional role. The diversity of participants extended to their patient populations as well, with each participant reporting a unique distribution of age, race and level of medical complexity among their patients. Most participants reported that a portion of their patients travel up to five hours, sometimes across county- or state-lines, to receive care.

Theme 1: A friction exists between aspects of patients’ rural identities and healthcare systems

Our participants comprised a collection of medical professions and reported variability among health-related reasons their patients seek care. However, most participants acknowledged similar characteristics that influence their patients’ challenges to healthcare access. These identified factors formed categories from which the first theme emerged. There exists a great deal of ‘rugged individualism’ among Montanans, which reflects a self-sufficient and self-reliant way of life. Stoicism marked a primary factor to characterize this quality. One participant explained:

True Montanans are difficult to treat medically because they tend to be a tough group. They don’t see doctors. They don’t want to go, and they don’t want to be sick. That’s an aspect of Montana that makes health culture a little bit difficult.

Another participant echoed this finding by stating:

The backwoods Montana range guy who has an identity of being strong and independent probably doesn’t seek out a lot of medical care or take a lot of medications. Their sense of vitality, independence and identity really come from being able to take care and rely on themselves. When that is threatened, that’s going to create a unique experience of illness.

Similar responses were shared by all twelve participants; stoicism seemed to be heavily embedded in many patient populations in Montana and serves as a key determinant of healthcare acceptability. There are additional factors, however, that may interact with stoicism but are multiply determined. Stigma is an example of this, presented in this context as one’s concern about judgement by the healthcare system. Respondents were openly critical of this perception of the healthcare system as it was widely discussed in interviews. One participant stated:

There is a real perception of a punitive nature in the medical community, particularly if I observe a health issue other than the primary reason for one’s hospital visit, whether that may be predicated on medical neglect, delay of care, or something that may warrant a report to social services. For many of the patients and families I see, it’s not a positive experience and one that is sometimes an uphill barrier that I work hard to circumnavigate.

Analysis of these factors suggest that low use of healthcare services may link to several characteristics, including access problems. Separately, a patient’s perceived stigma from healthcare providers may also impact a patient’s willingness to receive services. One participant put it best by stating

Sometimes, families assume that I didn’t want to see them because they will come in for follow up to meet with me but end up meeting with another provider, which is frustrating because I want to maintain patients on my panel but available time and resource occasionally limits me from doing so. It could be really hard adapting to those needs on the fly, but it’s an honest miss.

When a patient arrives for a healthcare visit and experiences this frustration, it may elicit a patient’s perceptions of neglect or disorganization. This ‘honest miss’ may, in turn, exacerbate other acceptable-related barriers to care.

Theme 2: Facilitating access to healthcare requires application of and respect for cultural differences

The biomedical model is the standard of care utilized in Western medicine [ 79 , 80 ]. However, the US comprises people with diverse social and cultural identities that may not directly align with Western conceptions of health and wellness. Approximately 11.5% of the Montana population falls within an ethnic minority group. 6.4% are of American Indian or Alaska Native origin, 0.5% are of Black or African American origin, 0.8% are of Asian origin and 3.8% are of multiple or other origins. [ 81 ]. Cultural insensitivity is acknowledged in health services research as an active deterrent for appropriate healthcare delivery [ 65 ]. Participants for this study were asked how they react when a patient brings up a cultural attitude or behavior that may impact the proposed treatment plan. Eight participants noted a necessity for humility when this occurs. One participant conceptualized this by stating:

When this happens, I learn about individuals and a way of life that is different to the way I grew up. There is a lot of beauty and health in a non-patriarchal, non-dominating, non-sexist framework, and when we can engage in such, it is really expansive for my own learning process.

The participants who expressed humility emphasized that it is best to work in tandem with their patient, congruently. Especially for those with contrasting worldviews, a provider and a patient working as a team poses an opportunity to develop trust. Without it, a patient can easily fall out of the system, further hindering their ability to access healthcare services in the future. One participant stated:

The approach that ends up being successful for a lot of patients is when we understand their modalities, and they have a sense we understand those things. We have to show understanding and they have to trust. From there, we can make recommendations to help get them there, not decisions for them to obey, rather views based on our experiences and understanding of medicine.

Curiosity was another reaction noted by a handful of participants. One participant said:

I believe patients and their caregivers can be engaged and loving in different ways that don’t always follow the prescribed approach in the ways I’ve been trained, but that doesn’t necessarily mean that they are detrimental. I love what I do, and I love learning new things or new approaches, but I also love being surprised. My style of medicine is not to predict peoples’ lives, rather to empower and support what makes life meaningful for them.

Participants mentioned several other characteristics that they use in practice to prevent cultural insensitivity and support a collaborative approach to healthcare. Table 1 lists these facilitating characteristics and quotes to explain the substance of their benefit.

Consensus among participants indicated that the use of these protective factors to promote cultural sensitivity and apply them in practice is not standardized. When asked, all but two participants said they had not received any culturally-based training since beginning their practice. Instead, they referred to developing skills through “on the job training” or “off the cuff learning.” The general way of medicine, one participant remarked, was to “throw you to the fire.” This suggested that use of standardized cultural humility training modules for healthcare providers was not common practice. Many attributed this to time constraints.

Individual efforts to gain culturally appropriate skills or enhance cultural humility were mentioned, however. For example, three participants reported that they attended medical conferences to discuss cultural challenges within medicine, one participant sought out cultural education within their organization, and another was invited by Native American community members to engage in traditional peace ceremonies. Participants described these additional efforts as uncommon and outside the parameters of a provider’s job responsibilities, as they require time commitments without compensation.

Additionally, eight participants said they share their personal contact information with patients so they may call them directly for medical needs. The conditions and frequency with which this is done was variable and more common among providers in specialized areas of medicine or those who described having a manageable patient panel. All who reported that they shared their personal contact information described it as an aspect of rural health service delivery that is atypical in other, non-rural healthcare systems.

Theme 3: Communication between healthcare providers is systematically fragmented

Healthcare is complex and multi-disciplinary, and patients’ treatment is rarely overseen by a single provider [ 82 ]. The array of provider types and specialties is vast, as is the range of responsibilities ascribed to providers. Thus, open communication among providers both within and between healthcare systems is vital for the success of collaborative healthcare [ 83 ]. Without effective communication achieved between healthcare providers, the appropriate delivery of healthcare services may be become compromised. Our participants noted that they face multiple challenges that complicate communication with other providers. Miscommunication between departments, often implicating the Emergency Department (ED), was a recurring point noted among participants. One participant who is a primary care physician said:

If one of my patients goes to the ER, I don’t always get the notes. They’re supposed to send them to the patient’s primary care doc. The same thing happens with general admissions, but again, I often find out from somebody else that my patient was admitted to the hospital.

This failure to communicate can negatively impact the patient, particularly if time sensitivity or medical complexity is essential to treatment. A patient’s primary care physician is the most accurate source of their medical history; without an effective way to obtain and synthesize a patient’s health information, there may be increased risk of medical error. One participant in a specialty field stated:

One of the biggest barriers I see is obtaining a concise description of a patient’s history and needs. You can imagine if you’re a mom and you’ve got a complicated kid. You head to the ER. The ER doc looks at you with really wide eyes, not knowing how to get information about your child that’s really important.

This concern was highlighted with a specific example from a different participant:

I have been unable to troubleshoot instances when I send people to the ER with a pretty clear indication for admission, and then they’re sent home. For instance, I had an older fellow with pretty severe chronic kidney disease. He presented to another practitioner in my office with shortness of breath and swelling and appeared to have newly onset decompensated heart failure. When I figured this out, I sent him to the ER, called and gave my report. The patient later came back for follow up to find out not only that they had not been admitted but they lost no weight with outpatient dialysis . I feel like a real opportunity was missed to try to optimize the care of the patient simply because there was poor communication between myself and the ER. This poor guy… He ended up going to the ER four times before he got admitted for COVID-19.

In some cases, communication breakdown was reported as the sole cause of a poor outcome. When communication is effective, each essential member of the healthcare team is engaged and collaborating with the same information. Some participants called this process ‘rounds’ when a regularly scheduled meeting is staged between a group of providers to ensure access to accurate patient information. Accurate communication may also help build trust and improve a patient’s experience. In contrast, ineffective communication can result in poor clarity regarding providers’ responsibilities or lost information. Appropriate delivery of healthcare considers the fit between providers and a patient’s specific healthcare needs; the factors noted here suggest that provider-provider miscommunication can adversely affect this dimension of healthcare access.

Another important mechanism of communication is the sharing of electronic medical records (EMRs), a process that continues to shift with technological advances. Innovation is still recent enough, however, for several of our study participants to be able to recall a time when paper charts were standard. Widespread adoption and embrace of the improvements inherent in electronic medical records expanded in the late 2000’s [ 84 ]. EMRs vastly improved the ability to retain, organize, safeguard, and transfer health information. Every participant highlighted EMRs at one point or another and often did so with an underlying sense of anger or frustration. Systematic issues and problems with EMRs were discussed. One participant provided historical context to such records:

Years back, the government aimed to buy an electronic medical record system, whichever was the best, and a number of companies created their own. Each were a reasonable system, so they all got their checks and now we have four completely separate operating systems that do not talk to each other. The idea was to make a router or some type of relay that can share information back and forth. There was no money in that though, so of course, no one did anything about it. Depending on what hospital, clinic or agency you work for, you will most likely work within one of these systems. It was a great idea; it just didn’t get finished.

Seven participants confirmed these points and their impacts on making coordination more difficult, relying on outdated communication strategies more often than not. Many noted this even occurs between facilities within the same city and in separate small metropolitan areas across the state. One participant said:

If my hospital decides to contract with one EMR and the hospital across town contracts with another, correspondence between these hospitals goes back to traditional faxing. As a provider, you’re just taking a ‘fingered crossed’ approach hoping that the fax worked, is picked up, was put in the appropriate inbox and was actually looked at. Information acquisition and making sure it’s timely are unforeseen between EMRs.

Participants reported an “astronomic” number of daily faxes and telephone calls to complete the communication EMRs were initially designed to handle. These challenges are even more burdensome if a patient moves from out of town or out of state; obtaining their medical records was repeatedly referred to as a “chore” so onerous that it often remains undone. Another recurring concern brought up by participants regarded accuracy within EMRs to lend a false sense of security. They are not frequently updated, not designed to be family-centered and not set up to do anything automatically. One participant highlighted these limitations by stating:

I was very proud of a change I made in our EMR system [EPIC], even though it was one I never should have had to make. I was getting very upset because I would find out from my nursing assistant who read the obituary that one of my patients had died. There was a real problem with the way the EMR was notifying PCP’s, so I got an EPIC-level automated notification built into our EMR so that any time a patient died, their status would be changed to deceased and a notification would be sent to their PCP. It’s just really awful to find out a week later that your patient died, especially when you know these people and their families really well. It’s not good care to have blind follow up.

Whether it be a physical or electronic miscommunication between healthcare providers, the appropriate delivery of healthcare can be called to question

Theme 4: Time and resource constraints disproportionately harm rural health systems

Several measures of system capacity suggest the healthcare system in the US is under-resourced. There are fewer physicians and hospital beds per capita compared to most comparable countries, and the growth of healthcare provider populations has stagnated over time [ 15 ]. Rural areas, in particular, are subject to resource limitations [ 16 ]. All participants discussed provider shortages in detail. They described how shortages impact time allocation in their day-to-day operations. Tasks like patient intakes, critical assessments, and recovering information from EMRs take time, of which most participants claimed to not have enough of. There was also a consensus in having inadequate time to spend on medically complex cases. Time pressures were reported to subsequently influence quality of care. One participant stated:

With the constant pace of medicine, time is not on your side. A provider cannot always participate in an enriching dialogue with their patients, so rather than listen and learn, we are often coerced into the mindset of ‘getting through’ this patient so we can move on. This echoes for patient education during discharge, making the whole process more arduous than it otherwise could be if time and resources were not as sparse.

Depending on provider type, specialty, and the size of patient panels, four participants said they have the luxury of extending patient visits to 40 + minutes. Any flexibility with patient visits was regarded as just that: a luxury. Very few providers described the ability to coordinate their schedules as such. This led some study participants to limit the number of patients they serve. One participant said:

We simply don’t have enough clinicians, which is a shame because these people are really skilled, exceptional, brilliant providers but are performing way below their capacity. Because of this, I have a smaller case load so I can engage in a level of care that I feel is in the best interest of my patients. Everything is a tradeoff. Time has to be sacrificed at one point or another. This compromise sets our system up to do ‘ok’ work, not great work.

Of course, managing an overly large number of patients with high complexity is challenging. Especially while enduring the burden of a persisting global pandemic, participants reflected that the general outlook of administering healthcare in the US is to “do more with less.” This often forces providers to delegate responsibilities, which participants noted has potential downsides. One participant described how delegating patient care can cause problems.

Very often will a patient schedule a follow up that needs to happen within a certain time frame, but I am unable to see them myself. So, they are then placed with one of my mid-level providers. However, if additional health issues are introduced, which often happens, there is a high-risk of bounce-back or need to return once again to the hospital. It’s an inefficient vetting process that falls to people who may not have specific training in the labs and imaging that are often included in follow up visits. Unfortunately, it’s a forlorn hope to have a primary care physician be able to attend all levels of a patient’s care.

Several participants described how time constraints stretch all healthcare staff thin and complicate patient care. This was particularly important among participants who reported having a patient panel exceeding 1000. There were some participants, however, who praised the relationships they have with their nurse practitioners and physician’s assistants and mark transparency as the most effective way to coordinate care. Collectively, these clinical relationships were built over long standing periods of time, a disadvantage to providers at the start of their medical career. All but one participant with over a decade of clinical experience mentioned the usefulness of these relationships. The factors discussed in Theme 4 are directly linked to the Availability dimension of access to healthcare. A patient’s ability to reach care is subject to the capacity of their healthcare provider(s). Additionally, further analysis suggests these factors also link to the Appropriateness dimension because the quality of patient-provider relationships may be negatively impacted if a provider’s time is compromised.

Theme 5: Profits are prioritized over addressing barriers to healthcare access in the US.

The US healthcare system functions partially for-profit in the public and private sectors. The federal government provides funding for national programs such as Medicare, but a majority of Americans access healthcare through private employer plans [ 85 ]. As a result, uninsurance rates influence healthcare access. Though the rate of the uninsured has dropped over the last decade through expansion of the Affordable Care Act, it remains above 8 percent [ 86 ]. Historically, there has been ethical criticism in the literature of a for-profit system as it is said to exacerbate healthcare disparities and constitute unfair competition against nonprofit institutions. Specifically, the US healthcare system treats healthcare as a commodity instead of a right, enables organizational controls that adversely affect patient-provider relationships, undermines medical education, and constitutes a medical-industrial complex that threatens influence on healthcare-related public policy [ 87 ]. Though unprompted by the interviewer, participants raised many of these concerns. One participant shared their views on how priorities stand in their practice:

A lot of the higher-ups in the healthcare system where I work see each patient visit as a number. It’s not that they don’t have the capacity to think beyond that, but that’s what their role is, making sure we’re profitable. That’s part of why our healthcare system in the US is as broken as it is. It’s accentuated focus on financially and capitalistically driven factors versus understanding all these other barriers to care.

