difference between book review and literature review

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• What is a Book Review or Book Report?
• What is a Literature Review?

Also referred to as a book report, a  book review  consists of "critical comments on a book, especially when it is first published" ("Book Review, 2006). 

Similar to a short essay, a book review typically includes several of these elements:

     •  Description of the book's main topic, purpose and/or point of view, answering questions such as:

            •  What is the genre of the work (i.e. novel, non-fiction, memoir etc.)?

            •  Who is the intended audience?

            •  If a fictional work, what are the key themes, motifs, and/or plot devices?

            •  If a non-fictional work, what are the main arguments and ideas?

      •  Assessment of the book's main points, biases or flaws

      •  Critical analysis of the book's strengths and weaknesses, literary value and/or overall quality and contribution to the subject area

      •  If non-fiction, an explanation of how the book fits into the academic or popular discourse on a topic or subject area

Book Review. (2006). In P. Collin (Ed.),  Dictionary of publishing and printing . London, United Kingdom: A&C Black. Retrieved from http://search.credoreference.com

Follow these links to learn more about book reviews:

• Book Reviews - University of North Carolina at Chapel Hill
• How to Write Book Reviews - Queens University
• How to write a book report and a book review - Concordia University Libraries

A literature review is a "comprehensive study and interpretation of literature that addresses a specific topic" (Aveyard, 2010).

Literature reviews are generally conducted in one of two ways:

1) As a preliminary review before a larger study in order to critically evaluate the current literature and justify why further study and research is required.

In this case, the researcher must "systematically search, critique and combine the literature to demonstrate a gap in the existing research base" while demonstrating "their understanding of both the research and the methods previously used to investigate the area" (Aveyard, 2010).

2) As a project in itself that provides a comprehensive survey of the works published in a particular discipline or area of research over a specified period of time.

Sometimes referred to as a systematic literature review or meta-analysis, this type of literature review is a critical survey that attempts to "evaluate and interpret all available research evidence relevant to a particular question" (Glasziou, 2001).

Aveyard, H. (2010). Doing a literature review in health and social care: A practical guide (2nd ed.). Bershire, United Kingdom: Open University Press.

Galsziou, P. (2001). Systematic reviews in health care: A practical guide . New York, NY: Cambridge University Press.

Learn more about literature reviews:

• Guidelines for writing a literature review - University of Minnesota Duluth A step-by-step guide for writing a literature review
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Literature Reviews

What this handout is about.

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

Introduction

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

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

What is a literature review, then?

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

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

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

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

Why do we write literature reviews?

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

Who writes these things, anyway?

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

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

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

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

Find models

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

Narrow your topic

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

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

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

Consider whether your sources are current

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

Strategies for writing the literature review

Find a focus.

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

Convey it to your reader

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

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

Consider organization

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

First, cover the basic categories

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

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

Organizing the body

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

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

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

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

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

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

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

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

Begin composing

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

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

Use evidence

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

Be selective

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

Use quotes sparingly

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

Summarize and synthesize

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

Keep your own voice

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

Use caution when paraphrasing

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

Revise, revise, revise

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

Works consulted

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

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

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

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

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

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

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
• Librarian Support

What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

• October 26, 2022 recording
• Last Updated: Oct 26, 2022 2:49 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

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Writing a Literature Review

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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What Is A Literature Review?

A plain-language explainer (with examples).

By:  Derek Jansen (MBA) & Kerryn Warren (PhD) | June 2020 (Updated May 2023)

If you’re faced with writing a dissertation or thesis, chances are you’ve encountered the term “literature review” . If you’re on this page, you’re probably not 100% what the literature review is all about. The good news is that you’ve come to the right place.

Literature Review 101

• What (exactly) is a literature review
• What’s the purpose of the literature review chapter
• How to find high-quality resources
• How to structure your literature review chapter
• Example of an actual literature review

What is a literature review?

The word “literature review” can refer to two related things that are part of the broader literature review process. The first is the task of  reviewing the literature  – i.e. sourcing and reading through the existing research relating to your research topic. The second is the  actual chapter  that you write up in your dissertation, thesis or research project. Let’s look at each of them:

Reviewing the literature

The first step of any literature review is to hunt down and  read through the existing research  that’s relevant to your research topic. To do this, you’ll use a combination of tools (we’ll discuss some of these later) to find journal articles, books, ebooks, research reports, dissertations, theses and any other credible sources of information that relate to your topic. You’ll then  summarise and catalogue these  for easy reference when you write up your literature review chapter. 

The literature review chapter

The second step of the literature review is to write the actual literature review chapter (this is usually the second chapter in a typical dissertation or thesis structure ). At the simplest level, the literature review chapter is an  overview of the key literature  that’s relevant to your research topic. This chapter should provide a smooth-flowing discussion of what research has already been done, what is known, what is unknown and what is contested in relation to your research topic. So, you can think of it as an  integrated review of the state of knowledge  around your research topic. 

What’s the purpose of a literature review?

The literature review chapter has a few important functions within your dissertation, thesis or research project. Let’s take a look at these:

Purpose #1 – Demonstrate your topic knowledge

The first function of the literature review chapter is, quite simply, to show the reader (or marker) that you  know what you’re talking about . In other words, a good literature review chapter demonstrates that you’ve read the relevant existing research and understand what’s going on – who’s said what, what’s agreed upon, disagreed upon and so on. This needs to be  more than just a summary  of who said what – it needs to integrate the existing research to  show how it all fits together  and what’s missing (which leads us to purpose #2, next). 

Purpose #2 – Reveal the research gap that you’ll fill

The second function of the literature review chapter is to  show what’s currently missing  from the existing research, to lay the foundation for your own research topic. In other words, your literature review chapter needs to show that there are currently “missing pieces” in terms of the bigger puzzle, and that  your study will fill one of those research gaps . By doing this, you are showing that your research topic is original and will help contribute to the body of knowledge. In other words, the literature review helps justify your research topic.  

Purpose #3 – Lay the foundation for your conceptual framework

The third function of the literature review is to form the  basis for a conceptual framework . Not every research topic will necessarily have a conceptual framework, but if your topic does require one, it needs to be rooted in your literature review. 

For example, let’s say your research aims to identify the drivers of a certain outcome – the factors which contribute to burnout in office workers. In this case, you’d likely develop a conceptual framework which details the potential factors (e.g. long hours, excessive stress, etc), as well as the outcome (burnout). Those factors would need to emerge from the literature review chapter – they can’t just come from your gut! 

So, in this case, the literature review chapter would uncover each of the potential factors (based on previous studies about burnout), which would then be modelled into a framework. 

Purpose #4 – To inform your methodology

The fourth function of the literature review is to  inform the choice of methodology  for your own research. As we’ve  discussed on the Grad Coach blog , your choice of methodology will be heavily influenced by your research aims, objectives and questions . Given that you’ll be reviewing studies covering a topic close to yours, it makes sense that you could learn a lot from their (well-considered) methodologies.

So, when you’re reviewing the literature, you’ll need to  pay close attention to the research design , methodology and methods used in similar studies, and use these to inform your methodology. Quite often, you’ll be able to  “borrow” from previous studies . This is especially true for quantitative studies , as you can use previously tried and tested measures and scales. 

How do I find articles for my literature review?

Finding quality journal articles is essential to crafting a rock-solid literature review. As you probably already know, not all research is created equally, and so you need to make sure that your literature review is  built on credible research . 

We could write an entire post on how to find quality literature (actually, we have ), but a good starting point is Google Scholar . Google Scholar is essentially the academic equivalent of Google, using Google’s powerful search capabilities to find relevant journal articles and reports. It certainly doesn’t cover every possible resource, but it’s a very useful way to get started on your literature review journey, as it will very quickly give you a good indication of what the  most popular pieces of research  are in your field.

One downside of Google Scholar is that it’s merely a search engine – that is, it lists the articles, but oftentimes  it doesn’t host the articles . So you’ll often hit a paywall when clicking through to journal websites. 

Thankfully, your university should provide you with access to their library, so you can find the article titles using Google Scholar and then search for them by name in your university’s online library. Your university may also provide you with access to  ResearchGate , which is another great source for existing research. 

Remember, the correct search keywords will be super important to get the right information from the start. So, pay close attention to the keywords used in the journal articles you read and use those keywords to search for more articles. If you can’t find a spoon in the kitchen, you haven’t looked in the right drawer. 

