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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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See an example

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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Political Science Subject Guide: Literature Reviews

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More Literature Review Writing Tips

• Thesis Whisperer- Bedraggled Daisy Lay advice on writing theses and dissertations. This article demonstrates in more detail one aspect of our discussion

Books on the Literature Review

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."

(from "The Literature Review: A Few Tips on Writing It," http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review )

Strategies for conducting your own literature review

1. Use this guide as a starting point. Begin your search with the resources linked from the political science subject guide. These library catalogs and databases will help you identify what's been published on your topic.

2. What came first? Try bibliographic tracing. As you're finding sources, pay attention to what and whom these authors cite. Their footnotes and bibliographies will point you in the direction of additional scholarship on your topic.

3. What comes next? Look for reviews and citation reports. What did scholars think about that book when it was published in 2003? Has anyone cited that article since 1971? Reviews and citation analysis tools can help you determine if you've found the seminal works on your topic--so that you can be confident that you haven't missed anything important, and that you've kept up with the debates in your field. You'll find book reviews in JSTOR and other databases. Google Scholar has some citation metrics; you can use Web of Science ( Social Sciences Citation Index ) for more robust citation reports.

4. Stay current. Get familiar with the top journals in your field, and set up alerts for new articles. If you don't know where to begin, APSA and other scholarly associations often maintain lists of journals, broken out by subfield . In many databases (and in Google Scholar), you can also set up search alerts, which will notify you when additional items have been added that meet your search criteria.

5. Stay organized. A citation management tool--e.g., RefWorks, Endnote, Zotero, Mendeley--will help you store your citations, generate a bibliography, and cite your sources while you write. Some of these tools are also useful for file storage, if you'd like to keep PDFs of the articles you've found. To get started with citation management tools, check out this guide . 

How to find existing literature reviews

1. Consult Annual Reviews.  The Annual Review of Political Science consists of thorough literature review essays in all areas of political science, written by noted scholars. The library also subscribes to Annual Reviews in economics, law and social science, sociology, and many other disciplines.

2. Turn to handbooks, bibliographies, and other reference sources. Resources like Oxford Bibliographies Online and assorted handbooks ( Oxford Handbook of Comparative Politics , Oxford Handbook of American Elections and Political Behavior , etc.) are great ways to get a substantive introduction to a topic, subject area, debate, or issue. Not exactly literature reviews, but they do provide significant reference to and commentary on the relevant literature--like a heavily footnoted encyclopedia for specialists in a discipline. 

3. Search databases and Google Scholar.   Use the recommended databases in the "Articles & Databases" tab of this guide and try a search that includes the phrase "literature review."

4. Search in journals for literature review articles.  Once you've identified the important journals in your field as suggested in the section above, you can target these journals and search for review articles. 

5. Find book reviews.  These reviews can often contain useful contextual information about the concerns and debates of a field. Worldwide Political Science Abstracts is a good source for book reviews, as is JSTOR . To get to book reviews in JSTOR, select the advanced search option, use the title of the book as your search phrase, and narrow by item type: reviews. You can also narrow your search further by discipline.

6. Cast a wide net--don't forget dissertations.  Dissertations and theses often include literature review sections. While these aren't necessarily authoritative, definitive literature reviews (you'll want to check in Annual Reviews for those), they can provide helpful suggestions for sources to consider.

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Literature and Policy Review and Analysis

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• Simon Copland 12  

Part of the book series: Global Masculinities ((GLMAS))

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This chapter outlines what is known about the intersection of masculinity and violent extremism, based on an extensive literature review. The literature review is composed of a systematic review of scholarly and policy literature on issues of masculinities in relation to both violent extremism and policies and programmes to CVE. It focuses on works published over the period 2010–2019, in English, addressing violent extremism and making reference to men and masculinities. Recent international studies indicate that higher levels of gender inequality, gender-based violence and misogyny contribute to a greater vulnerability to both intra-state political violence and a predisposition towards violent extremism. The ‘gender lens’ is an effective indicator of rising extremisms and must inform policy responses.

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Pearson ( 2019b , p. 96) notes that “CVE differs from the more recently introduced concept of ‘PVE’, in that PVE is understood to be more broadly focused on an earlier stage, ‘pre’-radicalisation, or to take a longer-term approach, addressing structural factors. However, in reality, many countries use the two terms synonymously and interchangeably.”

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A guide to policy analysis as a research method

Affiliations.

• 1 Department of Public Health, School of Psychology and Public Health, Latrobe University, Bundoora, Victoria, Australia.
• 2 Department of Global, Urban and Social Studies, RMIT University, 124 La Trobe Street, Melbourne, Victoria, Australia.
• 3 Department of Social Sciences, Faculty of Health, Arts and Design, Swinburne University, 24 Wakefield Street, Hawthorn, Victoria, Australia.
• 4 Department of Nutrition Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, Australia.
• PMID: 30101276
• DOI: 10.1093/heapro/day052

Policy analysis provides a way for understanding how and why governments enact certain policies, and their effects. Public health policy research is limited and lacks theoretical underpinnings. This article aims to describe and critique different approaches to policy analysis thus providing direction for undertaking policy analysis in the field of health promotion. Through the use of an illustrative example in nutrition it aims to illustrate the different approaches. Three broad orientations to policy analysis are outlined: (i) Traditional approaches aim to identify the 'best' solution, through undertaking objective analyses of possible solutions. (ii) Mainstream approaches focus on the interaction of policy actors in policymaking. (iii) Interpretive approaches examine the framing and representation of problems and how policies reflect the social construction of 'problems'. Policy analysis may assist understanding of how and why policies to improve nutrition are enacted (or rejected) and may inform practitioners in their advocacy. As such, policy analysis provides researchers with a powerful tool to understand the use of research evidence in policymaking and generate a heightened understanding of the values, interests and political contexts underpinning policy decisions. Such methods may enable more effective advocacy for policies that can lead to improvements in health.

Keywords: interpretive policy analysis; mainstream policy analysis; nutrition; public health; sugar sweetened beverage tax.

© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].

• Health Policy*
• Health Promotion
• Policy Making*
• Public Health / legislation & jurisprudence
• Public Health Administration
• Public Policy
• Research Design

Policy Analysis

You have clearly defined your problem and created a problem statement. Now it’s time to consider the policies that could address it. If you haven’t defined your problem, visit the Problem Identification page.

What is policy analysis?

Policy Analysis is the process of identifying potential policy options that could address your problem and then comparing those options to choose the most effective, efficient, and feasible one.

Why is policy analysis important?

Conducting a policy analysis ensures you have gone through a systematic process to choose the policy option that may be best for your situation.

Who should you involve in your policy analysis?

People who can provide and/or interpret information about the policy

Who they are:

• Subject matter experts
• Community Partners

How they can contribute:

• Provide and interpret information you need for your policy analysis

People affected by the policy

People whose jobs or lives might be affected by the policy

• Community members
• Community partners
• Local decision makers
• Provide contextual knowledge, such as potential social, educational, and cultural perspectives

People who administer resources related to the policy

• Public officials and administrators
• Include these stakeholders during the policy analysis process to help you understand the potential economic and/or budgetary impacts of the policy options being considered. They can also help you understand the legal landscape around the potential policies

You may want assistance from an economist or researcher when complex calculations are needed to determine some impacts.

How do you conduct a policy analysis?

1. Research and identify possible policy options.

You can do this by reviewing research literature, conducting an environmental scan, and surveying best practices to understand what other communities are doing.

2. Describe the possible policy options.

As you conduct your policy analysis, pay attention to the health impact, cost of implementation, and feasibility of each option. To describe these three factors, you can ask yourself and your stakeholders questions such as:

• What population(s) will be affected by each policy option? By how much? And when?
• What is the context around the possible policy options, including political history, environment, and policy debate?
• What are the costs and benefits associated with each policy option from a budgetary perspective?

When you are assessing feasibility, it is important to identify any barriers that could prevent a policy from being developed, enacted, or implemented. A policy might be more feasible in one city or at a certain time, but not others. You might find that as circumstances change, what is considered affordable or publicly acceptable may change with them.

3. Rank the possible policy options and pick the one you think is best.

Compare the policy options for health impact, economic and budgetary impact, and feasibility. Next, rank each one based on those criteria. Stakeholders can provide guidance on how to do this. Your rankings will always be partially subjective, so it helps to systematically document your rationale. In some cases, your review may reveal a clear winner—a policy that is a) feasible, b) has a strong, positive impact on public health, and c) is economically and fiscally viable. In other cases, ranking the options may be more complicated and involve assessing trade-offs.

For example, when considering policies for reducing smoking, there are trade-offs related to feasibility and impact between options. (Feasibility and impact depends on your context, like your location.) You may have to have choose between a more feasible policy (like an indoor smoking ban for restaurants) and one with more widespread impact (like raising prices on tobacco products in your state).

LITERATURE REVIEW: an examination of the current body of research about your policy problem (and can include possible policy options). This kind of review may help you identify what is already known about the policy options as well as any gaps in the current research.

ENVIRONMENTAL SCAN : a proactive, systematic collection of information about events, trends, and expectations of what you might encounter during the policy process.

Learn more – See CDC’s Policy Analysis Worksheet  for more examples of questions you can use in your policy analysis.

• You researched and identified possible policy options with a literature review, environmental scans, and surveys of best practices
• You described possible policy options, including each one’s health impact, cost of implementation, and feasibility
• You ranked each policy option based on health impact, economic and budgetary impact, and feasibility—and then chose the one you think is best for your situation

Policy Analysis: Key Questions : This worksheet provides questions that form a framework for your policy analysis.

Policy Analysis Table : This organizational table can help you assess each policy option against set criteria and then to compare policy options.

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• Published: 02 August 2019

The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework

• Bojana Klepac Pogrmilovic 1 ,
• Grant O’Sullivan 1 ,
• Karen Milton 2 ,
• Stuart J. H. Biddle 3 ,
• Adrian Bauman 4 ,
• William Bellew 4 ,
• Nick Cavill 5 ,
• Sonja Kahlmeier 6 ,
• Michael P. Kelly 7 ,
• Nanette Mutrie 8 ,
• Michael Pratt 9 ,
• Harry Rutter 10 ,
• Andrea Ramirez Varela 11 , 12 ,
• Catherine Woods 13 &
• Zeljko Pedisic 1  

International Journal of Behavioral Nutrition and Physical Activity volume  16 , Article number:  60 ( 2019 ) Cite this article

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Policy analysis is considered essential for achieving successful reforms in health promotion and public health. The only framework for physical activity (PA) policy analysis was developed at a time when the field of PA policy research was in its early stages. PA policy research has since grown, and our understanding of what elements need to be included in a comprehensive analysis of PA policy is now more refined. This study developed a new conceptual framework for PA policy analysis – the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework.

The development of the CAPPA framework was based on: (i) an extensive review of literature; (ii) an open discussion between the authors; (iii) three rounds of a Delphi process; and (iv) two-rounds of consultations with PA policy stakeholders.

The CAPPA framework specifies 38 elements of a comprehensive analysis of PA policies in the following six categories, which comprise the building blocks of the framework: (i) purpose of analysis (including auditing and assessment of policies); (ii) policy level (including: international; national; subnational; local; and institutional policies); (iii) policy sector (including: health; sport; recreation and leisure; education; transport; environment; urban/rural planning and design; tourism; work and employment; public finance; and research sectors); (iv) type of policy (including: formal written policies; unwritten formal statements; written standards and guidelines; formal procedures; and informal policies); (v) stage of policy cycle (including: agenda setting; formulation; endorsement/legitimisation; implementation; evaluation; maintenance; termination; and succession); and (vi) scope of analysis (including availability; context; processes; actors; political will; content; and effects). Based on the CAPPA framework, we also proposed broad and inclusive definitions of PA policy and PA policy analysis.

The CAPPA framework may be used to guide future studies related to PA policy and to provide a context for the analysis of its specific components. The framework could be used in the same way for sedentary behaviour policy research. Future research should examine the extent to which PA policy analysis has covered each of the elements specified in the CAPPA framework and analyse the elements for which evidence is lacking. Future studies should also determine whether the existing tools allow for auditing and assessment of all the CAPPA elements and develop new tools if needed to allow for a more comprehensive PA policy analysis.

Insufficient physical activity (PA) is among the key risk factors for non-communicable diseases (NCDs), such as type II diabetes, some types of cancer, and cardiovascular disease [ 1 , 2 ]. NCDs cause the deaths of nearly 40 million people per year world-wide, which is around 70% of overall global mortality [ 3 ]. Accordingly, insufficient PA is considered one of the main risk factors for premature mortality worldwide [ 4 ]. For example, in 2008, approximately 9% of all deaths globally were attributed to insufficient PA [ 5 ]. Insufficient PA is also associated with a range of poor mental health outcomes, such as increased risk of depression [ 1 ]. Current inadequate PA levels also generate a significant economic burden for national healthcare systems. Conservatively estimated, physical inactivity costs healthcare systems worldwide around 53.8 billion international dollars, of which 68% is paid by the public sector [ 6 ]. Given these large health and economic impacts, investing in PA promotion is widely considered a “best buy” [ 2 , 7 ]. The significant public health and economic burdens of insufficient PA also emphasise the need for good public health policy related to PA.

In the last two decades, several important events have contributed to PA planning and policy development [ 8 ]. One of the initial global-level policy developments in PA promotion occurred in 2004 when the World Health Organization (WHO) issued the Global Strategy on Diet, Physical Activity and Health [ 9 ]. Subsequently, in 2013, the WHO published the Global Action Plan for the Prevention and Control of NCDs [ 10 ]. In this document, national governments, as key players in the prevention and control of NCDs, are urged to: establish national NCD targets; develop national NCD plans; and measure their progress in tackling NCDs [ 10 ]. The plan provides a menu of policy options for governments and other stakeholders to take action in NCD control and prevention and includes a global target to reduce the prevalence of insufficient PA by 10% by 2025 [ 10 ]. In 2018, the WHO launched a Global Action Plan on Physical Activity which recommends 20 policy actions [ 11 ] and is currently preparing a monitoring framework that will provide member states with methods to appraise progress related to PA policy development. One of the key recommended actions to support the creation of active systems is strengthening of policy frameworks, governance, and leadership systems at both subnational and national levels, to encourage implementation of actions to increase PA [ 11 ].

Increasing PA in a population requires culturally adapted, large-scale actions across whole systems, including multiple contexts, such as the health, transport, sport, urban planning, and education sectors [ 11 , 12 ]. As such, one of the essential determinants of active living is the policy environment [ 13 ]. The development and implementation of policies may facilitate the creation of supportive environments for people to engage in physically active lifestyles [ 14 , 15 ]. Therefore, a vital platform for developing, managing, and providing such actions is a national-level policy [ 12 ]. By developing and implementing PA policies, national governments design political and legal frameworks that are necessary for local governments and municipalities to create opportunities and environments for PA and active living [ 16 ].

It has been suggested that further research is needed to better inform future PA policy development [ 8 , 17 , 18 ]. Understanding the policy process and impact is essential for facilitating successful reforms [ 19 ]. A valuable tool enabling evidence-based development and improvement of policies is policy analysis , a “craft” that has been evolving since the 1950s [ 20 , 21 ]. Policy analysis is perceived as crucial to achieving successful reforms in health promotion [ 19 ]. In relation to PA promotion, an analysis of PA-related policies can: raise awareness of current policy gaps and opportunities; demonstrate policy related actions being taken across the system; encourage important debates; contribute to meeting health objectives [ 22 ]; provide a catalyst for cooperation and communications across different sectors and levels [ 12 ]; and assist decision makers in making better informed choices in a specific problem situation [ 23 ].

In a recent systematic review, Klepac Pogrmilovic et al. [ 24 ] found more than 150 studies on national-level PA policies, which suggests that this research field is relatively well developed. However, the review also found that very few studies relied on explicit and rigorous conceptual or theoretical frameworks, which may have led to vague and/or varied definitions and conceptualisations of PA policy. The review also found that researchers in this area have not reached consensus on the definitions of PA policy and PA policy analysis [ 24 ]. Taking this into account, Klepac Pogrmilovic et al. [ 24 ] suggested that more coordinated efforts on a standardised approach to PA policy analysis would contribute to further advancement of this research area [ 24 ].