Eight participants echoed a similar concept, that addressing barriers to healthcare access in their organizations is largely complicated because so much attention is directed on matters that have nothing to do with patients. A few other participants supported this by alluding to a “cherry-picking” process by which those at the top of the hierarchy devote their attention to the easiest tasks. One participant shared an experience where contrasting work demands between administrators and front-line clinical providers produces adverse effects:

We had a new administrator in our hospital. I had been really frustrated with the lack of cultural awareness and curiosity from our other leaders in the past, so I offered to meet and take them on a tour of the reservation. This was meant to introduce them to kids, families and Tribal leaders who live in the area and their interface with healthcare. They declined, which I thought was disappointing and eye-opening.

Analysis of these factors suggest that those who work directly with patients understand patient needs better than those who serve in management roles. This same participant went on to suggest an ulterior motive for a push towards telemedicine, as administrators primarily highlight the benefit of billing for virtual visits instead of the nature of the visits themselves.

This study explored barriers and facilitators to healthcare access from the perspective of rural healthcare providers in Montana. Our qualitative analysis uncovered five key themes: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. Themes 2 and 3 were directly supported by earlier qualitative studies that applied Levesque’s framework, specifically regarding healthcare providers’ poor interpersonal quality and lack of collaboration with other providers that are suspected to result from a lack of provider training [ 67 , 70 ]. This ties back to the importance of cultural humility, which many previous culture-based trainings have referred to as cultural competence. Cultural competence is achieved through a plethora of trainings designed to expose providers to different cultures’ beliefs and values but induces risk of stereotyping and stigmatizing a patient’s views. Therefore, cultural humility is the preferred idea, by which providers reflect and gain open-ended appreciation for a patient’s culture [ 88 ].

Implications for Practice

Perhaps the most substantial takeaway is how embedded rugged individualism is within rural patient populations and how difficult that makes the delivery of care in rural health systems. We heard from participants that stoicism and perceptions of stigma within the system contribute to this, but other resulting factors may be influential at the provider- and organizational-levels. Stoicism and perceived stigma both appear to arise, in part, from an understandable knowledge gap regarding the care system. For instance, healthcare providers understand the relations between primary and secondary care, but many patients may perceive both concepts as elements of a single healthcare system [ 89 ]. Any issue experienced by a patient when tasked to see both a primary and secondary provider may result in a patient becoming confused [ 90 ]. This may also overlap with our third theme, as a disjointed means of communication between healthcare providers can exacerbate patients’ negative experiences. One consideration to improve this is to incorporate telehealth programs into an existing referral framework to reduce unnecessary interfacility transfers; telehealth programs have proven effective in rural and remote settings [ 91 ].

In fact, telehealth has been rolled out in a variety of virtual platforms throughout its evolution, its innovation matched with continued technological advancement. Simply put, telehealth allows health service delivery from a distance; it allows knowledge and practice of clinical care to be in a different space than a patient. Because of this, a primary benefit of telehealth is its impact on improving patient-centered outcomes among those living in rural areas. For instance, text messaging technology improves early infant diagnosis, adherence to recommended diagnostic testing, and participant engagement in lifestyle change interventions [ 92 , 93 , 94 ]. More sophisticated interventions have found their way into smartphone-based technology, some of which are accessible even without an internet connection [ 95 , 96 ]. Internet accessibility is important because a number of study participants noted internet connectivity as a barrier for patients who live in low resource communities. Videoconferencing is another function of telehealth that has delivered a variety of health services, including those which are mental health-specific [ 97 ], and mobile health clinics have been used in rural, hard-to-reach settings to show the delivery of quality healthcare is both feasible and acceptable [ 98 , 99 , 100 ]. While telehealth has potential to reduce a number of healthcare access barriers, it may not always address the most pressing healthcare needs [ 101 ]. However, telehealth does serve as a viable, cost-effective alternative for rural populations with limited physical access to specialized services [ 102 ]. With time and resource limitations acknowledged as a key theme in our study, an emphasis on expanding telehealth services is encouraged as it will likely have significant involvement on advancing healthcare in the future, especially as the COVID-19 pandemic persists [ 103 ].

Implications for Policy

One could argue that most of the areas of fragmentation in the US healthcare system can be linked to the very philosophy on which it is based: an emphasis on profits as highest priority. Americans are, therefore, forced to navigate a health service system that does not work solely in their best interests. It is not surprising to observe lower rates of healthcare usage in rural areas, which may be a result from rural persons’ negative views of the US healthcare system or a perception that the system does not exist to support wellness. These perceptions may interact with ‘rugged individualism’ to squelch rural residents’ engagement in healthcare. Many of the providers we interviewed for this study appeared to understand this and strived to improve their patients’ experiences and outcomes. Though these efforts are admirable, they may not characterize all providers who serve in rural areas of the US. From a policy standpoint, it is important to recognize these expansive efforts from providers. If incentives were offered to encourage maximum efforts be made, it may lessen burden due to physician burnout and fatigue. Of course, there is no easy fix to the persisting limit of time and resources for providers, problems that require workforce expansion. Ultimately, though, the current structure of the US healthcare system is failing rural America and doing little to help the practice of rural healthcare providers.

Implications for Future Research

It is important for future health systems research efforts to consider issues that arise from both individual- and system-level access barriers and where the two intersect. Oftentimes, challenges that appear linked to a patient or provider may actually stem from an overarching system failure. If failures are critically and properly addressed, we may refine our understanding of what we can do in our professional spaces to improve care as practitioners, workforce developers, researchers and advocates. This qualitative study was exploratory in nature. It represents a step forward in knowledge generation regarding challenges in access to healthcare for rural Americans. Although mental health did not come up by design in this study, future efforts exploring barriers to healthcare access in rural systems should focus on access to mental healthcare. In many rural areas, Montana included, rates of suicide, substance use and other mental health disorders are highly prevalent. These characteristics should be part of the overall discussion of access to healthcare in rural areas. Optimally, barriers to healthcare access should continue to be explored through qualitative and mixed study designs to honor its multi-dimensional stature.

Strengths and Limitations

It is important to note first that this study interviewed healthcare providers instead of patients, which served as both a strength and limitation. Healthcare providers were able to draw on numerous patient-provider experiences, enabling an account of the aggregate which would have been impossible for a patient population. However, accounts of healthcare providers’ perceptions of barriers to healthcare access for their patients may differ from patients’ specific views. Future research should examine acceptability- and appropriateness-related barriers to healthcare access in patient populations. Second, study participants were recruited through convenience sampling methods, so results may be biased towards healthcare providers who are more invested in addressing barriers to healthcare access. Particularly, the providers interviewed for this study represented a subset who go beyond expectations of their job descriptions by engaging with their communities and spending additional uncompensated time with their patients. It is likely that a provider who exhibits these behavioral traits is more likely to participate in research aimed at addressing barriers to healthcare access. Third, the inability to conduct face-to-face interviews for our qualitative study may have posed an additional limitation. It is possible, for example, that in-person interviews might have resulted in increased rapport with study participants. Notwithstanding this possibility, the remote interview format was necessary to accommodate health risks to the ongoing COVID-19 pandemic. Ultimately, given our qualitative approach, results from our study cannot be generalizable to all rural providers’ views or other rural health systems. In addition, no causality can be inferred regarding the influence of aspects of rurality on access. The purpose of this exploratory qualitative study was to probe research questions for future efforts. We also acknowledge the authors’ roles in the research, also known as reflexivity. The first author was the only author who administered interviews and had no prior relationships with all but one study participant. Assumptions and pre-dispositions to interview content by the first author were regularly addressed throughout data analysis to maintain study integrity. This was achieved by conducting analysis by unique interview question, rather than by unique participant, and recoding the numerical order of participants for each question. Our commitment to rigorous qualitative methods was a strength for the study for multiple reasons. Conducting member checks with participants ensured trustworthiness of findings. Continuing data collection to data saturation ensured dependability of findings, which was achieved after 10 interviews and confirmed after 2 additional interviews. We further recognize the heterogeneity in our sample of participants, which helped generate variability in responses. To remain consistent with appropriate means of presenting results in qualitative research however, we shared minimal demographic information about our study participants to ensure confidentiality.

The divide between urban and rural health stretches beyond a disproportionate allocation of resources. Rural health systems serve a more complicated and hard-to-reach patient population. They lack sufficient numbers of providers to meet population health needs. These disparities impact collaboration between patients and providers as well as the delivery of acceptable and appropriate healthcare. The marker of rurality complicates the already cumbersome challenge of administering acceptable and appropriate healthcare and impediments stemming from rurality require continued monitoring to improve patient experiences and outcomes. Our qualitative study explored rural healthcare providers’ views on some of the social, cultural, and programmatic factors that influence access to healthcare among their patient populations. We identified five key themes: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. This study provides implications that may shift the landscape of a healthcare provider’s approach to delivering healthcare. Further exploration is required to understand the effects these characteristics have on measurable patient-centered outcomes in rural areas.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to individual privacy could be compromised but are available from the corresponding author on reasonable request.

Ethics approval and consent to participate.

All study procedures and methods were carried out in accordance with relevant guidelines and regulations from the World Medical Association Declaration of Helsinki. Ethics approval was given by exempt review from the Institutional Review Board (IRB) at the University of Montana (IRB Protocol No.: 186–20). Participants received oral and written information about the study prior to interview, which allowed them to provide informed consent for the interviews to be recorded and used for qualitative research purposes. No ethical concerns were experienced in this study pertaining to human subjects.

Consent for publication.

The participants consented to the publication of de-identified material from the interviews.

Riley WJ. Health Disparities: Gaps in Access, Quality and Affordability of Medical Care. Trans Am Clin Climatol Assoc. 2012;123:167–74.

PubMed   PubMed Central   Google Scholar  

Levesque J, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18 .

Article   PubMed   PubMed Central   Google Scholar  

Serban N. A Multidimensional Framework for Measuring Access. In: Serban N. Healthcare System Access: Measurement, Inference, and Intervention. New Jersey: John Wiley & Sons; 2019. p. 13–59.

Google Scholar  

Roncarolo F, Boivin A, Denis JL, et al. What do we know about the needs and challenges of health systems? A scoping review of the international literature. BMC Health Serv Res. 2017;17:636. https://doi.org/10.1186/s12913-017-2585-5 .

Cabrera-Barona P, Blaschke T. Kienberger S. Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach. Soc Indic Res. 2017;133,719–739. https://doi.org/10.1007/s11205-016-1371-9 .

Coombs NC, Meriwether WE, Caringi J, Newcomer SR. Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM Popul Health. 2021;15:100847. https://doi.org/10.1016/j.ssmph.2021.100847 .

Farietta TP, Lu B, Tumin R. Ohio’s Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age. Matern Child Health. 2018;22(12):1771–9. https://doi.org/10.1007/s10995-018-2575-1 .

Article   Google Scholar  

Sommers BD, Blendon RJ, Orav EJ, Epstein AM. Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance. JAMA Intern Med. 2016;1;176(10):1501–1509. https://doi.org/10.1001/jamainternmed.2016.4419 .

National Alliance on Mental Illness: The Doctor is Out. Continuing Disparities in Access to Mental and Physical Health Care. 2017. https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out . Accessed 29 Aug 2021.

Pollitz K, Lopes L, Kearney A, Rae M, Cox C, Fehr F, Rousseau D, Kaiser Family Foundation. US Statistics on Surprise Medical Billing. JAMA. 2020;323(6):498. https://doi.org/10.1001/jama.2020.0065 .

Kahraman C, Orobello C, Cirella GT. hanging Dynamics with COVID-19: Future Outlook. In: XX Cirella GT, editor. Human Settlements: Urbanization, Smart Sector Development, and Future Outlook. Singapore: Springer; 2022. p. 235–52.

Book   Google Scholar  

Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 — Implications for the Health Care System. N Engl J Med. 2020;383(15):1483–8. https://doi.org/10.1056/NEJMsb2021088 .

Article   CAS   PubMed   Google Scholar  

Defêche J, Azarzar S, Mesdagh A, Dellot P, Tytgat A, Bureau F, Gillet L, Belhadj Y, Bontems S, Hayette M-P, Schils R, Rahmouni S, Ernst M, Moutschen M, Darcis G. In-Depth Longitudinal Comparison of Clinical Specimens to Detect SARS-CoV-2. Pathogens. 2021;10(11):1362. https://doi.org/10.3390/pathogens10111362 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Rosenblatt RA, Hart LG. Physicians and rural America. West J Med. 2000;173(5):348–51. https://doi.org/10.1136/ewjm.173.5.348 .

Kaiser Family Foundation Analysis of OECD Data. 2020. https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-physicians-density-per-1000-population-2000-2018 . Accessed 31 Oct 2021.

Government Accounting Office. Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs. 2017. https://www.gao.gov/assets/gao-17-411.pdf . Accessed 31 Oct 2021.

The Kaiser Family Foundation: The Uninsured in Rural America. 2003. https://www.kff.org/wp-content/uploads/2013/01/the-uninsured-in-rural-america-update-pdf.pdf . Accessed 15 Sept 2021.

Wright B, Potter AJ, Trivedi AN, Mueller KJ. The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries. J Rural Health. 2018;34(4):423–30. https://doi.org/10.1111/jrh.12253 .

Article   PubMed   Google Scholar  

Weichelt B, Bendixsen C, Patrick T. A Model for Assessing Necessary Conditions for Rural Health Care’s Mobile Health Readiness: Qualitative Assessment of Clinician-Perceived Barriers. JMIR Mhealth Uhealth. 2019;7(11): e11915. https://doi.org/10.2196/11915 .

Mangundu M, Roets L, Janse van Rensberg E. Accessibility of healthcare in rural Zimbabwe: The perspective of nurses and healthcare users. Afr J Prim Health Care Fam Med. 2020;12(1):e1-e7. https://doi.org/10.4102/phcfm.v12i1.2245 .

Rahayu YYS, Araki T, Rosleine D. Factors affecting the use of herbal medicines in the universal health coverage system in Indonesia. J Ethnopharmacol. 2020;260: 112974. https://doi.org/10.1016/j.jep.2020.112974 .

Bolin JN, Bellamy GR, Ferdinand AO, et al. Rural Healthy People 2020: New Decade, Same Challenges. Journal of Rural Health. 2015;31(3):326–33.

Reid S. The rural determinants of health: using critical realism as a theoretical framework. Rural Remote Health. 2019;19(3):5184. https://doi.org/10.22605/RRH5184 .

Wynia MK, Osborn CY. Health literacy and communication quality in health care organizations. J Health Commun. 2010;15 Suppl 2(Suppl 2):102–115. https://doi.org/10.1080/10810730.2010.499981 .

Centers for Disease Control and Prevention. What is Health Literacy? 2022. https://www.cdc.gov/healthliteracy/learn/index.html . Accessed 25 Feb 2022.

Davis TC, Arnold CL, Rademaker A, et al. Differences in barriers to mammography between rural and urban women. J Womens Health (Larchmt). 2012;21(7):748–55. https://doi.org/10.1089/jwh.2011.3397 .