Need a helping hand?

How should I structure my literature review?

Unfortunately, there’s no generic universal answer for this one. The structure of your literature review will depend largely on your topic area and your research aims and objectives.

You could potentially structure your literature review chapter according to theme, group, variables , chronologically or per concepts in your field of research. We explain the main approaches to structuring your literature review here . You can also download a copy of our free literature review template to help you establish an initial structure.

In general, it’s also a good idea to start wide (i.e. the big-picture-level) and then narrow down, ending your literature review close to your research questions . However, there’s no universal one “right way” to structure your literature review. The most important thing is not to discuss your sources one after the other like a list – as we touched on earlier, your literature review needs to synthesise the research , not summarise it .

Ultimately, you need to craft your literature review so that it conveys the most important information effectively – it needs to tell a logical story in a digestible way. It’s no use starting off with highly technical terms and then only explaining what these terms mean later. Always assume your reader is not a subject matter expert and hold their hand through a journe y of the literature while keeping the functions of the literature review chapter (which we discussed earlier) front of mind.

Example of a literature review

In the video below, we walk you through a high-quality literature review from a dissertation that earned full distinction. This will give you a clearer view of what a strong literature review looks like in practice and hopefully provide some inspiration for your own. 

Wrapping Up

In this post, we’ve (hopefully) answered the question, “ what is a literature review? “. We’ve also considered the purpose and functions of the literature review, as well as how to find literature and how to structure the literature review chapter. If you’re keen to learn more, check out the literature review section of the Grad Coach blog , as well as our detailed video post covering how to write a literature review . 

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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16 Comments

Thanks for this review. It narrates what’s not been taught as tutors are always in a early to finish their classes.

Thanks for the kind words, Becky. Good luck with your literature review 🙂

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Timothy T. Chol [email protected]

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Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core Collection This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

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• Last Updated: Jan 17, 2024 10:05 AM
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What is a Literature Review?

#scribendiinc

Learn the basics about writing a literature review

If you've ever written a research paper , it's likely you've done some form of literature review. A literature review is a survey of current books and articles on a particular topic. While they may sound tedious, literature reviews are helpful windows into the cutting edge of any field.

Literature reviews are often closely associated with annotated bibliographies, which also list and analyze scholarly sources. However, unlike an annotated bibliography, a literature review is usually written in the form of an essay, with full paragraphs, an introduction, and a conclusion. Literature reviews also differ from book reviews , despite their similar names, since they focus on bodies of work rather than singular sources.

Why are literature reviews important?

Doing a literature review is the first step to writing a great research paper. Whether you know a lot about a topic or only a little, a literature review will help familiarize you with the most important scholars, themes, and sources in the field.

Writing a literature review can also help you build a solid thesis before you tackle the rest of an essay. Even if you've selected an interesting topic, articulating a great argument can be trickier than you think. Often, students realize that their thesis is untenable halfway through writing their papers, usually because there aren't enough sources to support their arguments. By carrying out a literature review, you'll build an inventory of research that you can use at any point in the writing process.

Since most researchers draw on networks of other scholarship, reviewing literature can also help you find sources that you didn't know about before. For example, the citations in a journal article or book often direct you to seminal works in the field. Even if you can't read every last paper, a literature review will leave you better informed about where to turn if you need more information.

What are the stages of writing a literature review?

Poring over books and articles for a literature review takes some dedication. By dividing up your work into four different steps, you'll save time and finish your review faster.

1) Research

A thorough amount of research is a prerequisite for writing a good literature review. In the research stage, you should visit a library or browse a journal database to begin collecting your sources. Start by searching for a broad topic and hone in on your research question as you become more confident about your subject.

2) Consolidation of information

Next, you should compile all the information that you've gleaned from your research. Aim to organize your notes in a way that's logical, such as thematically or chronologically. It may be helpful to use visual aids, such as charts or graphs, to keep track of all the sources you’ve surveyed. For every book or article, make note of the full author's name, title, and publishing information, so that you can use these details in your bibliography .

3) Analysis

Now you can go back over the data that you've collected and look for connections between sources and your research question. You can also expand your notes from the consolidation phase and categorize each source by the author's main argument and type of evidence. This will help simplify your analysis and make it easier to draw conclusions in your literature review.

4) Presentation

The final stage is when you put everything you know onto paper. Introduce readers to your research question and lead them through existing scholarly works, starting with the most impactful and important sources. Don’t forget to write an introduction , make transitions between paragraphs, and present a conclusion. 

Putting the final touches on your literature review

After reading our guide, you may still have questions about perfecting your literature review. Our academic editors are happy to help—don't hesitate to contact us!

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Literature Reviews

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What is a literature review?

A literature review discusses published information in a particular subject area. Often part of the introduction to an essay, research report or thesis, the literature review is literally a "re" view or "look again" at what has already been written about the topic, wherein the author analyzes a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles. Literature reviews provide the reader with a bibliographic history of the scholarly research in any given field of study. As such,  as new information becomes available, literature reviews grow in length or become focused on one specific aspect of the topic.

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

A literature review is NOT:

• An annotated bibliography – a list of citations to books, articles and documents that includes a brief description and evaluation for each citation. The annotations inform the reader of the relevance, accuracy and quality of the sources cited.
• A literary review – a critical discussion of the merits and weaknesses of a literary work.
• A book review – a critical discussion of the merits and weaknesses of a particular book.
• Teaching Information Literacy Reframed: 50+ Framework-Based Exercises for Creating Information-Literate Learners
• The UNC Writing Center – Literature Reviews
• The UW-Madison Writing Center: The Writer’s Handbook – Academic and Professional Writing – Learn How to Write a Literature Review

What is the difference between a literature review and a research paper?

The focus of a literature review is to summarize and synthesize the arguments and ideas of others without adding new contributions, whereas academic research papers present and develop new arguments that build upon the previously available body of literature.

How do I write a literature review?

There are many resources that offer step-by-step guidance for writing a literature review, and you can find some of them under Other Resources in the menu to the left. Writing the Literature Review: A Practical Guide suggests these steps:

• Chose a review topic and develop a research question
• Locate and organize research sources
• Select, analyze and annotate sources
• Evaluate research articles and other documents
• Structure and organize the literature review
• Develop arguments and supporting claims
• Synthesize and interpret the literature
• Put it all together

What is the purpose of writing a literature review?

Literature reviews serve as a guide to a particular topic: professionals can use literature reviews to keep current on their field; scholars can determine credibility of the writer in his or her field by analyzing the literature review.

As a writer, you will use the literature review to:

• See what has, and what has not, been investigated about your topic
• Identify data sources that other researches have used
• Learn how others in the field have defined and measured key concepts
• Establish context, or background, for the argument explored in the rest of a paper
• Explain what the strengths and weaknesses of that knowledge and ideas might be
• Contribute to the field by moving research forward
• To keep the writer/reader up to date with current developments in a particular field of study
• Develop alternative research projects
• Put your work in perspective
• Demonstrate your understanding and your ability to critically evaluate research in the field
• Provide evidence that may support your own findings
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Research Methods

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

Literature Review

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

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

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

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

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

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

A literature review is important because it:

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

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

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

Not an essay 

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

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

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

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

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

Systematic review or meta-analysis?

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

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

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

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

Not all systematic reviews contain meta-analysis. 

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

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

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

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

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

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

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

The Differences in the Review Types

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

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

Literature Reviews

Literature Review: it is a product and a process.

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

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

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

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

Scoping Reviews

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

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

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

• Scoping review timeframe and limitations (Touro College of Pharmacy

Systematic Reviews

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

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

• Better evidence for a better world Browsable collection of systematic reviews
• Systematic Reviews in the Health Sciences by Molly Maloney Last Updated Apr 23, 2024 465 views this year
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Annotated Bibliography vs. Literature Review

What's the big deal.

There are fundamental differences between an annotated bibliography and a literature review that are crucial to completing the assignment correctly. The chart below is provides an overview of the biggest differences between the two types of assignments in a side-by-side comparison. However, if you need more specific information about either assignment, visit our Annotated Bibliography and/or Literature Review pages for more detailed information on how to complete them. 

Differences between an annotated bibliography and literature review

How to Write a Literature Review

• What is a literature review

How is a literature review different from a research paper?