In 2002, a major consultation on PA policy development took place between the WHO and the United States Centers for Disease Control and Prevention (CDC) [ 25 ], from which a PA policy framework was recommended. The framework addressed the necessary elements that PA policy needs to encompass [ 25 ]. The first and only framework designed specifically for PA policy research was developed by Schmid and colleagues in 2006, to improve categorisation, visualisation, and understanding of PA policy research [ 17 ]. The Schmid et al.’s framework is presented as a figure with three ‘axes’: policy , sector , and scale [ 17 ]. The most important axis is the vertical one which presents different ways in which policy may be studied: identifying policies (i.e. description), determinants of policy, developing and implementing policy, and the impacts of policies [ 17 ]. The remaining two axes are: the sector axis (including: health; transportation; parks/public spaces; worksite; and school sectors) and the levels axis (including: local; regional; state; national; and international policies) [ 17 ]. It furthermore conceptualises public policy at three levels as: formal written codes; written standards; and unwritten social norms. The framework was developed through four stages: a literature review; a review of other policy research frameworks; collaborative discussions; and three workshops.

Schmid et al.’s framework was developed at a time when the field of PA policy research was in its early stages, and it provided a useful foundation for several studies undertaken in the field [ 14 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. However, PA policy research has since grown as a research area [ 24 , 33 ], and our understanding of what elements need to be included in a comprehensive analysis of PA policy is now more refined. For example, the scope of Schmid et al.’s framework [ 17 ] does not cover formal processes and unwritten formal statements. Also, it is focused primarily on public policies, with less emphasis on non-governmental policies (e.g. private sector policies) related to PA. Furthermore, the framework does not: aim to provide a platform to facilitate a specific policy analysis; take into account all stages of the policy cycle at which policies may need to be studied; or acknowledge that PA policy analysis may be focused on various aspects, such as the content of a policy, the context surrounding a policy, or the actors involved in the development of a policy. Therefore, a more comprehensive framework is needed to reflect this evolving and diversifying field and to better guide contemporary and future PA policy research.

Applying a comprehensive approach to PA policy, with a focus on analysis, may strengthen the evidence base on PA policy development and content, improve comparability between studies, and provide insight into why some countries, institutions, and agencies are more successful in developing enabling contexts within which PA promotion is more likely to happen and achieve real impact. The aim of this paper was to develop a new conceptual framework for PA policy analysis – the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework.

The development of the CAPPA framework was based on: (i) an extensive review of literature; (ii) an open discussion between the authors; (iii) three rounds of a Delphi process; and (iv) two rounds of consultations with ten PA policy stakeholders. The development of the framework is depicted in Fig.  1 . We conducted a systematic literature review to identify studies that analysed national PA and/or SB policies [ 24 ]. By reviewing the content of 203 publications included in the review, we found 25 studies that relied on a theoretical or conceptual framework. For the current study, we reviewed the frameworks cited in these studies. Additionally, we conducted an extensive search of the literature on theoretical and conceptual frameworks used for the analysis of other PA policies (not national) and other public health policies. The search was conducted through reference lists of all identified articles in the systematic literature review, authors’ own archives, and the Google Scholar database. The initial draft of the CAPPA framework was developed by two authors (BKP and ZP) through a discussion based on the theoretical models and concepts presented in the existing literature related to policy analysis in general [ 20 , 21 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] and policy analysis within the health and PA research field [ 12 , 17 , 31 , 32 , 41 , 42 , 43 , 44 , 45 , 46 ].

Summary of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework development

The first draft of the framework was revised on the basis of written comments provided by three authors (GOS, KM, and SJHB) and an open discussion between five of the authors (BKP, GOS, KM, SJHB, and ZP). These five authors were selected purposefully, as each one of them had specific academic expertise important for the development of the framework, including political science (BKP), psychology and qualitative methods (GOS), PA policy analysis (KM), epidemiology of PA and SB (SJHB), and methods and measurement in public health (ZP). The second draft of the framework was further considered by these authors, through a three-staged Delphi decisional process. The purpose of the Delphi process was to: (i) get independent suggestions from the panel members about how to improve the second draft of the framework; and (ii) achieve consensus about the draft framework. The Delphi method was employed to ensure anonymity in the process of reaching consensus on the structure and wording of the draft framework.

The Delphi method is a systematic approach to reaching consensus through interactive communication among experts [ 47 ]. The Delphi methodology is often used in PA policy research [ 48 , 49 , 50 ], as well as within the field of PA research in general [ 51 ]. Various tools may be employed to administer a Delphi process [ 52 , 53 ]. For the current study, the panel members provided information by completing online surveys. An independent researcher outside the author team and the Delphi panel acted as the moderator for the Delphi process. Before starting each round, the moderator distributed to the panel members an email invitation containing the survey web link and a supplementary file with a detailed explanation of the draft structure of the framework and the definitions of the building blocks of the framework and their elements. After each round, the moderator collected the responses and provided feedback to the panel members. The feedback included summary comments related to each section of the survey as well as anonymised individual responses provided by all panel members.

The first round of the Delphi process covered three key areas: (i) name of the framework; (ii) overall structure of the framework; and (iii) the names and the definitions of all proposed building blocks of the framework and their respective elements. A combination of closed and open-ended questions was used in the survey for each specific section of the framework. For example, in the section of the survey related to the category “purpose of analysis”, these questions were posed: (i) “Do you agree with the inclusion, proposed names, and proposed definitions of the following elements of the framework in the ‘Purpose of analysis’ category?” (closed “yes/no” response); (ii) “If you disagree with the inclusion, name, and/or definition of any of the proposed elements, what would you suggest to change and why?” (open-ended response); (iii) “Do you think any other elements should be added to this category of the framework?” (closed “yes/no” response); and (iv) “If you do, please propose the names and definitions of the additional elements and briefly explain why you think they should be added” (open-ended response).

The third draft of the framework, developed in the Delphi process, was then revised through two-rounds of consultations with ten PA stakeholders, authors of the paper (AB, ARV, CW, HR, MK, MP, NC, NM, SK, and WB), who were asked to provide their written comments on the building blocks and elements of the framework and their definitions. The members of the consultation panel were selected purposefully, where the criteria for their inclusion in the panel were: (i) they have participated in the development of PA policy; and/or (ii) they are experts in PA policy research. Expertise of the consultation panel members relevant to the development of the framework included: development, implementation, and evaluation of PA policies and programmes; PA surveillance and monitoring; development of PA guidelines; PA interventions; public policy; and building international and global public health capacity. The consultation panel members were selected from various contexts, such as public policy, academia, national and international organisations for PA promotion, and public health consultancy. The comments on the third and pre-final draft of the framework made by the members of the consultation panel were discussed among all fifteen authors, which led to the development of the final version of the framework.

In this paper we relied on the broad and common definition of the term “policy analysis” that is “Policy analysis is any form of policy-relevant research” [ 54 ]. Based on the literature review and the CAPPA framework, herein we proposed definitions of PA policy and PA policy analysis that are aligned with a comprehensive approach to analysing PA policies.

The first draft of the framework, developed through the literature review and collaborative discussions of two authors, contained five categories (i.e. building blocks of the framework): purpose ; level ; sectors ; type of policy ; and aspect of policy and their 24 elements. The framework was modified after an open discussion and extensive comments from the remaining authors. The second draft of the framework contained six building blocks of the framework ( purpose of analysis ; policy level ; policy sector ; type of policy ; stage of policy cycle ; and scope of analysis ) and their 31 elements. The second draft of the framework was then refined through the Delphi process. During the three rounds, panel members reached consensus on more than 40 discussion points, while the final decision on two discussion points was made by a four-fifths supermajority vote. The Delphi panel agreed on the inclusion and definitions of six building blocks of the framework and their 35 individual elements. The final version of the framework was developed through two rounds of consultations with ten PA policy stakeholders. The consultation panel members made a total of 43 suggestions. Based on the suggestions and following a discussion between all authors of the paper, 32 final changes were made to the framework. This included: (i) changing the names of four elements of the framework; (ii) modification of fifteen definitions; (iii) adding two additional elements to the framework; (iv) dividing one element into two elements; and (v) refining the examples provided for ten elements.

The final CAPPA framework (Fig.  2 ) specifies 38 elements of a comprehensive analysis of PA policies in the following six categories (i.e. building blocks of the framework): purpose of analysis (including: auditing and assessment of policies); policy level (including: international; national; subnational; local; and institutional policies); policy sector (including: health; sport; recreation and leisure; education; transport; environment; urban/rural planning and design; tourism; work and employment; public finance; and research sectors); type of policy (including: formal written policies; unwritten formal statements; written standards and guidelines; formal procedures; and informal policies); stage of policy cycle (including: agenda setting; formulation; endorsement/legitimisation; implementation; evaluation; maintenance; termination; and succession); and scope of analysis (including: availability; context; processes; actors; political will; content; and effects) . In Table  1 , we provide the definitions of the building blocks and elements of the framework, together with examples that may facilitate their understanding.

Structure of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework

Definitions of PA policy and PA policy analysis

According to the CAPPA framework, PA policy is indicated by the totality of formal written policies , unwritten formal statements , written standards and guidelines , formal procedures , and informal policies (or lack thereof) that may directly or indirectly affect community- or population-level PA. Accordingly, we defined PA policy analysis as any kind of policy-relevant research that audits or assesses one or more aspects of PA policy.

In this study, we developed the CAPPA framework as a conceptual inventory of components necessary for a comprehensive analysis of PA policy, including definitions of two different purposes of analysis, five policy levels, eleven policy sectors, five types of policy, eight stages of policy cycle, and seven elements that reflect the scope of policy analysis. The framework was developed to improve the comprehensiveness and contribute to the standardisation of PA policy analysis research. This comprehensive conceptual framework may serve as a “road map” for researchers and academics interested in PA policy analysis as well as to policymakers and health policy practitioners interested in the development, monitoring, implementation, and analysis of PA policies. The framework can also be used for categorising PA policies or as a classification system for PA policy research. To further facilitate the standardisation of PA policy research, we also proposed definitions of PA policy and PA policy analysis that are aligned with the CAPPA framework.

Purpose of analysis

Studies can be conducted with the purpose of auditing and/or assessment of PA policies. Policy auditing is a prerequisite for policy assessment, as we first need to know which aspects of policy exist (or existed), before we can assess them. An assessment of the aspects of policy identified in the audit process will then determine how good they are against certain standards. For a comprehensive analysis of PA policies, it is important to both audit and assess relevant policies. For example, a country may have a range of national PA policies in place, including a PA strategy and a PA action plan, but it is possible that none of them are evidence based, none of them specify clear targets, none of them define feasible ways to improve population-levels of PA, and none are funded or implemented. Policy assessment may need to be done to elucidate some of the important questions about PA policies. It should be noted, however, that policy auditing and policy assessment may be extremely time-consuming, and it is, therefore, often not practical to conduct both within a single study.

Policy level

PA policies can be developed at various levels. The simplest classification found in the literature makes a distinction between PA policies that occur at the national and international levels [ 68 ]. PA policies at the national level are usually developed by the Government or a governmental body, but they may also be developed by non-governmental or advisory bodies, and later endorsed by the Government. The ways to classify policies below the national level may vary depending on the country in question and its political system. Policies can be developed and implemented on subnational levels such as state, federal, municipal, regional, and provincial. The CAPPA framework was developed with the intention of being as applicable as possible to various political systems. Therefore, we did not distinguish between a range of different levels that are below the national level and above the local level. Instead, we encompassed all such levels with the broad term “subnational”. PA policy researchers should, however, clearly distinguish between different subnational levels in the context of the political system they are investigating and endeavour to analyse policies separately at each of the levels. Schmid et al.’s conceptualisation of scale (i.e. equivalent to policy level in the CAPPA framework) does not include the “institutional” level, because their framework focused mainly on public policies [ 17 ], that is, the policies related to government actions [ 34 ]. In the CAPPA framework we included the “institutional” level, because policies at this level often have a key role in the development and implementation of PA interventions. Furthermore, it can be assumed that policies at one level may influence the adoption and shaping of policies at other levels. For a complete understanding of PA policy, it is therefore important to analyse policies at all levels, as well as to consider their possible interactions.

Policy sector

Policies in a range of sectors may directly or indirectly affect PA levels in the population [ 41 , 69 ]. This is also acknowledged in the Schmid et al.’s framework [ 17 ], which includes five sectors: health; transportation; parks/public spaces; worksite; and school. In the CAPPA framework we built on Schmid et al.’s sectors and added other sectors that were previously identified as relevant to this research field such as: public finance; research; sport; recreation and leisure; and tourism [ 11 , 17 , 41 , 69 ].

It should be noted, however, that policy sectors may be termed differently and overlap more or less, depending on the specific context of a given country. Therefore, the CAPPA sectors should be interpreted in the context of a specific country. Furthermore, we acknowledge that PA policies can, and in many cases should, be cross-sectoral, that is, developed and/or implemented across multiple sectors. When classifying a policy according to the CAPPA framework, one should, therefore, not necessarily try to fit it within a single sector. This may present a methodological challenge in some classifications, but it is inevitable due to the complex nature of PA policies. Future users of the CAPPA framework may choose to report on all sectors to which a policy applies or to prioritise the sector that initiated or is responsible for the policy. For example, in the case of a Walk to school policy issued by the Ministry of Education, the priority could be given to the education sector, but a policy analyst could choose to report that this policy also belongs to the transport sector. When making such classifications, it is, therefore, important to clearly describe the criteria that were applied.

We also aimed to clearly differentiate between “sectors” and “settings”, because one sector usually includes multiple settings and one setting can belong to multiple sectors. For example, the education sector includes settings such as childcare centres, primary schools, secondary schools, and universities. At the same time, each of these settings is also a part of the work and employment sector, because they employ their staff. There is a vast number of settings that might include PA-related policies, and any attempt to list them all is unlikely to result in an exhaustive inventory. For this reason, in the CAPPA framework we did not provide a list of settings that are potentially relevant from the perspective of a comprehensive PA policy analysis. PA policy researchers should consider analysing PA policies in all the sectors included in the CAPPA framework and in as many relevant settings as possible.

Type of policy

There are different types of policies, and they are not necessarily always in the written form. This has already been acknowledged by Schmid et al. [ 17 ]. They conceptualised policy at three levels: (i) formal written regulations, codes, or decisions bearing legal authority; (ii) written standards that guide choices; and (iii) unwritten social norms [ 17 ]. Formal written policies in the CAPPA framework correspond to Schmid et al.’s first level. Written standards and guidelines and informal policies in the CAPPA framework correspond to the second level and the third level in the Schmid et al.’s framework [ 17 ], respectively. As suggested by Schmid et al., informal policies are “considered to be part of culture rather than explicit policy and not a primary focus of initial physical activity policy research” [ 17 ]. However, analysing informal policies could bring additional valuable insights into overall PA policy directions that may subsequently inform policy decision-making. Policy may be conceptualised in a broader sense to also include formal procedures [ 44 ] and unwritten formal statements [ 35 ], which has been acknowledged in the CAPPA framework. Such statements may play an important role in shaping the general policy context within which the dominant beliefs may subsequently get converted into formal written policies. Formal procedures, such as PA surveillance, may be indicators of the body’s position or commitment regarding PA. Formal procedures are usually (but not necessarily) supported by a formal written or unwritten policy. Furthermore, the analysis of unwritten formal statements may also provide valuable insights about the intentions of a given body regarding PA. The definition of unwritten formal statements in the CAPPA framework is in line with the definition of public policy as an “authoritative statement by a government about its intentions” [ 35 ]. Unwritten formal statements related to PA have previously been studied mainly using discourse analysis as a research method [ 70 , 71 ].

Investigating understudied types of policies may help better elucidate policy-related correlates of PA. For example, a conclusion that a certain country has an underdeveloped PA policy simply based on an analysis that showed it lacks formal written policies , may be misleading. The country might have informal policies in place that promote PA, and unwritten formal statements created through announcements or verbal declarations by its decision makers may indicate the government has well-conceived plans and mechanisms for PA promotion. In a different example, a country might have a well-developed formal written policy , but certain informal policies and unwritten formal statements (or lack thereof) may indicate a lack of political will to support PA promotion. It is important to note, however, that analysing unwritten formal statements and informal policies could be challenging, as they may be more difficult to identify and evaluate than formal written statements, written standards and guidelines , and formal procedures .

Stage of policy cycle

The list and definitions of stages of policy cycle in the CAPPA framework, were mainly informed by the health policy and political science literature. The concept of policy cycles was originally “employed prescriptively as a way to organize policymaking”, but it further evolved as a framework common for analysing policies [ 38 ]. The WHO specified the following stages of the policy cycle: problem identification and agenda setting; policy formation; adoption; policy implementation; and policy evaluation [ 42 ]. Informed by Cairney’s conceptualisation of the policy cycle [ 38 ], for the purpose of the CAPPA framework we adapted the WHO’s five-stage policy cycle to include an additional three elements ─ maintenance, termination, and succession. The CAPPA framework contains eight stages which is an important advance from the four-stage structure of Schmid et al.’s earlier framework [ 17 ].