Halverson J, Martinez-Donate A, Trentham-Dietz A, et al. Health literacy and urbanicity among cancer patients. J Rural Health. 2013;29(4):392–402. https://doi.org/10.1111/jrh.12018 .

Zahnd WE, Scaife SL, Francis ML. Health literacy skills in rural and urban populations. Am J Health Behav. 2009;33(5):550–7. https://doi.org/10.5993/ajhb.33.5.8 .

Dogba MJ, Dossa AR, Breton E, Gandonou-Migan R. Using information and communication technologies to involve patients and the public in health education in rural and remote areas: a scoping review. BMC Health Serv Res. 2019;19(1):128. https://doi.org/10.1186/s12913-019-3906-7 .

Committee on the Science of Changing Behavioral Health Social Norms, Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. In: Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington: National Academics Press; 2016. p. 33–52.

Wu Y, Zhou H, Wang Q, Cao M, Medina A, Rozelle S. Use of maternal health services among women in the ethnic rural areas of western China. BMC Health Serv Res. 2019;19(1):179. https://doi.org/10.1186/s12913-019-3996-2 .

Meyer E, Hennink M, Rochat R, et al. Working Towards Safe Motherhood: Delays and Barriers to Prenatal Care for Women in Rural and Peri-Urban Areas of Georgia. Matern Child Health J. 2016;20(7):1358–65. https://doi.org/10.1007/s10995-016-1997-x .

Heinrich S. Medical science faces the post-truth era: a plea for the grassroot values of science. Curr Opin Anaesthesiol. 2020;33(2):198–202. https://doi.org/10.1097/ACO.0000000000000833 .

Esquivel MM, Chen JC, Woo RK, et al. Why do patients receive care from a short-term medical mission? Survey study from rural Guatemala. J Surg Res. 2017;215:160–6. https://doi.org/10.1016/j.jss.2017.03.056 .

Park LG, Dracup K, Whooley MA, et al. Symptom Diary Use and Improved Survival for Patients With Heart Failure [published correction appears in Circ Heart Fail. 2017 Dec;10(12):]. Circ Heart Fail. 2017;10(11):e003874. https://doi.org/10.1161/CIRCHEARTFAILURE.117.003874 .

Taleb F, Perkins J, Ali NA, et al. Transforming maternal and newborn health social norms and practices to increase utilization of health services in rural Bangladesh: a qualitative review. BMC Pregnancy Childbirth. 2015;15:75. https://doi.org/10.1186/s12884-015-0501-8 .

Billah SM, Hoque DE, Rahman M, et al. Feasibility of engaging “Village Doctors” in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh. J Glob Health. 2018;8(2): 020413. https://doi.org/10.7189/jogh.08.020413 .

Kaiser JL, Fong RM, Hamer DH, et al. How a woman’s interpersonal relationships can delay care-seeking and access during the maternity period in rural Zambia: An intersection of the Social Ecological Model with the Three Delays Framework. Soc Sci Med. 2019;220:312–21. https://doi.org/10.1016/j.socscimed.2018.11.011 .

Rao KD, Sheffel A. Quality of clinical care and bypassing of primary health centers in India. Soc Sci Med. 2018;207:80–8. https://doi.org/10.1016/j.socscimed.2018.04.040 .

Lee YT, Lee YH, Kaplan WA. Is Taiwan’s National Health Insurance a perfect system? Problems related to health care utilization of the aboriginal population in rural townships. Int J Health Plann Manage. 2019;34(1):e6–10. https://doi.org/10.1002/hpm.2653 .

Lyford M, Haigh MM, Baxi S, Cheetham S, Shahid S, Thompson SC. An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia. Int J Environ Res Public Health. 2018;15(2):337. https://doi.org/10.3390/ijerph15020337 .

Article   PubMed Central   Google Scholar  

Rohr JM, Spears KL, Geske J, Khandalavala B, Lacey MJ. Utilization of Health Care Resources by the Amish of a Rural County in Nebraska. J Community Health. 2019;44(6):1090–7. https://doi.org/10.1007/s10900-019-00696-9 .

Johnston K, Harvey C, Matich P, et al. Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers. Aust J Rural Health. 2015;23(5):257–64. https://doi.org/10.1111/ajr.12186 .

Legido-Quigley H, Naheed A, de Silva HA, et al. Patients’ experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study. PLoS ONE. 2019;14(1): e0211100. https://doi.org/10.1371/journal.pone.0211100 .

Shaw B, Amouzou A, Miller NP, Bryce J, Surkan PJ. A qualitative exploration of care-seeking pathways for sick children in the rural Oromia region of Ethiopia. BMC Health Serv Res. 2017;17(1):184. https://doi.org/10.1186/s12913-017-2123-5 .

Larson E, Vail D, Mbaruku GM, Kimweri A, Freedman LP, Kruk ME. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women. PLoS ONE. 2015;10(8): e0135621. https://doi.org/10.1371/journal.pone.0135621 .

Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health. 2014;30(1):79–88. https://doi.org/10.1111/jrh.12032 .

Weisgrau S. Issues in rural health: access, hospitals, and reform. Health Care Financ Rev. 1995;17(1):1–14.

CAS   PubMed   PubMed Central   Google Scholar  

National Center for Health Statistics. 2018. https://www.cdc.gov/nchs/surveys.htm . Accessed 29 Aug 2021.

Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. https://doi.org/10.1186/s12913-017-2031-8 .

Dyer TA, Owens J, Robinson PG. The acceptability of healthcare: from satisfaction to trust. Community Dent Health. 2016;33(4):242–51. https://doi.org/10.1922/CDH_3902Dyer10 .

Padgett DK. Qualitative and Mixed Methods in Public Health. Thousand Oaks, California: SAGE Publications Inc.; 2012.

Tolley EE, Ulin PR, Mack N, Robinson ET, Succop SM. Qualitative Methods in Public Health: A Field Guide for Applied Research. 2nd ed. San Francisco, California: John Wiley & Sons, Inc.; 2016.

Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. In: National Center for Health Statistics: Vital Health Statistics. 2014. https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf . Accessed 31 Oct 2021.

Health Resources & Services Administration. Health Professional Shortage Area Find. 2021. https://data.hrsa.gov/tools/shortage-area/hpsa-find . Accessed 31 Oct 2021.

Shaghaghi A, Bhopal RS, Sheikh A. Approaches to Recruiting “Hard-To-Reach” Populations into Re-search: A Review of the Literature. Health Promot Perspect. 2011;1(2):86–94. https://doi.org/10.5681/hpp.2011.009 .

Sadler GR, Lee HC, Lim RS, Fullerton J. Recruitment of hard-to-reach population subgroups via adaptations of the snowball sampling strategy. Nurs Health Sci. 2010;12(3):369–74. https://doi.org/10.1111/j.1442-2018.2010.00541.x .

Deterding NM, Waters MC. Flexible Coding of In-depth Interviews: A Twenty-first-century Approach. Sociological Methods & Research. 2021;50(2):708–39. https://doi.org/10.1177/0049124118799377 .

Schreier M, Stamann C, Janssen M, Dahl T, Whittal A. Qualitative Content Analysis: Conceptualizations and Challenges in Research Practice-Introduction to the FQS Special Issue" Qualitative Content Analysis I". InForum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2019;20:26 DEU.

Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE. 2020;15(5): e0232076. https://doi.org/10.1371/journal.pone.0232076 .

Mayring P. Qualitative Content Analysis. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2000;1(2). https://doi.org/10.17169/fqs-1.2.1089 .

O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine, Vol. 89, No. 9 / Sept 2014. https://doi.org/10.1097/ACM.0000000000000388 .

Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545–7. https://doi.org/10.1188/14.ONF.545-547 .

Miller S. Cultural humility is the first step to becoming global care providers. J Obstet Gynecol Neonatal Nurs. 2009;38(1):92–3. https://doi.org/10.1111/j.1552-6909.2008.00311.x .

Prasad SJ, Nair P, Gadhvi K, Barai I, Danish HS, Philip AB. Cultural humility: treating the patient, not the illness. Med Educ Online. 2016;21:30908. https://doi.org/10.3402/meo.v21.30908 .

George MS, Davey R, Mohanty I, Upton P. “Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare? Int J Equity Health. 2020;19(1):105. https://doi.org/10.1186/s12939-020-01216-1 .

Romanelli M, Hudson KD. Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. Am J Orthopsychiatry. 2017;87(6):714–28. https://doi.org/10.1037/ort0000306 .

Bailie J, Schierhout G, Laycock A, et al. Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. BMJ Open. 2015;5(11): e008103. https://doi.org/10.1136/bmjopen-2015-008103 .

Reeve C, Humphreys J, Wakerman J, Carter M, Carroll V, Reeve D. Strengthening primary health care: achieving health gains in a remote region of Australia. Med J Aust. 2015;202(9):483–7. https://doi.org/10.5694/mja14.00894 .

Swan LET, Auerbach SL, Ely GE, Agbemenu K, Mencia J, Araf NR. Family Planning Practices in Appalachia: Focus Group Perspectives on Service Needs in the Context of Regional Substance Abuse. Int J Environ Res Public Health. 2020;17(4):1198. https://doi.org/10.3390/ijerph17041198 .

Kabia E, Mbau R, Oyando R, et al. “We are called the et cetera”: experiences of the poor with health financing reforms that target them in Kenya. Int J Equity Health. 2019;18(1):98. https://doi.org/10.1186/s12939-019-1006-2 .

Ho JW, Kuluski K, Im J. “It’s a fight to get anything you need” - Accessing care in the community from the perspectives of people with multimorbidity. Health Expect. 2017;20(6):1311–9. https://doi.org/10.1111/hex.12571 .

Latif A, Mandane B, Ali A, Ghumra S, Gulzar N. A Qualitative Exploration to Understand Access to Pharmacy Medication Reviews: Views from Marginalized Patient Groups. Pharmacy (Basel). 2020;8(2):73. https://doi.org/10.3390/pharmacy8020073 .

Tschirhart N, Diaz E, Ottersen T. Accessing public healthcare in Oslo, Norway: the experiences of Thai immigrant masseuses. BMC Health Serv Res. 2019;19(1):722. https://doi.org/10.1186/s12913-019-4560-9 .

Ireland S, Belton S, Doran F. “I didn’t feel judged”: exploring women’s access to telemedicine abortion in rural Australia. J Prim Health Care. 2020;12(1):49–56. https://doi.org/10.1071/HC19050 .

Stokes T, Tumilty E, Latu ATF, et al. Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients. BMJ Open. 2019;9(11): e033524. https://doi.org/10.1136/bmjopen-2019-033524 .

Jafar TH, Ramakrishnan C, John O, et al. Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators. BMC Nephrol. 2020;21(1):26. https://doi.org/10.1186/s12882-020-1702-6 .

Doetsch J, Pilot E, Santana P, Krafft T. Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: a qualitative case study in Lisbon, Portugal. Int J Equity Health. 2017;16(1):184. https://doi.org/10.1186/s12939-017-0679-7 .

Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36. https://doi.org/10.1126/science.847460 .

Risberg G, Hamberg K, Johansson E.E. Gender perspective in medicine: a vital part of medical scientific rationality. A useful model for comprehending structures and hierarchies within medical science. BMC Med. 2006;4(1):1.

Montana Census & Economic Information Center. 2021. https://ceic.mt.gov/ . Accessed 18 Sept 2021.

Smith M, Saunders R, Stuckhardt L, McGinnis JM, Committee on the Learning Health Care System in America, Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington: National Academies Press; 2013.

O’Daniel M, Rosenstein AH, Professional Communication and Team Collaboration. In: Hughes RG, editor. Chapter 33: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality: Rockville; 2008.

Evans RS. Electronic Health Records: Then, Now, and in the Future. Yearb Med Inform. 2016;Suppl 1(Suppl 1):S48-S61. https://doi.org/10.15265/IYS-2016-s006 .

Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton GA. International Health Care System Profiles: United States. The Commonwealth Fund. 2020. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states . Accessed 19 Sept 2021.

Berchick ER, Barnett JC, Upton RD. Health Insurance Coverage in the United States. Washington: United States Census Bureau; 2018.

Brock DW, Buchanan A. Ethical Issues in For-Profit Health Care. In: Gray BH, editor. For-Profit Enterprise in Health Care. Washington: National Academics Press; 1986.

Lekas HM, Pahl K, Fuller Lewis C. Rethinking Cultural Competence: Shifting to Cultural Humility. Health Serv Insights. 2020;13:1178632920970580. https://doi.org/10.1177/1178632920970580 .

Beaulieu MD. Primary and secondary care: Breaking down barriers for our patients with chronic diseases. Can Fam Physician. 2013;59(2):221.

Crafford L, Jenkins LS. Why seek a second consultation at an emergency centre? A qualitative study. Afr J Prim Health Care Fam Med. 2017;9(1):e1–8. https://doi.org/10.4102/phcfm.v9i1.1397 .

Sorensen MJ, von Recklinghausen FM, Fulton G, et al. Secondary overtriage: The burden of unnecessary interfacility transfers in a rural trauma system. JAMA Surg. 2013;148:763–8.

Sutcliffe CG, Thuma PE, van Dijk JH, et al. Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study. BMC Pediatr. 2017;17(1):66. https://doi.org/10.1186/s12887-017-0822-z .

Baldwin LM, Morrison C, Griffin J, et al. Bidirectional Text Messaging to Improve Adherence to Recommended Lipid Testing. J Am Board Fam Med. 2017;30(5):608–14. https://doi.org/10.3122/jabfm.2017.05.170088 .

Albright K, Krantz MJ, Backlund Jarquín P, DeAlleaume L, Coronel-Mockler S, Estacio RO. Health Promotion Text Messaging Preferences and Acceptability Among the Medically Underserved. Health Promot Pract. 2015;16(4):523–32. https://doi.org/10.1177/1524839914566850 .

Cramer ME, Mollard EK, Ford AL, Kupzyk KA, Wilson FA. The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth. Public Health Nurs. 2018;35(6):508–16. https://doi.org/10.1111/phn.12543 .

Gbadamosi SO, Eze C, Olawepo JO, et al. A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study. J Med Internet Res. 2018;20(1): e18. https://doi.org/10.2196/jmir.8716 .

Trondsen MV, Tjora A, Broom A, Scambler G. The symbolic affordances of a video-mediated gaze in emergency psychiatry. Soc Sci Med. 2018;197:87–94. https://doi.org/10.1016/j.socscimed.2017.11.056 .

Schwitters A, Lederer P, Zilversmit L, et al. Barriers to health care in rural Mozambique: a rapid ethnographic assessment of planned mobile health clinics for ART. Glob Health Sci Pract. 2015;3(1):109–16. https://doi.org/10.9745/GHSP-D-14-00145 .

Kojima N, Krupp K, Ravi K, et al. Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India. BMC Infect Dis. 2017;17(1):189. https://doi.org/10.1186/s12879-017-2282-3 .

Gorman SE, Martinez JM, Olson J. An assessment of HIV treatment outcomes among utilizers of semi-mobile clinics in rural Kenya. AIDS Care. 2015;27(5):665–8. https://doi.org/10.1080/09540121.2014.986053 .