• What should I do before starting my literature review?
• What type of literature review should I write and how should I organize it?
• What should I be aware of while writing the literature review?
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The purpose of an academic research paper is to develop a new argument. The literature review is one part of a research paper. In a research paper, you use the literature review as a foundation and as support for the new insight that you contribute. The focus of a literature review, however, is to summarize and analyze the arguments and ideas of others without adding new contributions.

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Literature Review vs Systematic Review

• Literature Review vs. Systematic Review
• Primary vs. Secondary Sources
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Subject Guide

Definitions

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

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

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Systematic, Scoping, and Other Literature Reviews: Overview

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What Is a Systematic Review?

Regular literature reviews are simply summaries of the literature on a particular topic. A systematic review, however, is a comprehensive literature review conducted to answer a specific research question. Authors of a systematic review aim to find, code, appraise, and synthesize all of the previous research on their question in an unbiased and well-documented manner. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outline the minimum amount of information that needs to be reported at the conclusion of a systematic review project. 

Other types of what are known as "evidence syntheses," such as scoping, rapid, and integrative reviews, have varying methodologies. While systematic reviews originated with and continue to be a popular publication type in medicine and other health sciences fields, more and more researchers in other disciplines are choosing to conduct evidence syntheses. 

This guide will walk you through the major steps of a systematic review and point you to key resources including Covidence, a systematic review project management tool. For help with systematic reviews and other major literature review projects, please send us an email at  [email protected] .

Getting Help with Reviews

Organization such as the Institute of Medicine recommend that you consult a librarian when conducting a systematic review. Librarians at the University of Nevada, Reno can help you:

• Understand best practices for conducting systematic reviews and other evidence syntheses in your discipline
• Choose and formulate a research question
• Decide which review type (e.g., systematic, scoping, rapid, etc.) is the best fit for your project
• Determine what to include and where to register a systematic review protocol
• Select search terms and develop a search strategy
• Identify databases and platforms to search
• Find the full text of articles and other sources
• Become familiar with free citation management (e.g., EndNote, Zotero)
• Get access to you and help using Covidence, a systematic review project management tool

Doing a Systematic Review

• Plan - This is the project planning stage. You and your team will need to develop a good research question, determine the type of review you will conduct (systematic, scoping, rapid, etc.), and establish the inclusion and exclusion criteria (e.g., you're only going to look at studies that use a certain methodology). All of this information needs to be included in your protocol. You'll also need to ensure that the project is viable - has someone already done a systematic review on this topic? Do some searches and check the various protocol registries to find out. 
• Identify - Next, a comprehensive search of the literature is undertaken to ensure all studies that meet the predetermined criteria are identified. Each research question is different, so the number and types of databases you'll search - as well as other online publication venues - will vary. Some standards and guidelines specify that certain databases (e.g., MEDLINE, EMBASE) should be searched regardless. Your subject librarian can help you select appropriate databases to search and develop search strings for each of those databases.  
• Evaluate - In this step, retrieved articles are screened and sorted using the predetermined inclusion and exclusion criteria. The risk of bias for each included study is also assessed around this time. It's best if you import search results into a citation management tool (see below) to clean up the citations and remove any duplicates. You can then use a tool like Rayyan (see below) to screen the results. You should begin by screening titles and abstracts only, and then you'll examine the full text of any remaining articles. Each study should be reviewed by a minimum of two people on the project team. 
• Collect - Each included study is coded and the quantitative or qualitative data contained in these studies is then synthesized. You'll have to either find or develop a coding strategy or form that meets your needs. 
• Explain - The synthesized results are articulated and contextualized. What do the results mean? How have they answered your research question?
• Summarize - The final report provides a complete description of the methods and results in a clear, transparent fashion. 

Adapted from

Types of reviews, systematic review.

These types of studies employ a systematic method to analyze and synthesize the results of numerous studies. "Systematic" in this case means following a strict set of steps - as outlined by entities like PRISMA and the Institute of Medicine - so as to make the review more reproducible and less biased. Consistent, thorough documentation is also key. Reviews of this type are not meant to be conducted by an individual but rather a (small) team of researchers. Systematic reviews are widely used in the health sciences, often to find a generalized conclusion from multiple evidence-based studies. 

Meta-Analysis

A systematic method that uses statistics to analyze the data from numerous studies. The researchers combine the data from studies with similar data types and analyze them as a single, expanded dataset. Meta-analyses are a type of systematic review.

Scoping Review

A scoping review employs the systematic review methodology to explore a broader topic or question rather than a specific and answerable one, as is generally the case with a systematic review. Authors of these types of reviews seek to collect and categorize the existing literature so as to identify any gaps.

Rapid Review

Rapid reviews are systematic reviews conducted under a time constraint. Researchers make use of workarounds to complete the review quickly (e.g., only looking at English-language publications), which can lead to a less thorough and more biased review. 

Narrative Review

A traditional literature review that summarizes and synthesizes the findings of numerous original research articles. The purpose and scope of narrative literature reviews vary widely and do not follow a set protocol. Most literature reviews are narrative reviews. 

Umbrella Review

Umbrella reviews are, essentially, systematic reviews of systematic reviews. These compile evidence from multiple review studies into one usable document. 

Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal , vol. 26, no. 2, 2009, pp. 91-108. doi: 10.1111/j.1471-1842.2009.00848.x .

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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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

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ENGLISH: Research Guide

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In this section, you'll find:.

• Information on book reviews and where to find them
• Information on literary criticism  and where to find it

Book Reviews

Book reviews describe and analyze the contents of a book, and often make a recommendation about whether or not to read or purchase the book. Reviews vary in length from single paragraphs to full-length essays (remember writing book reports in middle school?).

Reviews of nonfiction books analyze the topics and/or arguments of the book. Reviewers judge the effectiveness of the authors' support for their arguments and assertions. An author should have some form of authority - they should have a credible reason for writing on the subject. Thus, a book review should cover the authors' credentials. Typically, book reviews compare the book to similar books on the subject. Pay attention to what reviewers consider to be important omissions and any potential biases.

Book Reviews - Fiction & Popular Works

• The New York Review of Books Literary magazine with essays and reviews (of theater and more, not just books).

Book Reviews - Nonfiction & Scholarly Works

• H-Net Reviews The largest online professional reviewing archive, with approximately 46,000 free reviews of scholarly books.

Literary Criticism

Literary criticism is the term given to studies that define, classify, analyze, interpret, and evaluate works of literature. There are many types of literary criticism:

• Moral Criticism, Dramatic Construction (~360 BC-present)
• Formalism, New Criticism, Neo-Aristotelian Criticism (1930s-present)
• Psychoanalytic Criticism, Jungian Criticism(1930s-present)
• Marxist Criticism (1930s-present)
• Reader-Response Criticism (1960s-present)
• Structuralism/Semiotics (1920s-present)
• Post-Structuralism/Deconstruction (1966-present)
• New Historicism/Cultural Studies (1980s-present)
• Post-Colonial Criticism (1990s-present)
• Feminist Criticism (1960s-present)
• Gender/Queer Studies (1970s-present)
• Critical Race Theory (1970s-present)

Literary criticism may examine a particular literary work or it may look at an author's writings as a whole. 

Literary Criticism in Academic Journals

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What is a Literature Review?

A  literature review  is a comprehensive study and interpretation of literature that addresses a specific topic.

Literature reviews are generally conducted in one of two ways:

1) As a preliminary review before a larger study in order to critically evaluate the current literature and justify why further study and research is required.

2) As a project in itself that provides a comprehensive survey of the works published in a particular discipline or area of research over a specified period of time.  

Why conduct a literature review? They provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone.

More:   different types of literature reviews  on how to conduct a literature review.

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How to Develop a Literature Review

How to develop a literature review from Academic Research Foundations: Quantitative by Rolin Moe

What is the Difference Between a Systematic Review and a Meta-analysis?

Dr. Singh discusses the difference between a systematic review and a meta-analysis.

Purpose of a Literature Review

Purpose of a literature review from Academic Research Foundations: Quantitative by Rolin Moe

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As you read research papers, you may notice that there are two very different kinds of review of prior studies. Sometimes, this section of a paper is called a literature review, and at other times, it is referred to as a critical review or a critical context . These differences may be more commonly seen across different fields. Although both these sections are about reviewing prior and existing studies, this article aims to clarify the differences between the two.