It should be noted that a policy will not necessarily go through all the stages of the policy cycle. For example, a policy may be enacted by Parliament, but that does not necessarily mean it will ever be implemented in practice. Furthermore, stages in the cycle of a given policy may not necessarily be in the order presented in the CAPPA framework. For example, some policies may be formulated without going through the agenda setting stage. Some policies may be formulated, maintained, and terminated without ever being implemented or ever being evaluated. Furthermore, a policy may pass multiple times through the same stage (e.g. a policy can be evaluated on several occasions). For a thorough understanding of a PA policy, it is important to analyse all the stages that it went through.

Scope of analysis

Most previous research on national PA policies has focused on analysing availability of policies (i.e. whether specific policies exist) and their content (i.e. what information they include) [ 24 ]. Analysis of availability of policies should not be confused with auditing as a purpose of PA policy analysis, because theoretically the availability of policies can be both audited (e.g. using the open-ended questionnaire item: “Please list the PA policies that are available in your country!”) and assessed (e.g. using the question: “How would you rate the range of PA policies available in your state compared to the national level?”, with the response scale: “Less available policies” / “Similar number of available policies” / “More available policies”). The analysis of policy content should not be confused with assessment as a purpose of PA policy analysis, because the content of a policy can also be both audited (e.g. using the question “Does the national PA strategy include specific targets for different population groups?”, with the “yes/no” response scale) and assessed (e.g. with the question: “On a scale from 0 to 10, please rate the overall quality of the national PA strategy”). For some types of PA policy, the analysis of content can be performed by using qualitative methods for content analysis, that is, by coding and interpreting text of written documents, transcribed oral communications, and graphics.

Furthermore, Walt’s simple health policy analysis framework distinguishes between four elements: context, content , process , and actors [ 45 ]. Context, content, processes, and actors often play pivotal roles in different stages of the policy cycle. In the CAPPA framework, we therefore acknowledge the importance of analysing all these elements in addition to the availability, political will, and the effects of policies. Political will represents a bridge between public health action and knowledge [ 72 ] and is considered to be essential for making changes in public health policy [ 73 ]. Political support and commitment to a PA policy are recognised as highly relevant factors for the success of the policy and are, therefore, important parts of a comprehensive PA policy analysis [ 69 , 74 , 75 , 76 ]. Researchers may be deterred from analysing the effects of PA policies, because these may be difficult to measure. It has therefore been suggested, as one of the key priorities for the progress of the PA policy research field, to develop better tools for analysing the effects of policies [ 17 ]. This was recognised by the Physical Activity Policy Research Network (PAPRN) in the USA, which conducted a ten-year study of the effectiveness of policies to increase levels of PA [ 77 ]. In 2017, they concluded there is a lack of studies on the outcomes of PA policies [ 78 ].

When it comes to an overall policy-making process, political power is often a vital force. In the political arena, various groups exercise their political power to reach their goals, either by advocating for a change or blocking it [ 79 ]. In health policy analysis, power is usually considered in relation to two elements of the CAPPA framework; namely, processes and actors [ 22 ]. However, power can also be studied within other elements of the scope of analysis category such as political will or context . Political will, necessary to introduce any policy change, may be highly influenced by power relations and values within and outside of the government. For example, members of the government can have a strong political will to increase resources necessary for the implementation of a nutrition and PA strategy that aims to reduce children’s obesity rates. However, powerful food industry lobbies may block the strategy implementation, if the proposed measures are not in their best interests.

Within the field of political science, there is no consensus on what constitutes “a policy” or a policy analysis [ 24 ]. Similarly, within the PA research field, “PA policy” was defined and conceptualised differently across studies, whilst a large majority of the studies on national PA polices did not explicitly state how they defined PA policy [ 24 ]. The majority of studies that provided their operational definition of PA policy conceptualised policy within Schmid et al.’s first level [ 24 ], that is, as the formal written regulation, code, or decision bearing legal authority [ 17 ] which corresponds to formal written policies in the CAPPA framework. For example, several PA policy studies relied on the definition of a policy that conceptualises ‘policy’ as a ‘policy document’, that is, “a written document that contains strategies and priorities, defines goals and objectives, and is issued by a part of the administration” [ 31 , 32 , 69 ]. Restricting the conceptualisation of PA policy only to “written documents” may be practical for researchers, because these types of policies are usually the easiest to identify. However, this approach may exclude other possible aspects of policy such as “unwritten statements”. Some health and PA policy researchers based their studies on a broader definition of policy, which besides formal statements also includes informal institutional procedures, arrangements, and justifications for action [ 44 ]. We acknowledge that various studies have different purposes and may therefore employ the most suitable definition for the scope of the study. We also acknowledge that it may be impossible to analyse all aspects of PA policy in a single study and that sometimes it may be necessary to reduce the analysis to only one or two aspects of PA policy. However, we believe a comprehensive standardised definition of PA policy may contribute to further development of the PA policy research field. Therefore, based on the CAPPA framework and various understandings of PA policies that were detected in our recent systematic scoping review [ 24 ], we defined PA policy broadly, to be as inclusive as possible. We used a similar comprehensive and inclusive approach in defining PA policy analysis, whilst relying on the CAPPA framework and a broad definition of policy analysis from the field of political science [ 54 ].

Possible applications of the CAPPA framework in PA policy research

The CAPPA framework can be used for a variety of purposes. These include (but are not limited to): (i) to help PA policy researchers conceptualise their study questions, that is, as a source of ideas what can and should be analysed; (ii) as a benchmark for evaluating what has been done in terms of PA policy research overall, in its specific areas, and in specific contexts (e.g. in specific countries); (iii) as a guide for policymakers, who want to influence population-level PA, on which types of policies and which policy sectors they can focus on in their endeavours; (iv) to help PA policy researchers improve between-study comparability, particularly by using the definitions provided within the framework; (v) to help assess the comprehensiveness and content validity of the available tools for PA policy analysis; and (vi) to guide the development of new PA policy analysis tools, particularly regarding the facets of PA policy they are intended to measure.

A practical example of a possible application of the CAPPA framework can be found in our recent systematic review of instruments for PA policy analysis [ 80 ]. For every instrument included in the review we determined whether it was designed for auditing or assessment of PA policies, which policy sectors , types of policy , and stages of policy cycle it covers, and what is encompassed in its scope of analysis . The list of elements of the CAPPA framework served as a benchmark for the assessment of comprehensiveness of the included instruments. An extract (for four sample instruments) from the data extraction table can be found in Table  2 . The definitions provided in the CAPPA framework enabled us to conduct the assessments consistently across all instruments and between two authors who took part in the data extraction process. In the same review, we used the CAPPA framework also to guide the synthesis of findings. It enabled us to easily identify which elements needed for a comprehensive analysis of PA policy cannot be analysed using the available instruments.

Applicability of the CAPPA framework to the analysis of sedentary behaviour policy

Research suggests that uninterrupted prolonged periods of sedentary behaviour (SB) (i.e. waking activities in a sitting, reclining, or lying posture with very low energy expenditure) are associated with increased risk of cardiovascular disease, type II diabetes, and some types of cancer [ 86 ]. It was estimated that high SB is responsible for nearly 4% of deaths from all causes internationally [ 5 ]. It is therefore of public health importance to reduce SB in the population. PA and SB are often considered within the same study, as these behaviours are co-dependent [ 87 ]. A recent review found that all but one study that analysed national SB policies also analysed PA policies [ 24 ]. Given that PA and SB policy research fields largely overlap and that contexts of PA and SB policies are very similar, the CAPPA framework and definitions analogous to the ones provided for PA policy and PA policy analysis may also be used to guide research on SB policies.

Strengths and limitations of the study

The key strength of this study is a rigorous method used to develop the framework, which included an extensive literature review, three rounds of Delphi process, and two rounds of consultations with stakeholders. The CAPPA framework provides a categorisation of a complex area into measurable component parts. Each of these components is defined, and can be audited and assessed in combination to provide a comprehensive understanding of PA policy. The main strengths of the CAPPA framework are its: (i) comprehensiveness; (ii) generalisability to different political contexts; (iii) supporting definitions that underpin each building block of the framework and its elements; and (iv) visual simplicity.

The CAPPA framework is also subject to some limitations. The authors aimed to make the building blocks of the framework and their elements as generalisable as possible, but given a variety of policy contexts internationally, some elements may not be applicable to all countries. Also, due to the complexities in the political context, an overlap between the various elements of the framework was inevitable. Future users of the framework should acknowledge the possible overlap and specify the way they choose to deal with it. Whilst the first draft of the framework was developed based on a comprehensive literature review, due to the wealth of literature in the fields of political science, health policy research, and PA policy research, the authors acknowledge there might be aspects of PA policy analysis that are not encompassed by the CAPPA framework.

The CAPPA framework may be used to guide future studies related to PA policy, provide a context for the description, understanding, and analysis of its specific components and serve as a classification system for research on PA policies. It may also serve as a benchmark for the evaluation of comprehensiveness of existing tools for the analysis of PA policy and guide the development of new tools. The framework can be used in the same way for SB policy research. Operational definitions of different aspects of policy varied significantly across previous studies in this area [ 24 ]. The definitions of specific types of policy, aspects of policy, and purposes of policy analysis provided in the CAPPA framework might help in achieving standardisation of terminology in this area and in improving the comparability of findings across different studies. Future research should examine the extent to which PA policy analysis has covered each of the elements specified in the CAPPA framework. Future studies should also evaluate whether the existing tools for PA policy analysis allow for auditing and assessment of all the elements of the CAPPA framework and develop new tools where needed.

Availability of data and materials

Not applicable.

Abbreviations

Comprehensive Analysis of Policy on Physical Activity

Centers for Disease Control and Prevention

Noncommunicable disease

• Physical activity
• Sedentary behaviour

World Health Organization

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de Rezende LFM, et al. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014;9(8):e105620.

Pedišić Ž, Dumuid D, Olds T. Integrating sleep, sedentary behaviour, and physical activity research in the emerging field of time-use epidemiology: definitions, concepts, statistical methods, theoretical framework, and future directions. Kinesiology. 2017;49(2):135–45.

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Acknowledgments

This article is a part of the PhD project of the first author, BKP, supervised by KM, SJHB, and ZP (principal supervisor). The authors wish to thank Jozo Grgic (JG) for his generous help as the moderator in the Delphi decisional process.

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Bojana Klepac Pogrmilovic, Grant O’Sullivan & Zeljko Pedisic

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Karen Milton

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Stuart J. H. Biddle

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Michael P. Kelly

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Nanette Mutrie

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Michael Pratt

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Harry Rutter

Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil

Andrea Ramirez Varela

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BKP and ZP conceived the idea for the study. BKP, GOS, and ZP reviewed the literature. BKP and ZP developed the initial version of the framework. BKP and ZP designed the questionnaire and supplementary materials used in the Delphi process. BKP, GOS, KM, SJHB, and ZP, participated in the open discussion and three rounds of the Delphi process about the framework. AB, ARV, CW, HR, MK, MP, NC, NM, SK, and WB participated in the consultation process. All authors participated in the discussion about the final version of the framework. BKP drafted the initial manuscript. ZP, KM, GOS, SJHB, AB, ARV, CW, HR, MK, MP, NC, NM, SK, and WB contributed to writing the manuscript. All authors read and approved the final manuscript.

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Klepac Pogrmilovic, B., O’Sullivan, G., Milton, K. et al. The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Int J Behav Nutr Phys Act 16 , 60 (2019). https://doi.org/10.1186/s12966-019-0822-5

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DOI : https://doi.org/10.1186/s12966-019-0822-5

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Literature Review of Policy Implications from Findings of the Center for Work, Health and Well-being

María andrée lópez gómez.

1. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

Emily Sparer-Fine

2. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

Glorian Sorensen

3. Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts

Gregory Wagner

Associated data.

To review the publications of a Total Worker Health® Center of Excellence, the Harvard T.H. Chan School of Public Health Center for Work, Health, and Wellbeing, in order to identify research findings relevant to either organizational or public policies.

Two researchers independently reviewed 57 publications from 2011 to 2019 to identify cross-cutting themes that focus on working conditions or related health outcomes and their organizational and public policy implications.

Twelve cross-cutting themes were identified with their respective organizational and public policy implications. Several policy implications cut across work-related themes.

Conclusions:

Policy implications of TWH® research will aid in setting priorities to translate this from research into practice in future studies and help identify gaps that we and others can use to plan future TWH® research.

Introduction:

The health, safety, and wellbeing of workers and the health and sustainability of the places they work are shaped by policies—both workplace-specific and broadly applicable public policies. Policies may describe or define desirable, expected, or mandatory standards of conduct or behavior. Policy may be regulatory and legally enforceable across workplaces (such as an OSHA or MSHA standard), enforceable in a specific organization or enterprise (workplace rules that, if violated, result in some adverse consequence for the violator), and/or advisory (such as are seen in guidelines from professional associations). A large body of literature underscores the central role that policies play in worker health and safety – ranging from long-standing policies specifically designed to reduce or eliminate exposures to physical hazards on the job, to policies related to work benefits such as healthcare coverage and compensation after an injury on the job. 1

Policies are key in shaping the work environment and consequently workers’ health, yet designing policy based on scientific research can be challenging, as the research itself can be time consuming, expensive, and limited in scope. Collaborations between researchers and policy decision-makers are infrequent, and scientific communications that provide evidence on occupational best practices may not always be accessible or comprehensible to audiences outside of academia. 2 Furthermore, randomized-control trials (RCTs), frequently considered the “gold standard” for the analysis of policy effectiveness, can be difficult or unethical to conduct in workplaces, as they require long periods of time to assess effectiveness, a counterfactual group may not always be possible or ethical to assemble, and context and individual changes may influence the results even when a control group is available. 3 These obstacles exacerbate the disconnect between evidence-informed policy design and decisions made by policy-makers. Nevertheless, we can (and should) consider the policy implications of all research studies, even those that are not RCTs, provided we understand the limitations and generalizability of the work. In many research papers, authors discuss their findings in relation to the broader body of literature, and at times, even the policy implications of the work. This paper seeks to go beyond what may normally be included in a discussion section of many papers, by identifying cross-cutting themes related to policy across the Harvard T.H. Chan School of Public Health Center for Work, Health, and Wellbeing (the Center) body of work. The Center is one of six Total Worker Health® (TWH) Centers of Excellence funded by the National Institute for Occupational Safety and Health. This initiative recognizes the central role of work-related factors in workers’ safety and health, and specifically attends to “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.” 4

The Center has conducted a range of studies focused on the different pathways that determine workers’ health, safety and well-being outcomes. These studies gave rise to and have been informed by the Center’s conceptual model, which focuses on how policies, programs and practices impact working conditions and how these conditions determine workers’ health, safety and well-being and mediate workers’ health behaviors. 5 The research also takes into account these relationships with respect to enterprise outcomes such as turnover rates and absenteeism. The Center’s priorities include understanding the policy implications of its research, in part through the work of its Policy Working Group (PWG). The PWG has conducted an in-depth review of the Center’s body of work, summarized here. The Center’s research investigating the relationships between conditions of work and health outcomes provides a foundation for potential policy applications. Explicating the relationship between “exposures” and “outcomes” can inform the translation of our research findings into policies at the organizational- and public-policy domains.

The purpose of this paper is to conduct a detailed and comprehensive review of the publications of one TWH Center of Excellence, to identify policy implications for this research relevant to both organizational and public policies. We conducted this review in order to identify core policy implications that will inform current policy decisions and identify priorities for future research. Additionally, we also hope that this work can serve as a roadmap for other groups who want to examine their research from a policy implications lens.

With the aim of providing a comprehensive review of the Center publications, we included all peer-reviewed articles based on Center work funded by NIOSH TWH ® . These articles were published between 2011 (when the first Center-funded research was published) and mid-2019 when the review was submitted for publication. To be included in the review, a publication must involve analysis of an association between aspects of the work environment and health outcomes, meaning case studies, creation and/or validation of measurement tools, or literature summaries were excluded from this analysis.

To initiate the review, two policy working group members (MALG and ESF) independently reviewed each publication, following a standardized protocol for data extraction and review. The two reviewers independently extracted details about each manuscript using a standard form, to record the following information: policy implications, study methods and results, whether or not policy implications were explicitly or implicitly discussed, at which level the policy was focused (e.g. organizational or public), generalizability, key limitations, and scientific gaps. For a full list of extracted details, see Appendix A . Findings from these reviews were examined by each publication’s authors for additional input on policy implications.