Lee S, Black D, Held ML. Factors Associated with Telehealth Service Utilization among Rural Populations. J Health Care Poor Underserved. 2019;30(4):1259–72. https://doi.org/10.1353/hpu.2019.0104 .

Agha Z, Schapira RM, Maker AH. Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population. Telemed J E Health. 2002;8(3):281–91. https://doi.org/10.1089/15305620260353171 .

Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of Telehealth During the COVID-19 Pandemic: Scoping Review. J Med Internet Res. 2020;22(12): e24087. https://doi.org/10.2196/24087 .

Download references

Acknowledgements

This research was supported by the Center for Biomedical Research Excellence award (P20GM130418) from the National Institute of General Medical Sciences of the National Institute of Health. The first author was also supported by the University of Montana Burnham Population Health Fellowship. We would like to thank Dr. Christopher Dietrich, Dr. Jennifer Robohm and Dr. Eric Arzubi for their contributions on determining inclusion criteria for the healthcare provider population used for this study.

 This research did not receive any specific grant from funding agencies in the public, commercial, and not-for-profit sectors. 

Author information

Authors and affiliations.

School of Public & Community Health Sciences, University of Montana, 32 Campus Dr, Missoula, MT, 59812, USA

Nicholas C. Coombs & James Caringi

Department of Psychology, University of Montana, 32 Campus Dr, Missoula, MT, 59812, USA

Duncan G. Campbell

You can also search for this author in PubMed   Google Scholar

Contributions

The authors confirm contribution to the paper as follows: study conception and design: NC and JC; data collection: NC; analysis and interpretation of results: NC and JC; draft manuscript preparation: NC, DC and JC; and manuscript editing: NC, DC and JC. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Nicholas C. Coombs .

Ethics declarations

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher's note.

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

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Coombs, N.C., Campbell, D.G. & Caringi, J. A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res 22 , 438 (2022). https://doi.org/10.1186/s12913-022-07829-2

Download citation

Received : 11 January 2022

Accepted : 21 March 2022

Published : 02 April 2022

DOI : https://doi.org/10.1186/s12913-022-07829-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Access to healthcare
• Rural health
• Qualitative methods

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• My Account Login
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Review Article
• Open access
• Published: 02 April 2024

How do we study misogyny in the digital age? A systematic literature review using a computational linguistic approach

• Lara Fontanella   ORCID: orcid.org/0000-0002-5441-0035 1 ,
• Berta Chulvi 2 , 3 ,
• Elisa Ignazzi 4 ,
• Annalina Sarra 5 &
• Alice Tontodimamma 1  

Humanities and Social Sciences Communications volume  11 , Article number:  478 ( 2024 ) Cite this article

343 Accesses

2 Altmetric

Metrics details

• Cultural and media studies

Nowadays, despite centuries of striving for equality, women still face higher levels of discrimination compared to men in nearly every aspect of life. Recently, this systemic inequality has manifested in cyberspace through the proliferation of abusive content that is even more aggressive than what one would expect in the 21st century. Various research disciplines are now attempting to characterise this new manifestation of misogyny. The endeavour to comprehend this phenomenon has resulted in a significant increase in publications from several fields, including Social Sciences, Arts and Humanities, Psychology, and Computer Science. This paper presents a systematic review of multidisciplinary research on misogyny from the years 1990 to 2022, encompassing a total of 2830 articles retrieved from the Scopus database as of December 31, 2022. The literature is thoroughly analysed using three approaches: bibliometric analysis, topic detection, and qualitative analysis of the documents. The findings suggest that the analysis of online misogyny has been the primary driver behind the exponential growth in publications in this field. Additionally, the results of the topic analysis and topic interaction reveal a limited connection between the areas of knowledge that are necessary to fully grasp this complex phenomenon.

Similar content being viewed by others

Negativity drives online news consumption

Claire E. Robertson, Nicolas Pröllochs, … Stefan Feuerriegel

Persistent interaction patterns across social media platforms and over time

Michele Avalle, Niccolò Di Marco, … Walter Quattrociocchi

Artificial intelligence and illusions of understanding in scientific research

Lisa Messeri & M. J. Crockett

Introduction

Nowadays, regardless of centuries of fighting for equality, women continue to face a disproportionate amount of discrimination compared to men across various contexts. Women and girls encounter prejudice, sexist attitudes, open discrimination, and violence throughout their lives, while the extent of these experiences varies by location, identity, and culture. Disgust, intolerance, or entrenched prejudice, serving to legitimise women’s oppression, persist even in countries often alleged to be post-patriarchal, like the United States, Australia, and the United Kingdom (Manne, 2017 ). The all-pervasive form of hostility and aversion against women and girls is referred to as misogyny, a term derived from the Ancient Greek word “mĩsoguniã”, which means hatred of women. According to Allen ( 2021 ), misogyny has a disputed definition. Some authors offer a definition of misogyny that, in some respects, overlaps with the concept of sexism. For example, Code ( 2000 ) defines misogyny as any of the following acts or feelings: sexual and physical violence against women, exclusion of women, promotion of patriarchy, belittlement, and marginalisation of women. In this approach, the promotion of patriarchy, broadly conceptualised as a system or systems producing and reproducing gendered and intersectional inequalities, is clearly the spread of a sexist mentality. Here, sexism is linked to the acceptance of sex-role stereotypes and can manifest at various levels: individual, organisational, institutional, and cultural (VandenBos, 2015 ). In the same line of reasoning, Jukes ( 1993 ) states that misogyny can be obvious and explicit at times, but it can also be subtle and insidious. However, the subtle expression of misogyny is more linked to sexist attitudes than to the expression of hate. Other authors, such as Manne ( 2017 ), set out a clear distinction between sexism and misogyny. In her book, “Down Girl: The Logic of Misogyny”, Kate Manne ( 2017 ) describes misogyny as the patriarchal order’s “law enforcement” branch, which rewards “good” women who adhere to social norms while punishing those who disobey. Sexism, on the other hand, is viewed as the “justificatory” branch, which rationalises and justifies male dominance through beliefs, theories, stereotypes, and cultural narratives that portray women as naturally inferior. This conceptual debate is due to two reasons. First, the fact that misogyny is strictly linked to the concepts of patriarchy and sexism, and second, the evidence that our societies are facing new ways of conveying misogynistic content in the form of open denigration of women.

Focusing on the link between concepts that describe women’s discrimination, it is evident that the powerful dynamics of a patriarchal society contribute to the development of a sexist culture, and this leads to the oppression of women both in their personal lives and within societal institutions (Millet, 1970 ). Additionally, hostile and benevolent sexism (Glick and Fiske, 1997 ) functions to preserve patriarchy and conventional gender norms. Benevolent sexism manifests through subjectively positive attitudes towards women in traditional roles, encompassing protective paternalism, idealisation, and a desire for intimacy. On the other hand, hostile sexism is expressed in a blatant and resentful way toward women who violate traditional roles and includes the negative equivalents of each dimension of benevolent sexism: dominant paternalism, derogatory beliefs, and heterosexual hostility. The aforementioned patriarchal culture legitimises openly misogynistic expressions, which represent the most extreme manifestation of aggression against women.

In this complex dynamic, studies from different disciplines tend to use different terminology when examining hostility towards women. Specifically, research in psychology is more inclined to use terms related to sexism, especially in distinguishing between hostile and benevolent sexism, and the notion of patriarchy is extensively examined in social science, particularly in sociological studies. The concept of misogyny is more commonly used in communication studies and computational science. The findings reported in the Supplementary Material provide evidence of the emphasis of different disciplines on different concepts.

Regarding the emergence of new ways of transmitting misogynistic content, the rise of interactive social media has been widely considered (Moloney and Love, 2018 ; Rubio Martìn and Gordo Lòpez, 2021 ; Tranchese and Sugiura, 2021 ).

Misogyny on the internet is not a new phenomenon. Indeed, legislation pertaining to women’s online safety dates back to the Beijing Declaration in 1995. However, it was not until the events of Gamergate Footnote 1 (Massanari, 2020 ) in August 2014 that the mainstream media and academic research took notice. In fact, in the gaming community, 2014 saw the emergence of the controversy and online movement known as “Gamergate”. It started out as a reaction to questions about ethics in video game journalism, but it soon turned into a harassment campaign directed at female journalists. The movement brought attention to misogyny, sexism, and the need for diversity in the gaming industry.

With the development of social networks, the historical aversion to women has become articulated through new modes of communication and social interaction. While digital spaces have amplified female voices, online platforms have notoriously facilitated the spread of misogynistic content: women’s systematic inequality and discrimination have been replicated in cyberspace in the form of abusive content much more aggressive than we would have expected in the 21st century (Bates, 2021 ). The online realm provides ample opportunities for misogyny to be linguistically expressed in various ways, ranging from subtle forms such as social exclusion and discrimination to more severe forms like sexual objectification and violent threats (Anzovino et al., 2018 ). Studies examining online misogynistic discourse have employed different terminology, such as “gender cyber hatred” (Jane, 2017 ), “cyber harassment” (Citron, 2014 ), “technological violence” (Ostini and Hopkins, 2015 ), “gender trolling” (Mantilla, 2013 ), “e-bile”, and “gender hate speech” (Jane, 2015 ). Other scholars (see, for instance, Ging and Siapera, 2018 ) chose to use a broader definition of misogyny which almost always results in some form of harm, either directly, in the form of psychological, professional, or physical harm, or indirectly, making the internet a less equal, less safe, or less inclusive space for women and girls.

Our study aims to investigate the current state of research on misogyny. For this purpose, we focus on the scientific literature on this subject during the period between 1990 and 2022. To the best of our knowledge, our study is the first systematic review on misogyny which combines three approaches: bibliometrics, topic detection, and qualitative analysis of the documents.

For the bibliometric research, we first analyse the existing literature extracted from the Scopus database within the misogyny research field by exploiting bibliometric tools. Bibliometric analysis provides a systematic, transparent, and replicable manner to investigate extant literature in a given field and discover the progress of disciplinary research from a macro perspective, supporting future research directions. Using bibliometric methods, we explore the main lines of research in the scientific literature on misogyny and offer a summary of the research activity in terms of the volume of work and evolution over time, as well as in terms of the social, intellectual and conceptual structures of this research area.

Although bibliometric tools provide a broad overview of current research, they cannot deliver detailed insights into studies in the literature based on semantic content analysis. In order to conduct an in-depth semantic analysis, it is necessary to supplement bibliometric methods with text-mining techniques (Hu et al., 2014 ). In accordance, our work employs topic analysis based on the Latent Dirichlet Allocation method (LDA; Blei et al., 2003 ) in order to identify the most prevalent latent themes in misogyny literature. LDA is gaining popularity among scholars in diverse fields (Alghamdi and Alfalqi, 2015 ). Two important findings emerge from a topic model: a list of topics (i.e., clusters of words that appear frequently together) and a list of documents that are strongly associated with each topic. As a result, this method offers a probabilistic quantification of relevance for both the identification of topics and the classification of documents, making it useful for locating interpretable topics with semantic meaning and assigning these topics to literature documents (Tontodimamma et al., 2021 ). According to Suominen and Toivanen ( 2016 ), the main innovation of topic modelling in categorising scientific knowledge is that it essentially eliminates the need to fit knowledge that is brand-new to the world into definitions that are already well-established.

Finally, we complement the study with a qualitative analysis aimed to discover the sociological perspective of the literature on online misogyny, on the one hand, and the computational aspects, on the other hand.

Bibliometric analyses

Bibliographic dataset.

For the analysis, we use a bibliometric dataset covering the period 1990–2022, retrieved from the Scopus database on 31 December 2022. Since we focus on the broad spectrum of scientific research on misogyny, the bibliographic dataset was extracted by looking for publications containing terms related to the generic query “misogyn*” in the content of the title, abstract, and keywords. All types of publications were included in the search, and 2830 documents were retrieved. The top publication fields include Social Sciences, Arts and Humanities, Psychology, and Computer Science.

Information about document distribution by research field is given in the Supplementary Material , along with the document distribution by source and the ranking of the most productive countries and authors.

Research activity

The evolution over time of the number of published documents shows remarkable growth (see Fig. 1 ). We found out that the number of published documents has increased dramatically over time. Since 1992, it has been possible to distinguish two distinct phases. A gradual increase in publications occurred during the first phase, which lasted from 1990 to 2010. The second phase, from 2010 to 2022, has a higher growth rate, indicating increased interest. This finding aligns with the three-stage development theory (Price, 1963 ) of productivity on a particular subject. Small increments in the scientific literature are documented during the precursor period when some scholars begin publishing research on a new topic. The number of papers increases exponentially in the second phase as the topic expands and draws a growing number of scientists, as many facets of the subject remain unexplored. Finally, in the third phase, the curve aspect shifts from exponential to logistic, testifying to a stabilisation in production and a consolidation of the body of knowledge.

Number of publications on misogyny per year: observed and expected temporal evolution according to exponential growth.

To verify the rapid increase, we fit an exponential growth curve to the data. The yearly rate of change in this model is 13.1%, demonstrating how research on misogyny might be cast in the second phase of development: although more research is being released, there is still space for improvement in many areas.

It is noteworthy to highlight that, as shown in the Supplementary Material , the research on misogyny from 1990 to 2002 follows a similar trend as sexism and has a slightly higher yearly growth rate compared to patriarchy. However, when considering only the five years prior to 2022, a more noticeable rise in the volume of published research on misogyny becomes evident, with a twofold increase in the number of published documents.

Social Structure of research on misogyny: collaboration network

To capture the essential characteristics of the misogyny research field, with a specific emphasis on collaborative efforts among different authors, we construct the authors’ collaboration network. We used the Bibliometrix R package, for performing network analysis and visualisation (Aria and Cuccurullo, 2017 ). Within the collaboration network, researchers act as nodes, and the connections between them (edges) represent co-authorships on articles. The node size is indicative of the authors’ productivity, measured in terms of the number of manuscripts authored or co-authored. The edges are weighted according to the frequency of co-authorship. Figure 2 visually illustrates the collaboration network among authors, highlighting the most significant cliques, each distinguished by different colours. The term “clique” is commonly employed to identify highly interconnected groups of elements, such as nodes or vertices, within a network. In our context, a “clique” signifies a group of authors who closely and frequently collaborate with one another compared to their counterparts, thereby creating a densely interconnected structure within the network. The most central scholars, with the highest number of connections, are Elisabetta Fersini, Paolo Rosso, Bilal Ghanem and Viviana Patti, who are also among the most proficient authors in the field of research on misogyny, as shown in the Supplementary Material . The noteworthy aspect is that the densest subgraphs link authors whose research falls under the computer science category.

Authors’ collaboration network.

Intellectual Structure of research on misogyny: citation analysis

The top five documents with the highest number of citations are: “Gamergate and The Fappening: How Reddit’s algorithm, governance, and culture support toxic technocultures” (Massanari, 2017 ), “Down girl: The logic of misogyny” (Manne, 2017 ), “Attitudinal antecedents of rape myth acceptance: A theoretical and empirical re-examination” (Lonsway and Fitzgerald, 1995 ), “Post-postfeminism?: new feminist visibilities in postfeminist times” (Gill, 2016 ) and “Beauty and Misogyny Harmful Cultural Practices in the West” (Jeffreys, 2005 ). These works investigate misogyny from various angles.