Literature review

A literature review is a summary of prior or existing studies that are related to your own research paper . A literature review can be a part of a research paper or can form a paper in itself . For the former, the literature review is designed as a basis upon which your own current study is designed and built. The latter forms a synthesis of prior studies and is a way to highlight future research agendas or a framework.

Writing a literature review

In a literature review, you should attempt to discuss the arguments and findings in prior studies and then work to build on these studies as you develop your own research. You can also highlight the connection between existing and prior literature to demonstrate how the current study you are presenting can advance your knowledge in the field .

When performing a literature review, you should aim to summarise your discussions using a specific aspect of the literature, such as by topic, time, methodology/ design and findings . By doing so, you should be able to establish an effective way to present the relevant literature and demonstrate the connection between prior studies and your research.

Do note that a literature review does not include a presentation or discussion of any results or findings – this should come at a later point in the paper or study. You should also not impose your subjective viewpoints or opinions on the literature you discuss. 

Critical review

A critical review is also a popular way of reviewing prior and existing studies. It can cover and discuss the main ideas or arguments in a book or an article, or it can review a specific concept, theme, theoretical perspective or key construct found in the existing literature .

However, the key feature that distinguishes a critical review from a literature review is that the former is more than just a summary of different topics or methodologies. It offers more of a reflection and critique of the concept in question, and is engaged by authors to more clearly contextualise their own research within the existing literature and to present their opinions, perspectives and approaches .

Given that a critical review is not just a summary of prior literature, it is generally not considered acceptable to follow the same strategy as for a literature review. Instead, aim to organise and structure your critical review in a way that would enable you to discuss the key concepts, assert your perspectives and locate your arguments and research within the existing body of work. 

Structuring a critical review

A critical review would generally begin with an introduction to the concepts you would like to discuss. Depending on how broad the topics are, this can simply be a brief overview or it could set up a more complex framework. The discussion that follows through the rest of the review will then address and discuss your chosen themes or topics in more depth. 

Writing a critical review

The discussion within a critical review will not only present and summarise themes but also critically engage with the varying arguments, writings and perspectives within those themes. One important thing to note is that, similar to a literature review , you should keep your personal opinions, likes and dislikes out of a review. Whether you personally agree with a study or argument – and whether you like it or not – is immaterial. Instead, you should focus upon the effectiveness and relevance of the arguments , considering such elements as the evidence provided, the interpretations and analysis of the data, whether or not a study may be biased in any way, what further questions or problems it raises or what outstanding gaps and issues need to be addressed.

In conclusion

Although a review of previous and existing literature can be performed and presented in different ways, in essence, any literature or critical review requires a solid understanding of the most prominent work in the field as it relates to your own study. Such an understanding is crucial and significant for you to build upon and synthesise the existing knowledge, and to create and contribute new knowledge to advance the field .

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Clinical Psychology Capstone: Literature Review & Peer Review

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• Literature Review & Peer Review

Literature Review

What are the differences between literature reviews?

• Literature Review - A general summary, or overview of the topic that is typically qualitative and subjective
• Systematic Review - A type of literature review that answers a focused clinical question
• Meta-Analysis - A type of systematic review using statistical methods to combine data from systematic reviews

What is the best way to find literature reviews?

• PsycINFO - A psychology database with the capacity to limit by Methodology

How do I know a journal is peer reviewed?

• If searching in a database (eg: Social Work Abstracts,GenderWatch), select Peer Review from the Refine/Limit Results options.
• Check the journal's website:  look for the 'about' or 'about this journal' section.
• Check Ulrich's Periodicals Directory ; Search by journal name and look for the little black referee's jersey icon.
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What does Peer Review mean anyway?

When you submit an article to a journal, someone has to determine if it's worth printing.  Peer review was developed as a way to screen articles and determine the quality of your article. 

At a peer reviewed journal, the editor sends your article out to several reviewers (usually three) who are in the same field, or 'peers'.  Generally, your name will be taken off of the article so personalities don't interfer with the process.  The reviewers read through your article looking to see if:  the topic is unique or novel, if the data or research is sound, and if it's well written.  The reviewers can: reject the article; accept it with revisions; accept it as is.  

Benefits of peer review is that multiple people decide vs just the editor and the review process weeds out poorly written or researched articles.

Drawbacks of peer review is that it's only as good as the reviewers so poorly written or researched articles have gotten published.  Also, peer review was established as a way to check quality not catch fraud.

For more on peer review (I know that someone is interested...), check out Nature Peer Review Debate

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Taylor Swift’s Tortured Poetry

By Amanda Petrusich

In the past several months, Taylor Swift has become culturally ubiquitous in a way that feels nearly terrifying. Superstardom tends to turn normal people into cartoons, projections, gods, monsters. Swift has been inching toward some sort of tipping point for a while. The most recent catalyst was, in part, love: in the midst of her record-breaking Eras Tour , Swift, who is thirty-four, began dating Travis Kelce , a tight end for the Kansas City Chiefs. Whenever Swift appeared at one of Kelce’s games, the broadcasters whipped their extra-high-definition cameras toward her, sending legions of amateur lip-readers scrambling for their phones. I’m paid to give legibility to such things, and even I couldn’t help but think that we were crossing some sort of Rubicon with regard to our collective sanity. Swift was everywhere, beheld by everyone. She is one of the most streamed artists of all time on Spotify; Billboard reported that, at one point, she accounted for seven per cent of all vinyl sales in the U.S. Swift is a capable and hugely savvy businesswoman (a billionaire, in fact), yet I began to worry about her in a nearly maternal way: How could anyone survive that sort of scrutiny and retain her humanity? Detaching from reality can be lethal for a pop star, particularly one known for her Everygirl candor. I thought of the oft-memed bit from “Arrested Development,” in which Lucille Bluth, the oblivious matriarch, asks, “I mean, it’s one banana, Michael—what could it cost? Ten dollars?”

This month, Swift released “The Tortured Poets Department,” her eleventh studio album. She has now reached a level of virtuosity within her genre that feels nearly immutable—she’s too practiced, too masterly, to swing and really miss. But “The Tortured Poets Department” suffers from being too long (two hours after it was released, Swift announced a second disk, bringing the total number of tracks to thirty-one) and too familiar. Swift co-wrote most of the record with Jack Antonoff and with Aaron Dessner. (The two producers have oppositional melodic sensibilities: Antonoff sharpens Swift; Dessner softens her.) The new songs suggest that, after a decade, her partnership with Antonoff has perhaps run its course. The tracks written with Dessner are gentler, more tender, and more surprising. The raw and stirring “Robin” seems to address a child—either a very young Swift (the album contains several references to her hijacked youth, including “The Manuscript,” a sombre song about a relationship with an older man), or maybe a future son or daughter.

“The Tortured Poets Department” was released following the end of Swift’s six-year relationship with the actor Joe Alwyn, and the album is mostly about the utter unreliability of love—how bonkers it is that we build our entire lives around a feeling that can simply dissipate. “You said I’m the love of your life / About a million times,” Swift sings on “Loml,” a wrenching piano ballad. “You shit-talked me under the table, talking rings and talking cradles.” Shortly after Swift and Alwyn split, she reportedly had a fling with Matty Healy , the front man for the British rock band the 1975. (“I took the miracle move-on drug / The effects were temporary,” she sings on “Fortnight.”) Healy is a provocateur, prone to making loutish jokes; onstage, he smokes, eats raw steak, and makes out with strangers. The rumored relationship sent Swifties into spasms of outrage, and revealed the unusual extent to which Swift is beholden to her fans. She has encouraged and nurtured a parasocial affection (at times she nearly demanded it: inviting fans to her home, baking them cookies), and she now has to contend with their sense of ownership over her life. On “But Daddy I Love Him,” she scornfully chastises the “judgmental creeps” who relentlessly hounded her about her love life: “I’d rather burn my whole life down / Than listen to one more second of all this bitching and moaning.” (She saves the nastiest barb for the final verse: “All the wine moms are still holding out.”) Regardless, things with Healy ended fast, and, a few months later, she did the most wholesome thing possible: she started dating a football player whose team would go on to win the Super Bowl.