The reviewers then conducted an iterative, detailed, and rigorous review of the extracted policy implications and grouped them by cross-cutting themes. In the case of varying assessment of policy implications between reviewers and the author, all identified implications were included in the results presented here. The cross-cutting themes fit under two umbrella topics, that reflect the majority of the center’s research: working conditions (e.g. job demands and decision latitude, and social support) or related health outcomes (e.g. physical activity and psychological distress). However, it should be noted that the themes often cut across these two categories, as often one working condition is associated with several health outcomes and one health outcome is associated with several working conditions.

This review included 32 out of the 57 publications that covered the Center’s work and affiliated projects from 2011 to 2019 ( Table 1 ). Twenty-five publications were excluded from this analysis because they did not meet inclusion criteria. All authors generally concurred with the reviewers’ initial assessment or added comments that further expanded the reviewer conclusions. The final framing of policy implications is a combination of the conclusions of the two reviewers and primary author of each publication.

Industry Type and Study Design of Reviewed Studies

Review findings

As summarized in Table 2 , we identified twelve cross-cutting themes among the reviewed publications, focusing on either working conditions or related health outcomes that in turn have policy implications at the organizational and/or public policy levels.

Examples of Policy Implications from findings of the Center for Work, Health and Well-being

Working Conditions

Ergonomic practices.

Several Center studies involved examining the relationship between ergonomic practices and various health outcomes. Ergonomic practices were measured using a modified version of the Organizational Policies and Practices questionnaire developed by Amick, et al., 2010. 6 Questions focused on workers’ perceptions of the design of the physical work environment and the promotion of the use of tools for reducing biomechanical workload. Results from Center studies found that decreased ergonomic practices were associated with increased levels of self-reported musculoskeletal pain in four body areas (low back, neck/shoulder, arms, and lower extremity) in the past 3-months. 7 Additionally, increased ergonomic practices were found to be associated with increased preventive care utilization 8 and decreased work limitations (a measure of the degree to which someone experiences limitations at work due to health problems and health-related productivity loss). 9

The findings from the Center’s studies on ergonomic practices demonstrate the importance of strong ergonomic practices at the workplace. 10 Implementation of clear policies that support positive ergonomic practices, at the organizational and/or public policy level, could help to improve working conditions and in turn, impact a range of outcomes, including non-occupational outcomes such as preventive care utilization. These findings also strengthen the case for engaging employees in improving ergonomic practices . 7 Although there are no federal regulations that explicitly focus on ergonomics, data from the Center demonstrate the importance of ergonomic practices and policies at multiple levels.

Harassment and abuse

Workplace harassment was associated with obesity 11 , injuries 12 , 13 , and sleep deficiency. 12 Workers who reported incivility or bullying also reported higher rates of mental health claims. 14 In their discussions, authors integrated policy-relevant evidence of potential factors that may reduce or eliminate harassment and verbal abuse at work for patient-care workers. These conclusions were summarized by Sabbath 2014 et al.: “Intervention efforts could be deployed at the organizational, interpersonal and individual levels in order to reduce prevalence of abuse and its associated risk of injury.” 13 Policy implications emphasized an integrated organizational approach towards creating a culture and climate that protects against abuse, but also supports workers at different levels. 11 - 13 This emphasizes the responsibility of leaders and managers to promote awareness about physical and verbal abuse. Furthermore, as described by Sabbath et al. 2014, “administrative efforts to reduce workplace verbal abuse may be most effective if they simultaneously address the overall social context of the unit and specific interactions between a worker and a workplace abuse perpetrator.” 13 This statement highlights the fact that while workplace policies may be effective in reducing harassment and abuse, it is critical to account for the intricacies of specific workplace environments.

OSHA has also developed some examples of workplace violence prevention guidelines that include: the establishment of clear policy addressing workplace violence, verbal and nonverbal threats, and related actions; encouraging workers to report any incidents and suggest ways to prevent them, assigning responsibility and authority for the violence prevention program to individuals or teams with appropriate training and skills, and affirming management commitment towards worker health and safety. 15 From a legislative perspective, efforts to establish a zero-tolerance policy towards workplace abuse (that includes abuse from co-workers and supervisors, and in the healthcare setting, patients and families) may help towards improving the working conditions for workers and in turn, have a positive impact on health outcomes.

In addition, Nelson et al. 2014 cited a strategy to prevent harassment from the nursing literature that encourages workplaces to build social supports among patient care workers, thereby sharing the responsibility for negative behavior and/or violent acts among all workers. 11 This is consistent with specific actions mentioned by Sabbath et al. 2014: promotion of an informative discussion about harassment and abuse in workers’ trainings, creation of “ procedures for reporting and investigating incidents in a swift and anonymous manner” and eliminating or making appropriate changes to situations that may precipitate violence such as receiving bad news, long waiting times and limited visits. 13 At the interpersonal level, Sabbath et al. 2014 made recommendations that organizations could provide guidelines for interactions among workers but also between patients and their families with health care providers. These guidelines could focus on workplace social norms against abuse, as well as other organizational factors such as trust and cooperation. 13

Safety practices

Center studies focusing on safety practices were measured by using a modified version of the Organizational Policies and Practices questionnaire by Amick, et al. 2010. 6 The safety practice subscale focused on questions around workers’ perception of safety leadership, safety training, and safety diligence. Results showed that positive safety practices, characterized by the identification and control of occupational hazards, are associated with higher job satisfaction 15 and a decrease of self-reported sharps injuries 17 (but not administrative records of these injuries). An intervention study in a hospital setting observed positive perceived safety practices and a reduction in recordable worker injuries when the focus of the intervention was on integrated efforts at a system level to improve safe patient handling by patient-care workers. The intervention focused on earlier and more frequent mobilization of patients using lifts and slings. Without proper and systematic use of this equipment, lifting patients has the potential to increase workers’ physical demands. 18 Furthermore, program was successful due in large part to the system-wide policy implemented in the context of an improvement in patient safety. The multi-component program included training, clear communication of the policy, coordination across departments, and engaging leadership in support of the program.

Organizational policies that identify and manage safety hazards through a systems level approach that includes engagement of leadership, coordination across multiple departments and fostering system-wide communications can align the goals of worker safety with patient safety 18 and job satisfaction. 19

Social support

Two studies conducted with a sample of patient-care workers found that social support was associated with lower injury rates. 19 , 20 Tveito et al. 2014 found that co-workers’ support was associated with lower injury rates in bivariate analyses; this association was found among registered nurses, but not among patient-care associates, and was not found for the relationship between supervisor support and injury rates. 19 However, a study by Reme et al. 2014, which controlled for additional working conditions and job title, found that supervisor support, but not co-workers support, was associated with lower injury rates and that rates were significantly lower for workers with musculoskeletal injuries than for workers with other types of injuries. 20 In both studies, the authors underscored the importance of looking at musculoskeletal injury from a multi-causal perspective that would suggest the need for organizational policies that support several factors, one of them being social support.

In other studies, supervisor support was found to be associated with increased frequency of meal breaks, which in turn related to lower psychological distress. 21 Low social support has also been associated with musculoskeletal pain 22 and sleep deficiency. 12

Policy implications related to social support include the importance of holding supervisors accountable for taking actions that support their employees. This accountability could be promoted by offering trainings to build skills and providing supervisors resources for supporting employees. Policies and trainings aimed at preventing abuse, harassment, discrimination and violence, as described above, and that encourage employees and supervisors to build respect of the ideas, values and beliefs of others also support a thriving environment for social support.

Results from the Center’s work support the importance of creating psychosocial standards at the public policy level. Currently, OSHA in the US does not explicitly include regulations on psychosocial factors or mental stress at work 23 , but does provide some voluntary guidance. Nonetheless, examples of such standards exist elsewhere. For example, the European Agency for Safety and Health at Work (EU-OSHA) has published guidelines on identifying, preventing and managing psychosocial risks, as well as setting a legal imperative with the Framework Directive 89/391/ECC that sets minimum standards on technical safety but also on prevention of ill-health. 24 Canada also has a voluntary standard, “Psychological Health and Safety in the Workplace,” that aims to promote worker psychological health and prevent psychological harm resulting from workplace factors. 25

Staffing Levels

Kim et al. 2014 found that perceived inadequate staffing from patient-care workers in a hospital setting is associated with musculoskeletal pain even after controlling for demographic variables and physical work factors that measure time spent doing different types of physical effort during a shift. 26 Results suggest that at the organizational level two activities could reduce musculoskeletal injury as follows: i) assessing regularly whether staffing level is sufficient among hospital workers, and ii) providing adequate staffing. The authors suggested that assessing perceived inadequate staffing from workers themselves might be a better approach to align job demands with available resources than merely considering administrative data on number of patients per nurse.

An example of a proposed federal regulation intended to address this issue is HR5052/S2446 - Safe Staffing for Nurse and Patient Safety Act of 2018 , which was introduced in Congress in February of 2018 and is currently under committee review. Another example was the 2018 ballot initiative in Massachusetts (the Initiative Petition For A Law Relative To Patient Safety And Hospital Transparency ). While it did not pass, the proposed initiative would have required that hospitals have mandated nurse-staffing levels. Although the Center’s papers do not explicitly evaluate specific staffing ratios, they support scheduling shifts and tasks to optimize the work experiences of nurses, which might be accomplished through regulation of staffing ratios.

Work-family conflict

Work-family conflict arises when time, participation and behaviors required for one role (work role) make it difficult to fulfill requirements for another role (non-work role). 27 In the past century, the composition of the workforce has changed significantly with increased participation of women, single-parent households and an ageing population, but little has been done on policies on work organization and social benefits supportive of achieving work-life balance that allows workers to fulfill other non-work roles such as caregiving for children and older adults. 27 , 28 Evidence from studies conducted with the Boston Hospital Worker Health Study (BHWHS) shows that higher levels of work-family conflict are associated with sleep deficiency 29 and with musculoskeletal pain 31 in several parts of the body, even after controlling for relevant factors such as job stress and psychological distress. 30

Work-family conflict and related ill outcomes may be attenuated and prevented by designing policies and interventions that prioritize job flexibility and discourage stigmatization and/or sanctioning of workers for enabling their right to schedule control, urging employees to prioritize sleep and attain work-family time balance. The aim of this organizational policy would be to nurture long-term wellbeing and effectiveness of employees. In the public policy arena, policies that establish minimum and maximum shift hours and a minimum amount of hours between shifts may be able to influence work-life balance in a positive way.

Work Schedules

Our review included multiple papers that generated research findings related to work schedules. For example, four papers examined job flexibility among patient care workers, finding associations between job flexibility and increased physical activity 11 as well as lower levels of psychological distress 32 increased preventive care utilization 8 , and increased job satisfaction. 33 Another paper found that shift characteristics (e.g., longer shifts, more consecutive days worked, longer total hours worked, more night shifts, and more frequent overtime) were associated with higher injury rates. 34 A fourth paper found a positive association between the frequency of meal breaks and lower levels of psychological distress. 21

These research findings support organizational policies intended to improve work schedules, such as scheduling policies that encourage flexibility in task scheduling and working hours, and a break policy that is consistently enforced. For example, Hopcia, et al., 2012 found that consecutive shifts of two or more days, as well as cumulative shifts over a week and month (especially night shifts) were associated with increased odds of an injury. 34 Hopcia noted in the paper: “ Occupational health nurses should assess, when possible, whether policies address details such as minimum number of days or weeks on a specific shift, how shifts rotate, number of days that can be worked consecutively without a day off, the maximum length of a shift, or the amount of overtime in a given shift or week.” 34 This is a reminder that an important organizational policy involves regularly reviewing shift characteristics. Similarly, another related policy example relates to breaks within a work day as important organizational policy, as Hurtado et al. 2015 notes: “Meal breaks should provide daily opportunities for fatigue recovery; for access to healthier, more enjoyable meals; to enjoy meals and leisure or personal time, factors that explain the positive effect of meal breaks on mental health. ” 21

Work Stress, job demands and decision-making

Evidence from the Center’s studies showed that psychological demands and decision latitude have implications for physical health outcomes and workers’ health behaviors. The combination of high psychological demands and low decision latitude were associated with increased musculoskeletal pain among patient-care workers. 12 , 22 On the other hand, greater decision latitude and job flexibility was associated with greater physical activity. 11 A study by Arias et al. 2017 with patient-care workers found that workers reporting moderate and vigorous levels of physical activity at work actually spent 99% of their work time below moderate and vigorous activity as measured by an accelerometer. 35 Authors suggested that this perceived differential may be due to the fatigue created by high job demands related to trunk flexion and bends, also measured with tri-axial accelerometer, but not by actual physical activity (same reference).

Evidence from these studies demonstrates the importance of modifying organizational policies to support adequate job demands and increased job flexibility. Organizations may be able to modify job demands by regular reviews of job responsibilities to ensure that workers have manageable workloads. Public policies that could support adequate job demands include the creation of scheduling regulations and well-designed patient-to-nurse ratios.

Health Outcomes

Injuries and injury reporting.

The Center also conducted research that focused on factors that were related to injury reporting, along with the distribution of injuries in the workplace. For example safety practices were found to be associated with self-reported sharps injuries but not administrative records of these injuries. 17 Additionally, Center work found that the undercount of occupational injuries in an administrative dataset was greater among black workers when compared to white workers. 36 Another Center paper found that workers with an injury reported increased medical expenditures at both 3 and 6 months post-injury. 37

Organizational and public policy implications that relate to such findings include policies that seek to reduce barriers to injury reporting or reward reporting of adverse events and near misses, or policies that seek to prohibit and punish retaliation following an injury report.

In a recent paper by Sabbath et al. 2019, authors re-analyzed the results of a Center intervention evaluation 18 and found that while the intervention had a positive impact overall, this effect did not benefit all populations equally and may in fact have contributed to widening disparities. 38 Thus, these results underscore the importance of tailoring interventions, as well as policies, to the group of workers who are most at risk and often have the least amount of agency. These results also reiterate the need to account for diverse populations in a workplace.

Center research on occupational injury also examined the distribution of injuries within the workplace. For example, one study found that injury rates within the same hospital differed by occupation and type of unit. 39 The policy implications of this work suggest that data-driven surveillance systems put in place at the organizational and/or public policy levels may be able to capture the distribution of injuries within an organization, and thus can be used to help target preventive workplace interventions. Additionally, the research suggests that policies should seek to provide consistent definitions of injury and exposure terms.

Mental health

Research from the Center indicated that mental distress was associated with increased self-reported injury and musculoskeletal pain 40 as well as with increased pain interference with work. 41 Additionally, increased levels of mental health related claims were associated with workers who reported incivility or bullying. 12

These findings support policies at both the organizational and public policy level. For example, the finding that psychological distress is closely associated with injury and pain outcomes provides evidence of the importance of creating policies that contribute to a psychologically safe and healthy environment. The authors point to the need for more research on the topic, noting that: “an intervention targeting psychological factors that has the potential to prevent disability, reduce injuries, alleviate mental distress, and reduce health-care costs in more than 11 million [construction] workers, certainly warrants a rigorously designed large-scale study.” 40

Improvements to psychological environments may include implementing an internal monitoring program that records psychological hazards in addition to physical hazards and facilitates regular updates to this system.

The Center’s findings also provide supporting evidence for many public polices, such as those that hold employers accountable in the protection of workers against psychological hazards. Some countries are beginning to include psychological hazards under the umbrella of their occupational safety and health administrations (e.g. Australia and Canada). 25 Other public policies, such as unemployment benefits, regulations on types of work contracts, or even minimum wage policies may prevent exposure to psychological hazards created by economic challenges. 42 , 43

Physical activity

Several studies from the Center focused on physical activity, specifically aiming to investigate the relationship between work-factors and occupational and/or recreational physical activity. For example, research in the construction industry indicated that construction workers have a substantial amount of physical activity at work, and that this was positively associated with self-reported fatigue. 44 A related finding from a study in the health care industry found that self-reported fatigue and functional limitations were negatively correlated with measured minutes of vigorous activity outside of work. 45 Another paper found that workers who did not meet physical activity guidelines reported lower levels of decision latitude and an increased 10-year cardiometabolic risk. 46 The Center’s findings imply that policies designed to evaluate and address job demands may provide more time for workers’ physical activity outside of work, which in turn may have a number of health benefits.