Manne’s book explores the logic of misogyny, which “primarily targets women because they are women in a man’s world ” (Manne, 2017 , p. 64). Manne argues that misogyny still exists in alleged post-patriarchal cultures and has taken different forms since legal equality, requiring women to be moral “givers” and validating a sense of entitlement among privileged men. Misogyny often takes the form of taking from women what they supposedly owe men and preventing women from competing for positions of power and authority traditionally held by men. In addition, Manne examines various examples of rape culture, including online harassment.

Considering attitudes toward sexual violence, Lonsway and Fitzgerald investigate the relationship between misogyny and rape myth acceptance. Here, rape myths can be defined as “attitudes and beliefs that are generally false but are widely and persistently held, and that serve to deny and justify male sexual aggression against women” (Lonsway and Fitzgerald, 1994 , pag. 134).

From a feminist perspective, Jeffreys argues that some Western beauty practices (e.g., makeup, high-heeled shoes, breast implants) should be included in the United Nations’ definition of harmful traditional/cultural practices due to the damaging effects they have on women’s health, the creation of sexual difference, and the enforcement of female deference. Gill’s article contends that it is crucial to examine how the media portrays feminism and to delve into the complexities of a cultural moment that seems to be characterised by a range of feminist ideologies (both contemporary and traditional), as well as a resurgence of anti-feminist attitudes and prevalent misogyny.

Massanari’s research centres on online misogyny and is based on a long-term participant-observation and ethnographic study of Reddit’s culture and community. The research specifically focuses on the #Gamergate and The Fappening cases. The Fappening involved the illegal distribution of nude photos of celebrities via anonymous image-board 4chan and Reddit, while #Gamergate was ostensibly about ethics in gaming journalism but became a campaign of harassment against female and minority game developers, journalists, and critics. The study highlights how Reddit’s design, algorithm, and platform politics implicitly support toxic technocultures, providing a fertile ground for anti-feminist and misogynistic movements to flourish. Online misogyny is also discussed in the papers with the highest number of local citations (i.e., citations from other documents within our bibliographic dataset): “#MasculinitySoFragile: Culture, structure, and networked misogyny” (Banet-Weiser and Miltner, 2016 ), “Back to the kitchen, cunt: Speaking the unspeakable about online misogyny” (Jane, 2014 ), and “Drinking male tears: language, the Manosphere, and networked harassment” (Marwick and Caplan, 2018 ).

Conceptual Structure of research on misogyny

To understand the conceptual structure of the research on misogyny, we initially performed an exploratory analysis of the textual content of the keywords chosen by the authors.

Figure 3 shows the most used keywords, after removing the term “misogyny”. Besides the extensive terms gender, feminism and sexism, we find keywords related to the phenomenon of violence against women, to the emerging theme of the Manosphere and to the classical theme of patriarchy and hegemonic masculinity. It is also worth noting the presence of several keywords strictly linked to the online diffusion of misogynistic content.

Most used keywords.

To deepen the analysis, a conceptual structure map (see Fig. 4 ) of the literature on misogyny was created using the Bibliometrix R package (Aria and Cuccurullo, 2017 ), which enables performing multiple correspondence analysis (MCA, Greenacre and Blasius, 2006 ) and hierarchical clustering. MCA, in particular, allows the generation of a low-dimensional Euclidean representation of the original data matrix by performing a homogeneity analysis of the “documents by keywords” indicator matrix, which is constructed by taking into account a dummy variable for each keyword. The words are plotted on a two-dimensional plane, where closer words have a more consistent distribution across the documents.

Conceptual map of research on misogyny.

The two dimensions of the maps that emerged from the MCA can be interpreted as follows. The first dimension separates keywords emphasising the problem of misogyny in general and on social media platforms (on the right) from those related to the methodological aspects of the automatic detection of misogynistic language (on the left). The second dimension separates keywords emphasising the problem of misogyny from a general point of view (on the upper) from those related to the Manosphere and Incels ( involuntary celibates ) and their presence on the Reddit platform (on the bottom). Figure 4 also displays the results obtained through a hierarchical cluster analysis carried out adopting the method of average linkage on the factorial coordinates obtained through MCA. Five clusters emerge from the conceptual structure map. The orange cluster refers to publications related to the automatic detection of misogynistic content through machine learning and deep learning techniques. The green cluster displays the connection between misogyny and hate speech and the exploitation of Natural Language Processing (NLP) methodologies to investigate these phenomena. The blue cluster refers to the intersectionality of research on misogyny. The red cluster is strictly linked to studies of the presence of misogynistic content on social media. Finally, the purple cluster is related to publications dealing with the topics of the Manosphere and the Incel phenomenon.

Research themes in misogyny literature

A topic modelling approach is exploited to investigate the textual content of title, abstract and authors’ keywords to give extra insight into multiple latent themes emerging from the literature on misogyny. To reveal the themes, research interests and trends of studies in the existing misogyny literature, we rely on the LDA model.

Topic analysis: LDA model

LDA is an unsupervised machine-learning-based algorithm allowing to discovery of latent (unobserved) “topics” in large unstructured text datasets (Blei et al., 2003 ). Previous research applied LDA to bibliometrics as an efficient tool for understanding a field’s rich underlying topical structure (see, among others, Suominen and Toivanen, 2016 , Tontodimamma et al., 2021 ). The idea behind LDA is that documents contain multiple topics, and each topic is represented as a probability distribution over terms in a fixed vocabulary, with different topics represented by different probabilities of words in the vocabulary. LDA generative process specifies a joint distribution of hidden and observed variables. The algorithm aims to estimate the posterior distribution of the hidden variables given the observed data, but exact inference is intractable, requiring approximate inference algorithms like sampling-based and variational algorithms (Blei et al., 2003 ; Steyvers and Griffiths, 2006 ). To employ LDA, the user needs to specify the number of latent topics in the corpus and two hyperparameters that control how documents and words contribute to topics. A detailed explanation of the LDA algorithm can be found in the studies by Blei ( 2012 ) and Steyvers and Griffiths ( 2006 ).

In our analysis, we use LDA to model a corpus with each document consisting of the publication title, abstract, and keywords. LDA analysis was performed through the Fitlda Matlab routine, available in the Text Analytics Toolbox (MATLAB, 2022 ).

Topic interpretation

The themes generated by LDA are hidden variables that require proper interpretation, typically done by examining the top keywords associated with each topic (Steyvers and Griffiths, 2006 ). To this end, Figs. 5 and 6 show the most important words for each topic, with importance determined by normalising the posterior word probabilities for each topic by the geometric mean of the posterior probabilities for the word across all topics. The topics are ranked based on their estimated likelihood of being observed in the entire dataset. Section 2 of the Supplementary Material contains the list of the most significant terms and their relevance measurements. The twelve selected topics address crucial areas of research on misogyny and can be summarised as follows.

Word clouds for topics 1–6.

Word clouds for topics 7–12.

Topic 1 revolves around a comprehensive discussion on the feminist perspective of the misogyny phenomenon and addresses the root causes of misogyny and gender-based discrimination. The primary focus is on patriarchal male gender privilege and its role in perpetuating misogyny. This topic covers a range of issues related to gender inequality, such as the leadership gap between men and women, women’s rights, and the intersection of misogyny with other forms of oppression.

Topic 2 focuses on how misogyny is expressed in literary works from the early and medieval periods to the modern era. Overall, this topic highlights the role of novels, prose, tales, and fiction in shaping societal attitudes and beliefs about gender and how this has influenced the treatment of women throughout history.

Along similar lines, Topic 3 centres on the study of misogyny in relation to the representation of women in films and on how it influences the portrayal of women on visual media.

Topic 4 is focused on the study of misogyny within the realm of politics and examines how misogyny can be perpetuated within political systems and movements. In particular, the inclusion of terms like “American”, “white”, and “altright” suggests that research included in this topic might focus on the ways in which misogyny is manifested in American politics, particularly within white nationalist and alternative-right movements.

Topic 5 is centred on the study of masculinity and how it relates to misogyny. In particular, the word “hegemonic” suggests that this topic may focus on how dominant forms of masculinity reinforce misogyny and gender-based discrimination.

Topic 6 pertains to the research on women’s rights, including reproductive rights, family law, and access to healthcare, particularly within legal and political systems and on how these systems can either promote or hinder gender equality.

The latent theme of Topic 7 seems to refer to a broad subject area that encompasses issues related to education, sexuality, and sexual identity. Additionally, the related terms suggest a focus on the ways in which sexuality is addressed within educational institutions, including schools and universities.

Topic 8 is a subject area that focuses on the study of digital misogyny, which refers to the ways in which sexism and gender-based discrimination are perpetuated through online and digital media platforms.

The set of words linked to Topic 9 clearly indicates studies focusing on the subject of sexual violence and harassment.

Research included in Topic 10 is related to the investigation of misogyny in the context of music and religion.

Topic 11 appears to be focused on the intersection of misogyny and racism, particularly as it relates to the misogynoir phenomenon.

Finally, Topic 12 deals with the identification and classification of online misogyny.

Topic interactions

By modelling each document as a mixture of several topics and each topic as a combination of words, the LDA technique assigns topics to documents. In our analysis, we awarded the top three document-topic probabilities to each document in this study as long as the probabilities are greater than 0.2. We developed a topic relationship network by considering the topic co-occurrence matrix. The topic network is depicted in Fig. 7 , along with node centrality measures. The nodes are coloured according to their degree, and the edges are weighted depending on co-occurrences. The stronger the link, the thicker the line. Edges with weights less than the average number of co-occurrences have been omitted. The investigation of the linkages reveals relationships between research fronts, emphasising the multidisciplinary character of research on misogyny. The highest degrees are associated with the first three topics, which encompass broader themes dealing with the feminist perspectives of patriarchal society (Topic 1) and the representation of women in literary works (Topic 2) and cinema (Topic 3). Moreover, the latter two topics show the strongest interconnection. Lower degrees are associated with more specialistic research fronts related to the presence of misogyny in music and religion, the misogynoir phenomenon, and the recent field of misogyny detection in computational sciences. In particular, the theme of automatic identification of misogynistic content (Topic 12) is only linked to the research dealing with digital misogyny (Topic 8). A high betweenness, measuring the extent to which the node is part of paths that connect an arbitrary pair of nodes in the network, is associated with Topics 5 and 6, dealing with the study of masculinity and how it relates to misogyny and to research on women rights, respectively. These findings suggest that those research areas are more effective and accessible in the network and form the densest bridges with other nodes.

Topic co-occurence network for the publications on misogyny and nodes’ centrality measures.

Topic temporal evolution

The temporal evolution of the scientific productivity for each topic can be captured through Fig. 8 . The temporal trend of most topics agrees with exponential growth. However, looking at Topic 2, related to studies of misogyny in literary works, we notice how the number of publications in the last period falls below the number expected according to the exponential law. Conversely, the number of published documents for Topics 8 and 12 shows a sudden rise starting from 2018. This trend testifies to the increasing interest in the study of online misogyny and the related techniques for automatic detection and identification. A relatively more contained rise in the size of publications is recorded for Topics 10 related to the investigation of misogyny in the context of music and religions.

Number of publications on misogyny for each topic: observed and expected distributions according to exponential growth.

The appearance and development of new fields of interest and innovative ideas in the research activity on misogyny are confirmed by the heatmaps provided in the Supplementary Material , which show the number of documents, by years, assigned to the identified topics.

Sociological research on online misogyny

To improve our comprehension of the ongoing research on the online dissemination of misogynistic content, we utilised a more specific selection query in our search of the original set of documents, which targeted terms associated with the online environment. We limited our search to articles published in journals categorised under the Social Science subject area. After analysing 277 articles, we identified 187 that were suitable for our study.

Among these documents, four articles provide a review of the literature on online misogyny from different perspectives. Moloney and Love ( 2018 ) review the way online misogyny is conceptualised in the social scientific literature within feminist media studies. The authors identify four different terms that are used to describe different types of online misogyny: online sexual harassment, gendertrolling, e-bile, and disciplinary rhetoric. They also examine the sociological perspective and introduce the concept of “virtual manhood acts” (VMAs), which is situated within the broader context of critical gender theory. VMAs are examples of technologically facilitated misogyny that occur in online social spaces: textual and visual cues are exploited to signal a masculine self, enforce traditional gender norms, oppress women, and restrict men to predefined gender roles. Bosch and Gil-Juarez ( 2021 ) conducted both a systematic review of 33 articles found in Web of Science and a traditional review of academic, institutional, and feminist-activist publications. Their findings show that the majority of aggressors in online gender-based violence are cis-hetero-patriarchal men, who are mostly known to the victims and are often partners or ex-partners. The types of violence range from sexual insults and threats to sexual and high-tech violence. Rubio Martìn and Gordo Lòpez ( 2021 ) provide an overview of the most recent academic literature within the feminist technosocial literature, specifically related to sexual and gender-based violence in digital environments. In addition to discussing the contemporary antecedents of this perspective and presenting current positions and the most representative studies on topics related to online misogyny, the authors demonstrate the potential of the feminist technosocial approach for analysing digital environments and their designs. The main conclusion drawn is that both the values of a misogynistic culture and the possibilities for its reproduction and dissemination are embedded in the design and architecture of digital platforms. The article also highlights the increasing relevance of hybrid realities that result from the synergies between the physical and digital realms, as they enable amplified discourses and actions of online misogyny. Faith ( 2022 ) investigates how gender, technology, and development are interconnected by analysing various works from different fields, including feminist technology studies, gender and development, feminist criminology, and ICT for development. The study also draws data from sources such as civil society, news reports, and international organisations, like the UN, to examine online violence. The author argues for a critical research approach to better understand the complex and opaque power dynamics that shape the digital economy and how it affects gender and development goals.

The articles on online misogyny, which were found in the Social Science category, underwent a manual annotation process to extract various pieces of information. Regarding the different methodologies and techniques used to investigate online misogyny, our findings indicate that discourse analysis and content analysis are the primary methodologies employed in social science literature. Several studies utilise in-depth interviews and surveys to examine the individuals targeted by and responsible for online misogyny. Additionally, digital ethnography, corpus linguistics, and network analysis are also employed. The most analysed social media platforms include Twitter, Reddit and Facebook. Further details on the methodological approaches and the social networks are provided in the Supplementary Material . The subsequent sections delve into details regarding target victims, misogynistic groups, and potential measures to counteract online misogyny.

Targets of online misogyny

Scholars studying online misogyny have identified various target groups that are particularly vulnerable to misogynistic content. These groups include female politicians, journalists, celebrities, influencers, musicians, gamers and developers, YouTubers, university students, and women who have been sexually assaulted. By focusing on specific target groups, research helps in achieving a more nuanced understanding of the ways in which online misogyny manifests and the specific harms that it causes.