Quite a few of the album’s lyrics seem to evoke Healy: “You’re not Dylan Thomas / I’m not Patti Smith / This ain’t the Chelsea Hotel / We’re modern idiots,” Swift sings on the title track, a shimmering song about broken people clinging to each other. I like that line—it suggests self-awareness—but it’s followed by one of the weirdest verses of Swift’s career: “You smoked then ate seven bars of chocolate / We declared Charlie Puth should be a bigger artist / I scratch your head, you fall asleep / Like a tattooed golden retriever.” Other lyrics lack Swift’s signature precision: “At dinner you take my ring off my middle finger and put it on the one people put wedding rings on,” she sings. Even the greatest poets whiff a phrase now and then, but a lot of the language on the record is either incoherent (“I was a functioning alcoholic till nobody noticed my new aesthetic”) or just generally bewildering (“Florida is one hell of a drug”). My favorite lyrics are the simplest, and are delivered with a kind of exhausted calm. On “Down Bad,” a woozy song about feeling like shit, Swift admits defeat: “Now I’m down bad, crying at the gym / Everything comes out teen-age petulance / Fuck it if I can’t have him.” Feel you, dude.

Each of Swift’s records has a distinct visual component—this is more or less the premise of the Eras Tour . “The Tortured Poets Department” is preoccupied with writerly accoutrements, but the vibe is ultimately more high-end stationery store than musty rare-books room. Initially, the title seemed as if it might be a smirking reference to Joe Alwyn (he once joked about being part of a WhatsApp group called the Tortured Man Club). But I find that the phrase works well as a summation of Swift’s entire self-conception. She has always made a big deal about her pain being generative. “This writer is of the firm belief that our tears become holy in the form of ink on the page,” she wrote on Instagram. She has talked about this album as if the songs were mere monuments to her suffering: “Once we have spoken our saddest story, we can be free of it.”

An unusual number of Swift’s songs portray love as combative, perhaps because she is so prone to working from a place of wounded longing. On “Better Than Revenge,” a song she wrote at eighteen, Swift sings about art as a useful weapon, a way to punish anyone who does her dirty: “She thinks I’m psycho / ’Cause I like to rhyme her name with things.” It’s a funny lyric, but, by Swift’s current age, most people understand that love isn’t about winning. (Art isn’t, either.) Yet, in Swift’s universe, love is often a battlefield. On “Who’s Afraid of Little Old Me?,” she catalogues the ways in which fame can pervert and destroy a person: “I was tame, I was gentle, till the circus life made me mean,” she sings. She is paranoid, wild-eyed: “Tell me everything is not about me / But what if it is ?” (After the year Swift has had, she’s not wrong to ask.) The song itself is so tightly produced that it doesn’t sound dangerous. But, midway through, her voice briefly goes feral. I found the moment thrilling, which is maybe part of the problem.

In the weeks before “The Tortured Poets Department” was released, it seemed as though a backlash was inevitable. Swift’s lyrics are often focussed on her perseverance against all odds, but, these days, she is too omnipresent and powerful to make a very convincing underdog. Still, interest in Swift has yet to diminish or fully sour. She announced the album at the Grammys, in February, as she was accepting the award for Best Pop Vocal Album, for her previous record, “Midnights.” I found her speech so profoundly mercenary it was sort of funny. “I want to say thank you to the fans by telling you a secret that I’ve been keeping from you for the last two years, which is that my brand-new album comes out April 19th,” Swift said. “I’m gonna go and post the cover.”

As I’ve grown older, I’ve mostly stopped thinking about art and commerce as being fundamentally at odds. But there are times when the rapaciousness of our current pop stars seems grasping and ugly. I’m not saying that pop music needs to be ideologically pure—it wouldn’t be much fun if it were—but maybe it’s time to cool it a little with the commercials? A couple of days before the album’s release, Swift unveiled a library-esque display at the Grove, a shopping mall in Los Angeles. It included several pages of typewritten lyrics on faux aged paper, arranged as though they had recently been tugged from the platen of a Smith Corona. (The word “talisman” was misspelled on one, to the delight of the haters.) The Spotify logo was featured prominently at the bottom of each page. Once again, I laughed. What is the point of all that money if it doesn’t buy you freedom from corporate branding? For a million reasons—her adoption of the “poet” persona; her already unprecedented streaming numbers—such an egregious display of sponsorship was worse than just incongruous. It was, as they say, cringe.

Among the other clues Swift doled out were five exclusive playlists for Apple Music (sorry, Spotify!), comprising her own songs and organized according to the five stages of grief: denial, anger, bargaining, depression, and acceptance. At first, I thought the playlists were just another bit of overwrought marketing, but the more I listened to “The Tortured Poets Department” the more germane the concept felt. Anyone who has grieved knows that these categories are not a ladder you climb toward peace: it is possible, instead, to feel all of them at once, briefly or forever. Each stage is evident on “The Tortured Poets Department.” Sometimes they oppose one another: Swift is cocky and self-loathing, tough and vulnerable, totally fine and completely destroyed. She is free, but trapped. Dominant, powerless. She wants this, but she doesn’t. Those sorts of contradictions can be dizzying, but, in the end, they’re also the last things keeping her human. ♦

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Understanding the influence of different proxy perspectives in explaining the difference between self-rated and proxy-rated quality of life in people living with dementia: a systematic literature review and meta-analysis

• Open access
• Published: 24 April 2024

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• Lidia Engel   ORCID: orcid.org/0000-0002-7959-3149 1 ,
• Valeriia Sokolova 1 ,
• Ekaterina Bogatyreva 2 &
• Anna Leuenberger 2  

Proxy assessment can be elicited via the proxy-patient perspective (i.e., asking proxies to assess the patient’s quality of life (QoL) as they think the patient would respond) or proxy-proxy perspective (i.e., asking proxies to provide their own perspective on the patient’s QoL). This review aimed to identify the role of the proxy perspective in explaining the differences between self-rated and proxy-rated QoL in people living with dementia.

A systematic literate review was conducted by sourcing articles from a previously published review, supplemented by an update of the review in four bibliographic databases. Peer-reviewed studies that reported both self-reported and proxy-reported mean QoL estimates using the same standardized QoL instrument, published in English, and focused on the QoL of people with dementia were included. A meta-analysis was conducted to synthesize the mean differences between self- and proxy-report across different proxy perspectives.

The review included 96 articles from which 635 observations were extracted. Most observations extracted used the proxy-proxy perspective (79%) compared with the proxy-patient perspective (10%); with 11% of the studies not stating the perspective. The QOL-AD was the most commonly used measure, followed by the EQ-5D and DEMQOL. The standardized mean difference (SMD) between the self- and proxy-report was lower for the proxy-patient perspective (SMD: 0.250; 95% CI 0.116; 0.384) compared to the proxy-proxy perspective (SMD: 0.532; 95% CI 0.456; 0.609).

Different proxy perspectives affect the ratings of QoL, whereby adopting a proxy-proxy QoL perspective has a higher inter-rater gap in comparison with the proxy-patient perspective.

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Quality of life (QoL) has become an important outcome for research and practice but obtaining reliable and valid estimates remains a challenge in people living with dementia [ 1 ]. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria [ 2 ], dementia, termed as Major Neurocognitive Disorder (MND), involves a significant decline in at least one cognitive domain (executive function, complex attention, language, learning, memory, perceptual-motor, or social cognition), where the decline represents a change from a patient's prior level of cognitive ability, is persistent and progressive over time, is not associated exclusively with an episode of delirium, and reduces a person’s ability to perform everyday activities. Since dementia is one of the most pressing challenges for healthcare systems nowadays [ 3 ], it is critical to study its impact on QoL. The World Health Organization defines the concept of QoL as “individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” [ 4 ]. It is a broad ranging concept incorporating in a complex way the persons' physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationships to salient features of the environment.

Although there is evidence that people with mild to moderate dementia can reliably rate their own QoL [ 5 ], as the disease progresses, there is typically a decline in memory, attention, judgment, insight, and communication that may compromise self-reporting of QoL [ 6 ]. Additionally, behavioral symptoms, such as agitation, and affective symptoms, such as depression, may present another challenge in obtaining self-reported QoL ratings due to emotional shifts and unwillingness to complete the assessment [ 7 ]. Although QoL is subjective and should ideally be assessed from an individual’s own perspective [ 8 ], the decline in cognitive function emphasizes the need for proxy-reporting by family members, health professionals, or care staff who are asked to report on behalf of the person with dementia. However, proxy-reports are not substitutable for self-reports from people with dementia, as they offer supplementary insights, reflecting the perceptions and viewpoints of people surrounding the person with dementia [ 9 ].