Sleep deficiency

Studies found associations between increased sleep deficiency and higher rates of overweight and obesity among health care workers 11 , as well as between increased sleep deficiency and increased musculoskeletal pain, work interference, and functional limitations. 11 Another study found that health care workers who reported higher levels of sleep deficiency had an increased 10-year cardio-metabolic risk. 46

The findings from these studies imply that policies, at the organizational or public policy level, that are designed to protect sleep cycles are recommended. For example Buxton et al. 2012 notes that multi-level interventions for workers that acknowledge how individuals fit into the overall work context may be effective at reducing sleep deficiency. 47 Buxton notes that: “ policies that provide increased flexibility on shift length and timing may contribute to a supportive work environment that acknowledges the pivotal role of sleep in worker health outcomes. In tandem, educational programs to inform workers of the important associations between sleep, musculoskeletal disorders and pain may motivate workers to consider improved sleep hygiene practices .” 47

Our goal was to provide a thorough review the publications of our TWH® Center of Excellence, the Harvard T.H. Chan School of Public Health Center for Work, Health, and Wellbeing to identify policy implications of this research that would be relevant to both organizational and public policies. Our review extended beyond the policy implications of individual articles in order to extract cross-cutting themes. The definition of TWH® and the approaches involved in developing and implementing TWH® programs are still relatively new, only taking shape in the last few years. We hope that this review can help lead the way for additional consideration of the policy implications of TWH research and serve as a model for other groups considering the policy implications of their own work, thus facilitating the translation of TWH® research to practice.

The review involved extracting research findings from the Center’s body of work, organizing them into twelve policy-related themes that fell into two categories: working conditions (e.g. social support, safety practices) and related health outcomes (e.g. mental health, physical activity). These categories and the themes align with the Center’s conceptual framework. 5

Results show that policy implications related to the TWH® framework cut across work-related themes. This underscores that working conditions interact with one another; that is, characteristics of one working condition may generate changes in other working conditions that at the same time may have an impact on workers’ health and behavior. For example, the policy implications of research findings from the themes of work schedules, sleep deficiency, and work-family conflict all support scheduling policies at the organizational level and scheduling regulations at the public policy level. Similarly, the research for both social support and harassment/abuse implies that organizational policies should aim to prevent abuse, harassment, discrimination, and violence. These multiple shared pathways reflect one of the core components of TWH® -- that shared pathways of certain working conditions can affect multiple health outcomes.

This review has several benefits. First, it allows us to understand the potential impact of our research and helps set priorities for translating this work from research to practice. Second, we were able to demonstrate the feasibility and utility of conducting a review that draws out relevant policy implications of TWH® research and can serve as an exemplar for other groups seeking to understand their own body of work. Third, this review allows us to identify gaps in our own work that we and others can use to plan future research priorities.

It is worth mentioning that from the 57 articles reviewed, 25 of them did not study associations between the work environment and health outcomes, and thus did not include implications related to organizational and public policy. These 25 articles included pilot studies, case studies, creation and/or validation of measurement tools, commentaries summarizing the literature and/or providing relevant information for future research and the Center’s conceptual framework which summarizes a research agenda that addresses disease prevention by integrating health protection and health promotion in the workplace. Our approach in this study involved extracting policy implications based on results from the study of working conditions and health outcomes, thus, the above-mentioned articles were not included in the results of this review. Nevertheless, they could potentially contribute to the design and study of policies that impact the workplace. Validated tools may aid in measuring the effectiveness of organizational policies and practices and conceptual frameworks can help guide the design and analysis of policies.

Although policy implication reviews have been conducted in other aspects of occupational health 48 - 50 , to our knowledge, this is the first time such review has taken place within TWH® research framework, but limitations should be addressed. First, our review highlighted a few scientific gaps that should be addressed in future research. For the most part, the Center’s body of work only includes a limited number of working populations, and thus the policy implications described may only be generalized to these populations. The study populations were relatively homogeneous, consisting mostly of women in the health care sector and men in the construction industry, as well as a predominantly white population, although some work covered small to medium sized businesses and two studies focused on racial disparities and injury reporting. 17 , 36 Most of the studies were also cross-sectional and/or involved retrospective and self-reported data where exposure and/or outcome misclassification may be a concern.

This review of policy implications is not the study of policy effectiveness; for this, we would need to include review of the broader scientific literature. Literature published by authors outside of the Center was beyond the scope of this analysis. While the entire body of scientific literature on a given topic should be consulted when developing policies for organizations or the public, here we aimed to only focus on the implications of the research generated by the Center.

Despite these limitations, the strengths of this process are noteworthy. While a challenging and iterative process that required the knowledge and collaboration of authors and reviewers, this innovative method aimed to set a policy lens on TWH® research. We conducted a detailed and comprehensive review by two independent reviewers that was checked by study authors, all of which increases the robustness of this study. We believe that the results described here will aid in setting research priorities that will in turn translate findings to inform policy.

Conclusions

In this paper, we considered the policy implications emerging from a comprehensive review of one TWH® Center’s scientific output and the value of the review in identifying policy gaps to assist in setting future research priorities. Ultimately, policies can either advance or impede the potential of TWH® to make a difference in the lives of workers and the success of employers. We identified cross-cutting themes from our research findings and the associated policy implications at both the organizational and public policy levels.

This review process can serve as a model for other research groups who seek to examine the TWH® policy implications of their own work and identify future areas of focus. By reviewing our research to date, we have identified common themes and related policy recommendations, along with some important scientific gaps for future research. We were able to demonstrate the feasibility and utility of conducting a review that draws out relevant policy implications of TWH® research. We hope that this review can serve as a model for other groups and can lead to an increased focus on policy discussions in manuscripts.

Supplementary Material

Supplemental digital content, acknowledgments.

This work was supported by the U.S. Centers for Disease Control and Prevention National Institute of Occupational Health and Safety (NIOSH) grant number 5U19-OH008861

Conflict of interest: None Declared

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• Published: 01 May 2023

What are the core concerns of policy analysis? A multidisciplinary investigation based on in-depth bibliometric analysis

• Yuxue Yang   ORCID: orcid.org/0000-0002-8772-1024 1 , 2 ,
• Xuejiao Tan 1 ,
• Yafei Shi 1 &
• Jun Deng 1 , 2  

Humanities and Social Sciences Communications volume  10 , Article number:  190 ( 2023 ) Cite this article

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• Environmental studies
• Medical humanities
• Social policy

Policy analysis provides multiple methods and tools for generating and transforming policy-relevant information and supporting policy evolution to address emerging social problems. In this study, a bibliometric analysis of a large number of studies on historical policy analysis was performed to provide a comprehensive understanding of the distribution and evolution of policy problems in different fields among countries. The analysis indicates that policy analysis has been a great concern for scholars in recent two decades, and is involved in multiple disciplines, among which the dominant ones are medicine, environment, energy and economy. The major concerns of policy analysts and scholars are human health needs, environmental pressures, energy consumption caused by economic growth and urbanization, and the resulting demand for sustainable development. The multidisciplinary dialog implies the complicated real-world social problems that calls for more endeavors to develop a harmonious society. A global profiling for policy analysis demonstrates that the central policy problems and the corresponding options align with national development, for example, developing countries represented by China are faced with greater environmental pressures after experiencing extensive economic growth, while developed countries such as the USA and the UK pay more attention to the social issues of health and economic transformation. Exploring the differences in policy priorities among countries can provide a new inspiration for further dialog and cooperation on the development of the international community in the future.

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Introduction

Social problems are evolving with the rapid development of economy, and the problems mankind is facing and options they choose reflect the developmental demand. Policy is a political action with specific subjects, targets, and strategies in a certain period of time, which primarily aims to create a healthy environment for the development of society (Porter, 1998 ; Lasswell and Kaplan, 1950 ; Yang et al., 2020 ). As for policy analysis, the definition varies a lot. According to William Dunn ( 2015 ), policy analysis is ‘an applied social science discipline, which uses multiple methods of inquiry and argument to produce and transform policy-relevant information that may be utilized in political settings to resolve policy problems.’ Jabal et al. ( 2019 ) defined that policy analysis provides methods and tools for assessing whether a policy is ‘correct and fit for their use’ and supporting policy evolution. Manski ( 2019 ) regarded policy analysis as a shorthand term that describes the process of scientific evaluation for the impact of past public policies and prediction of the potential outcomes of future policies. More generically, policy analysis is aimed to understand who develops and implements certain policies, for whom, by what, with what effects, and what techniques and tools can be used, and so on (Blackmore and Lauder, 2005 ; Collins, 2005 ).

Accordingly, regarding the typology of policy analysis, three categories can be established based on ontology and epistemology (Fig. 1 ) (Bacchi, 1999 ; Colebatch, 2006 ; Jennifer et al., 2018 ): (1) Positivism paradigm. Focusing on policy facts, this orientation of policy analysis aims to identify policy problems and weighting the optimal solution guided by the theory of economic frameworks, basic scientific models, and behavioral psychology through objective analysis. Economic analysis, cost-benefit analysis, quantitative modeling and nudge politics are the most commonly used methods in this orientation (Althaus et al., 2013 ; Jennifer et al., 2018 ); (2) Constructivism paradigm. In this orientation, policy is conceptualized as ‘the interaction of values, interests and resources guided through institutions and mediated through politics’ (Davis et al., 1993 ) rather than a comprehensively rational and linear process in which analysis involves policy agenda setting, policy processes, policy networks and governance, mainly focusing on values, actors and political rationality of policy. Theoretical frameworks, such as multiple stream theory, behavioral psychology and advocacy coalition framework, etc. are typically used in such orientation (Kingdon, 1984 ; Browne et al., 2019 ; Sabatier and Weible, 2014 ); (3) Interpretivism paradigm. This orientation is focused on interpreting how policy problems can be defined or constructed and how the problem framing shapes the possible policy responses (Bardach, 2000 ). A substantial body of research has discussed the theory underlying the problem, framing and governmentality using narrative analysis, discourse analysis, ethnographic methods, etc. (Hajer, 1995 ; Hajer, 2006 ; Martson and Mcdonald, 2006 ). Therefore, a systematic review of policy analysis can present the past and present policy problems of concern and the relevant possible options from an evolutionary perspective.

The framework was organized according to Jennifer et al. ( 2018 ).

The profoundly complex and diversified realistic demands such as equity and sustainability (Akadiri et al., 2020 ), the changes of energy planning (Banerjee et al., 2000 ; Pandey et al., 2000 ; Pandey, 2002 ) and transition of modern markets (Blackman and Wu, 1999 ) have important implication on policy decisions (Munda, 2004 ). A multidisciplinary investigation on policy analysis can provide more reflections on how to develop a harmonious society. Studies have shown that the priority of policy agenda is determined by three key factors: the nature of the issue (Shiffman and Smith, 2007 ), the policy environment (Adams and Judd, 2016 ; Sweileh, 2021 ) and the capabilities of proponents (Shawar and Shiffman, 2017 ). Due to differences in geography, economics, politics and many other aspects, social concerns and policy priorities vary enormously in different countries. In the global context, how countries set policy priorities in different stages of development, and how policy priorities align with the national development remain unknown. So, developing a global profiling for policy analysis can present the differences in core concerns of polices among countries, thus promoting further dialog and cooperation on the development of the international community in the future.

Bibliometric analysis has long been used as a statistical tool to systematically review scientific literature (Hood and Concepcion, 2001 ). A rigorous bibliometric analysis can provide systematic insights into previous publications, which can not only delve into the academic research community of active and influential researchers, but also identify the current research topics, and further explore potential directions for future research (Fahimnia et al., 2015 ). Bibliometrics has been widely applied in a wide range of sectors and specific domains, for example, mapping and visualizing the knowledge progress avenues and research collaboration patterns of cultural heritage (Vlase and Lähdesmäki, 2023 ), analyzing the sub-areas and core aspects of disease (Baskaran et al., 2021 ), visualizing and graphing the evolution of research related to sustainable development goals (Belmonte-Ureña et al., 2021 ), and studying policies, such as agricultural policy (Fusco, 2021 ), medical information policy (Yuxi et al., 2018 ), and science, technology and innovation policy (Zhang et al., 2016 ). However, the research trajectory and focus of policy analysis around the world remain a black box. In the present paper, a bibliometric analysis was performed from three dimensions: time, intensity, and scope, which referred to hot point changes over time, the quantity of research and the core concerns of policy, respectively.

In the present paper, a bibliometric analysis of a large number of studies on historical policy analysis was performed to answer the questions: (1) What core concerns are reflected in the policy analysis and how does these core concerns reflect real-world social problems? (2) How do these core concerns change over time? (3) What are the differences in core concerns among countries and what drives those differences? From an evolutionary perspective, this paper aims to uncover the past and present policy problems of concern and the relevant possible options, thus providing a clue for future policy analysis. The analysis of the evolution and differences in policy problems among countries may provide a view of the development context of different countries and put forward new inspiration and hope for further dialog and cooperation on the development of the international community in the future. Furthermore, another possible key sustainability implication with respect to the core concerns of policy analysis is to provide a reference for exploring the gaps between academic research and policy agenda.

Literature research

In the present study, Web of Science (WOS) Core Collection database was used for data retrieval (Vlase and Lähdesmäki, 2023 ). This research was conducted in four steps. Firstly, articles related to policy analysis were searched to select the most cited ones, which reflect the most influential research and the cutting-edge knowledge over time. MerigÓ et al. ( 2016 ) and Markard et al. ( 2012 ) weighted the most citation in an absolute term that means the total citations of all time. According to Fusco ( 2021 ) and Essential Science Indicators, the most citation was weighted in a relative term, which means the citation number in the publication year. The top 1% papers, compared to other articles in the academic field published in the same publication year, were included in this study following the refining principle of Essential Science Indicators, ensuring that the impact of these articles does not fade with time. Secondly, the selected papers were further screened, and narrowed down to different collected datasets for in-depth analysis according to the results of screening. Thirdly, statistical analysis and network visualization of authorship, organization and geographical distribution, topics and their chronological trends in each dataset were performed using VOSviewer software, which is freely available to construct and visualize bibliometric network (see www.vosviewer.com ) (Van-Eck and Waltman, 2010 ). Lastly, the association between policy analysis and academic articles was explored in different fields.

Dataset construction

Originally, a total of 118,535 articles related to policy analysis were retrieved using the strategy “TS = (policy analysis)”. For further discipline analysis, the most cited articles were selected with the quick filtering toolbar of WOS. Consequently, 1287 most cited papers of policy analysis were included in dataset 1. Then co-citation analysis of journals was performed to provide clues for discipline research (Supplementary Table 2 ). Accordingly, policy analysis-related articles from journals in the medicine field were selected for dataset 2, and 7963 articles were finally included. Similarly, 15,705 articles from journals in the field of environment were included in dataset 3; 6253 articles from journals in the field of energy in dataset 4; 1268 articles from journals in the field of economy in dataset 5; and 2243 articles from multidisciplinary journals in dataset 6. According to Journal Citation Reports of WOS, multidisciplinary journals refer to those journals in which articles involve at least two disciplines, such as Ecological Economics that involves ecology and economics. The search strategy of each database is shown in Table 1 .

Network visualization

Publication information of policy analysis was presented, including publication number, countries and organizations of key players, which reflects the value of and actual needs for policy analysis. Then, VOSviewer was used for network visualization of co-authorship, co-occurrence and citation. Co-authorship analysis for organizations and countries, which met the thresholds identified more than 5 articles for further investigation of the key players’ geographical distributions and their collaboration patterns. Co-occurrence analysis for all keywords based on the frequency of keywords used in the same article was carried out for topic mining (Kern et al., 2019 ). Citation analysis was performed to investigate the citation attributes received by other items. Meaningless or common terms were removed (Zhang and Porter, 2021 ). The research framework is shown in Fig. 2 .

The research framework for multidisciplinary investigation in policy analysis.

Publication information of policy analysis

Firstly, the publication number of policy analysis was determined. A total of 118,535 policy analysis articles were published between 2003 and 2021 (Fig. 3 ), showing a surge in the development of policy analysis with an exponential growth rate of 53.98 and 84.03% in the last 5 years (2017–2021) and 10 years (2012–2021), respectively.

Source : Data was collected from Web of Science (WOS) Core Collection database on the topic (TS) “policy analysis”.