Studies on online misogyny directed towards female politicians have concentrated on analysing the experiences of women from various countries, examining the types of misogynistic content directed towards them and the platforms on which it is disseminated. Silva-Paredes and Ibarra Herrera ( 2022 ), using a corpus-based critical discourse analysis, explore abuse received by a Chilean right-wing female politician. Phipps and Montgomery ( 2022 ) conducted an investigation into the portrayal of Nancy Pelosi as the monstrous feminine in the deeply misogynistic attack advertisements of Donald Trump’s 2020 presidential re-election campaign. In light of the prevalent misogynistic and anti-feminist depictions of Senator Hillary Clinton across all types of media, Ritchie ( 2013 ) examines how online media continues to have the power to create harmful representations of female politicians and the consequences for the political campaigns of women and for the democratic process as a whole. Focusing on Canadian politicians, Wagner ( 2022 ) discusses how online harassment is a gendered phenomenon. The study, drawing upon interviews with 101 people from diverse genders, racial/ethnic identities, sexual orientations, and partisan affiliations, shows that women are more aware of online harassment than men and how it succeeds in making women feel they are in a hostile political environment. Saluja and Thilaka ( 2021 ), analysing the Twitter discourse referring to three well-known female politicians in India, reveal similar findings, emphasising how female politicians are subjected to a different and distinct pattern of reception compared to their male counterparts. Instances of misogynistic or sexist hate speech and abusive language against female politicians in Japan are investigated in Fuchs and Schäfer ( 2021 ).

The research conducted by Chen et al. ( 2020 ) through in-depth interviews with 75 female journalists from Germany, India, Taiwan, the United Kingdom, and the USA revealed that those journalists frequently encounter online gendered harassment. The harassment, which includes sexist comments that criticise, attack, marginalise, stereotype, or threaten them based on their gender or sexuality, has led to some female journalists being subjected to misogynistic attacks and even threats of sexual violence. The study suggests that this kind of harassment limits their level of interaction with their audience without being attacked or sexually undermined.

By examining the findings of the qualitative in-depth interview of 48 female journalists, Similar findings are reported by Koirala ( 2020 ), whose study, based on the qualitative in-depth interview of 48 female journalists in Nepal, highlights how some of them tolerate harassment by being ‘strong like a man’, while many avoid social media platforms to keep free of such abusive behaviour. Along the same lines, Rego ( 2018 ) analyses Twitter conversations with Indian journalists and argues that social media platforms constitute convenient havens of harassment against assertive women.

Ghaffari ( 2022 ), analysing user-generated comments on the Instagram profile of a female American celebrity, shows how women are required to suppress their feelings and limit their authentic online presentation to maintain the outward countenance that matches the stereotypical gender roles in audiences’ state of mind. The research conducted by Döring and Mohseni ( 2019 ) supports these findings, focusing on video producers on YouTube. Their study found that female video producers are more likely to receive negative comments compared to male producers, but only if they display their sexuality or address feminist topics. However, if they conform to traditional gender role expectations, they do not experience this kind of negative feedback.

The emergence of female gamers in video game communities has led to a rise in misogynistic attacks against those who challenge the traditional hypermasculine culture of gaming. The 2014 #gamergate incident is a prime example of this, where a group of gamers opposed “Social Justice Warriors” who highlighted discrimination and exclusion in the gaming industry. Female gamers were subject to death threats, rape threats, and doxxing, where their private information was shared online (Tomkinson and Harper, 2015 ). The video gaming community has a long history of gender-based attacks on women, which serve to create a toxic environment for them when making and playing video games. According to Jenson and De Castell ( 2021 ), who approach the subject from a feminist perspective, video games have been predominantly masculine and gendered spaces. Repeated displays of aggression, referred to as “shock and awe”, perpetuate and legitimise gendered hostility. These displays also help to preserve exclusionary media practices designed to maintain the status quo.

The Manosphere

Numerous articles on online misogyny examine the Manosphere, a collection of websites and social media groups that endorse misogynistic beliefs. These networks are not uniform but consist of multiple misogynistic groups with differing perspectives and degrees of violence, which are associated with far-right, homophobic, and racist ideologies (Dickel and Evolvi, 2022 ). Despite their variations, all these groups portray feminism as innately discriminatory and threatening to men (Farci and Righetti, 2019 ). The Manosphere adheres to the beliefs of a ‘gynocentric order’ and the Red Pill ideology, a metaphor derived from the movie The Matrix, in which the protagonist’s eyes are opened to reality upon taking the “red pill”. Although these groups may have distinct beliefs, many members use the term misandry, referring to the hate against men, which has ideological and community-building functions. It reinforces a misogynistic belief system that portrays feminism as a movement that hates men and boys (Marwick and Caplan, 2018 ). The use of misandry caters to both extremist misogynistic subcultures and moderate men’s rights groups. It enables these groups to adopt the language of identity politics, positioning men as the silenced victims of reverse discrimination in all aspects of political, economic, and social life and solidifying their sense of entitlement (Farci and Righetti, 2019 ).

Men’s rights activists employ a personal action frame to construct a plausible but fictional narrative of men’s oppression (Carian, 2022 ). The movement against feminism revolves around advocating for men’s rights while denying that gendered violence exists (Garcìa-Mingo et al., 2022 ). The Manosphere engages in a crucial ideological effort that normalises, trivialises, and legitimises sexual violence against women in various forms (Garcìa-Mingo et al. 2022 ). Some of the primary themes of this ideology are: criticising and verbally abusing women, downplaying or not taking seriously accusations or reports of rape, depicting #MeToo as a feminist plot, portraying men as victims, and advocating for the restoration of patriarchal values (Dickel and Evolvi, 2022 ). Hopton and Langer ( 2022 ), analysing Twitter content to understand how the Manosphere constructs masculinity and femininity, identify three discursive strategies: co-opting discourses of oppression, naming power, and disavowal by disaggregation. These strategies are used to position men as victims, portray women as monstrous others, and re-establish gendered power hierarchies through continuous references to rape in their discourse.

One of the main groups in the Manosphere, the Incels, believes in a hetero-patriarchal racial hierarchy and justifies their lack of sexual activity through ideas rooted in biological determinism and victimisation by women and feminism (Lindsay, 2022 ). Scotto di Carlo’s analysis of Incels (Scotto di Carlo, 2023 ) reveals a conflation of apparently sarcastic metaphors, dark humour, and misogyny to describe women, as well as unique self-representations of forum participants that do not conform to typical ‘us vs them’ identity pattern (van Dijk, 1998 ): instead of highlighting the positive qualities of their in-group, the Incels describe themselves in a derogatory manner, leading to a spiral of self-pity and self-contempt that can foster a sense of brotherhood within the community. These findings stem from a content-discourse analysis of posts from threads specifically discussing women on an incel forum and from the study of nominations and predications of self-representations used in the ‘Introductions’ thread of the same forum. Halpin ( 2022 ), drawing on a qualitative analysis of comments made on a popular Incel discussion board, demonstrates how the group uses its perceived subordinate status to justify their misogyny and legitimise its degradation of women. Conducting an ethnographic content analysis of incel-identified subreddits and using femmephobia as a lens, Menzie ( 2022 ) examines how Incels employ heteropatriarchal conceptions of femininity to devalue women and to describe the social conditions that force them to remain celibate. The study focuses on the symbolic actors constructed by Incels, namely Stacy, who represents the most attractive women, Becky, who represents women of ordinary or moderate attractiveness, and Chad, who represents dominant alpha males. Five themes emerge from the analysis. First, Incels use these symbolic gendered actors to describe a sex deficit most men suffer, implying their own undesirability. Second, Incels’ femmephobia towards hyper-feminine women for not fitting heteropatriarchal requirements is evident in “Stacy”.Third, “Becky” shows a more flexible femmephobia towards women of different appearances who uphold “unrealistic standards” and date men more attractive than themselves or rely on feminism to cope with not attracting the same men as Stacy. Through “Chad”, the fourth topic examines the idea of masculinity, incorporating feelings of jealousy and recognition of victimisation under societal conditions that allow women to exploit men financially or emotionally. Finally, the analysis reveals how Incels prioritise partner display as a symbol of wealth. Along the same lines, Koller and Heritage ( 2020 ) analysed a textual corpus created from threads posted and commented on by Incels. The study examined keywords, word frequencies, and concordance lines to explore the representation of gendered social actors. The findings suggest that Incels position different groups of men in a hierarchy in which conventionally attractive men occupy the top position. Female social actors are not placed in a similar hierarchy. Furthermore, an additional appraisal analysis of the most frequently occurring male and female social actors reveals that men are judged as unable to function, while women are viewed as immoral, dishonest, and capable of causing harm to men.

Chang ( 2022 ), analysing the discourses circulating on a Reddit forum for self-proclaimed Incels, explores the perceptions created by the term “femoid”, a derogatory term generated by Incels to refer to women, constructing them as an abject “monstrous-feminine”, serving a dehumanising function and thus justifying the violence enacted upon them. Tranchese and Sugiura ( 2021 ) focus on the similarities between the language used in pornography and that of Incels, arguing that both are different manifestations of the same misogyny. Their study involves a linguistic analysis that compares a collection of posts from an Incel subreddit community with a reference collection of posts from 688 subreddits covering other subjects. From a different perspective, Byerly ( 2020 ) investigated news media language in the coverage of Incel behaviour associated with sexual aggression. The study employs qualitative textual analysis on a sample of 70 articles obtained using keyword combinations ‘incels and violence’, ‘incels and social media’, and ‘incels and sexism’ from 29 distinct news sources across 6 countries throughout the years 2018 and 2019. Research findings indicate that news stories emphasise the role of social media in helping Incels find each other and form online communities. Additionally, specific social media sites served as locations to amplify misogynistic attitudes and to boast about their murders. Speckhard et al. ( 2021 ) conducted a study that involved gathering information on Incels’ social and personal lives, adherence to incel ideology, opinions on incel-related violence, support for violent actions, and beliefs regarding the classification of Incels as violent extremists. The data was collected through a Google Forms survey that was distributed to active adult members of a prominent Incel forum. The final sample under analysis comprises 272 respondents who self-identify as Incels. The findings demonstrate that while most of them do not advocate violence and are non-violent, those who strongly hold misogynistic beliefs are more likely to endorse violent actions. Participation in Incel online forums, which validate their viewpoints, could also lead to an increase in their misogyny. O’Donnell and Shor ( 2022 ) investigated how misogynistic Incels discuss mass violence committed by their peers. Through qualitative content analysis of comments related to the 2018 Toronto van attack, in which self-declared Incel Alek Minassian drove a van into pedestrians, killing 10 and injuring 16, they found that a large majority of self-proclaimed Incels expressed support for such violence, as well as violence in general. Incels believed that mass violence was a means to achieve four main goals: gaining more attention, seeking revenge, reinforcing traditional masculinity, and bringing about political change.

MGTOW (Men Going Their Own Way), a separatist group within the Manosphere, also promotes a misogynistic agenda. Unlike Men’s Rights Activists and Incels, MGTOWs focus on individualistic and self-empowering actions, encouraging men to lead a self-sufficient life away from women. Jones et al. ( 2020 ), using content and thematic analyses of a corpus of tweets from three of the most active MGTOW users on Twitter, have linked the MGTOW ideology with toxic masculinity, showing that the online harassment it generates is deeply misogynistic and upholds heterosexual and hegemonic masculinity. The authors note that, although misogyny and violence produced by MGTOW are not extreme, the group’s appeals to rational thinking make them appear to be common sense. Wright et al. ( 2020 ) delve deeper into the structural underpinnings and nature of MGTOW debate within their discussion forums, including leadership, moderation, in-group dynamics, and the discursive form of debates, and how this contributes to the propagation of misogyny and different calls to action. The authors conducted a content analysis of comments in the official MGTOW website’s forum and a digital ethnographic approach. Their findings showed that discussions primarily revolve around women and the MGTOW community. When discussing women, users did so in an openly misogynistic way. When discussing MGTOW, conversations sought to define and rationalise it as an ideology, both for individuals and the collective. The authors also note that the communicative form was mainly communitarian, with strong group bonding, ties, and engagement.

Countering online misogyny

Strategies and tactics used by women to cope with and address gender violence online are diverse and sometimes activated simultaneously. Some of these strategies prioritise self-care and protection, while others focus on resistance and challenging such violence. From a self-care perspective, it is crucial to adopt mitigation measures that reduce harm and minimise risks, such as assessing online identities, adopting pseudonyms or collective identities, using masks, strengthening accounts, creating distance, silencing or erasing sensitive content (Bosch and Gil-Juarez, 2021 ). In the research by Chen et al. ( 2020 ), it is shown how female journalists have developed multiple strategies for coping with abuse, including modifying their social media postings, altering their reporting subjects, and utilising technological tools to prevent offensive comments on their public pages.

Merely prioritising self-care is insufficient; an active approach should be taken to resist and transform the current state of online misogyny. This involves engaging in actions that challenge the status quo and strive for meaningful change, with the ultimate goal of repoliticising the internet and social media with, for, and from a feminist perspective (Bosch and Gil-Juarez, 2021 ). From this standpoint, social media platforms can give space to the promotion of gender-based harassment but can also serve as crucial spaces for feminist education and activism and for the formation of a feminist counter-public that directly contests a misogynistic culture (Sills et al. 2016 ). In this perspective, Kurasawa et al. ( 2021 ) discuss a new form of feminist activism called evidentiary activism, which uses evidence of gender-based online violence (GBOV). Evidentiary activism engages with existing formal evidentiary cultures by advocating for legislative and regulatory reforms to address GBOV, promoting platform-based technological solutions, and challenging conventional notions of user privacy and anonymity. In addition, it involves contributing to and embracing informal evidentiary cultures, which use evidence as a tool for cultural and political mobilisation against GBOV. Strategies used include publicising instances of GBOV, highlighting the moral implications of such violence, and fostering feminist digital citizenship. As an example of online feminist activism, Kim ( 2017 ) explored the role of the 2015 hashtag #iamafeminist in promoting feminist identification and activism against misogyny in South Korea. The hashtag persisted for three months by addressing current gender issues and promoting activism both online and offline. The article by Shesterina and Fedosova ( 2021 ) examines the methods used by female bloggers to promote feminist ideas on Instagram. The authors found that while many posts are logically argued, female bloggers often use emotional manipulation and persuasion techniques to promote their ideas. The study identifies both the main topics in support of feminism, such as domestic violence and gender stereotypes, victim blaming, and the most common attitudes that female bloggers challenge in their posts (e.g., “gender roles are determined by nature”, “a woman must obey a man”, “female intelligence is worse than male”, “all women are hysterical”). The authors also describe the lexical means and rhetorical techniques commonly used in female blogs, such as metaphors, allusions, appeals, and rhetorical questions. The language used is generally colloquial, making texts easier to read, but it also includes harsh criticism and increased emotionality compared to traditional journalistic texts.

However, according to Jane ( 2016 ), taking matters into one’s own hands when faced with online harassment may have limited effectiveness and is not a sufficient solution to the problem of gendered cyber-hate. This approach shifts the responsibility from the perpetrators to the targets and the private sphere rather than addressing the broader social issue. The author suggests that a combination of feminist activism efforts, including a revised approach to collectivism, is needed to enact the necessary legislative and corporate changes to combat gendered online hate. The study by Davis and Santillana ( 2019 ) examines the potential and limitations of digital media activism in raising awareness about gender-based harassment using the case study of Las Morras, a Mexico City-based feminist media group. The study demonstrates the paradoxical role of networked digital media as an activist tool. While it rapidly circulated a critique of misogyny, it also attracted negative attention, leading to the group’s eventual demise due to doxing, trolling, and personal threats directed at its members.