Previous research has consistently highlighted a disagreement between self-rated and proxy-rated QoL in people living with dementia, with proxies generally providing lower ratings (indicating poorer QoL) compared with person’s own ratings [ 8 , 10 , 11 , 12 ]. Impairment in cognition associated with greater dementia severity has been found to be associated with larger difference between self-rating and proxy-rating obtained from family caregivers, as it becomes increasingly difficult for severely cognitively impaired individuals to respond to questions that require contemplation, introspection, and sustained attention [ 13 , 14 ]. Moreover, non-cognitive factors, such as awareness of disease and depressive symptoms play an important role when comparing QoL ratings between individuals with dementia and their proxies [ 15 ]. Qualitative evidence has also shown that people with dementia tend to compare themselves with their peers, whereas carers make comparisons with how the person used to be in the past [ 9 ]. The disagreement between self-reported QoL and carer proxy-rated QoL could be modulated by some personal, cognitive or relational factors, for example, the type of relationship or the frequency of contact maintained, person’s cognitive status, carer’s own feeling about dementia, carer’s mood, and perceived burden of caregiving [ 14 , 16 ]. Disagreement may also arise from the person with dementia’s problems to communicate symptoms, and proxies’ inability to recognize certain symptoms, like pain [ 17 ], or be impacted by the amount of time spent with the person with dementia [ 18 ]. This may also prevent proxies to rate accurately certain domains of QoL, with previous evidence showing higher level of agreement for observable domains, such as mobility, compared with less observable domains like emotional wellbeing [ 8 ]. Finally, agreement also depends on the type of proxy (i.e., informal/family carers or professional staff) and the nature of their relationship, for instance, proxy QoL scores provided by formal carers tend to be higher (reflecting better QoL) compared to the scores supplied by family members [ 19 , 20 ]. Staff members might associate residents’ QoL with the quality of care delivered or the stage of their cognitive impairment, whereas relatives often focus on comparison with the person’s QoL when they were younger, lived in their own home and did not have dementia [ 20 ].

What has been not been fully examined to date is the role of different proxy perspectives employed in QoL questionnaires in explaining disagreement between self-rated and proxy-rated scores in people with dementia. Pickard et al. (2005) have proposed a conceptual framework for proxy assessments that distinguish between the proxy-patient perspective (i.e., asking proxies to assess the patient’s QoL as they think the patient would respond) or proxy-proxy perspective (i.e., asking proxies to provide their own perspective on the patient’s QoL) [ 21 ]. In this context, the intra-proxy gap describes the differences between proxy-patient and proxy-proxy perspective, whereas the inter-rater gap is the difference between self-report and proxy-report [ 21 ].

Existing generic and dementia-specific QoL instruments specify the perspective explicitly in their instructions or imply the perspective indirectly in their wording. For example, the instructions of the Dementia Quality of Life Measure (DEMQOL) asks proxies to give the answer they think their relative would give (i.e., proxy-patient perspective) [ 22 ], whereas the family version of the Quality of Life in Alzheimer’s Disease (QOL-AD) instructs the proxies to rate their relative’s current situation as they (the proxy) see it (i.e., proxy-proxy perspective) [ 7 ]. Some instruments, like the EQ-5D measures, have two proxy versions for each respective perspective [ 23 , 24 ]. The Adult Social Care Outcome Toolkit (ASCOT) proxy version, on the other hand, asks proxies to complete the questions from both perspectives, from their own opinion and how they think the person would answer [ 25 ].

QoL scores generated using different perspectives are expected to differ, with qualitative evidence showing that carers rate the person with dementia’s QoL lower (worse) when instructed to comment from their own perspective than from the perspective of the person with dementia [ 26 ]. However, to our knowledge, no previous review has fully synthesized existing evidence in this area. Therefore, we aimed to undertake a systematic literature review to examine the role of different proxy-assessment perspectives in explaining differences between self-rated and proxy-rated QoL in people living with dementia. The review was conducted under the hypothesis that the difference in QoL estimates will be larger when adopting the proxy-proxy perspective compared with proxy-patient perspective.

The review was registered with the International Prospective Register of Systematic Reviews (CRD42022333542) and followed the Preferred Reporting Items System for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (see Appendix 1 ) [ 27 ].

Search strategy

This review used two approaches to obtain literature. First, primary articles from an existing review by Roydhouse et al. were retrieved [ 28 ]. The review included studies published from inception to February 2018 that compared self- and proxy-reports. Studies that focused explicitly on Alzheimer’s Disease or dementia were retrieved for the current review. Two reviewers conducted a full-text review to assess whether the eligibility criteria listed below for the respective study were met. An update of the Roydhouse et al. review was undertaken to capture more recent studies. The search strategy by Roydhouse et al. was amended and covered studies published after January 1, 2018, and was limited to studies within the context of dementia. The original search was undertaken over a three-week period (17/11/2021–9/12/2021) and then updated on July 3, 2023. Peer-reviewed literature was sourced from MEDLINE, CINAHL, and PsycINFO databases via EBSCOHost as well as EMBASE. Four main search term categories were used: (1) proxy terms (i.e., care*-report*), (2) QoL/ outcome terms (i.e., ‘quality of life’), (3) disease terms (i.e., ‘dementia’), and (4) pediatric terms (i.e., ‘pediatric*’) (for exclusion). Keywords were limited to appear in titles and abstracts only, and MeSH terms were included for all databases. A list of search strategy can be found in Appendix 2 . The first three search term categories were searched with AND, and the NOT function was used to exclude pediatric terms. A limiter was applied in all database searches to only include studies with human participants and articles published in English.

Selection criteria

Studies from all geographical locations were included in the review if they (1) were published in English in a peer-reviewed journal (conference abstracts, dissertations, a gray literature were excluded); (2) were primary studies (reviews were excluded); (3) clearly defined the disease of participants, which were limited to Alzheimer’s disease or dementia; (4) reported separate QoL scores for people with dementia (studies that included mixed populations had to report a separate QoL score for people with dementia to be considered); (5) were using a standardized and existing QoL instrument for assessment; and (6) provided a mean self-reported and proxy-reported QoL score for the same dyads sample (studies that reported means for non-matched samples were excluded) using the same QoL instrument.

Four reviewers (LE, VS, KB, AL) were grouped into two groups who independently screened the 179 full texts from the Roydhouse et. al (2022) study that included Alzheimer’s disease or dementia patients. If a discrepancy within the inclusion selection occurred, articles were discussed among all the reviewers until a consensus was reached. Studies identified from the database search were imported into EndNote [ 29 ]. Duplicates were removed through EndNote and then uploaded to Rayyan [ 30 ]. Each abstract was reviewed by two independent reviewers (any two from four reviewers). Disagreements regarding study inclusions were discussed between all reviewers until a consensus was reached. Full-text screening of each eligible article was completed by two independent reviewers (any two from four reviewers). Again, a discussion between all reviewers was used in case of disagreements.

Data extraction

A data extraction template was created in Microsoft Excel. The following information were extracted if available: country, study design, study sample, study setting, dementia type, disease severity, Mini-Mental Health State Exam (MMSE) score details, proxy type, perspective, living arrangements, QoL assessment measure/instrument, self-reported scores (mean, SD), proxy-reported scores (mean, SD), and agreement statistics. If a study reported the mean (SD) for the total score as well as for specific QoL domains of the measure, we extracted both. If studies reported multiple scores across different time points or subgroups, we extracted all scores. For interventional studies, scores from both the intervention group and the control group were recorded. In determining the proxy perspective, we relied on authors’ description in the article. If the perspective was not explicitly stated, we adopted the perspective of the instrument developers; where more perspectives were possible (e.g., in the case of the EQ-5D measures) and the perspective was not explicitly stated, it was categorized as ‘undefined.’ For agreement, we extracted the Intraclass Correlation Coefficient (ICC), a reliability index that reflects both degree of correlation and agreement between measurements of continuous variables. While there are different forms of ICC based on the model (1-way random effects, 2-wy random effects, or 2-way fixed effects), the type (single rater/measurement or the mean k raters/measurements), and definition of relationship [ 31 ], this level of information was not extracted due to insufficient information provided in the original studies. Values for ICC range between 0 and 1, with values interpreted as poor (less than 0.5), moderate (0.5–0.75), good (0.75–0.9), and excellent (greater than 0.9) reliability between raters [ 31 ].