For network construction, 1287 most cited papers were screened. The collaboration network of countries was visualized and illustrated, showing that 112 countries have published the most cited policy analysis articles. As for the co-authorship of countries and organizations, 2286 universities were identified, and 193 of them from 59 countries met the criteria of network analysis, among which the universities from the USA (University of Washington, Harvard University), the UK (University of Oxford, University of Cambridge) and China (University of Chinese Academy of Sciences) had the largest number of links and the strongest willingness to cooperate with other organizations (Fig. 4A, B and Supplementary Table 1 ). The willingness of cooperation not only meets the needs of academic research, but also conforms to the general expectations of the international community. Citation analysis for sources identified 51 journals from five different fields (Fig. 4C and Supplementary Table 2 ), in which environment-related journals accounted for the largest number (e.g., Journal of Cleaner Production, Science of The Total Environment , Global Environmental Change-Human and Policy Dimensions , Transportation Research Part D: Transport and Environment and Environmental Modeling & Software) , followed by medicine-related journals ( The Lancet , JAMA , The Lancet Infectious Diseases , PLOS One and The Lancet Global Health) , the journals of energy science ( Sustainable Cities and Society , Energy Policy , Applied Energy , Renewable Energy and Energy ), the journals of economy ( International Journal of Production Economics and Transportation Research Part A: Policy and Practice ), and then several multidisciplinary journals ( Ecological Economics , Nature , PNAS, Nature Communications and European Journal of Operational Research ).

A Co-authorship analysis for countries; B Co-authorship analysis for organizations; C Citation network; D Co-occurrence network.

In the co-word network of policy analysis, four main clusters were displayed: the blue cluster concerned with environmental policy problems; the green cluster related to medicine (e.g., public health, prevalence and mortality of disease); the red cluster centering policy, such as policy framework, policy systems, and policy implementation; and the yellow cluster mainly concerned with energy (e.g., energy consumption, energy efficiency and electricity generation) (Fig. 4D and Table 2 ). Simultaneously, more details related to real-world social issues were also found, such as the common and core concerns about carbon emission, economic growth, prevalence and mortality of disease. Additionally, management is in the spotlight (e.g., system, framework, efficiency and challenge).

Publication information of policy analysis in different fields

Policy analysis-related articles mainly involved the fields of medicine, environment, energy, economy and multidiscipline. The publication information in different fields was investigated. First, the volume growth trend over time was traced. Generally, a growing number of articles were published annually. The most obvious growth was found in policy analysis in environment, followed by medicine and energy, and the growth in economy and multidiscipline was relatively stable (Fig. 5 ). Specifically, the first increase in the publication number of policy analysis in medicine was seen in 2009, and then a steady growth was maintained, followed by a second acceleration after 2019, which may relate to the pandemic of H1N1 influenza and COVID-19, respectively (WHO, 2012 ; Wouters et al., 2021 ). A great growth in environmental policy analysis was observed after 2015, and a linear growth after 2017. In energy policy analysis, the first increase occurred in 2009, reaching a peak in 2013, followed by a second increase in 2016, reaching another peak in 2020. Then the publication information about organizations and countries was explored. The top five countries and institutions with the largest number of policy analysis articles in different fields are presented in Supplementary Table 3 . The results showed that the USA, the UK and China attached great importance to policy analysis in all of these fields.

Publication dynamics of policy analysis-related articles in the fields of medicine, environment, energy, economy and multidiscipline between 2003 and 2021.

Policy analysis in the field of medicine

A total of 8381 organizations from 177 countries contributed to medical policy analysis. Further investigation showed that universities from the UK (e.g., University of London, London School of Hygiene & Tropical Medicine and University College London), the USA (e.g., Harvard University and University of California San Francisco), Canada (e.g., University of Toronto) and Australia (e.g., University of Melbourne, University of Sydney) contributed the most to medical policy analysis with the greatest willingness to collaborate both domestically and internationally. By contrast, Chinese universities, such as Peking University, University of Chinese Academy of Sciences and Zhejiang University, were more prone to domestic collaboration (Fig. 6A, B ).

A Co-authorship analysis for countries; B Co-authorship analysis for organizations; C Co-occurrence network; D Overlay network.

Co-occurrence analysis of keywords showed that of the 16,719 keywords identified from 7963 retrieved items, 1778 keywords met the threshold. In addition to the three core topics “medicine”, “policy” and “health” (e.g. health policy, public health), the mortality, prevalence, risk factors as well as prevention of diseases have been the key focus of medical policies. Additionally, the issues of children and adolescents, such as physical activity, overweight and childhood obesity, have also attracted medical scientists and policy analysts. Figure 6D shows the average annual overlay network of keywords. The most recent concerns are the prevalence of COVID-19 and relevant topics associated with SARS-CoV-2 and coronavirus. Moreover, sex-specific mortality, life satisfaction and affordable care act are also the hot topics in recent years (Fig. 6C, D ).

Policy analysis in the field of environment

Co-authorship analysis showed that 9060 organizations from 160 countries contributed to environmental policy analysis, among which universities from China played a key role, especially University of Chinese Academy of Sciences, Tsinghua University, Beijing Normal University, North China Electric Power University and Beijing Institute of Technology (Fig. 7A, B and Supplementary Table 3 ). Of the 44,213 keywords in retrieved 1 5705 articles related to environmental policy analysis, 3638 met the threshold of keyword co-occurrence analysis. The co-word network showed that apart from the words with vague meanings such as “policy”, “impact” and “management”, “carbon emission”, “climate change” and “sustainability” were the most visible in the network. Note that the terms like “energy”, “economic growth” and “urbanization” were also easy to notice (Fig. 7C ). The analysis for the average annual overlay showed that “kyoto protocol”, “acid deposition” and “policy development”, etc. were earlier terms, while “plastic pollution”, “Cross-Sectionally Augmented Autoregressive Distributed Lag” and “population structure”, though lightly weighted, were the most recent ones. The color of overlay network visualization of environmental policy analysis appeared to be yellow, indicating that environmental problems have attracted researchers all over the world in past decades (Fig. 7D ). The abovementioned results demonstrated the positive attitude of policy analysts and indicated a shift of their attention over time, possibly due to the evolution of environmental problems.

Policy analysis in the field of energy

The collaboration network showed that 3668 organizations from 117 countries performed policy analysis in energy. The top five organizations were Tsinghua University, University of Chinese Academy of Sciences, Xiamen University, North China Electric Power University and Beijing Institute of Technology, all of which showed strong willingness to collaborate both domestically and internationally. The network showed that there was complex knowledge interaction and flow in the citation of energy policy analysis (Fig. 8A, B ). Of the 15,027 keywords in retrieved 6253 articles, 1225 met the threshold. Co-occurrence network (Fig. 8C ) revealed that policy analysis in energy was primarily focused on the demand for renewable energy (such as “wind power”, “solar power”, “bioenergy”) due to emission (e.g. “carbon emission”, “greenhouse gas emission”) and energy consumption. The terms “restructuring”, “discount rates” and “kyoto protocol” were early noticed by researchers, and the analysis of kyoto protocol was performed earlier in energy than that in ecology. Then, “green power”, “green certificates” and “energy policy analysis” gradually came into the eyes of analysts. Similarly, the prevalence of COVID-19 was the greatest concern of energy policy analysts, followed by “energy communities” and “renewable energy consumption” (Fig. 8D ).

Policy analysis in the field of economy

1144 organizations from 67 countries were found to contribute almost the same to policy analysis in economy. Hong Kong Polytechnic University, Delft University of Technology, University of Leeds, Rensselaer Polytechnic Institute and University of Sydney had the largest number of publications. Hong Kong Polytechnic University, Delft University of Technology, University of British Columbia, University of Sydney and Rensselaer Polytechnic Institute had the highest collaboration (Fig. 9A, B ). Of the 5970 keywords in retrieved 1268 papers, 395 met the threshold. The co-word network showed that in addition to the general words frequently used in articles (e.g. “policy”, “impact”, “system”), the specific words reflecting the most common topics for policy problem of economy were “transport” (associated with vehicles, public transport, travel behavior, etc.), “supply chain” (related to supply chain management, supply chain coordination, green supply chain, etc.), and “inventory” (related to the model, control and system of inventory, etc.) (Fig. 9C ). The overlay network analysis showed that economic policy analysts had an early interest in inventory-related topics and the issue of supply chain management, but has been concerned with the sustainability of supply chain management only in recent years. Additionally, topics like “circular economy”, “life-cycle assessment”, “industry 4.0” and “automated vehicles” also attracted scholars’ attention. (Fig. 9D ).

Policy analysis in multidiscipline

In the co-authorship network, universities such as Stanford University, University of Chinese Academy of Sciences, University of Maryland, University of California, Berkeley and University of Cambridge had the most publications and a high collaboration. University of California Irvine had fewer publications but relatively higher link, showing that this university was strongly willing to cooperate with other organizations (Fig. 10A, B ). Of the 9467 keywords in retrieved 2243 articles, 648 met the threshold. This multidisciplinary research revealed the relationship between economy, environment and energy. However, there were obstacles to extend the relationship between them. Co-word network demonstrated that the policy analysis articles published on the multidisciplinary journals were mainly focused on the topics of “climate change”, “sustainability” and “inventory”. The term “climate change” is mainly related to issues of environmental resources (e.g., land use, deforestation, biodiversity), greenhouse gas emission (especially carbon emission) and energy consumption. The term “sustainability” is mainly connected with the relationship between environmental resources and economic growth. In addition to COVID-19, the terms “big data” and “circular economics” were on the cut edge (Fig. 10C, D ).

Policy analysis aims to understand what is the governments’ focal point, investigate why and how governments issue policies, evaluate the effects of certain policies (Browne et al., 2019 ), and reflect political agenda driven by social concerns or international trends (Kennedy et al., 2019 ). In this study, a bibliometric analysis of a large number of publications on historical policy analysis was carried out to explore the policy problems of concern and the relevant possible options from an evolutionary perspective, and provide a guide for future research. From 2003 to 2021, the number of publications on policy analysis grew exponentially. Before 2011, little attention was paid to policy analysis, but in recent decades, more importance has been attached to policy analysis around the world due to increasingly prominent social problems, especially the human health needs, degradation of environment, energy consumption and the relationship between economy, energy and environment.

From the perspective of global visibility, the policy analysis in medicine has received increasing attention from scholars from 8381 organizations of 177 countries, indicating that health problems, though not numerically dominant, have the widest coverage. Among these countries, the USA, the UK, Australia, Canada and China are the major contributors. The developed countries, such as the USA, the UK, Canada and Australia, have strongly supported addressing complex public health issues by developing effective policy responses (Moore et al., 2011 ; Atkinson et al., 2015 ). Typically, they spend the most on health, with 12318, 5387, 5905 and 5627 dollars per capital, respectively, while the developing countries spend relatively less, such as 894 dollars per capital in China and 231 dollars per capital in India (OECD, 2022 ). Great attempts have been made to analyze the burden of prevalence and mortality of diseases such as cancer, cardiovascular diseases and diabetes both globally and regionally (Yusuf et al., 2020 ; Rudd et al., 2020 ; Kearney et al., 2005 ). Other health issues of women, children and adolescents have been monitored and measured for years in many countries that respond to the Countdown to 2030 (Countdown to 2030 Collaboration, 2018 ). In addition, the worldwide outbreak of epidemics such as H1N1 influenza and COVID-19 pandemic has caused excess mortality and enormous social and economic costs all over the world, which greatly affect social policy and reveal the fragility of health systems to shocks (Wouters et al., 2021 ; Chu et al., 2020 ). By analyzing the global burden of disease, scholars have recommended policy-makers to give priority to the prevention and management of relevant diseases (Kearney et al., 2005 ).

Environmental policy analysis involving 15,705 articles has attracted largest attention from policy analysts and scientists. Greenhouse gas emission (mainly carbon emission) resulting in climate change and environmental degradation remains to be the most threatening and urgent issue, and has attracted attention of governments and the society (Tang et al., 2021 ; Ahmad et al., 2019 ). Different countries issued different climate policies aiming to reduce greenhouse gas emissions. The Kyoto protocol, ratified by 180 countries, committed to reduce the GHG emissions by 5% by 2012, compared with the 1990 emission levels (Kuosmanen et al., 2009 ). In the EU climate policy framework in 2014, the carbon emissions were projected to reduce by 40% by 2030, and by 80% by 2050 (European Council, 2014 ). The relationship between urbanization and environmental pressure was observed in the present research. During urbanization, the consumption of resources such as land, water and fuel has increased significantly, causing serious ecological pressure such as climate change, loss of biodiversity, land erosion and pollution. With the acceleration of economic growth and social commercialization, urbanization further increases the demands for housing, food, transportation, electricity and so on, which in turn aggravates the ecological pressure because of natural resource consumption, climate change, over-extraction and pollution (Ahmed et al., 2019 ; Wang et al., 2019 ). Hence, urbanization policies with restrictions on unplanned urban sprawl are under the way (Ahmed et al., 2020 ).

Energy is another big agenda for policy analysis. The close connection between energy and emission has been presented noticeably in this study. Governments have come to a consensus that there should be greater balance between ecological purity, energy supply and economic well-being if a country strives for healthy and sustainable economic development (Alola and Joshua, 2021 ). New environmental policies should be designed to control environmental pollution through reducing pollutant emissions and sustaining economic growth, and should be incorporated into governments’ macro policies (Halicioglu, 2009 ). Transformation of energy sector was on agenda to meet the ambitious goals (Cong, 2013 ). The UK, the USA and China are the global leaders in reducing actual emissions and increasing energy supply. In the USA, the shale revolution brought global attention to energy supply and remains to be a driving force for energy policies. Low-cost shale gas combined with the policy support for renewables have notably reduced CO 2 emissions over the past decades. Environmental deregulation is another central focus, which may affect the trajectory of greenhouse gas emission (International Energy Agency, IEA, 2019a , 2019b ). In the UK, the policy objectives of actual emission reduction, carbon budgets setting and investment in energy technology and innovation reflect the ambition for decarbonization (IEA, 2019a , 2019b ). As is known, China’s GDP grows rapidly, which has multiplied more than 170 times since the founding of the People’s Republic of China 73 years ago. However, the extensive economic growth mode depending on the primary and secondary industries has put high pressure on environment, such as large amounts of consumption and pollution (He et al., 2016 ; Yue et al., 2021 ; Yu and Liu, 2020 ). Data showed that the greenhouse gas emission (OECD, 2020 ) and air pollution exposure (OECD, 2022 ) in China have been far higher than those in other countries for a long time, posing great challenges to both the government and scholars. A specific policy package, such as the “Atmosphere Ten Articles”, “Soil Ten Plan” and “Water Ten Plan” from 2013 to 2016, and the “Regulation on the Implementation of the Environmental Protection Tax Law of the People’s Republic of China” in 2017, has been issued by Chinese government, aiming to improve the ecological environment. Furthermore, goals for renewable energy production were also set by scholars. Jacobson suggested that wind, water and sunlight energy should be produced by 2030, and then replace the existing energy by 2050 (Jacobson and Delucchi, 2011 ), while Lund proposed that renewable energy (the combination of biomass with wind, wave and solar) should account for 50% by 2030, and 100% by 2050 (Lund and Mathiesen, 2009 ). However, it remains unclear how many countries can achieve their stated goals. Numerous studies have shown the efforts of governments and scholars to transform the resource and energy usage-driven economic expansion to sustainable development.

From the economics perspective, the environmental Kuznets curve (EKC) hypothesis demonstrates the relationship between environmental quality and economic output, which has been proved by empirical studies (Fodha and Zaghdoud, 2010 ; Saboori et al., 2012 ). Additionally, the relationship between economic growth and energy consumption has also been confirmed (Shahbaz et al., 2015 ). In recent years, countries have been facing the challenge of economic structural transformation. The mode of economic growth that relies on the consumption of natural resource and waste disposal seems increasingly outdated (McDowall et al., 2017 ). Circular economy, a new mode for reconciling environmental and economic imperatives, has come into the public eye and appears to meet the common vision of sustainable development. With the increase of requirements of sustainable development and circular economy, greening of supply chain management also faces challenges, including inventory management, mode of transportation, life-cycle assessment and coordination with other areas (Ghosh and Shah, 2012 ; Ghosh and Shah, 2015 ). Thus, providing support for green supply chain supplier deserves the attention from policy-makers and practitioners.

Key findings

(1) Policy analysis has been a great concern of scholars for many years and has attracted increasing attention year by year, which reflects the value of and actual needs for policy analysis. (2) The world is facing common problems, which requires attention and efforts of the whole world, and a more harmonious social development such as the management of epidemics and complex disease, environmental-friendly development, green energy production and transformation from resource and energy usage-driven economic expansion to sustainable development is on the way. (3) Global profiling for policy analysis demonstrates that the central policy problems align with national development, which inspires further dialog and cooperation on the development of the international community in the future.

Limitations

This study has limitations. First, keywords cannot fully reflect the essential intent of an article although they are the key points of a study. Therefore, using keywords as an element for bibliometric analysis is far from enough. Second, this paper deals with academic research of policy analysis, but whether it is fully consistent with the policy agenda is unexplored. Moreover, we have shown the correlations between different phenomena, but the underlying mechanism remains indefinable.