Megalians, a cyberfeminist community in South Korea, utilised the technique of “mirroring” to combat online misogyny (Jeong and Lee, 2018 , Moon et al., 2022 , Yang and Lee, 2022 ). This practice involved mimicking the language of misogynistic online communities and reversing the roles of perpetrators and victims. Megalians also used parodies to subvert the humour and power dynamic that men often used to make fun of women. By appropriating and using the language of misogynists, they aimed to strip men of their ability to use misogynistic speech for their own entertainment. This approach also exposed the absurdity and ridiculousness of the misogynistic rhetoric. However, the success of mirroring is not clear-cut. In fact, while Megalians’ voices were heard in society, the strong message and crude language proved divisive and polarising (Kim, 2021 ).

An alternative strategy for addressing misogyny is to use social re-norming and appeal to the empathy of those engaging in harassing behaviour. The goal of re-norming is to challenge cultural attitudes and beliefs that tolerate or encourage violence against women and to promote new standards of behaviour that prioritise respect, equality, and safety for all individuals. One example of this approach is the experiment conducted by Whiley et al. ( 2023 ) on Twitter. Their experiment aimed to inform misogynistic offenders that their sexist language was disapproved of by the majority of people. However, this intervention did not result in a reduction in the number or frequency of sexist Tweets or users, nor did it affect the tone or emotional intensity of subsequent tweets. In contrast, research has demonstrated the efficacy of creative humour, such as that used by the IncelTears subreddit to ridicule Incels, in promoting (dis)affiliative and informative functions (Dynel, 2020 ).

Computational science research on online misogyny

In this section, we focus on documents on misogyny classified by Scopus in the “Computer Science” subject area. A total of 196 documents were found; 30 documents were excluded as they were off-topic. Two surveys were identified in the retrieved documents, which centre on the automated detection of online misogyny. In one survey, Shushkevich and Cardiff ( 2019 ) present an examination of techniques for identifying misogyny in social media through automation. Meanwhile, Sultana et al. ( 2021 ) conducted a systematic literature review of prior research to reveal different aspects of misogyny and sexist humour and to create a codebook for annotation purposes.

Automatic detection of misogyny

Manual classification of the retrieved articles reveals a wealth of valuable information regarding the automatic detection of misogyny. This includes details about the social networks that are being analysed, the primary techniques employed, and the availability of datasets.

In line with research in the social science area (see Section 4), Twitter (with 95 publications) and Reddit (with 46 publications) continue to be the most commonly used sources, even in the area of computational science. The number of studies dealing with Facebook and Instagram is very limited. Researchers frequently prioritise the study of Twitter (now rebranded X) and Reddit above other social media platforms due to their historically liberal provision of Application Programming Interface (API) access. Furthermore, Reddit, which has been described as ’a community of communities’ (Massanari, 2017 , p. 331), has a diverse array of subreddits that cater to different interests, some of which foster misogynistic beliefs. However, the new pricing plans for using the Twitter API, introduced in March 2023, are expected to significantly affect research. A survey conducted by the Coalition for Independent Technology Research Footnote 2 outlines the potential consequences of discontinuing free and affordable API access. These drawbacks include the disruption of research on the dissemination of harmful content. A similar survey on the impact of Reddit’s recent API changes Footnote 3 emphasises how researchers are concerned about interruptions in their research resulting from API modifications. It is worth noting that only one study (Semenzin and Bainotti, 2020 ) reports the results of research on Telegram, which, in fact, has become a widely used platform for the dissemination of abusive and misogynistic content due to its high degree of anonymity and limited content-moderation policies (Guhl and Davey, 2020 ).

The automatic detection of misogyny typically utilises various techniques, with pre-trained deep-learning models and multimodal models being the most commonly employed. Other techniques include machine learning algorithms such as SVM, Naïve Bayes, or Random Forest. Additionally, some documents rely on convolutional neural network models. More details on the published documents employing the different techniques are provided in the Supplementary Material .

Four articles employ the use of lexicons for automatic detection of misogyny. Attanasio and Pastor ( 2020 ) propose misogyny lexicons for automatic misogyny identification in order to improve sentence embedding similarity. Hurtlex (Bassignana et al. 2018 ), which is a lexicon of offensive, aggressive, and hateful words in more than 50 languages, is exploited for misogyny identification in the studies by Chiril et al. ( 2022 ) and Pamungkas et al. ( 2018 ). Kwarteng et al. ( 2022 ) created a specific lexicon around misogynoir.

Taxonomies and guidelines

When releasing annotated datasets, a crucial aspect is to clearly outline the guidelines for categorising misogynistic language. Four articles in the retrieved documents address this issue (Anzovino et al., 2018 , Guest et al., 2021 , Sultana et al., 2021 , Zeinert et al., 2021 ).

Sultana et al. ( 2021 ) proposed eleven categories to classify misogynistic remarks: Discredit (slurring over women with no other larger intention), Stereotyping (description of women’s physical appeal and/or comparisons to narrow standards), Sexual harassment (to physically assert power over women), Threats of violence (intent to physically assert power over women or to intimidate and silence women through threats of violence), Dominance (to preserve male control, protect male interest and exclude women from the conversation), Derailing (to justify abuse, reject male responsibility, and attempt to disrupt the conversation in order to refocus it), Victim blaming (blaming the victims for the problems they are facing), Mixed bias (gender bias might be mixed with other kinds of biases like religious or racial), Sexual objectification (evoke sexual imagery), and Damning (contains prayers to hurt women). Regarding the expression of misogyny using humour, this research proposes eight categories of jokes: Devaluation of personal characteristics, Women’s place in the private sphere, Violence against women, Feminist backlash, Sexual objectification, Excluding and/or objectifying humour, Transphobic Jokes and Cruel or Humiliation. All the categories proposed in Anzovino et al. ( 2018 ) are included in Sultana et al. ( 2021 ). The same occurs with categories proposed by Zeinert et al. ( 2021 ), except for the interesting concept of neosexism. Neosexism is a concept defined in Francine Tougas et al. ( 1999 ), and presents as the belief that women have already achieved equality and that discrimination of women does not exist. Neosexism was the most common form of misogyny present in the dataset of Zeinert et al. ( 2021 ). Guest et al. ( 2021 ) define four categories of misogynistic content: misogynistic pejoratives, descriptions of misogynistic treatment, acts of misogynistic derogation and gendered personal attacks against women.

Evaluation campaigns

A number of the documents on misogyny that fall within the Computer Science subject area were produced in connection with various evaluation campaigns. These campaigns include EVALITA (Evaluation of NLP and Speech Tools for Italian), IberLEF (Iberian Languages Evaluation Forum), SemEval (International Workshop on Semantic Evaluation), and FIRE (Forum for Information Retrieval Evaluation). The EVALITA campaign includes the Automatic Misogyny Identification (AMI) task (Fersini et al. 2018 ). The IberLEF annual campaign features the EXIST task, which is sEXism Identification in Social neTworks (Rodrìguez-Sanchez et al. 2021 ). SemEval has a task called MAMI, which is Multimedia Automatic Misogyny Identification (Fersini et al., 2022 ). Lastly, FIRE includes the Arabic Misogyny Identification (ArMI) task (Mulki and Ghanem, 2022 ).

Thanks to these evaluation campaigns, datasets for automatic misogyny detection in multiple languages are now available. Specifically, the AMI task made available two datasets, in English and Italian, downloaded from Twitter. The EXIST task provided datasets of tweets in both English and Spanish. The dataset released for the MAMI challenge comprises memes that were downloaded from popular social media platforms such as Twitter and Reddit, as well as from websites dedicated to meme creation and sharing. Lastly, the ArMI task provided a dataset of tweets written in Modern Standard Arabic (MSA) and various Arabic dialects.

The bibliometric analysis reveals that research on misogyny has witnessed exponential growth from 2010 to 2022. This growth can be attributed to various areas of research, but one prominent factor contributing to this trend is the increased attention given to the online dissemination of hate towards women. Several findings support this initial conclusion.

Firstly, the analysis indicates that the most productive authors in the field of misogyny research come from the area of computer science. This suggests that experts in this field have been actively investigating and publishing on the topic, further driving the growth of research in this area.

Moreover, examining the topics covered in the analysed documents provides additional evidence for the influence of online misogyny. Topic 8, which is related to digital misogyny, and Topic 12, which focuses on the automatic identification of misogyny in social media, have experienced significantly higher growth compared to the broader field of misogyny research (as depicted in Fig. 8 ). This finding indicates that the study of misogyny in online platforms and the development of methods to detect misogyny in social media have gained considerable attention within the research community.

The major role that online misogyny plays in the development of the area supports the idea that the research seeks to delineate the contours of a new face of misogyny, the latest manifestation of hate towards women which is expressed more crudely and more openly on social networks because they facilitate anonymity and a greater distance from the victims.

Another conclusion drawn from the analysis of the conceptual structure of misogyny research (Fig. 4) and the interactions between topics (Fig. 7 ) is that the research focused on the automatic detection of misogyny in online platforms (Topic 12) exhibits weak connections with other conceptual areas that address different aspects of the phenomenon. This area of research only demonstrates some conceptual relation to the broader study of online misogyny (Topic 8). This presents a significant challenge, considering that qualitative analysis of sociological research emphasises the growing relevance of hybrid realities resulting from the synergies between the physical and digital realms, not just in violence against women but also in specific domains such as politics. Moreover, the lack of relationship between Topic 12, which focuses on the automatic detection of misogyny, and Topic 9, which explores violence against women and the concept of Manosphere (primarily a digital phenomenon), is particularly noteworthy. This suggests that research in the computational science domain may not be adequately addressing the most extreme manifestations of online misogyny. Furthermore, it also indicates that the tools offered by computational linguistics are underutilised in social science-led research.

In general, the absence of stronger connections between certain topics that attract the attention of various disciplines could be seen as a sign of the practical challenges encountered in interdisciplinary research. For instance, Topic 6, which focuses on the study of women’s rights within legal and political systems, exhibits very weak relationships with Topics 8 and 12, despite qualitative sociological research emphasising the need to consider the new dynamics emerging in virtual spaces. Another illustration can be found in the qualitative review of computational science literature. It becomes apparent that this research area relies on the definition of taxonomies that would benefit from clarification through collaboration with social science research. For instance, the inclusion of stereotypes against women as part of the types of misogyny raises the question of whether the concept of misogyny should be reserved for the most extreme forms of hatred or should encompass the wide range of sexist attitudes and gender symbolic constructions derived from a patriarchal culture.

The main conclusion drawn from this work is that research across different disciplines is addressing a new facet of misogyny, a revitalised version of outdated beliefs about women’s inferiority that circulate in novel forms within the online realm. Understanding the characteristics and functions of this new expression of misogyny poses a challenge that necessitates an interdisciplinary approach, leveraging the strengths of different areas of knowledge to effectively address it.

The above-mentioned lack of collaboration between different areas prevents the establishment of connections that would enrich the analysis of the way misogyny is disseminated today in both the virtual and real world. For example, social science knowledge in combination with computational discourse analysis or NLP technologies could be used to study the connections and similarities between agents disseminating misogyny online and mainstream social actors such as political parties or religious organisations. In the same way, the similarity between misogynist discourses and those of left-leaning feminists in open battle against other fractions of the feminist movement could also be monitored and would allow for a more complex view of the phenomenon. For both approaches, it is necessary that social science knowledge strongly rooted in the study of social relations be combined with the new methodologies that computer science offers for the analysis of discourse produced naturally in digital or real communicative exchanges, such as in parliaments, rallies or interviews.

Data availability

Data sharing is not applicable to this research, as no data were generated. The analysed data were retrieved from the commercial Web of Science (WOS) and Scopus databases, following the search procedure detailed in the Supplementary Material .

https://www.theguardian.com/technology/2015/jan/11/gamergate-a-brief-history-of-a-computer-age-war , https://time.com/3510381/gamergate-faq/

https://independenttechresearch.org/letter-twitters-new-api-plans-will-devastate-public-interest-research/

https://independenttechresearch.org/reddit-survey-results/

Alghamdi R, Alfalqi K (2015) A survey of topic modeling in text mining. Int J Adv Comput Sci Appl 6(1):147–153

Google Scholar  

Allen A (2021) Feminist perspectives on power. In: Zalta E (ed) The Stanford encyclopedia of philosophy. Metaphysics Research Lab, Stanford University

Anzovino M, Fersini E, Rosso P (2018) Automatic identification and classification of misogynistic language on Twitter. In: Silberztein M, Atigui F, Kornyshova E et al (eds) Natural language processing and information systems (NLDB) 2018. Lecture notes in computer science, vol 10859. Springer, Cham, pp. 57–64

Aria M, Cuccurullo C (2017) bibliometrix: an R-tool for comprehensive science mapping analysis. J Informetr 11(4):959–975

Article   Google Scholar  

Attanasio G, Pastor E (2020) PoliTeam @ AMI: improving sentence embedding similarity with misogyny lexicons for automatic misogyny identification in Italian tweets. In: Proceedings of the 7th evaluation campaign of natural language processing and speech tools for Italian (EVALITA 2020) (eds Basile V, Croce D, Maro M, Passaro LC) CEUR workshop proceedings, vol 2765, Accademia University Press, Torino

Banet-Weiser S, Miltner KM (2016) #MasculinitySoFragile: culture, structure, and networked misogyny. Fem Media Stud 16(1):171–174

Bassignana E, Basile V, Patti V (2018) Hurtlex: a multilingual lexicon of words to hurt. In: Proceedings of the fifth Italian Conference on Computational Linguistics (CLiC-it 2018), Torino, December 10–12, 2018, (eds Cabrio E, Mazzei A, Tamburini F) CEUR Workshop Proceedings, vol 2253, Accademia University Press, Torino, Italy

Bates L (2021) Men who hate women: from incels to pickup artists: the truth about extreme misogyny and how it affects us all. Sourcebooks, Naperville, IL

Blei DM (2012) Probabilistic topic models. Commun ACM 55(4):77–84

Blei DM, Ng AY, Jordan MI (2003) Latent Dirichlet allocation. J Mach Learn Res 3(1):993–1022

Bosch NV, Gil-Juarez A (2021) Un acercamiento situado a las violencias machistas online y a las formas de contrarrestarlas. Rev Estud Fem 29(3). https://doi.org/10.1590/1806-9584-2021V29N374588

Byerly CM(2020) Incels online reframing sexual violence Commun Rev 23(4):290–308

Carian EK(2022) "We’re all in this together”: leveraging a personal action frame in two men’s rights forums Mobilization 27(1):47–68

Chang W(2022) The monstrous-feminine in the incel imagination: Investigating the representation of women as “femoids” on /r/Braincels Fem Media Stud 22(2):254–270

Article   MathSciNet   Google Scholar  

Chen GM, Pain P, Chen VY(2020) ‘You really have to have a thick skin’: a cross-cultural perspective on how online harassment influences female journalists Journalism 21(7):877–895