Data synthesis and analysis

Characteristics of studies were summarized descriptively. Self-reported and proxy-reported means and SD were extracted from the full texts and the mean difference was calculated (or extracted if available) for each pair. Studies that reported median values instead of mean values were converted using the approach outlined by Wan et al. (2014) [ 32 ]. Missing SDs (5 studies, 20 observations) were obtained from standard errors or confidence intervals reported following the Cochrane guidelines [ 33 ]. Missing SDs (6 studies, 29 observations) in studies that only presented the mean value without any additional summary statistics were imputed using the prognostic method [ 34 ]. Thereby, we predicted the missing SDs by calculating the average SDs of observed studies with full information by the respective measure and source (self-report versus proxy-report).

A meta-analysis was performed in Stata (17.1 Stata Corp LLC, College Station, TX) to synthesize mean differences between self- and proxy-reported scores across different proxy perspectives. First, the pooled raw mean differences were calculated for each QoL measure separately, given differences in scales between measures. Secondly, we calculated the pooled standardized mean difference (SMD) for all studies stratified by proxy type (family carer, formal carers, mixed), dementia severity (mild, moderate, severe), and living arrangement (residential/institutional care, mixed). SMD accounts for the use of different measurement scales, where effect sizes were estimated using Cohen’s d. Random-effects models were used to allow for unexplained between-study variability based on the restricted maximum-likelihood (REML) estimator. The percentage of variability attributed to heterogeneity between the studies was assessed using the I 2 statistic; an I 2 of 0%-40% represents possibly unimportant heterogeneity, 30–60% moderate heterogeneity, 50–90% substantial heterogeneity, and 75%-100% considerable heterogeneity [ 35 ]. Chi-squared statistics (χ 2 ) provided evidence of heterogeneity, where a p -value of 0.1 was used as significance level. For studies that reported agreement statistics, based on ICC, we also ran a forest plot stratified by the study perspective. We also calculated Q statistic (Cochran’s test of homogeneity), which assesses whether observed differences in results are compatible with chance alone.

Risk of bias and quality assessment

The quality of studies was assessed using the using a checklist for assessing the quality of quantitative studies developed by Kmet et al. (2004) [ 36 ]. The checklist consists of 14 items and items are scored as ‘2’ (yes, item sufficiently addressed), ‘1’ (item partially addressed), ‘0’ (no, not addressed), or ‘not applicable.’ A summary score was calculated for each study by summing the total score obtained across relevant items and dividing by the total possible score. Scores were adjusted by excluding items that were not applicable from the total score. Quality assessment was undertaken by one reviewer, with 25% of the papers assessed independently by a second reviewer.

The PRISMA diagram in Fig.  1 shows that after the abstract and full-text screening, 38 studies from the database search and 58 studies from the Roydhouse et al. (2022) review were included in this review—a total of 96 studies. A list of all studies included and their characteristics can be found in Appendix 3.

PRISMA 2020 flow diagram

General study characteristics

The 96 articles included in the review were published between 1999 and 2023 from across the globe; most studies (36%) were conducted in Europe. People with dementia in these studies were living in the community (67%), residential/institutional care (15%), as well as mixed dwelling settings (18%). Most proxy-reports were provided by family carers (85%) and only 8 studies (8%) included formal carers. The mean MMSE score for dementia and Alzheimer’s participants was 18.77 (SD = 4.34; N  = 85 studies), which corresponds to moderate cognitive impairment [ 37 ]. Further characteristics of studies included are provided in Table  1 . The quality of studies included (see Appendix 4) was generally very good, scoring on average 91% (SD: 9.1) with scores ranging from 50 to 100%.

Quality of life measure and proxy perspective used

A total of 635 observations were recorded from the 96 studies. The majority of studies and observations extracted assumed the proxy-proxy perspective (77 studies, 501 observations), followed by the proxy-patient perspective (18 studies, 62 observations), with 18 studies (72 observations) not clearly defining the perspective. Table 2 provides a detailed overview of number of studies and observations across the respective QoL measures and proxy perspectives. Two studies (14 observations) adopted both perspectives within the same study design: one using the QOL-AD measure [ 5 ] and the second study exploring the EQ-5D-3L and EQ VAS [ 38 ]. Overall, the QOL-AD was the most often used QoL measure, followed by the EQ-5D and DEMQOL. Mean scores for specific QoL domains were accessible for the DEMQOL and QOL-AD. However, only the QOL-AD provided domain-specific mean scores from both proxy perspectives.

Mean scores and mean differences by proxy perspective and QoL measure

The raw mean scores for self-reported and proxy-reported QoL scores are provided in the Supplementary file 2. The pooled raw mean difference by proxy perspective and measure is shown in Table  3 . Regardless of the perspective adopted and the QoL instrument used, self-reported scores were higher (indicating better QoL) compared with proxy-reported scores, except for the DEMQOL, where proxies reported better QoL than people with dementia themselves. Most instruments were explored from one perspective, except for the EQ-5D-3L, EQ VAS, and QOL-AD, for which mean differences were available for both perspectives. For these three measures, mean differences were smaller when adopting the proxy-patient perspective compared with proxy-proxy perspective, although mean scores for the QOL-AD were slightly lower from the proxy-proxy perspective. I 2 statistics indicate considerable heterogeneity (I 2  > 75%) between studies. Mean differences by specific QoL domains are provided in Appendix 5, but only for the QOL-AD measure that was explored from both perspectives. Generally, mean differences appeared to be smaller for the proxy-proxy perspective than the proxy-patient perspective across all domains, except for ‘physical health’ and ‘doing chores around the house.’ However, results need to be interpreted carefully as proxy-patient perspective scores were derived from only one study.

Standardized mean differences by proxy perspective, stratified by proxy type, dementia severity, and living arrangement

Table 4 provides the SMD by proxy perspective, which adjusts for the different QoL measurement scales. Findings suggest that adopting the proxy-patient perspective results in lower SMDs (SMD: 0.250; 95% CI 0.116; 0.384) compared with the proxy-proxy perspective (SMD: 0.532; 95% CI 0.456; 0.609). The largest SMD was recorded for studies that did not define the study perspective (SMD: 0.594; 95% CI 0.469; 0.718). A comparison by different proxy types (formal carers, family carers, and mixed proxies) revealed some mixed results. When adopting the proxy-proxy perspective, the largest SMD was found for family carers (SMD: 0.556; 95% CI 0.465; 0.646) compared with formal carers (SMD: 0.446; 95% CI 0.305; 0.586) or mixed proxies (SMD: 0.335; 95% CI 0.211; 0.459). However, the opposite relationship was found when the proxy-patient perspective was used, where the smallest SMD was found for family carers compared with formal carers and mixed proxies. The SMD increased with greater level of dementia severity, suggesting a greater disagreement. However, compared with the proxy-proxy perspective, where self-reported scores were greater (i.e., better QoL) than proxy-reported scores across all dementia severity levels, the opposite was found when adopting the proxy-patient perspective, where proxies reported better QoL than people with dementia themselves, except for the severe subgroup. No clear trend was observed for different living settings, although the SMD appeared to be smaller for people with dementia living in residential care compared with those living in the community.

Direct proxy perspectives comparison studies

Two studies assessed both proxy perspectives within the same study design. Bosboom et al. (2012) found that compared with self-reported scores (mean: 34.7; SD: 5.3) using the QOL-AD, proxy scores using the proxy-patient perspective were closer to the self-reported scores (mean: 32.1; SD: 6.1) compared with the proxy-proxy perspective (mean: 29.5; SD: 5.4) [ 5 ]. Similar findings were reported by Leontjevas et al. (2016) using the EQ-5D-3L, including the EQ VAS, showing that the inter-proxy gap between self-report (EQ-5D-3L: 0.609; EQ VAS: 65.37) and proxy-report was smaller when adopting the proxy-patient perspective (EQ-5D-3L: 0.555; EQ VAS: 65.15) compared with the proxy-proxy perspective (EQ-5D-3L: 0.492; EQ VAS: 64.42) [ 38 ].

Inter-rater agreement (ICC) statistics

Six studies reported agreement statistics based on ICC, from which we extracted 17 observations that were included in the meta-analysis. Figure  2 shows the study-specific and overall estimates of ICC by the respective study perspective. The heterogeneity between studies was high ( I 2  = 88.20%), with a Q test score of 135.49 ( p  < 0.001). While the overall ICC for the 17 observations was 0.3 (95% CI 0.22; 0.38), indicating low agreement, the level of agreement was slightly better when adopting a proxy-patient perspective (ICC: 0.36, 95% CI 0.23; 0.49) than a proxy-proxy perspective (ICC: 0.26, 95% CI 0.17; 0.35).

Forest plot depicting study-specific and overall ICC estimates by study perspective

While previous studies highlighted a disagreement between self-rated and proxy-rated QoL in people living with dementia, this review, for the first time, assessed the role of different proxy perspectives in explaining the inter-rater gap. Our findings align with the baseline hypothesis and indicate that QoL scores reported from the proxy-patient perspective are closer to self-reported QoL scores than the proxy-proxy perspective, suggesting that the proxy perspective does impact the inter-rater gap and should not be ignored. This finding was observed across different analyses conducted in this review (i.e., pooled raw mean difference, SMD, ICC analysis), which also confirms the results of two previous primary studies that adopted both proxy perspectives within the same study design [ 5 , 38 ]. Our findings emphasize the need for transparency in reporting the proxy perspective used in future studies, as it can impact results and interpretation. This was also noted by the recent ISPOR Proxy Task Force that developed a checklist of considerations when using proxy-reporting [ 39 ]. While consistency in proxy-reports is desirable, it is crucial to acknowledge that each proxy perspective holds significance in future research, depending on study objectives. It is evident that both proxy perspectives offer distinct insights—one encapsulating the perspectives of people with dementia, and the other reflecting the viewpoints of proxies. Therefore, in situations where self-report is unattainable due to advanced disease severity and the person’s perspective on their own QoL assessment is sought, it is recommended to use the proxy-patient perspective. Conversely, if the objective of future research is to encompass the viewpoints of proxies, opting for the proxy-proxy perspective is advisable. However, it is important to note that proxies may deviate from instructed perspectives, requiring future qualitative research to examine the adherence to proxy perspectives. Additionally, others have argued that proxy-reports should not substitute self-reports, and only serve as supplementary sources alongside patient self-reports whenever possible [ 9 ].

This review considered various QoL instruments, but most instruments adopted one specific proxy perspective, limiting detailed analyses. QoL instruments differ in their scope (generic versus disease-specific) as well as coverage of QoL domains. The QOL-AD, an Alzheimer's Disease-specific measure, was commonly used. Surprisingly, for this measure, the mean differences between self-reported and proxy-reported scores were smaller using the proxy-proxy perspective, contrary to the patterns observed with all other instruments. This may be due to the lack of studies reporting QOL-AD proxy scores from the proxy-patient perspective, as the study by Bosboom et al. (2012) found the opposite [ 5 ]. Previous research has also suggested that the inter-rater gap is dependent on the QoL domains and that the risk of bias is greater for more ‘subjective’ (less observable) domains such as emotions, feelings, and moods in comparison with observable, objective areas such as physical domains [ 8 , 40 ]. However, this review lacks sufficient observations for definitive results on QoL dimensions and their impact on self-proxy differences, emphasizing the need for future research in this area.

With regard to proxy type, there is an observable trend suggesting a wider inter-rater gap when family proxies are employed using the proxy-proxy perspective, in contrast to formal proxies. This variance might be attributed to the use of distinct anchoring points; family proxies tend to assess the individual's QoL in relation to their past self before having dementia, while formal caregivers may draw comparisons with other individuals with dementia under their care [ 41 ]. However, the opposite was found when the proxy-patient perspective was used, where family proxies scores seemed to align more closely with self-reported scores, resulting in lower SMD scores. This suggests that family proxies might possess a better ability to empathize with the perspective of the person with dementia compared to formal proxies. Nonetheless, it is important to interpret these findings cautiously, given the relatively small number of observations for formal caregiver reports. Additionally, other factors such as emotional connection, caregiver burden, and caregiver QoL may also impact proxy-reports by family proxies [ 14 , 16 ] that have not been explored in this review.

Our review found that the SMD between proxy and self-report increased with greater level of dementia severity, contrasting a previous study, which showed that cognitive impairment was not the primary factor that accounted for the differences in the QoL assessments between family proxies and the person with dementia [ 15 ]. However, it is noteworthy that different interpretations and classifications were used across studies to define mild, moderate, and severe dementia, which needs to be considered. Most studies used MMSE to define dementia severity levels. Given the MMSE’s role as a standard measure of cognitive function, the study findings are considered generalizable and clinically relevant for people with dementia across different dementia severity levels. When examining the role of the proxy perspective by level of severity, we found that compared with the proxy-proxy perspective, where self-reported scores were greater than proxy-reported scores across all dementia severity levels, the proxy-patient perspective yielded the opposite results, and proxies reported better QoL than people with dementia themselves, except for the severe subgroup. It is possible that in the early stages of dementia, the person with dementia has a greater awareness of increasing deficits, coupled with denial and lack of acceptance, leading to a more critical view of their own QoL than how proxies think they would rate their QoL. However, future studies are warranted, given the small number of observations adopting the proxy-patient perspective in our review.

The heterogeneity observed in the studies included was high, supporting the use of random-effects meta-analysis. This is not surprising given the diverse nature of studies included (i.e., RCTs, cross-sectional studies), differences in the population (i.e., people living in residential care versus community-dwelling people), mixed levels of dementia severity, and differences between instruments. While similar heterogeneity was observed in another review on a similar topic [ 42 ], our presentation of findings stratified by proxy type, dementia severity, and living arrangement attempted to account for such differences across studies.

Limitations and recommendations for future studies

Our review has some limitations. Firstly, proxy perspectives were categorized based on the authors' descriptions, but many papers did not explicitly state the perspective, which led to the use of assumptions based on instrument developers. Some studies may have modified the perspective's wording without reporting it. Due to lack of resources, we did not contact the authors of the original studies directly to seek clarification around the proxy perspective adopted. Regarding studies using the EQ-5D, which has two proxy perspectives, some studies did not specify which proxy version was used, suggesting the potential use of self-reported versions for proxies. In such cases, the proxy perspective was categorized as undefined. Despite accounting for factors like QoL measure, proxy type, setting, and dementia severity, we could not assess the impact of proxy characteristics (e.g., carer burden) or dementia type due to limited information provided in the studies. We also faced limitations in exploring the proxy perspective by QoL domains due to limited information. Further, not all studies outlined the data collection process in full detail. For example, it is possible that the proxy also assisted the person with dementia with their self-report, which could have resulted in biased estimates and the need for future studies applying blinding. Although we assessed the risk of bias of included studies, the checklist was not directly reflecting the purpose of our study that looked into inter-rater agreement. No checklist for this purpose currently exists. Finally, quality appraisal by a second reviewer was only conducted for the first 25% of the studies due to resource constraints and a low rate of disagreement between the two assessors. However, an agreement index between reviewers regarding the concordance in selecting full texts for inclusion and conducting risk of bias assessments was not calculated.

This review demonstrates that the choice of proxy perspective impacts the inter-rater gap. QoL scores from the proxy-patient perspective align more closely with self-reported scores than the proxy-proxy perspective. These findings contribute to the broader literature investigating factors influencing differences in QoL scores between proxies and individuals with dementia. While self-reported QoL is the gold standard, proxy-reports should be viewed as complements rather than substitutes. Both proxy perspectives offer unique insights, yet QoL assessments in people with dementia are complex. The difference in self- and proxy-reports can be influenced by various factors, necessitating further research before presenting definitive results that inform care provision and policy.

Data availability

All data associated with the systematic literature review are available in the supplementary file.

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LE contributed to the study conception and design. The original database search was performed by AL and later updated by VS. All authors were involved in the screening process, data extraction, and data analyses. Quality assessment was conducted by VS and LE. The first draft of the manuscript was written by LE and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Engel, L., Sokolova, V., Bogatyreva, E. et al. Understanding the influence of different proxy perspectives in explaining the difference between self-rated and proxy-rated quality of life in people living with dementia: a systematic literature review and meta-analysis. Qual Life Res (2024). https://doi.org/10.1007/s11136-024-03660-w

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