Data availability

The datasets analyzed during the current study are available in the Dataverse repository ( https://doi.org/10.7910/DVN/XZMVMN ).

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Acknowledgements

This work was financially supported by Special Project on Innovation and Generation of Medical Support Capacity (NO. 20WQ008) and Chongqing Special Project on Technological Foresight and Institution Innovation (NO. cstc2019jsyj-zzysbAX0037). We are also deeply grateful to prof. Ying Li and prof. Xia Zhang for their constructive suggestions to improve the manuscript.

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Yang, Y., Tan, X., Shi, Y. et al. What are the core concerns of policy analysis? A multidisciplinary investigation based on in-depth bibliometric analysis. Humanit Soc Sci Commun 10 , 190 (2023). https://doi.org/10.1057/s41599-023-01703-0

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Research Article

Moderating role of political stability and economic policy uncertainty between country governance practice and stock market performance. A comparative analysis of Pakistan and Kurdistan Region of Iraq

Roles Conceptualization, Data curation, Funding acquisition, Investigation, Writing – original draft

* E-mail: [email protected] (RSM); [email protected] (MW)

Affiliation Department of Business Administration, Faculty of Humanities and Social Sciences, Koya University, Kurdistan Region—F.R. Iraq

Roles Funding acquisition, Investigation, Methodology, Writing – original draft

Roles Conceptualization, Methodology, Software

Affiliation College of Political Sciences, Salahaddin University-Erbil, Kurdistan Region—F.R. Iraq

Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Writing – original draft

Affiliation Department of Management Sciences, UE Business School, University of Education, Lahore, Punjab, Pakistan

Roles Conceptualization, Formal analysis, Methodology, Software

Affiliation UE Business School, Division of Management and Administrative Sciences, University of Education, Lahore, Pakistan

• Rekurd S. Maghdid, 
• Saeed Mohammed Kareem, 
• Yaseen Salih Hama, 
• Muhammad Waris, 
• Rana Tahir Naveed

• Published: April 16, 2024
• https://doi.org/10.1371/journal.pone.0301698
• Peer Review
• Reader Comments

The objective of the study is to explore the relationship between country governance practices along with political stability and Economic policy uncertainty, and stock market performance of two different economies, Pakistan and Kurdistan region of Iraq. To meet our objectives, we used the 25 years past data from 1996 to 2021. Data is collected from the DataStream database. The regression analysis is used as the method of estimation for linear and moderation effect. Our results show that regulatory quality, rules of law and political stability has significant positive relationship with stock market performance of Pakistan, but all the governance indicators have significant positive relationship with stock market performance of the Kurdistan Region of Iraq. Moreover, political stability has significant moderating impact between the governance practices and the performance of the stock markets of both economies indicating that the governance practices perform well with the political stability that leads to rise in the stock market indices of selected countries. Economic policy uncertainty has significant negative moderation impact due to creating the risk in both economies that decrease the performance of the stock markets of the selected economies. Finally, our study advocated some implications for the investors to increase their confidence on the stock of high political stability and low economic policy uncertainty economies. Government can take significant measures to control the uncertainty of the policy and portfolio managers can adjust their risk on the ground of the political stability and efficient governance practices countries.

Citation: Maghdid RS, Kareem SM, Salih Hama Y, Waris M, Naveed RT (2024) Moderating role of political stability and economic policy uncertainty between country governance practice and stock market performance. A comparative analysis of Pakistan and Kurdistan Region of Iraq. PLoS ONE 19(4): e0301698. https://doi.org/10.1371/journal.pone.0301698

Editor: Evan Poh Hock Lau, Universiti Malaysia Sarawak, MALAYSIA

Received: October 24, 2023; Accepted: March 20, 2024; Published: April 16, 2024

Copyright: © 2024 Maghdid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information file.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

1. Introduction

Stock market fluctuation is the main concern around the globe due to the stock market is the barometer of economy. The stock market is affected by different factors such as crisis, pandemics, environmental policies, economic policies and political stability. On the grounds of the getting more significance around the globe, in the range of finance and investing, understanding the dynamics of stock market performance is critical. This study is important in assisting investors, policymakers, and financial institutions in making educated decisions on portfolio management, risk management, and capital allocation. This study can help to more effective investment strategies, economic policy development, and improved risk management by shedding light on the intricate interplay of factors driving stock market behavior, thereby benefiting both individual investors and the broader financial ecosystem.

The relationship between country governance practices and market performance is a complex issue, and it significantly depending on the country and the specific culture related to the governance practices. Governance practices have a significant impact on a country’s economy. The weak governance practices lead to uncertainty, lack of investment, and a decrease or increase in economic growth [ 1 ]. Political instability can take many forms, including coups, civil war, and protests. It can lead to a lack of confidence in the government, which in turn can lead to a decrease in investment and economic growth. This can be seen in the stock market, as investors may be hesitant to invest in a country with political instability. Control of corruption also affects the stock market performance. The regulatory quality within the economy may affect the performance of the financial markets.

Moreover, analyzing the relationship between country governance practices and stock market performance is vital for investors and policymakers alike. Effective governance, encompassing political stability, regulatory transparency, and the rule of law, is a key determinant of a country’s economic health. Countries with sound governance practices often attract more foreign and domestic investment, fostering confidence in financial markets. Additionally, governance influences the formulation and consistency of economic policies, directly impacting market dynamics. Understanding this connection enables investors to assess risks, make informed decisions, and navigate volatile market conditions, while policymakers can identify areas for improvement to create an environment conducive to sustainable economic growth and a robust stock market. In essence, examining the nexus between governance and stock market performance provides valuable insights into the broader economic landscape, aiding stakeholders in optimizing their financial strategies and fostering long-term economic stability.

The relationship between political stability and economic policy uncertainty holds paramount importance in influencing financial markets. Political stability serves as a linchpin for financial market confidence, creating an environment where investors feel secure in committing capital for the long term. A stable political climate minimizes the risk of abrupt policy changes, expropriation, or political turmoil, providing a foundation for sustained economic growth and investment. Conversely, economic policy uncertainty can significantly impact financial markets, introducing volatility and complicating decision-making for investors. Clarity and predictability in economic policies are crucial, as uncertainty can lead to hesitancy, market fluctuations, and potential disruptions. As such, the delicate balance between political stability and economic policy certainty is a critical factor in shaping investor sentiment, determining capital flows, and ultimately influencing the overall health and resilience of financial markets.

However, the impact of economic policy uncertainty on stock market performance is an important another research issue because it dives into the complex interaction that exists between government policies and financial markets. Investors, policymakers, and economists must all understand how swings in economic policy uncertainty affect stock prices, trading volumes, and market volatility. This research could help investors make more informed decisions and policymakers design policies that promote market stability and economic growth by providing valuable insights into the extent to which government decisions and policy changes can disrupt or stabilize financial markets.

Pakistan and the Kurdistan Region of Iraq were chosen for a comparative analysis because of their distinct economic, geopolitical, and financial characteristics, which make them compelling cases for studying the moderating role of political stability and economic policy uncertainty between country governance practices and stock market performance. As a South Asian economy with a broad market, Pakistan is subject to the interaction of geopolitical factors, domestic political dynamics, and varying governance styles operations [ 2 ]. Meanwhile, the Kurdistan Region of Iraq presents a unique setting, being an autonomous region within Iraq with specific economic policies and geopolitical considerations [ 3 ]. Both regions have encountered periods of political instability and economic policy changes, offering a rich landscape to examine how these factors moderate the relationship between governance practices and stock market performance. Additionally, the contrast in their economic structures and geopolitical contexts provides an opportunity to draw insightful comparisons, contributing to a nuanced understanding of the complex dynamics between governance, political stability, economic policies, and financial markets in diverse geopolitical settings.

The two distinct regions belong to emerging economies with different political, economic, and cultural context gain little attention in the previous literature that provides interesting research gap for investigation. Therefore, this study first aim is to investigate the governance mechanism and stock market performance of Pakistan and Kurdistan Region of Iraq. Moreover, we contributed to the previous literature that governance practice in both economies is different due to the economy structure, politics and cultural aspects. Secondly, these two countries faced strong effects of the political instability and the other issue of the governance practices from last decades that create the significant consequences to the neighborhood countries, the discussion of the trend of the governance is very interesting and taking the World governance indicators (WGI) create another gap for research and develop another research objective for the current study. In this regard, our study contributed to the previous literature that effective governance practices along with political stability contribute positive consequences on the stock market’s performance. Moreover, the study also contributed to the existing literature that political stability is necessary with other factors to stabilize and growth of the stock market especially in the emerging economy. The moderating impact of the economic policy uncertainty between corporate governance practices and stock market performance has limited evidence in the previous literature, but this study extracts the gap and contributed that the economic policy uncertainty creates the risk in stock markets and decrease the investors confidence that leads to lower stock market performance. Moreover, the methodological approach through robustness analysis makes more rigor to the study.

Investigating the moderating role in Pakistan and the Kurdistan Region of Iraq is crucial for understanding how political stability and economic policy uncertainty shape the relationship between governance and stock markets, providing insights essential for informed investment decisions and policy formulation in dynamically changing geopolitical and economic landscapes. The comparative analysis enhances the study’s significance by offering a nuanced understanding of the diverse influences on stock market performance in these distinct regions. Therefore, the findings of the study have important implications for investors, policymakers, and businesses. Investors may adjust their investment strategies based on the findings. The weak governance practices related to political instability, rules of law, control of corruption, voice and accountability reduce the investors’ confidence due to high political risk, potentially leading to capital outflows and lower demand for stocks [ 4 ]. Policymakers may consider implementing policies to make improvements in governance mechanisms and promote stability in the economy especially in high economic uncertainty. The regulators and government make measures to reduce corruption, improve governance, and enhance political stability, all of which could contribute to better stock market performance. Businesses may adjust their strategies based on the findings [ 5 ].

With the wide range of its scope, this study provides new insight on the country governance, stock market performance, political stability and economic policy uncertainty. Moreover, two distinctive economy is selected as sample on the ground of different culture, political structure and economic condition. This study covers the country governance measures such as voice and accountability, rules of law, regulatory quality, effective government policies, political stability and control of corruption. Similarly, the economic policy uncertainty is also included in the study for evaluating provides the guidelines for the investors and other stakeholders. Moreover, the comprehensive analysis by including wide range of data from both developed and emerging economy stock markets and governance create the limitation and provide the future research suggestion.

The rest of the article is organized as follows: Section 2 provides a thorough overview of contemporary research and theoretical underpinnings, as well as the introduction of different hypotheses for testing, all with the goal of throwing light on the variables. Section 3 provides an overview of the conceptual framework, research design, and methods. Section 4 presents the study’s findings, while Section 5 includes the conclusion, future research proposals, limitation, and practical implications.

2. Theoretical and empirical literature review

The economic theories such as the rational expectations theory, portfolio theory, agency theory, and efficient market hypothesis, provide insights into how country governance related to political unrest, regulatory quality, rules of law and others impact stock market performance. The rational expectations theory suggests that stock market investors base their decisions on rational expectations of future events. Weak governance practices create uncertainty and increase the perceived risk of investing, leading to cautious decision-making by investors and a decline in stock market performance [ 5 ]. The eventuality about the outcome of political events, such as elections or government changes, impact investors’ expectations about future economic conditions and corporate earnings, leading to changes in stock prices and overall stock market performance.

The portfolio theory suggests that investors hold a diversified portfolio of stocks to minimize risk. However, uncertainty of the governance and economic indicators increase the overall risk of investing in a particular country or region, leading to a decrease in demand for stocks from that area and a decline in stock market performance [ 6 ]. Investors may become more risk-averse during times of political instability and weak regulatory quality, which leads to reduced demand for stocks and a subsequent decrease in stock prices [ 6 ].

The agency theory suggests that investors are concerned with the actions of management and government officials who can impact a company’s financial performance. Uncertainty led to changes in government policies, regulations, and leadership, which can negatively impact companies’ financial performance and reduce stock market returns [ 4 ]. Moreover, [ 4 ] also suggested that Investors may become concerned about the stability and predictability of the business environment during times of political instability, leading to a decline in stock market performance.

The efficient market hypothesis suggests that financial markets are efficient and reflect all available information. However, political instability creates uncertainty and information asymmetry, leading to market inefficiencies and a decline in stock market performance. For example, political events may trigger emotional responses among investors, leading to market reactions that may not be fully rational [ 2 ]. This can result in deviations from market efficiency and impact stock prices.

Moreover, these economic theories provide insights into how political instability and economic uncertainty impact stock market performance via the governance practices through various channels, including uncertainty, risk, expectations formation, and market efficiency. Uncertainty reducing demand for stocks, impacting companies’ financial performance, creating risk and information asymmetry, and influencing investors’ decision-making behavior. However, it’s important to note that the moderation of political stability and economic policy uncertainty with stock market performance is complex and it is influenced by other factors as well. Further research is needed to better understand the dynamics of this relationship and its implications for financial markets.

There are several studies that justify the relationship between governance indicator of the country and its stock market performance. The regulatory framework embedded within the economy serves as the structural underpinning for business entities, facilitating their operations and various undertakings. Empirical and theoretical literature abounds with substantial evidence elucidating the intricate relationship between regulatory quality and stock market performance across diverse economies. In the study by [ 7 ], it was revealed that regulatory quality had an adverse impact on the stock market, as indicated by various markers, including renewable energy sources, among others. Different sectors are affiliated with distinct business activities, yet stringent regulations governing these activities often result in diminished business operations, stemming from both local and international regulatory constraints. Conversely, [ 8 ] identified a positive correlation between regulatory quality and stock market prices, underscoring the pivotal role effective regulation plays in ensuring a harmonious flow of economic resources, subsequently fostering business growth and augmenting stock market returns. Therefore, previous literature has the gap in the literature that the regulatory quality effect the stock markets with different ways. On the ground of the previous evidence in literature, we developed the following Hypothesis related to regulatory quality.

• H1 : There is positive relationship between regulatory quality and stock market performance of Pakistan and Kurdistan region of Iraq.

Numerous scholars have probed the multifaceted effects of regulatory quality on various facets of stock market operation and performance, offering valuable insights into the imperative nature of sound regulation [ 9 ]. Further research by [ 10 ] has substantiated that diminished levels of “voice and accountability” exert a detrimental influence on stock market development, investor confidence, and market integrity. In countries where civic participation is limited and government accountability wanes, investor trust may be undermined, leading to suboptimal stock market performance, as demonstrated by [ 11 ]. Moreover, the free economy without any collapse make more improvement in the stock market [ 12 ]. Corruption has garnered substantial scrutiny with respect to its repercussions on stock market performance, and prior research has conducted an exhaustive exploration of this interconnection. Corruption can inflict damage across various dimensions of stock market operations and results, as underscored by investigations [ 13 ]. Therefore, there is gap in the existing literature related to the relationship between control of corruption and voice accountability, and stock market performance in selected regions are found. Moreover, on the ground of the previous literature, we developed the following hypothesis.

• H2 : There is positive relationship between Control of Corruption and stock market performance of Pakistan and Kurdistan region of Iraq.
• H3 : There is positive relationship between Voice and accountability and stock market performance of Pakistan and Kurdistan region of Iraq.

Prior research has homed in on the ramifications of efficacious government policies on the stock market. Scholars have delved into the ways in which diverse government policies shape the outcomes of stock markets, shedding light on the pivotal role of robust policy frameworks in fostering a well-operating stock market. A multitude of studies, exemplified by the work of [ 14 ], have unearthed a nexus between sound government policies and stock market performance. The findings of [ 15 ] underscored that countries characterized by proactive and supportive government policies tend to yield stock markets that are more substantial, liquid, and operationally efficient. Therefore, the underlying studies provides the gap for further investigation. On the grounds of the previous empirical and theoretical literature, we developed the following hypothesis.

• H4 : There is positive relationship between Government effectiveness and stock market performance of Pakistan and Kurdistan region of Iraq.
• H5 : Rules of law has significant positive impact on the stock market performance of Pakistan and Kurdistan region of Iraq.

There have been several studies that have examined the impact of political instability on the economy through the use of MSCI index values. [ 16 ] found that political instability in emerging markets has a significant negative impact on stock market performance as measured by the MSCI Emerging Markets Index. Moreover, every economy show different behavior at different time domain [ 17 , 18 ]. found that political instability in emerging markets has a significant negative impact on the performance of the MSCI Emerging Markets Index. The study found that political instability was negatively correlated with MSCI index values, and again that this relationship was stronger in more developed countries. The study also found that political instability had a greater negative impact on the MSCI Emerging Markets Index than on the MSCI World Index. [ 19 ] found that political instability in emerging markets has a significant negative impact on the performance of the MSCI Emerging Markets Index. Therefore, from the previous literature, we extract that the political stability may moderating impact between the governance practices and the stock market performance on the ground of the political instability is the significant problem especially in the merging and underdeveloped countries. On the grounds of the previous literature, we developed the following hypothesis related to political stability.

• H6 : There is positive relationship between Political stability and stock market performance of Pakistan and Kurdistan region of Iraq.
• H7 : Political stability has significant moderating impact between governance practices and stock market performance in two distinctive regions.

Economic policy uncertainty indeed exert a negative impact on stock market performance [ 20 ]. When there is a lack of clarity and stability in economic policies, investors often become more risk-averse, leading to increased market volatility and reduced stock prices [ 20 ]. Uncertainty surrounding policies related to taxation, trade, fiscal stimulus, or regulatory changes can make it challenging for businesses to plan and make strategic decisions. In such an environment, investors may hesitate to commit capital, which can result in lower stock prices and subdued market activity. Moreover, heightened economic policy uncertainty can undermine consumer and investor confidence, which further dampens economic growth and, consequently, stock market performance. Therefore, the previous literature has the gap related to the moderating impact of the economic policy uncertainty for further investigation in two regions study. It’s essential for policymakers to provide clear, consistent, and stable economic policies to mitigate these adverse effects and promote a more favorable stock market environment. Moreover, investors want to manage their risk [ 21 ]. On the ground of the previous literature, we developed the following hypothesis,

• H8 : Economic policy uncertainty has a significant negative impact on the stock market performance.
• H9 : Economic policy uncertainty has significant moderating impact between governance practices and stock market performance in two distinctive regions.

3. Research design

This study covers two region Pakistan and Kurdistan in which peoples of the economy faced the many distresses period due to the economic, social and cultural aspect. To meet our objectives of the study, we used the 25 years quantitative based secondary data from 1996 to 2021 on an annual basis. From all emerging economies, the reason for the selection of both economies on the ground of the rapid change in their politics regime. Another reason Both Pakistan and Iraq have experienced significant political and social challenges, such as conflicts, which could make them relevant choices for a study on conflict resolution, security, or post-conflict reconstruction. The data of the MSCI indices of these two economies are collected from the DataStream database. The WGI indicators data is collected from the world bank data portal ( https://info.worldbank.org/governance/wgi/ ). Moreover, the data of the economic policy uncertainty are collected from the database ( https://www.policyuncertainty.com/ ). The Conceptual model developed on the basis of the previous theory and literature are given in Fig 1 .

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• TIFF original image

https://doi.org/10.1371/journal.pone.0301698.g001

The Ordinary Least Squares (OLS) method is a frequently used statistical strategy in business analysis, used to assess the relationship between a dependent variable and one or more independent variables. OLS is frequently used in regression analysis to determine both the magnitude and direction of the associations between variables [ 20 ]. In another study used OLS regression analysis to examine the relationship between ethical leadership and employee well-being [ 23 ]. Furthermore, the OLS method has found widespread application in business analysis, where it is critical in evaluating varied linkages and providing valuable insights for decision-making. Its versatility and user-friendliness have made it a popular technique used by both researchers and practitioners. Furthermore, regression analysis is a powerful tool for analyzing data, allowing predictions and predicting of future patterns. Numerous studies have demonstrated the utility of regression analysis in a variety of sectors, including finance, economics, and medical. For example, a recent study investigated the relationship between economic growth and foreign direct investment (FDI) in the ASEAN region. The researchers used multiple regression analysis to analyze the data [ 24 ].

https://doi.org/10.1371/journal.pone.0301698.t001

Another used regression analysis to examine the relationship between stock market returns and exchange rates in China ([ 25 ]. In the field of medicine, a study used regression analysis to analyze data on patient satisfaction with healthcare services [ 26 ]. These studies demonstrate the usefulness of regression analysis in diagnosing the relationship between two or more variables in a range of fields. It allows researchers to identify significant relationships and make informed decisions based on data-driven insights. This study utilizes quantitative methodology, analyzing time-series data on a key economic indicator, namely the Stock Market. Moreover, the research employs a descriptive study approach to investigate the impact of different governance indicators effects in the Kurdistan Region of Iraq (KRI) and Pakistan on the economy and the mechanisms through which such instability affects economic outcomes. To carry out this investigation, the study draws on data from the MSCI index and the WGI indicators for the KRI and Pakistan.

4. Empirical findings and discussion

Table 2 signifies descriptive statistics for our study for the data of Pakistan. Control of corruption has means value of -0.93 that indicating the week governance towards corruption control by the Government of Pakistan. Government effectives has the mean value of -0.781 that also indicating the week performance of the Pakistan towards government effective policies. The MSCI index has an average of 2.333. Pakistan has average score of the political stability of -2.190 that indicating the week performance and Rules of law has means value of -0.919 and Regulatory quality has also mean value in negative that indicate the week governance within Pakistan. Voice and accountability have a mean value is -0.861 that also indicates the week performance towards the voice and accountability score. Moreover, Iraq all the Governance indicators has mean value in negative that shows the week performance towards control of corruption, government effective policy making, rules of law and other. Control of corruption has a mean value -1.38 and Government effectiveness has mean value -1.4190. Political stability has -2.28 and regulatory quality has also -1.35 respectively.

https://doi.org/10.1371/journal.pone.0301698.t002

Table 3 shows the correlation matrix of the data of Pakistan and Kurdistan (Iraq), all variables correlation value is less than 0.80, indicating the low correlation existed between them and fit for the analysis. The criterion of the high correlation is 0.80, if any value of the correlation between two variables is greater than this criterion then we should remove the correlation through different methods then we run the analysis.

https://doi.org/10.1371/journal.pone.0301698.t003

Results and findings

In our regression analysis that shown in Table 4 related to Pakistan, Government effectiveness has not significant relationship due to cultural differences across the country. In Pakistan Political stability, rules of law and voice and accountability has significant at 1% level of the significance that indicate the increase in these indicators lead to rise the stock market index of Pakistan stock exchange.

https://doi.org/10.1371/journal.pone.0301698.t004

In our results related to the KRI in Table 4 , all the World governance indicators has significant at 1%, 5%, and 10% levels and has positive impact on the stock market performance, indicating that when there is the good governance mechanism within the economy including the political stability then there is positive impact on the indices. When all indicators improved then Stock market indices of the Iraq improved.

Table 5 represents the moderating impact of political stability to enhance the relationship between country governance practices and the stock market performance. Our findings shows that the political stability has significant positive moderating impact between Pakistan and KRI governance practices and their stock market performance. It means that the control of corruption with political stability promotes the financial market that leads to the growth of the financial market. When a country effectively manages corruption and fosters a stable political environment, it instills confidence in investors, both domestic and foreign, by ensuring a level playing field and protection of their rights. Such conditions also enable greater transparency, bolster the rule of law, and encourage long-term investment. As a result, these critical factors attract capital, stimulate economic growth, and facilitate the development of a vibrant and robust financial market that plays a fundamental role in channeling resources, facilitating economic expansion, and creating opportunities for businesses and individuals, ultimately contributing to broader economic prosperity. Therefore our findings are justified with the findings of the [ 27 ].

https://doi.org/10.1371/journal.pone.0301698.t005

Moreover, our findings shows that the government effectiveness with political stability increase the stock market indices of Pakistan and KRI. It means that a government that efficiently executes its policies and regulations provides a conducive environment for businesses, which in turn attracts both domestic and foreign investments. This heightened investor confidence, coupled with political stability, reduces uncertainty and risk in the market. As a result, stock market indices tend to rise as businesses thrive, the rule of law is upheld, and economic growth ensues. Political stability further encourages long-term investment strategies, contributing to the upward trajectory of stock market indices. In essence, a well-functioning government and political stability are crucial factors that can instill trust, attract capital, and foster growth in stock markets, reflecting the overall health and optimism in the national economy. In this way, our findings are similar with the findings of the [ 28 ].

Our findings shows that the regulatory quality with political stability increase the stock market indices of Pakistan and Kurdistan region of Iraq. In Pakistan, a regulatory framework that promotes transparency, investor protection, and fair market practices, when coupled with political stability, can attract local and foreign investors. It enhances trust and confidence in the market, leading to increased capital inflow and improved stock market performance. Similarly, in the Kurdistan region of Iraq, where political stability has been historically tenuous due to regional conflicts, a robust regulatory environment can mitigate some of the associated risks and help attract investment. By upholding transparency and the rule of law, regulatory quality complements political stability, fostering economic growth and encouraging long-term investments. In both regions, the convergence of regulatory quality and political stability is instrumental in elevating stock market indices, reflecting a positive outlook for investors and the overall economic environment. Similarly, our findings are justified with the previous findings of the [ 29 ].

Similarly, our findings show that the rules of law and voice and accountability with political stability increase the stock market. A strong rule of law ensures that contracts are enforced, property rights are protected, and disputes are resolved impartially, providing a dependable foundation for investment. Voice and accountability mechanisms enable citizens to participate in the decision-making process and hold their government accountable, leading to stable governance and more predictable economic policies. Political stability complements these factors by reducing uncertainty and risk for investors. When these elements work in synergy, they build investor confidence, encourage capital inflow, and create an environment conducive to sustainable economic growth, all of which ultimately contributes to the growth and prosperity of the stock market. Similarly, [ 30 ] also find the similar results that justify our findings with solid reason.

Table 6 shows the findings of the moderating impact of the economic policy uncertainty that leads to decrease the stock market performance of both selected countries. It means that Corruption control is essential for a functioning stock market because it develops investor confidence and maintains a level playing field. However, when combined with considerable economic policy uncertainty, it might have a negative impact on stock market performance. Uncertainty in economic policy, such as abrupt and unforeseen changes in rules or fiscal policies, generates an atmosphere of instability and risk for investors. Therefore, our findings are justified through the findings of [ 31 ]. Even in a low-corruption environment, economic policy uncertainty can discourage investment and distort market dynamics. Investors may become reluctant, and corporations may postpone financial decisions, both of which can have a negative impact on stock market performance [ 32 ]. To create the conditions for a healthy stock market, reducing corruption must be accompanied by stable and transparent economic policies.

https://doi.org/10.1371/journal.pone.0301698.t006

Moreover, our results show that the Government effectiveness, rules of law and regulatory quality with economic policy uncertainty decrease the stock market performance. It indicates that Effective governance, legal frameworks, and quality regulations support investor confidence and provide a predictable market environment. Economic policy uncertainty, as manifested by abrupt changes in fiscal or regulatory policies, adds a degree of risk and unpredictability. Investors are more cautious, and corporations may postpone investments and financial choices, lowering stock market performance. The tension between robust institutional foundations and economic policy uncertainty can erode trust and upset market dynamics, highlighting the importance of consistent and transparent economic policies to support a thriving stock market.

5. Summary and conclusions

This study examines the relationship between the country governance practices and the stock market performance of the Pakistan and Iraq. Moreover, this study also investigated the moderating impact of political stability and economic policy uncertainty. Our study finds the positive impact of the governance indicators on the stock market performance, but its relationship varies across the country as we can see in our analysis related to Pakistan and Kurdistan region of Iraq. The effect of the governance indicators is different in both countries with similar directions that shows the cultural and governance variance across the nations. From our findings of the regression without moderation, we concluded that the disparities in socioeconomic, cultural, and institutional circumstances, governance methods have diverse effects across countries. The efficiency of governance measures can be influenced by a country’s history, economic development, and institutional maturity. Furthermore, cultural norms, political institutions, and social dynamics all influence how governance methods are viewed and implemented, as well as their impact on economic and social results. As a result of these contextual differences, what may be good governance techniques in one country may not deliver the same outcomes in another.

Moreover, our study shows that political stability is the dominant factor that increase the effect of the governance mechanism. From our findings we concluded that in a politically stable environment, governance measures can be consistently implemented and enforced, ensuring that they have a more significant impact on economic and social outcomes. Stability also fosters confidence among investors and the general population, facilitating the acceptance and adherence to governance principles, which in turn promotes their overall success. Additionally, political stability often leads to more predictable policymaking, aligning governance practices with long-term objectives and thus magnifying their positive effects on a country’s development.

However, the economic policy uncertainty creates the risk for the investors that lead to decrease the stock market indices. Our findings show that the governance indicators become weak with the economic policy uncertainty. We conclude that the Governance indicators tend to weaken when economic policy uncertainty is high. Elevated economic policy uncertainty can disrupt the consistent implementation of governance measures, leading to inconsistent enforcement and diminishing their overall effectiveness. Additionally, such uncertainty can erode investor confidence and trust in governance institutions, making it harder to achieve their intended goals. In this context, maintaining stable and predictable economic policies is essential to support and strengthen governance indicators.

The findings of the study have important implications for investors, policymakers, and businesses. Investors may adjust their investment strategies based on the findings. The weak governance practices related to political instability, rules of law, control of corruption, voice and accountability reduce the investors’ confidence due to high political risk, potentially leading to capital outflows and lower demand for stocks (Koepke, 2019). Policymakers may consider implementing policies to make improvements in governance mechanisms and promote stability in the economy especially in high economic uncertainty. The regulators and government make measures to reduce corruption, improve governance, and enhance political stability, all of which could contribute to better stock market performance. Businesses may adjust their strategies based on the findings. Moreover, the government can control the economic policy uncertainty by timely making decision and its implementations.

Due to the limitations some economic indicators such as GDP, foreign investment, and the fiscal policy determinants are not taken into account. Therefore, future research may be conducted on these indicators to assess the relation with stock market performance. Moreover, in this study only two economies selected due to data limitations, but future research may be conducted on the Asian as well as other developed economies across different regions. The stock market volatility due to different crises and pandemics should be investigated related to stock market performance in future research.

Supporting information

S1 dataset..

https://doi.org/10.1371/journal.pone.0301698.s001

• View Article
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• 7. Costantiello, A. and A. Leogrande, The Regulatory Quality and ESG Model at World Level. Available at SSRN 4388957, 2023
• 11. Shah A., Performance accountability and combating corruption. 2007: World Bank Publications.
• PubMed/NCBI

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PUBPOL 4960

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PUBPOL 4960 State Policy and Advocacy Clinic I

Course description.

Course information provided by the Courses of Study 2023-2024 . Courses of Study 2024-2025 is scheduled to publish mid-June.

We will learn how to design and advocate for specific state-level public policies by practicing these skills before the legislative and administrative branches of the State of New York. In consultation with the professor, student teams will design public policy proposals based on a review of the academic, governmental and think tank literature; conversations with subject matter experts at Cornell and various NGOs; research and analysis of similar proposals in other states and countries; conversations with state and local policymakers; and discussions with community members and organizations, including community partners with lived experience. Although we will engage in policy design and advocacy primarily in New York State, we will also provide research and policy design services to stakeholders in other states, especially when a comparative or multi-state approach offers strategic benefits.

When Offered Fall.

Permission Note Enrollment limited to: third-year and fourth-year students.

• Develop a strong understanding of state and local politics in New York, the extent to which legislative and administrative institutions and machinery mold political choices, and the extent to which political considerations influence the menu of viable policy choices. Build a theoretical and practical understanding of legislative and administrative process in New York and other states.
• Develop a strong understanding of state and local politics in New York, the extent to which legislative and administrative institutions and machinery mold political choices, and the extent to which political considerations influence the menu of viable policy choices.
• Develop the legal research and reasoning skills needed to engage in comparative state policy analysis; develop a basic understanding of state and federal constitutional constraints on legislative and administrative decision-making.
• Develop the policy research, design and reasoning skills needed to design and evaluate various policy alternatives. Gain an introduction to basic legislative or regulatory drafting skills.
• Design, in teams, a creative, compelling, and politically viable state legislative, or administrative solution to a pressing public policy challenge, based on a review of the academic, government and think tank literature, comparative state and country policy research, discussions with subject matter experts, and conversations with community partners and leaders, including community members with lived experience.

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  Regular Academic Session.   Combined with: PUBPOL 5960

Credits and Grading Basis

4 Credits GradeNoAud (Letter grades only (no audit))

Class Number & Section Details

11207 PUBPOL 4960   SEM 101

Meeting Pattern

• TR 8:00am - 9:55am To Be Assigned
• Aug 26 - Dec 9, 2024

Instructors

Dufresne, A

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Instruction Mode: In Person Enrollment limited to juniors and seniors. Application required to enroll. Application deadline 12:00pm April 30th. https://cornell.ca1.qualtrics.com/jfe/form/SV_4ZxK6sABymFppky

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