Chiril P, Pamungkas E, Benamara F (2022) Emotionally informed hate speech detection: a multi-target perspective. Cogn Comput 14(1):322–352

Citron DK (2014) Hate crimes in cyberspace. Harvard University, Cambridge, MA

Book   Google Scholar  

Code L (2000) Encyclopedia of feminist theories. Routledge, London

Davis S, Santillana M(2019) From the streets to the screen to nowhere: Las morras and the fragility of networked digital activism Westminst Pap Commun Cult 14(1):18–32

Dickel V, Evolvi G (2022) “Victims of feminism”: exploring networked misogyny and #MeToo in the manosphere. Fem Media Stud https://doi.org/10.1080/14680777.2022.2029925

Döring N, Mohseni MR(2019) Male dominance and sexism on YouTube: results of three content analyses Fem Media Stud 19(4):512–524

Dynel M(2020) Vigilante disparaging humour at r/IncelTears: humour as critique of incel ideology Language Commun 74:1–14

Faith B(2022) Tackling online gender-based violence; understanding gender, development, and the power relations of digital spaces Gend Technol Dev 26(3):325–340

Farci M, Righetti N(2019) Italian men’s rights activism and online backlash against feminism Rass Ital Sociol 60(4):765–781

Fersini E, Nozza D, Rosso P (2018) Overview of the EVALITa 2018 task on automatic misogyny identification (AMI). In: CEUR workshop proceedings (eds Caselli T, Novielli N, Patti V, Rosso P) vol 2263 (CEUR-WS), Accademia University Press, Torino

Fersini E, Gasparini F, Rizzi G et al (2022) SemEval-2022 Task 5: multimedia automatic misogyny identification. In: Proceedings of the 16th international workshop on Semantic Evaluation (SemEval-2022) (eds Emerson G, Schluter N, Stanovsky G. et al) Association for Computational Linguistics, pp. 533–549

Francine Tougas F, Brown R, Beaton AM (1999) Neosexism among women: the role of personally experienced social mobility attempts. Personal Soc Psychol Bull 25(12):1487–1497

Fuchs T, Schäfer F(2021) Normalizing misogyny: hate speech and verbal abuse of female politicians on Japanese Twitter Jpn Forum 33(4):553–579

Garcìa-Mingo E, Fernàndez SD, Tomàs-Forte S (2022) (Re)configurando el imaginario sobre la violencia sexual desde el antifeminismo: el trabajo ideològico de la manosfera española. Polit Sociedad 59(1). https://doi.org/10.5209/poso.80369

Ghaffari S(2022) Discourses of celebrities on Instagram: digital femininity, self-representation and hate speech Crit Discourse Stud 19(2):161–178

Gill R (2016) Post-postfeminism?: new feminist visibilities in postfeminist times. Fem Media Stud 16(4):610–630

Ging D, Siapera E (2018) Special issue on online misogyny. Fem Media Stud 18(4):515–524

Glick P, Fiske ST (1997) Hostile and benevolent sexism: measuring ambivalent sexist attitudes toward women. Psychol Women Q 21(1):119–135

Greenacre M, Blasius J (2006) Multiple correspondence analysis and related methods. Chapman and Hall/CRC, New York

Guest E, Vidgen B, Mittos A et al An expert annotated dataset for the detection of online misogyny. In: Proceedings of the 16th conference of the European Chapter of the Association for Computational Linguistics: main volume. Association for Computational Linguistics, pp. 1336–1350 (2021)

Guhl J, Davey J (2020) A safe space to hate: white supremacist mobilisation on telegram. Technical report. ISD Global

Halpin M(2022) Weaponized subordination: how incels discredit themselves to degrade women Gend Soc 36(6):813–837

Hopton K, Langer S(2022) “Kick the XX out of your life”: an analysis of the manosphere’s discursive constructions of gender on Twitter Fem Psychol 32(1):3–22

Hu Y, Boyd-Graber J, Satinoff B (2014) Interactive topic modeling. Mach Learn 95(3):423–469

Jane EA(2014) Back to the kitchen, cunt: speaking the unspeakable about online misogyny Continuum 28(4):558–570

Jane EA (2015) Flaming? What flaming? The pitfalls and potentials of researching online hostility. Ethics Inf Technol 17(1):65–87

Jane EA(2016) Online misogyny and feminist digilantism Continuum 30(3):284–297

Jane EA (2017) Misogyny online: a short (and Brutish) history. Sage, London

Jeffreys S (2005) Beauty and misogyny: harmful cultural practices in the West. Routledge, New York, NY, USA

Jenson J, De Castell S(2021) Patriarchy in play: video games as gendered media ecologies Explor Media Ecol 20(2):195–212

Jeong E, Lee J(2018) We take the red pill, we confront the DickTrix: online feminist activism and the augmentation of gendered realities in South Korea Fem Media Stud 18(4):705–717

Jones C, Trott V, Wright S(2020) Sluts and soyboys: MGTOW and the production of misogynistic online harassment New Media Soc 22(10):1903–1921

Jukes A (1993) Why men hate women. Free Association Books Ltd, London

Kim J(2017) #iamafeminist as the “mother tag”: feminist identification and activism against misogyny on Twitter in South Korea Fem Media Stud 17(5):804–820

Kim Y(2021) Mirroring misogyny in Hell Choson: Megalia, womad, and Korea’s feminism in the age of digital populism Eur J Korean Stud 20(2):101–133

Koirala S(2020) Female journalists’ experience of online harassment: a case study of Nepal Media Commun 8(1):47–56

Koller V, Heritage F(2020) Incels, in-groups, and ideologies. The representation of gendered social actors in a sexuality-based online community J Language Sex 9(2):152–178

Kurasawa F, Rondinelli E, Kilicaslan G(2021) Evidentiary activism in the digital age: on the rise of feminist struggles against gender-based online violence Inf Commun Soc 24(14):2174–2194

Kwarteng J, Perfumi S, Farrell T et al (2022) Misogynoir: challenges in detecting intersectional hate. Soc Netw Anal Min 12(1). https://doi.org/10.1007/s13278-022-00993-7

Lindsay A(2022) Swallowing the Black Pill: Involuntary Celibates’ (Incels) anti-feminism within Digital Society Int J Crime Justice Soc Democr 11(1):210–224

Lonsway KA, Fitzgerald LF (1994) Rape myths: in review. Psychol Women Q 18:133–164

Lonsway KA, Fitzgerald LF (1995) Attitudinal antecedents of rape myth acceptance: a theoretical and empirical reexamination. J Personal Soc Psychol 68(4):704–711

Manne K (2017) Down girl: the logic of misogyny. Oxford Academic, New York

Mantilla K (2013) Gendertrolling: misogyny adapts to new media. Fem Stud 39(2):563–571

Marwick AE, Caplan R(2018) Drinking male tears: language, the manosphere, and networked harassment Fem Media Stud 18(4):543–559

Massanari A (2017) #Gamergate and The Fappening: how Reddit’s algorithm, governance, and culture support toxic technocultures. New Media Soc 19(3):329–346

Massanari AL (2020) Gamergate. John Wiley & Sons, Ltd, pp. 1–5

MATLAB (2022) MATLAB version R2022b. The MathWorks Inc., Natick, MA

Menzie L(2022) Stacys, Beckys, and Chads: the construction of femininity and hegemonic masculinity within incel rhetoric Psychol Sex 13(1):69–85

Millet K (1970) Sexual Politics. Doubleday, New York, NY

Moloney ME, Love TP (2018) Assessing online misogyny: perspectives from sociology and feminist media studies. Sociol Compass 12(5):e12,577

Moon YE, Kim HH, Park D (2022) “Can I become a true feminist?”: an interpretive analysis on the mirroring experience of young Korean women. Fem Media Stud https://doi.org/10.1080/14680777.2022.2042830

Mulki H, Ghanem B (2022) Working notes of the workshop Arabic Misogyny Identification (ArMI-2021). In: Proceedings of the 13th annual meeting of the Forum for Information Retrieval Evaluation. Association for Computing Machinery, New York, NY, USA, pp. 7–8

O’Donnell C, Shor E(2022) "This is a political movement, friend”: why “incels” support violence Br J Sociol 73(2):336–351

Article   PubMed   Google Scholar  

Ostini J, Hopkins S (2015) Online harassment is a form of violence. The Conversation 8: 1–4

Pamungkas EW, Cignarella AT, Basile V et al (2018) Automatic identification of misogyny in English and Italian Tweets at EVALITA 2018 with a multilingual hate lexicon. In: Proceedings of the sixth evaluation campaign of natural language processing and speech tools for Italian. Final workshop (EVALITA 2018), Turin co-located with the fifth Italian conference on Computational Linguistics (CLiC-it 2018), Turin (eds Caselli T, Novielli N, Patti V, Rosso P) December 12–13, 2018, CEUR Workshop Proceedings, vol 2263, Accademia University Press, Torino, Italy

Phipps EB, Montgomery F(2022) "Only YOU Can Prevent This Nightmare, America”: Nancy Pelosi as the monstrous-feminine in Donald Trump’s YouTube attacks Women’s Stud Commun 45(3):316–337

Price DJ (1963) Little science, big science. Columbia University Press, New York

Rego R(2018) Changing forms and platforms of misogyny: sexual harassment of women journalists on twitter Media Watch 9(3):472–485

Ritchie J(2013) Creating a monster: Online media constructions of Hillary Clinton during the Democratic Primary Campaign, 2007-8 Fem Media Stud 13(1):102–119

Rodrìguez-Sanchez FJ, Carrillo-de Albornoz J, Plaza L (2021) Overview of EXIST 2021: sEXism Identification in Social neTworks. Proces Leng Nat 67:195–207

Rubio Martìn MJ, Gordo Lòpez A (2021) La perspectiva tecnosocial feminista como antídoto para la misoginia online. Rev Esp Sociol 30(3). https://doi.org/10.22325/fes/res.2021.64

Saluja N, Thilaka DN(2021) Women leaders and digital communication: gender stereotyping of female politicians on Twitter J Content Community Commun 13(7):227–241

Scotto di Carlo G(2023) An analysis of self-other representations in the incelosphere: between online misogyny and self-contempt Discourse Soc 34(1):3–21

Semenzin S, Bainotti L (2020) The use of telegram for non-consensual dissemination of intimate images: gendered affordances and the construction of masculinities. Soc Media + Soc 6(4):2056305120984,453

Shesterina AM, Fedosova OA (2021) Promotion of feminist ideas in instagram texts. Vestnik Mosk Univ Seriya 10 Zhurnalistika 2021(4):114–134

Shushkevich E, Cardiff J (2019) Automatic misogyny detection in social media: a survey. Comput Sist 23(4):1159–1164

Sills S, Pickens C, Beach K(2016) Rape culture and social media: young critics and a feminist counterpublic Fem Media Stud 16(6):935–951

Silva-Paredes D, Ibarra Herrera D (2022) Resisting anti-democratic values with misogynistic abuse against a Chilean right-wing politician on Twitter: the #CamilaPeluche incident Discourse Commun 16(4):426–444

Speckhard A, Ellenberg M, Morton J, Ash A (2021) Involuntary Celibates’ experiences of and grievance over sexual exclusion and the potential threat of violence among those active in an Online Incel Forum. J Strateg Secur 14(2):89–121

Steyvers M, Griffiths T (2006) Probabilistic topic models. In: Landauer T, McNamara D, Dennis S et al (eds) Latent semantic analysis: a road to meaning. Lawrence Erlbaum

Sultana S, Sarker J, Bosu A (2021) A Rubric to identify misogynistic and sexist texts from software developer communications. In: Proceedings of the 15th ACM/IEEE International Symposium on Empirical Software Engineering and Measurement (ESEM). Association for Computing Machinery, New York, NY, USA

Suominen A, Toivanen H (2016) Map of science with topic modeling: comparison of unsupervised learning and human-assigned subject classification. J Assoc Inf Sci Technol 67(10). https://doi.org/10.1002/asi.23596

Tomkinson S, Harper T(2015) The position of women in video game culture: Perez and Day’s Twitter Incident Continuum 29(4):617–634

Tontodimamma A, Nissi E, Sarra A (2021) Thirty years of research into hate speech: topics of interest and their evolution. Scientometrics 126(157–179):69–81

Tranchese A, Sugiura L(2021) "I don’t hate all women, just those stuck-up bitches”: how incels and mainstream pornography speak the same extreme language of misogyny Violence Against Women 27(14):2709–2734

Article   PubMed   PubMed Central   Google Scholar  

van Dijk TA (1998) Editorial: discourse and ideology. Discourse Soc 9(3):307–308

VandenBos GR (ed) (2015) APA dictionary of psychology, 2nd edn. American Psychological Association

Wagner A(2022) Tolerating the trolls? Gendered perceptions of online harassment of politicians in Canada Fem Media Stud 22(1):32–47

Whiley LA, Walasek L, Juanchich M(2023) Contributions to reducing online gender harassment: social re-norming and appealing to empathy as tried-and-failed techniques Fem Psychol 33(1):83–104

Wright S, Trott V, Jones C(2020) ‘The pussy ain’t worth it, bro’: assessing the discourse and structure of MGTOW Inf Commun Soc 23(6):908–925

Yang S, Lee K(2022) The intertextuality and interdiscursivity of “mirroring” in South Korean cyberfeminist posts Discourse Soc 33(5):671–689

Zeinert P, Inie N, Derczynski L (2021) Annotating online misogyny. In: Proceedings of the 59th annual meeting of the Association for Computational Linguistics and the 11th international joint conference on natural language processing (vol 1: Long Papers). Association for Computational Linguistics, pp. 3181–3197

Download references

Acknowledgements

This research was undertaken as part of the ICOMIC (Identifying and Counteracting Online Misogyny in Cyberspace) Project funded by EU Next Generation, MUR-Fondo Promozione e Sviluppo-DM 737/2021

Author information

Authors and affiliations.

Department of Legal and Social Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti-Pescara, Italy

Lara Fontanella & Alice Tontodimamma

PRHLT, Universitat Politècnica de València, Valencia, Spain

Berta Chulvi

Social Psychology Department, Universitat de València, Valencia, Spain

Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti-Pescara, Italy

Elisa Ignazzi

Department of Philosophical, Pedagogical and Economic-Quantitative Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti-Pescara, Italy

Annalina Sarra

You can also search for this author in PubMed   Google Scholar

Contributions

LF and BC contributed to the study conception and design, with LF leading the study supervision. LF, BC, and AS contributed to the writing of the manuscript. LF, EI, and AT developed the dataset and conducted the statistical analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lara Fontanella .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethics approval

Ethical approval was not required as the study did not involve human participants.

Informed consent

Informed consent was not required as the study did not involve human participants.

Additional information

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

Supplementary information

Supplementary material, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Fontanella, L., Chulvi, B., Ignazzi, E. et al. How do we study misogyny in the digital age? A systematic literature review using a computational linguistic approach. Humanit Soc Sci Commun 11 , 478 (2024). https://doi.org/10.1057/s41599-024-02978-7

Download citation

Received : 14 July 2023

Accepted : 18 March 2024

Published : 02 April 2024

DOI : https://doi.org/10.1057/s41599-024-02978-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies