what is thematic literature review

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How to Write a Thematic Literature Review: A Beginner’s Guide

Literature reviews provide a comprehensive understanding of existing knowledge in a particular field, offer insights into gaps and trends, and ultimately lay the foundation for innovative research. However, when tackling complex topics spanning multiple issues, the conventional approach of a standard literature review might not suffice. Many researchers present a literature review without giving any thought to its organization or structure, but this is where a thematic literature review comes into play. In this article, we will explore the significance of thematic reviews, delve into how and when to undertake them, and offer invaluable guidance on structuring and crafting a compelling thematic literature review.

Table of Contents

What is a thematic literature review?

A thematic literature review, also known as a thematic review, involves organizing and synthesizing the existing literature based on recurring themes or topics rather than a chronological or methodological sequence. Typically, when a student or researcher works intensively on their research there are many sub-domains or associated spheres of knowledge that one encounters. While these may not have a direct bearing on the main idea being explored, they provide a much-needed background or context to the discussion. This is where a thematic literature review is useful when dealing with complex research questions that involve multiple facets, as it allows for a more in-depth exploration of specific themes within the broader context.

When to opt for thematic literature review?

It is common practice for early career researchers and students to collate all the literature reviews they have undertaken under one single broad umbrella. However, when working on a literature review that involves multiple themes, lack of organization and structure can slow you down and create confusion. Deciding to embark on a thematic literature review is a strategic choice that should align with your research objectives. Here are some scenarios where opting for a thematic review is advantageous:

• Broad Research Questions: When your research question spans across various dimensions and cannot be adequately addressed through a traditional literature review.
• Interdisciplinary Research: In cases where your research draws from multiple disciplines, a thematic review helps in synthesizing diverse literature cohesively.
• Emerging Research Areas: When exploring emerging fields or topics with limited existing literature, a thematic review can provide valuable insights by focusing on available themes.
• Complex Issues: Thematic reviews are ideal for dissecting complex issues with multiple contributing factors or dimensions.

Advantages of a Thematic Literature Review

With better comprehension and broad insights, thematic literature reviews can help in identifying possible research gaps across themes. A thematic literature review has several advantages over a general or broad-based approach, especially for those working on multiple related themes.

• It provides a comprehensive understanding of specific themes within a broader context, allowing for a deep exploration of relevant literature.
• Thematic reviews offer a structured approach to organizing and synthesizing diverse sources, making it easier to identify trends, patterns, and gaps.
• Researchers can focus on key themes, enabling a more detailed analysis of specific aspects of the research question.
• Thematic reviews facilitate the integration of literature from various disciplines, offering a holistic view of the topic.
• Researchers can provide targeted recommendations or insights related to specific themes, aiding in the formulation of research hypotheses.

Now that we know the benefits of a thematic literature review, what is the best way to arrange reviewed literature in a thematic format?

How to write a thematic literature review

To effectively structure and write a thematic literature review, follow these key steps:

• Define Your Research Question: Clearly define the overarching research question or topic you aim to explore thematically. When writing a thematic literature review, go through different literature review sections of published research work and understand the subtle nuances associated with this approach.
• Identify Themes: Analyze the literature to identify recurring themes or topics relevant to your research question. Categorize the bibliography by dividing them into relevant clusters or units, each dealing with a specific issue. For example, you can divide a topic based on a theoretical approach, methodology, discipline or by epistemology. A theoretical review of related literature for example, may also look to break down geography or issues pertaining to a single country into its different parts or along rural and urban divides.
• Organize the Literature: Group the literature into thematic clusters based on the identified themes. Each cluster represents a different aspect of your research question. It is up to you to define the different narratives of thematic literature reviews depending on the project being undertaken; there is no one formal way of doing this. You can weigh how specific areas stack up against others in terms of existing literature or studies and how many more aspects may need to be added or further looked into.
• Review and Synthesize: Within each thematic cluster, review and synthesize the relevant literature, highlighting key findings and insights. It is recommended to identify any theme-related strengths or weaknesses using an analytical lens.
• Integrate Themes: Analyze how the themes interact with each other, draw linkages between earlier studies and see how they contribute to your own research. A thematic literature review presents readers with a comprehensive overview of the literature available on and around the research topic.
• Provide a Framework: Develop a framework or conceptual model that illustrates the relationships between the themes. Present the most relevant part of the thematic review toward the end and study it in greater detail as it reflects the literature most relevant and directly related to the main research topic.
• Conclusion: Conclude your thematic literature review by summarizing the key findings and their implications for your research question. Be sure to highlight any gaps or areas requiring further investigation in this section.
• Cite and Reference: It is important to remember that a thematic review of literature for a PhD thesis or research paper lends greater credibility to the student or researcher. So ensure that you properly cite and reference all sources according to your chosen citation style.
• Edit and Proofread: Take some time to review your work, ensure proper structure and flow and eliminate any language, grammar, or spelling errors that could deviate reader attention. This will help you deliver a well-structured and elegantly written thematic literature review.

Thematic literature review example

In essence, a thematic literature review allows researchers to dissect complex topics into smaller manageable themes, providing a more focused and structured approach to literature synthesis. This method empowers researchers to gain deeper insights, identify gaps, and generate new knowledge within the context of their research.

To illustrate the process mentioned above, let’s consider an example of a thematic literature review in the context of sustainable development. Imagine the overarching research question is: “What are the key factors influencing sustainable urban planning?” Potential themes could include environmental sustainability, social equity, economic viability, and governance. Each theme would have a dedicated section in the review, summarizing relevant literature and discussing how these factors intersect and impact sustainable urban planning. Close with a strong conclusion that highlights research gaps or areas of investigation. Finally, review and refine the thematic literature review, adding citations and references as required.

In conclusion, when tackling multifaceted research questions, a thematic literature review proves to be an indispensable tool for researchers and students alike. By adopting this approach, scholars can navigate the intricate web of existing literature, unearth meaningful patterns, and contribute to the advancement of knowledge in their respective fields. We hope the information in this article helps you create thematic reviews that illuminate your path to new discoveries and innovative insights.

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . Fourth edition. Thousand Oaks, CA: SAGE, 2014.

Importance of a Good Literature Review

A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

• Give a new interpretation of old material or combine new with old interpretations,
• Trace the intellectual progression of the field, including major debates,
• Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
• Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.

Given this, the purpose of a literature review is to:

• Place each work in the context of its contribution to understanding the research problem being studied.
• Describe the relationship of each work to the others under consideration.
• Identify new ways to interpret prior research.
• Reveal any gaps that exist in the literature.
• Resolve conflicts amongst seemingly contradictory previous studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way in fulfilling a need for additional research.
• Locate your own research within the context of existing literature [very important].

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper. 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . Los Angeles, CA: SAGE, 2011; Knopf, Jeffrey W. "Doing a Literature Review." PS: Political Science and Politics 39 (January 2006): 127-132; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012.

Types of Literature Reviews

It is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the primary studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally among scholars that become part of the body of epistemological traditions within the field.

In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews. Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are a number of approaches you could adopt depending upon the type of analysis underpinning your study.

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

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

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

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

Systematic Review This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyze data from the studies that are included in the review. The goal is to deliberately document, critically evaluate, and summarize scientifically all of the research about a clearly defined research problem . Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?" This type of literature review is primarily applied to examining prior research studies in clinical medicine and allied health fields, but it is increasingly being used in the social sciences.

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

NOTE: Most often the literature review will incorporate some combination of types. For example, a review that examines literature supporting or refuting an argument, assumption, or philosophical problem related to the research problem will also need to include writing supported by sources that establish the history of these arguments in the literature.

Baumeister, Roy F. and Mark R. Leary. "Writing Narrative Literature Reviews."  Review of General Psychology 1 (September 1997): 311-320; Mark R. Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Kennedy, Mary M. "Defining a Literature." Educational Researcher 36 (April 2007): 139-147; Petticrew, Mark and Helen Roberts. Systematic Reviews in the Social Sciences: A Practical Guide . Malden, MA: Blackwell Publishers, 2006; Torracro, Richard. "Writing Integrative Literature Reviews: Guidelines and Examples." Human Resource Development Review 4 (September 2005): 356-367; Rocco, Tonette S. and Maria S. Plakhotnik. "Literature Reviews, Conceptual Frameworks, and Theoretical Frameworks: Terms, Functions, and Distinctions." Human Ressource Development Review 8 (March 2008): 120-130; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

Structure and Writing Style

I.  Thinking About Your Literature Review

The structure of a literature review should include the following in support of understanding the research problem :

• An overview of the subject, issue, or theory under consideration, along with the objectives of the literature review,
• Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
• An explanation of how each work is similar to and how it varies from the others,
• Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research.

The critical evaluation of each work should consider :

• Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
• Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
• Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Persuasiveness -- which of the author's theses are most convincing or least convincing?
• Validity -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

II.  Development of the Literature Review

Four Basic Stages of Writing 1.  Problem formulation -- which topic or field is being examined and what are its component issues? 2.  Literature search -- finding materials relevant to the subject being explored. 3.  Data evaluation -- determining which literature makes a significant contribution to the understanding of the topic. 4.  Analysis and interpretation -- discussing the findings and conclusions of pertinent literature.

Consider the following issues before writing the literature review: Clarify If your assignment is not specific about what form your literature review should take, seek clarification from your professor by asking these questions: 1.  Roughly how many sources would be appropriate to include? 2.  What types of sources should I review (books, journal articles, websites; scholarly versus popular sources)? 3.  Should I summarize, synthesize, or critique sources by discussing a common theme or issue? 4.  Should I evaluate the sources in any way beyond evaluating how they relate to understanding the research problem? 5.  Should I provide subheadings and other background information, such as definitions and/or a history? Find Models Use the exercise of reviewing the literature to examine how authors in your discipline or area of interest have composed their literature review sections. Read them to get a sense of the types of themes you might want to look for in your own research or to identify ways to organize your final review. The bibliography or reference section of sources you've already read, such as required readings in the course syllabus, are also excellent entry points into your own research. Narrow the Topic The narrower your topic, the easier it will be to limit the number of sources you need to read in order to obtain a good survey of relevant resources. Your professor will probably not expect you to read everything that's available about the topic, but you'll make the act of reviewing easier if you first limit scope of the research problem. A good strategy is to begin by searching the USC Libraries Catalog for recent books about the topic and review the table of contents for chapters that focuses on specific issues. You can also review the indexes of books to find references to specific issues that can serve as the focus of your research. For example, a book surveying the history of the Israeli-Palestinian conflict may include a chapter on the role Egypt has played in mediating the conflict, or look in the index for the pages where Egypt is mentioned in the text. Consider Whether Your Sources are Current Some disciplines require that you use information that is as current as possible. This is particularly true in disciplines in medicine and the sciences where research conducted becomes obsolete very quickly as new discoveries are made. However, when writing a review in the social sciences, a survey of the history of the literature may be required. In other words, a complete understanding the research problem requires you to deliberately examine how knowledge and perspectives have changed over time. Sort through other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to explore what is considered by scholars to be a "hot topic" and what is not.

III.  Ways to Organize Your Literature Review

Chronology of Events If your review follows the chronological method, you could write about the materials according to when they were published. This approach should only be followed if a clear path of research building on previous research can be identified and that these trends follow a clear chronological order of development. For example, a literature review that focuses on continuing research about the emergence of German economic power after the fall of the Soviet Union. By Publication Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on environmental studies of brown fields if the progression revealed, for example, a change in the soil collection practices of the researchers who wrote and/or conducted the studies. Thematic [“conceptual categories”] A thematic literature review is the most common approach to summarizing prior research in the social and behavioral sciences. Thematic reviews are organized around a topic or issue, rather than the progression of time, although the progression of time may still be incorporated into a thematic review. For example, a review of the Internet’s impact on American presidential politics could focus on the development of online political satire. While the study focuses on one topic, the Internet’s impact on American presidential politics, it would still be organized chronologically reflecting technological developments in media. The difference in this example between a "chronological" and a "thematic" approach is what is emphasized the most: themes related to the role of the Internet in presidential politics. Note that more authentic thematic reviews tend to break away from chronological order. A review organized in this manner would shift between time periods within each section according to the point being made. Methodological A methodological approach focuses on the methods utilized by the researcher. For the Internet in American presidential politics project, one methodological approach would be to look at cultural differences between the portrayal of American presidents on American, British, and French websites. Or the review might focus on the fundraising impact of the Internet on a particular political party. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Other Sections of Your Literature Review Once you've decided on the organizational method for your literature review, the sections you need to include in the paper should be easy to figure out because they arise from your organizational strategy. In other words, a chronological review would have subsections for each vital time period; a thematic review would have subtopics based upon factors that relate to the theme or issue. However, sometimes you may need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. However, only include what is necessary for the reader to locate your study within the larger scholarship about the research problem.

Here are examples of other sections, usually in the form of a single paragraph, you may need to include depending on the type of review you write:

• Current Situation : Information necessary to understand the current topic or focus of the literature review.
• Sources Used : Describes the methods and resources [e.g., databases] you used to identify the literature you reviewed.
• History : The chronological progression of the field, the research literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Selection Methods : Criteria you used to select (and perhaps exclude) sources in your literature review. For instance, you might explain that your review includes only peer-reviewed [i.e., scholarly] sources.
• Standards : Description of the way in which you present your information.
• Questions for Further Research : What questions about the field has the review sparked? How will you further your research as a result of the review?

IV.  Writing Your Literature Review

Once you've settled on how to organize your literature review, you're ready to write each section. When writing your review, keep in mind these issues.

Use Evidence A literature review section is, in this sense, just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence [citations] that demonstrates that what you are saying is valid. Be Selective Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the research problem, whether it is thematic, methodological, or chronological. Related items that provide additional information, but that are not key to understanding the research problem, can be included in a list of further readings . Use Quotes Sparingly Some short quotes are appropriate if you want to emphasize a point, or if what an author stated cannot be easily paraphrased. Sometimes you may need to quote certain terminology that was coined by the author, is not common knowledge, or taken directly from the study. Do not use extensive quotes as a substitute for using your own words in reviewing the literature. Summarize and Synthesize Remember to summarize and synthesize your sources within each thematic paragraph as well as throughout the review. Recapitulate important features of a research study, but then synthesize it by rephrasing the study's significance and relating it to your own work and the work of others. Keep Your Own Voice While the literature review presents others' ideas, your voice [the writer's] should remain front and center. For example, weave references to other sources into what you are writing but maintain your own voice by starting and ending the paragraph with your own ideas and wording. Use Caution When Paraphrasing When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. Even when paraphrasing an author’s work, you still must provide a citation to that work.

V.  Common Mistakes to Avoid

These are the most common mistakes made in reviewing social science research literature.

• Sources in your literature review do not clearly relate to the research problem;
• You do not take sufficient time to define and identify the most relevant sources to use in the literature review related to the research problem;
• Relies exclusively on secondary analytical sources rather than including relevant primary research studies or data;
• Uncritically accepts another researcher's findings and interpretations as valid, rather than examining critically all aspects of the research design and analysis;
• Does not describe the search procedures that were used in identifying the literature to review;
• Reports isolated statistical results rather than synthesizing them in chi-squared or meta-analytic methods; and,
• Only includes research that validates assumptions and does not consider contrary findings and alternative interpretations found in the literature.

Cook, Kathleen E. and Elise Murowchick. “Do Literature Review Skills Transfer from One Course to Another?” Psychology Learning and Teaching 13 (March 2014): 3-11; Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . London: SAGE, 2011; Literature Review Handout. Online Writing Center. Liberty University; Literature Reviews. The Writing Center. University of North Carolina; Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: SAGE, 2016; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012; Randolph, Justus J. “A Guide to Writing the Dissertation Literature Review." Practical Assessment, Research, and Evaluation. vol. 14, June 2009; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016; Taylor, Dena. The Literature Review: A Few Tips On Conducting It. University College Writing Centre. University of Toronto; Writing a Literature Review. Academic Skills Centre. University of Canberra.

Writing Tip

Break Out of Your Disciplinary Box!

Thinking interdisciplinarily about a research problem can be a rewarding exercise in applying new ideas, theories, or concepts to an old problem. For example, what might cultural anthropologists say about the continuing conflict in the Middle East? In what ways might geographers view the need for better distribution of social service agencies in large cities than how social workers might study the issue? You don’t want to substitute a thorough review of core research literature in your discipline for studies conducted in other fields of study. However, particularly in the social sciences, thinking about research problems from multiple vectors is a key strategy for finding new solutions to a problem or gaining a new perspective. Consult with a librarian about identifying research databases in other disciplines; almost every field of study has at least one comprehensive database devoted to indexing its research literature.

Frodeman, Robert. The Oxford Handbook of Interdisciplinarity . New York: Oxford University Press, 2010.

Another Writing Tip

Don't Just Review for Content!

While conducting a review of the literature, maximize the time you devote to writing this part of your paper by thinking broadly about what you should be looking for and evaluating. Review not just what scholars are saying, but how are they saying it. Some questions to ask:

• How are they organizing their ideas?
• What methods have they used to study the problem?
• What theories have been used to explain, predict, or understand their research problem?
• What sources have they cited to support their conclusions?
• How have they used non-textual elements [e.g., charts, graphs, figures, etc.] to illustrate key points?

When you begin to write your literature review section, you'll be glad you dug deeper into how the research was designed and constructed because it establishes a means for developing more substantial analysis and interpretation of the research problem.

Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1 998.

Yet Another Writing Tip

When Do I Know I Can Stop Looking and Move On?

Here are several strategies you can utilize to assess whether you've thoroughly reviewed the literature:

• Look for repeating patterns in the research findings . If the same thing is being said, just by different people, then this likely demonstrates that the research problem has hit a conceptual dead end. At this point consider: Does your study extend current research?  Does it forge a new path? Or, does is merely add more of the same thing being said?
• Look at sources the authors cite to in their work . If you begin to see the same researchers cited again and again, then this is often an indication that no new ideas have been generated to address the research problem.
• Search Google Scholar to identify who has subsequently cited leading scholars already identified in your literature review [see next sub-tab]. This is called citation tracking and there are a number of sources that can help you identify who has cited whom, particularly scholars from outside of your discipline. Here again, if the same authors are being cited again and again, this may indicate no new literature has been written on the topic.

Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: Sage, 2016; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

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How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

Psst… there’s more!

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

27 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

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.

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 summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write 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, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will 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 scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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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 objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. 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 if 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 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 use boolean operators to help narrow down your search:

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.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

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?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• 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 find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

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’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference 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.

You can use our free APA Reference Generator for quick, correct, consistent citations.

To begin organising your literature review’s argument and structure, you need to 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 organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

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 summarising sources in order.

Try to analyse 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 organise 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.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

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, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, 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 transitions and topic sentences to draw connections, comparisons and contrasts.

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

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

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 dissertation , thesis, research paper , or proposal .

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

• To familiarise 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  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

Cite this Scribbr article

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How to Write a Literature Review

• What Is a Literature Review
• What Is the Literature

Writing the Review

Why Are You Writing This?

There are two primary points to remember as you are writing your literature review:

• Stand-alone review: provide an overview and analysis of the current state of research on a topic or question
• Research proposal: explicate the current issues and questions concerning a topic to demonstrate how your proposed research will contribute to the field
• Research report: provide the context to which your work is a contribution.
• Write as you read, and revise as you read more. Rather than wait until you have read everything you are planning to review, start writing as soon as you start reading. You will need to reorganize and revise it all later, but writing a summary of an article when you read it helps you to think more carefully about the article. Having drafts and annotations to work with will also make writing the full review easier since you will not have to rely completely on your memory or have to keep thumbing back through all the articles. Your draft does not need to be in finished, or even presentable, form. The first draft is for you, so you can tell yourself what you are thinking. Later you can rewrite it for others to tell them what you think.

General Steps for Writing a Literature Review

Here is a general outline of steps to write a thematically organized literature review. Remember, though, that there are many ways to approach a literature review, depending on its purpose.

• Stage one: annotated bibliography. As you read articles, books, etc, on your topic, write a brief critical synopsis of each. After going through your reading list, you will have an abstract or annotation of each source you read. Later annotations are likely to include more references to other works since you will have your previous readings to compare, but at this point the important goal is to get accurate critical summaries of each individual work.
• Stage two: thematic organization. Find common themes in the works you read, and organize the works into categories. Typically, each work you include in your review can fit into one category or sub-theme of your main theme, but sometimes a work can fit in more than one. (If each work you read can fit into all the categories you list, you probably need to rethink your organization.) Write some brief paragraphs outlining your categories, how in general the works in each category relate to each other, and how the categories relate to each other and to your overall theme.
• Stage three: more reading. Based on the knowledge you have gained in your reading, you should have a better understanding of the topic and of the literature related to it. Perhaps you have discovered specific researchers who are important to the field, or research methodologies you were not aware of. Look for more literature by those authors, on those methodologies, etc. Also, you may be able to set aside some less relevant areas or articles which you pursued initially. Integrate the new readings into your literature review draft. Reorganize themes and read more as appropriate.
• Stage four: write individual sections. For each thematic section,  use your draft annotations (it is a good idea to reread the articles and revise annotations, especially the ones you read initially) to write a section which discusses the articles relevant to that theme. Focus your writing on the theme of that section, showing how the articles relate to each other and to the theme, rather than focusing your writing on each individual article. Use the articles as evidence to support your critique of the theme rather than using the theme as an angle to discuss each article individually.
• Stage five: integrate sections. Now that you have the thematic sections, tie them together with an introduction, conclusion, and some additions and revisions in the sections to show how they relate to each other and to your overall theme.

Specific Points to Include

More specifically, here are some points to address when writing about specific works you are reviewing. In dealing with a paper or an argument or theory, you need to assess it (clearly understand and state the claim) and analyze it (evaluate its reliability, usefulness, validity). Look for the following points as you assess and analyze papers, arguments, etc. You do not need to state them all explicitly, but keep them in mind as you write your review:

• Be specific and be succinct. Briefly state specific findings listed in an article, specific methodologies used in a study, or other important points. Literature reviews are not the place for long quotes or in-depth analysis of each point.
• Be selective. You are trying to boil down a lot of information into a small space. Mention just the most important points (i.e. those most relevant to the review's focus) in each work you review.
• Is it a current article? How old is it? Have its claims, evidence, or arguments been superceded by more recent work? If it is not current, is it important for historical background?
• What specific claims are made? Are they stated clearly?
• What evidence, and what type (experimental, statistical, anecdotal, etc) is offered? Is the evidence relevant? sufficient?
• What arguments are given? What assumptions are made, and are they warranted?
• What is the source of the evidence or other information? The author's own experiments, surveys, etc? Historical records? Government documents? How reliable are the sources?
• Does the author take into account contrary or conflicting evidence and arguments? How does the author address disagreements with other researchers?
• What specific conclusions are drawn? Are they warranted by the evidence?
• How does this article, argument, theory, etc, relate to other work?

These, however, are just the points that should be addressed when writing about a specific work. It is not an outline of how to organize your writing. Your overall theme and categories within that theme should organize your writing, and the above points should be integrated into that organization. That is, rather than write something like:

     Smith (2019) claims that blah, and provides evidence x to support it, and says it is probably because of blip. But Smith seems to have neglected factor b.      Jones (2021) showed that blah by doing y, which, Jones claims, means it is likely because of blot. But that methodology does not exclude other possibilities.      Johnson (2022) hypothesizes blah might be because of some other cause.

list the themes and then say how each article relates to that theme. For example:

     Researchers agree that blah (Smith 2019, Jones 2021, Johnson 2022), but they do not agree on why. Smith claims it is probably due to blip, but Jones, by doing y, tries to show it is likely because of blot. Jones' methodology, however, does not exclude other possibilities. Johnson hypothesizes ...

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• Last Updated: Jan 11, 2024 9:48 AM
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How To Structure and Write a Thematic Literature Review: A Beginner’s Guide

Introduction to Thematic Literature Review

First of all, what is a Thematic literature review? A thematic literature review is like sorting and studying different stories about the same topic. It helps researchers understand the big ideas in a field by grouping similar information. This way of reviewing literature is neat because it lets you see patterns and gaps in research. It’s like putting puzzle pieces together to get a clear picture of what’s known and what questions still need answers. So, it’s a way to organise and understand lots of information about a particular theme in a simple and smart manner.

Table of Contents

In this blog, we will guide you through the process of structuring a perfect thematic literature review. Starting with tips on topic selection and conducting a thorough literature search, we delve into techniques for organising and presenting findings cohesively. Emphasising the importance of a well-structured review, the blog aims to enhance the credibility of academic research by providing clear insights into crafting a comprehensive and impactful thematic literature review.

Understanding Thematic Literature Reviews

A thematic literature review is like a superhero, who’s out there, helping researchers and writers make sense of a bunch of information in an organised way. It’s a special way of looking at what other smart people have written about a specific topic. Imagine gathering puzzle pieces together, the review helps put them together to see the whole picture. So, its first job is to find common themes or ideas in all the studies, sort of like finding similar colours in the puzzle pieces.

Now, why is this superhero review so important? Well, it helps researchers know what’s already known in a certain area, finding the cool stuff and the missing bits. This is super handy because it guides them in figuring out what new questions to ask or what’s still a mystery. It’s like a treasure map for researchers, helping them see where the unexplored territories are.

In writing, this review helps make academic work more believable and strong. It shows that the writer really knows what’s going on in the subject and can connect all the ideas in a clear way. So, this superhero review is like a map, guide, and puzzle solver all in one, making research and writing way cooler and smarter.

Importance of a Well-Structured Review

A well-structured thematic literature review is super important because it’s like building a strong and smart foundation for research. Just like a good house needs a solid base, a clear and organised review makes research trustworthy. It helps people see the patterns and gaps in what’s already known, guiding researchers to ask the right questions. When it’s well-organised, like putting puzzle pieces together neatly, it makes the whole study look polished and sharp. So, the importance is like having a superhero sidekick – it supports and boosts the quality of research, making it reliable and impressive.

Preparing for Your Thematic Literature Review

Preparing a thematic literature review is like getting ready for a long journey, not the boring ones. First, pick a topic you’re interested in – your theme. Then, go on a hunt for information using keywords and checking out different sources. Organise what you find by grouping similar ideas together, like sorting treasures. Write short summaries for each group to remember the cool stuff. It’s like making a map. Finally, put it all together in a clear order. Imagine you’re telling a friend the coolest parts of your adventure. That’s it! You’ve prepared a thematic literature review, turning a bunch of information into a smart and organised story.

Selecting Your Topic

Choosing a topic is like picking your favourite game to play. First, think about what really interests you- something that makes you curious. It could be whatever is best for you. Then, check if there’s enough information about it. If there is, great! If not, maybe choose something related. Make sure it’s not too big or too small, just like picking the right-sized puzzle, as mentioned above. And most importantly, pick something you enjoy because researching a topic you like is like playing your favourite game- it’s fun and exciting! So, go for a topic that sparks your curiosity and joy.

Conducting a Comprehensive Literature Search

To conduct a comprehensive literature search, begin by defining specific keywords related to your topic. Use various platforms such as online databases and libraries to explore relevant sources. Focus on gathering pertinent and up-to-date information, paying attention to publication dates. Check reference lists for additional sources. Keep your search broad initially, then narrow down to the most relevant and valuable pieces of literature- it works. Stay organised by using tools like citation management software. This systematic approach ensures a thorough exploration of existing knowledge on your chosen theme, laying a solid foundation for a well-informed thematic literature review.

Reviewing and Organizing Literature

Reviewing and organising literature involves systematically examining and categorising information. Begin by thoroughly reading each piece to grasp its main ideas. Group similar concepts together, creating distinct categories or sections. Consider using tools like spreadsheets or note-taking methods for efficient organisation. Ensure easy retrieval of information when needed.

This process facilitates a clear understanding of patterns and connections within the literature, streamlining the writing process for each identified theme or category. The emphasis is on a structured and methodical approach to handling the gathered information, fostering clarity and coherence in your thematic literature review.

Crafting the Structure

Crafting the structure is like building a strong house for your ideas. Begin with an introduction, introducing your main themes or topics. Imagine it as the front door welcoming readers. Then, organise your themes logically, like arranging rooms so everything makes sense. Each theme gets its section, creating a clear flow. Write summaries for each theme, acting like labels on different rooms. Connect themes smoothly, so it feels like moving through the house effortlessly. Finally, conclude by summarising the main points, like a closing statement. Crafting the structure is about creating a well-organised home for your ideas, making it easy for others to navigate.

Introduction to Thematic Categories

Introducing thematic categories involves defining and presenting the main topics or themes that will be explored in your literature review. It’s like providing a roadmap for readers. Begin by clearly identifying each theme, offering a concise overview of what each section will cover. This introduction sets the stage for the reader, helping them understand the structure and focus of your thematic literature review. It’s akin to creating signposts that guide readers through the distinct categories, ensuring a clear and organised presentation of information. In essence, this section serves as a preview, laying the foundation for a cohesive exploration of each thematic category.

Organising Themes

Organising themes is about systematically arranging and structuring the identified topics or concepts within your literature review. Start by grouping similar themes together, creating a logical and coherent structure. It’s like sorting items into distinct categories for better clarity. Each theme should have its own section, allowing for a focused exploration. Consider the flow between themes, ensuring a smooth transition from one to the next. This organisation is essential for readers to follow and understand the progression of ideas. By effectively organising themes, you provide a structured framework that enhances the overall coherence and impact of your thematic literature review.

Writing the Literature Review

Writing the literature review is like telling a story about your themes. Begin by summarising key points for each theme, keeping it short and clear. It’s like giving a snapshot of each chapter in your story. Connect themes smoothly, creating a natural flow, similar to linking chapters in a book. Use simple language to explain complex ideas, ensuring your story is easy to follow. Be sure to highlight important findings and gaps in research, adding depth to your narrative. Writing the literature review is about crafting a compelling and straightforward tale of what’s known and what questions remain in your chosen thematic landscape.

Common Pitfalls to Avoid

Avoiding common pitfalls in a thematic literature review is crucial for a successful and credible exploration. First, steer clear of bias by maintaining objectivity and fairness. Ensure the inclusion of recent sources to stay updated and relevant. Diversify your sources to prevent over-reliance on a specific type, promoting a comprehensive view. Critically evaluate each source for reliability and relevance. Organise your themes systematically to enhance clarity and understanding. Resist the temptation to overload your review with excessive information, prioritising relevance and conciseness. By addressing these pitfalls, your thematic literature review will stand out for its reliability, coherence, and focused exploration of the chosen theme.

Editing and Refining Your Review

Editing and refining your thematic literature review is a crucial step to enhance its quality. Begin by checking for and correcting any spelling and grammar errors to ensure clarity. Review the overall structure of your review to confirm that themes are logically organized, creating a coherent flow. Trim unnecessary details to maintain focus and relevance. Evaluate the clarity and conciseness of your sentences, avoiding unnecessary complexity. Seek feedback from others to gain different perspectives and identify areas for improvement. This process is essential for fine-tuning your literature review, making it a polished and effective piece of scholarly work.

In wrapping up this journey through crafting a perfect thematic literature review, think of it like putting the finishing touches on a well-prepared meal. We’ve explored selecting engaging topics, navigating the treasure hunt of literature searches, and meticulously organizing themes. Crafting a structured and clear narrative, while avoiding common pitfalls, was our recipe. Editing and refining became the final seasoning, ensuring our literary dish is not just informative but also delightful to consume. Remember, a thematic literature review isn’t just a collection of facts; it’s your story within the broader academic conversation. So, as you venture into your own review, think of it as telling your unique tale, contributing a piece to the grand mosaic of knowledge. Happy writing!

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What is a thematic literature review?

A thematic literature review is an organized summary of existing research that focuses on identifying and analyzing common themes or topics across various studies within a specific field.

How do I select a topic for my thematic literature review?

Choose a topic that genuinely interests you, ensuring there’s enough relevant literature available. Keep it manageable- not too broad or too narrow- and align it with your research goals.

Why is organizing themes important in a literature review?

Organizing themes systematically enhances the clarity and coherence of your review. It helps readers follow the logical progression of ideas and makes your review more accessible and impactful.

What common pitfalls should I avoid in a thematic literature review?

Steer clear of bias, include recent sources, diversify your references, critically evaluate each source, maintain a clear structure, and avoid information overload. These practices contribute to a more reliable and effective literature review.

What is thematic analysis in literature?

Thematic analysis in literature involves identifying, analyzing, and reporting patterns or themes within data. It’s a method for organizing and interpreting various aspects of a text or a collection of texts, helping to understand overarching ideas or themes within the literature.

What are the steps for conducting a thematic literature review?

The steps include selecting a topic, conducting a comprehensive literature search, reading and evaluating sources, identifying and categorizing themes, synthesizing findings, and writing the review while maintaining a coherent structure that reflects the identified themes.

What are the best practices in thematic literature analysis?

Best practices involve systematically organizing and categorizing your data, maintaining an unbiased approach, using a mix of deductive and inductive reasoning, staying open to emerging themes, and backing your analysis with evidence from the literature.

How does thematic literature review differ from a systematic literature review?

A thematic literature review focuses on identifying themes and patterns across a range of literature and is more interpretive. In contrast, a systematic literature review follows a strict methodology to find and analyze all relevant studies on a specific question, aiming for comprehensiveness and minimizing bias.

How can I identify themes in a literature review?

Identify themes by closely reading your sources and noting recurring ideas, concepts, or patterns. Group similar findings together and label each group with a theme that represents the underlying concept. Refine these themes as you delve deeper into your reading.

What is the methodology of a thematic literature review?

The methodology includes defining the scope and objectives of the review, developing a search strategy, selecting relevant literature, analyzing and categorizing the literature into themes, and synthesizing the findings in a structured narrative.

Can you give tips for effective thematic literature research?

Sure! Focus on a well-defined research question, use diverse sources, maintain a systematic approach in searching and analyzing literature, remain adaptable to emerging themes, and critically evaluate and synthesize your findings.

What role does thematic literature review play in qualitative research?

In qualitative research, a thematic literature review helps to understand the broader context of a topic, identify trends and patterns in qualitative studies, and inform the development of research questions and methodologies.

Where can I find examples of thematic literature reviews?

Examples of thematic literature reviews can be found in academic journals, particularly those focused on qualitative research methodologies. University libraries, online databases like JSTOR , Google Scholar , and specific academic websites also provide access to such reviews.

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• Locations and Hours
• UCLA Library
• Research Guides
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Systematic Reviews

• Types of Literature Reviews

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

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

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

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• Next: Planning Your Systematic Review >>
• Last Updated: Jul 23, 2024 3:40 PM
• URL: https://guides.library.ucla.edu/systematicreviews

Academic Writing & Research

An online resource for students and researchers

Thematic Literature Review: A Beginner’s Guide

A thematic literature review is a powerful tool for synthesizing and analyzing existing research within a specific thematic framework. It enables researchers to explore key themes, patterns, and trends across a body of literature, providing valuable insights and understanding in a particular field or topic. In this beginner’s guide, we’ll delve into the essential steps and strategies for crafting a compelling thematic literature review.

Understanding Thematic Literature Reviews:

A thematic literature review focuses on identifying, analyzing, and synthesizing common themes, concepts, or patterns within a body of literature related to a specific research topic or question. Unlike traditional narrative reviews, which provide a chronological overview of literature, thematic reviews organize and categorize information based on thematic connections and relationships.

Steps to Write a Thematic Literature Review:

Define Your Research Question and Objectives:

• Clearly define your research question or topic of interest that will guide the thematic review.
• Determine the specific objectives or goals of the review, such as identifying themes, exploring relationships, or evaluating gaps in knowledge.

Conduct a Comprehensive Literature Search:

• Use academic databases, journals, books, and other sources to gather relevant literature related to your research topic.
• Employ keyword searches, Boolean operators, and advanced search techniques to identify key studies and resources.

Select and Evaluate Relevant Literature:

• Evaluate the quality, relevance, and credibility of each source based on criteria such as authorship, methodology, research design, and publication date.
• Select literature that directly contributes to addressing your research question and thematic focus.

Organize Literature Based on Themes:

• Identify common themes, concepts, or patterns emerging from the selected literature.
• Create a thematic framework or coding scheme to categorize and organize literature based on thematic connections and relationships.

Synthesize and Analyze Themes:

• Analyze each theme or category in-depth, summarizing key findings, arguments, and perspectives from the literature.
• Identify similarities, differences, contradictions, and gaps within and across themes to develop a comprehensive understanding of the research landscape.

Write the Thematic Literature Review:

• Structure the review based on thematic categories or sections, clearly labelling and defining each theme.
• Provide a synthesis of findings, discussing the implications, significance, and contributions of each theme to the research topic.

Include Critical Reflection and Discussion:

• Critically reflect on the strengths, limitations, and methodological considerations of the reviewed literature.
• Engage in a thoughtful discussion of the implications, theoretical frameworks, and future research directions based on the thematic analysis.

Use Clear and Concise Writing Style:

• Write in a clear, concise, and organized manner, presenting information logically and cohesively.
• Use transitions, signposts, and citations to guide readers through the thematic review and connect ideas seamlessly.

Tips for Writing a Compelling Thematic Literature Review:

• Stay Focused: Maintain focus on the thematic analysis and avoid unnecessary tangents or deviations from the main themes.
• Engage Critically: Critically evaluate and analyze literature, offering insights, interpretations, and evaluations within each theme.
• Provide Evidence: Support your analysis and arguments with evidence, citations, and references from the reviewed literature.
• Be Objective: Maintain objectivity and impartiality in presenting and interpreting findings, avoiding bias or personal opinions.
• Revise and Edit: Revise and edit your thematic review for clarity, coherence, and accuracy, ensuring that it meets scholarly standards and expectations.

Conclusion:

Crafting a thematic literature review requires careful planning, thorough research, critical analysis, and effective synthesis of findings. By following the steps outlined in this beginner’s guide and incorporating tips for writing a compelling thematic review, researchers can create a valuable scholarly contribution that enhances understanding, identifies trends, and informs future research in their field of study. Remember to approach the thematic review process with curiosity, rigour, and attention to detail, striving to uncover meaningful insights and contribute to the advancement of knowledge within your research area.

Recommended reading

Greetham, B. (2020). How to write your literature review. Macmillan (Click to view on Amazon #Ad)

This engaging guide by bestselling author Bryan Greetham takes students step-by-step through the process of writing a literature review, and equips them with practical strategies to help them navigate each stage. Each bite-sized chapter focuses on a specific aspect of the process, from generating ideas and pinning down the research problem through to searching for sources, citing references and planning, writing and editing the review.

Posted by Glenn Stevens

Glenn is an academic writing and research specialist with 15 years experience as a writing coach and PhD supervisor. Also a qualified English teacher, he previously had an extensive career in publishing. He is currently the editor of this website. Glenn lives in the UK. Contact Glenn Useful article? Why not buy Glenn a coffee!

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Literature Review Guide: How to organise the review

• What is a Literature Review?
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How to structure your literature review (ignore the monotone voice as advice is good)

How to structure and write your literature review

• Chronological, ie. by date of publication or trend
• Methodological
• Use Cooper's taxonomy to explore and determine what elements and categories to incorporate into your review
• Revise and proofread your review to ensure your arguments, supporting evidence and writing is clear and precise

Cronin, P., Ryan, F. & Coughlan, M. (2008). Undertaking a literature review: A step-by-step approach . British Journal of Nursing, 17 (1), pp.38-43.

Different ways to organise a Literature Review

CHRONOLOGICAL (by date): This is one of the most common ways, especially for topics that have been talked about for a long time and have changed over their history. Organise it in stages of how the topic has changed: the first definitions of it, then major time periods of change as researchers talked about it, then how it is thought about today.

BROAD-TO-SPECIFIC : Another approach is to start with a section on the general type of issue you're reviewing, then narrow down to increasingly specific issues in the literature until you reach the articles that are most specifically similar to your research question, thesis statement, hypothesis, or proposal. This can be a good way to introduce a lot of background and related facets of your topic when there is not much directly on your topic but you are tying together many related, broader articles.

MAJOR MODELS or MAJOR THEORIES : When there are multiple models or prominent theories, it is a good idea to outline the theories or models that are applied the most in your articles. That way you can group the articles you read by the theoretical framework that each prefers, to get a good overview of the prominent approaches to your concept.

PROMINENT AUTHORS : If a certain researcher started a field, and there are several famous people who developed it more, a good approach can be grouping the famous author/researchers and what each is known to have said about the topic. You can then organise other authors into groups by which famous authors' ideas they are following. With this organisation it can help to look at the citations your articles list in them, to see if there is one author that appears over and over.

CONTRASTING SCHOOLS OF THOUGHT : If you find a dominant argument comes up in your research, with researchers taking two sides and talking about how the other is wrong, you may want to group your literature review by those schools of thought and contrast the differences in their approaches and ideas.

Ways to structure your Literature Review

Different ways to organise your literature review include:

• Topical order (by main topics or issues, showing relationship to the main problem or topic)
• Chronological order (simplest of all, organise by dates of published literature)
• Problem-cause-solution order
• General to specific order
• Known to unknown order
• Comparison and contrast order
• Specific to general order
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Four Ways to Structure Your Literature Review

• February 2, 2023

The literature review is a critical part of any research project. It provides a comprehensive overview of the existing body of knowledge on a topic, and how that knowledge has been developed over time.

A literature review can be structured in a number of ways, depending on the purpose and scope of the work. In general, a literature review should be organized around a central question or theme and use a logical approach to synthesizing and evaluating the existing body of work.

In determining the structure of your literature review, it is important to consider the approach you will take. 

There are four common approaches to structuring a literature review: 

• Theoretical
• Methodological
• Chronological

🚀 Pro Tip: Use our literature review AI tool to get help structuring your literature review.

What is a Literature Review?

A literature review is a written overview of the existing research on a topic. A literature review is a critical component of a dissertation, thesis, or journal article. It can be used to:

• Assess the current state of knowledge on a topic
• Identify gaps in the existing research
• Inform future research directions

The best structure for a literature review depends on the purpose of the review and the audience. Ultimately, it is up to the researcher to decide which type of literature review is best suited for their needs.

Four Common Literature Review Structures

Theoretical literature review.

A theoretical literature review is a comprehensive survey of all the theories that relate to a particular area of research. It includes both published and unpublished works and covers both classic and contemporary theory.

Theoretical literature reviews can be divided into two main types: those that focus on a specific theory, and those that adopt a more general approach. In the former case, the review will critically assess the chosen theory and evaluate its strengths and weaknesses. In the latter case, the review will survey all the major theories in the field and identify common themes and areas of disagreement.

Theoretical literature reviews can be conducted at any stage in a research project, but they are usually most helpful when developing your research question and methodology. A good theoretical literature review will help to situate your research within the wider field, and to identify the gaps in current knowledge that your research aims to fill.

Example of a Theoretical Literature Review: Burnout in nursing: A theoretical review .

Thematic Literature Review

A thematic literature review is an evaluation of existing research on a particular topic, with a focus on themes or patterns that emerge from the work as a whole. This type of review can be helpful in identifying gaps in the current body of knowledge, or in pointing out areas where future research may be needed. In order to write a successful thematic literature review, it is important to select a manageable topic and to carefully read and analyze the existing body of work on that topic. It is also crucial to identify and articulate the main theme or pattern that emerges from the literature; this will be the focus of your review.

Example of a Thematic Literature Review: The ethics of digital well-being: A thematic review .

Methodological Literature Review

A methodological literature review is a detailed and comprehensive assessment of all the research methods used in a particular area of study. It involves critically evaluating the strengths and weaknesses of different research methods, and determining which method is best suited to answering a specific research question. A methodological literature review is an important tool for any researcher, as it helps to identify the most appropriate research methods for their particular area of inquiry.

Research methods can be broadly classified into two categories: qualitative and quantitative. Qualitative methods are those that aim to gather an in-depth understanding of a phenomenon, often through interviews, observations, or case studies. Quantitative methods, on the other hand, focus on collecting large amounts of data that can be analyzed statistically. A methodological literature review might compare the findings of a single approach or compare the results that have emerged in both approaches.

Example of a Methodological Review: . A Methodological Review of Resilience Measurement Scales .

Chronological Literature Review

A chronological literature review is a type of review that looks at the development of a particular topic or idea over time. This can be helpful in understanding how an issue has evolved or changed over time and provide insights into current debates on the topic. In order to write a chronological literature review, you will need to identify and locate relevant sources that cover the topic in question. Once you have gathered your sources, you will need to read and analyze them in order to identify key trends and developments. Finally, you will need to synthesize this information in a way that tells a coherent story about the evolution of the topic.

Example of a Chronological Review: Cervical Cancer Detection Techniques: A Chronological Review .

Factors to Consider When Choosing a Literature Review Structure

When choosing a literature review structure, there are several factors to consider.

1. Purpose of the literature review. Is it to provide an overview of the field, or is it to evaluate a specific theory or research methodology?

2. Audience for the literature review. Will it be read by scholars in the field, or is it intended for a general audience?

3. Scope of the literature review. What time period should the sources cover? What types of sources do you need to identify? Are you focusing on a specific research method or theory?

4. Resources available. What sources will be used, and how will they be accessed? Will you include gray literature? Will you evaluate the quality of the sources?

With these considerations in mind, you can choose a literature review structure that best suits your needs.

Literature reviews are an essential part of any research project. Understanding the different types of structures and how to select the best structure for your specific project is key to ensuring that you create the most effective review possible. We hope this guide has given you a better understanding of what literature reviews are, how they can be used, and which type is right for your needs.

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Literature Reviews

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Organization

Organization of your Literature Review

What is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? What order should you present them?

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

Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.

Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).

Conclusions/Recommendations: Discuss what you have drawn from reviewing the literature so far. Where might the discussion proceed?

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

To help you come up with an overall organizational framework for your review, consider the following scenario and then three typical ways of organizing the sources into a review:

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

Chronological

If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.

By publication

Order your sources chronologically by publication if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.

Another way to organize sources chronologically is to examine the sources under a trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Using this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.

Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a "chronological" and a "thematic" approach is what is emphasized the most: the development of the harpoon or the harpoon technology.

More authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as "evil" in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.

Methodological

A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the "methods" of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Once you've decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

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

Current Situation: Information necessary to understand the topic or focus of the literature review.

History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.

Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

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

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Deciding between the Chronological and Thematic approaches to a Literature Review

By charlesworth author services.

• Charlesworth Author Services
• 25 June, 2022

Depending on the discipline that your research is located in and your specific research project, there are broadly two different ways in which you can approach organising, reading for and writing your literature review : either chronologically or thematically . This article explores some of the factors to consider as you begin to plan your literature review .

Note : This is not to say that you must decide on and take only one approach exclusively for the whole of the review. You may start a review thematically, but organise and review the literature within a theme in a chronological fashion, as illustrated in the examples towards the end.

Purpose of conducting a literature review

Regardless of the approach, either chronological or thematic, both have the same purpose – to contextualise and identify the need for your specific research. As such, the literature review is never purely descriptive, but should ultimately be analytical and argumentative. 

Whichever approach you take, your literature review needs to demonstrate that you have a clear understanding of the existing relevant literature in your field. You seek to acknowledge what has been accomplished, but also to identify gaps , problems or unanswered questions within these studies. Ultimately, you aim to show how your research relates to the existing body of work . In other words, this section explains how you will address those gaps or questions and how this study will contribute to and extend that knowledge.

Defining key terms and concepts for your literature review

A useful way to start your literature review is to reflect upon how a specific term or concept has been understood and how the definition has developed. You can then proceed as follows.

• Explain why and how you wish to understand, frame and engage with that term/concept for your research.
• Review the literature on the topic based on that definition or understanding of a key term.
• Assess exactly what approaches you can take to that topic – whether chronologically or thematically, theoretically and/or methodologically. 

Deciding between the approaches

Taking the chronological approach.

Where there have been clear developments sequentially, over a period of time , then it makes sense to track these developments chronologically. You establish and express your academic credibility here through your identification of the most significant and relevant authors/studies at each stage. Your readers will note whom you see as being worthy of mention and whose work you are using to contextualise your own. 

Going with the thematic approach

With this approach, you are examining and discussing existing literature/studies not by their chronological development but by the principal themes, debates, perspectives or approaches that they address. This thematic approach offers you the advantage of determining and structuring the order of themes to fit the narrative and development of your research. It also helps you to more clearly identify the links between disparate literatures , as well as to play a more actively engaged role in evaluating the literature you’ve selected. 

In this extract taken from an article on writing introductions to research articles , you can see both types of organisation being used. (Note the highlighted parts.) The first paragraph of the article is a broad thematic review of the research on journal articles. The second paragraph from this article focuses on a (mostly) chronological review but organised within themes.

Broadly thematic approach

Over the last 20 years, a large number of studies on academic writing have been devoted to the research article, in particular, its structure, social construction and historical evolution. A number of these studies have concerned themselves with the overall organization of various parts of the research article , such as the introduction (e.g. Swales, 1981, Swales, 1990, Swales and Najjar, 1987), the results sections (Brett, 1994, Thompson, 1993), discussions (Hopkins & Dudley-Evans, 1988) and even the abstracts that accompany the research articles (Salager-Meyer, 1990, Salager-Meyer, 1992). Various lexico-grammatical features of the research article (RA) have also been explored, ranging from tense choice to citation practices. Beyond the textual structure of this genre, research has also focused on the historical development of the research article (Bazerman, 1988, Atkinson, 1993, Salager-Meyer, 1999, Vande Kopple, 1998) and the social construction of this genre (Myers, 1990).

Mostly chronological approach

One aspect of the RA [research article] that has perhaps been most studied is the introduction. Since Swales’ (Swales, 1981 , Swales, 1990 ) seminal work on the move structure of RA introductions, there has been considerable interest in applying the proposed model to other sets of texts. Crookes ( 1986 ), for example, through further analysis, has pointed to the cyclical nature of introductions. Jacoby ( 1987 ) has investigated in greater detail the use of references in introductions. Scholars have also used Swales’ model to examine texts written in different languages (such as Malay and Swedish) and cultures and have concluded that RA introductions are influenced by linguistic and cultural differences (Fredrickson and swales, 1994 , Ahmad, 1997 ). There has been less research, however, on the variations in RA introductions across disciplines despite the growing interest in disciplinary differences in academic writing. Some recent studies have focused on disciplinary variation in RAs as a whole. Posteguillo’s ( 1999 ) study of RAs in computer science and Nwogu’s ( 1997 ) study of medical science nicely illustrate variations in the whole genre across disciplines and underscores the need for further research on disciplinary variation. However, there have been only a few studies which have focused primarily on the introduction. Swales and Najjar ( 1987 ) examined RAs from educational psychology and physics focusing on the presence of principal findings in Move 3 of introductions. A much more recent study by Anthony ( 1999 ) of RA introductions from engineering reveals that Swales’ Create-A-Research-Space (CARS) model does not account for some important features of the introduction, such as the presence of definitions of terms, exemplifications of difficult concepts, and evaluation of the research presented.

Whichever approach you decide to take, return frequently to the original premise of your study to keep yourself focused on exactly what you are trying to find out and what you need to know from existing literature to do that effectively. This will help you to be more selective with the literature, studies and authors you include in your own study.

Read next (second) in series: How to structure and write a Chronological Literature Review

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What Is a Literature Review?

A literature review surveys and synthesizes the scholarly research literature related to a particular topic. Literature reviews both explain research findings and analyze the quality of the research in order to arrive at new insights.

Literature reviews may describe not only the key research related to a topic of inquiry but also seminal sources, influential scholars, key theories or hypotheses, common methodologies used, typical questions asked, or common patterns of inquiry.

There are different types of literature reviews.  A narrative literature review summarizes and synthesizes the findings of numerous research articles, but the purpose and scope of narrative literature reviews vary widely. The term "literature review" is most commonly used to refer to narrative literature reviews, and these are the types of works that are described in this guide. 

Some types of literature reviews that use prescribed methods for identifying and evaluating evidence-based literature related to specific questions are known as systematic reviews or meta-analyses . Systematic reviews or meta-analyses are typically conducted by at least two scholars working in collaboration as prescribed by certain guidelines, but narrative literature reviews may be conducted by authors working alone.

Purpose of a Literature Review

Literature reviews serve an important function in developing the scholarly record. Because of the vast amount of scholarly literature that exists, it can be difficult for readers to keep up with the latest developments related to a topic, or to discern which ideas, themes, authors, or methods are worthy of more attention. Literature reviews help readers to understand and make sense of a large body of scholarship.

Literature reviews also play an important function in assessing the quality of the evidence base in relation to a particular topic. Literature reviews contain assessments of the evidence in support of particular interventions, policies, programs, or treatments.

The literature that is reviewed may include a variety of types of research, including empirical research, theoretical works, and reports of practical application. The scholarly works that are considered for inclusion in a literature review may appear in a variety of publication types, including scholarly journals, books, conference proceedings, reports, and others. 

Steps in the Process

Follow these steps to conduct your literature review:

• Select a topic and prepare for searching.  Formulate a research question and establish inclusion and exclusion criteria for your search.
• Search for and organize the research. Use tools like the library website, library-subscription databases, Google Scholar, and others to locate research on your topic.
• Organize your research, read and evaluate it, and take notes. Use organizational and note-taking strategies to read sources and prepare for writing. 
• Write and edit the paper. Synthesize information from sources to arrive at new insights.

Literature Reviews: An Overview for Graduate Students

View the video below for an overview of the process of writing literature review papers.

Video:  Literature Reviews: An Overview for Graduate Students  by  libncsu

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How to Find Themes in a Literature Review: A Comprehensive Guide

Finding themes in a literature review can seem like a big task, but it’s really about looking for patterns and ideas that come up again and again. By grouping these similar ideas together, you can see the bigger picture and understand what the research says about your topic. This guide will help you step-by-step to find and organize these themes, making your literature review clear and meaningful.

Key Takeaways

• Identify themes by closely reading your sources and noting recurring ideas, concepts, or patterns.
• Group similar findings together and label each group with a theme that represents the underlying concept.
• Refine these themes as you delve deeper into your reading.
• The steps include selecting a topic, conducting a comprehensive literature search, reading and evaluating sources, identifying and categorizing themes, synthesizing findings, and writing the review while maintaining a coherent structure that reflects the identified themes.
• Avoid common pitfalls by ensuring rigor and validity, and consider using software tools to help organize and analyze your themes.

Understanding Thematic Literature Reviews

A thematic literature review is like sorting and studying different stories about the same topic. It helps researchers understand the big ideas in a field by grouping similar information. This way of reviewing literature is neat because it lets you see patterns and gaps in research. It’s like putting puzzle pieces together to get a clear picture of what’s known and what questions still need answers. So, it’s a way to organize and understand lots of information.

Preparing for a Thematic Literature Review

Getting ready for a thematic literature review is like preparing for an exciting journey. First, you need to pick a topic that interests you. This will be your theme. Then, you go on a hunt for information using keywords and checking out different sources. Organize what you find by grouping similar ideas together, like sorting treasures. Write short summaries for each group to remember the cool stuff you found.

Identifying Themes in Literature

Close reading techniques.

To identify themes in literature, start with close reading techniques. This involves carefully reading your sources and paying attention to details. Look for recurring ideas and concepts that appear throughout the text. Take notes and highlight important passages that seem to connect to larger ideas.

Noting Recurring Ideas and Patterns

As you read, note any recurring ideas and patterns. These could be repeated phrases, concepts, or even specific words. Group similar findings together to see if they form a pattern. This step is crucial for identifying themes that are not immediately obvious.

Grouping and Labeling Themes

Once you have identified recurring ideas, group them together. Label each group with a theme that represents the underlying concept. This helps in organizing your findings and makes it easier to draw connections between different parts of the literature. Refine these themes as you delve deeper into your reading.

Synthesizing Findings and Developing Themes

Integrating themes across studies.

When you start to synthesize your findings, it's important to see how different themes interact with each other. Synthesis helps readers see where you can connect ideas from various studies. This step involves comparing and contrasting themes to understand their relationships. You should also consider how these themes answer your research question .

Drawing Linkages Between Themes

Describing how sources converse with each other is crucial. Organize similar ideas together so readers can understand how they overlap. This helps in drawing linkages between themes, making it easier to see the bigger picture. You might find that some themes support each other, while others might present conflicting viewpoints.

Refining and Finalizing Themes

After identifying and linking themes, the next step is to refine them. This involves reviewing the themes to ensure they are clear and well-defined. You may need to combine some themes or break others down into smaller parts. The goal is to present a coherent and comprehensive view of the literature that directly relates to your main research topic.

Writing and Structuring the Review

When writing your literature review , it's crucial to create a clear and logical structure. This helps make your academic work more believable and strong. A well-structured review shows that you really know what’s going on in the subject and can connect all the ideas in a clear way. This type of review acts like a map, guide, and puzzle solver all in one, making research and writing way cooler and smarter.

Crafting a Coherent Narrative

Your review should tell a story that makes sense. Start with an introduction that explains the purpose of your review. Then, move on to the main body where you discuss the themes you've identified. Finally, wrap up with a conclusion that summarizes your findings and suggests future research directions.

Organizing Themes Logically

Arrange your themes in a way that makes sense. You can use headings and subheadings to break down the information. This process facilitates a clear understanding of patterns and connections within the literature, streamlining the writing process for each identified theme or category.

Editing and Refining the Review

Once you've written your review, take the time to edit and refine it. Look for any areas that are unclear or need more explanation. Make sure your review is free of errors and flows smoothly from one section to the next. This step is crucial for ensuring that your review is both rigorous and valid.

Best Practices in Thematic Literature Analysis

Common pitfalls to avoid.

When conducting thematic analysis, it's crucial to be aware of common mistakes. One major pitfall is organizing and categorizing your data haphazardly, which can lead to confusion and misinterpretation. Another common error is allowing personal biases to influence your analysis. To avoid this, always approach your data with an open mind and be prepared to adjust your themes as new insights emerge.

Ensuring Rigor and Validity

To ensure the rigor and validity of your thematic analysis, use a mix of deductive and inductive reasoning. Deductive reasoning involves starting with a theory or hypothesis and looking for data that supports it, while inductive reasoning involves observing patterns in the data and developing theories based on those observations. Additionally, always back your analysis with evidence from the literature to strengthen your findings.

Utilizing Software Tools

Using software tools can greatly enhance the efficiency and accuracy of your thematic analysis. These tools can help you systematically organize and categorize your data, making it easier to identify and track emerging themes. Some popular software options include NVivo, ATLAS.ti, and MAXQDA. These tools offer various features that can assist in coding, visualizing, and analyzing your data, ultimately leading to more robust and reliable results.

Analyzing literature thematically can be tricky, but following best practices can make it easier. Start by identifying key themes and patterns in the text. Then, organize your findings in a clear and logical way. For more tips and detailed guides, visit our website and explore our resources. You'll find everything you need to master thematic literature analysis.

In conclusion, finding themes in a literature review is a crucial skill for any researcher. By carefully reading and analyzing your sources, you can identify recurring ideas and patterns that will help you group similar findings together. This process not only helps in organizing your review but also in providing a clear and coherent structure. Remember to refine your themes as you delve deeper into your reading to ensure they accurately represent the underlying concepts. By following the steps and best practices outlined in this guide, you can conduct a thorough and effective thematic literature review that will contribute valuable insights to your field of study.

Frequently Asked Questions

What is a thematic literature review.

A thematic literature review is a way to summarize research by finding and discussing common themes or topics across different studies in a certain field.

How do I choose a topic for my thematic literature review?

Pick a topic that interests you and has enough research available. Make sure it's not too broad or too narrow, and that it matches your research goals.

How can I identify themes in a literature review?

You can find themes by reading your sources carefully and noting ideas, concepts, or patterns that come up often. Group similar findings together and name each group with a theme that represents the main idea.

What are the steps for conducting a thematic literature review?

The steps include choosing a topic, doing a thorough literature search, reading and evaluating sources, identifying and grouping themes, combining findings, and writing the review with a clear structure that shows the themes.

Why is organizing themes important in a literature review?

Organizing themes helps make your review clearer and more understandable. It shows how different pieces of research connect and supports your overall analysis.

What common mistakes should I avoid in a thematic literature review?

Avoid picking a topic that's too broad or too narrow, not doing enough research, ignoring important themes, and not organizing your review well. Make sure to edit and refine your work to keep it clear and focused.

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The Guide to Literature Reviews

• What is a Literature Review?
• The Purpose of Literature Reviews
• Guidelines for Writing a Literature Review
• How to Organize a Literature Review?
• Software for Literature Reviews
• Using Artificial Intelligence for Literature Reviews
• How to Conduct a Literature Review?
• Common Mistakes and Pitfalls in a Literature Review
• Methods for Literature Reviews

When to conduct a systematic review?

How do systematic literature reviews differ from other reviews, how to conduct a systematic literature review.

• What is a Narrative Literature Review?
• What is a Descriptive Literature Review?
• What is a Scoping Literature Review?
• What is a Realist Literature Review?
• What is a Critical Literature Review?
• Meta Analysis vs. Literature Review
• What is an Umbrella Literature Review?
• Differences Between Annotated Bibliographies and Literature Reviews
• Literature Review vs. Theoretical Framework
• How to Write a Literature Review?
• How to Structure a Literature Review?
• How to Make a Cover Page for a Literature Review?
• How to Write an Abstract for a Literature Review?
• How to Write a Literature Review Introduction?
• How to Write the Body of a Literature Review?
• How to Write a Literature Review Conclusion?
• How to Make a Literature Review Bibliography?
• How to Format a Literature Review?
• How Long Should a Literature Review Be?
• Examples of Literature Reviews
• How to Present a Literature Review?
• How to Publish a Literature Review?

What is a Systematic Literature Review?

A systematic literature review is a structured, organized and transparent process for identifying, selecting, and critically appraising relevant research studies to answer a specific research question . Systematic reviews apply predefined criteria for selecting studies, assessing their quality, and synthesizing their findings. This rigorous methodology ensures that a literature review is exhaustive and reproducible.

At the heart of a systematic review lies a well-defined protocol that guides the entire process, from the formulation of research questions to the selection and appraisal of relevant studies. This systematic approach contrasts with other literature reviews, which may be conducted more flexibly.

The methods in a systematic literature review are designed to offer a comprehensive textual summary and synthesis of existing research, providing context and background information critical to understanding the broader research landscape. Systematic reviews are essential for informing evidence-based practices and policy decisions, as they consolidate findings from numerous studies and offer a high level of evidence.

A systematic review often follows specific guidelines such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Page et al., 2020). The guidelines ensure that reviews are conducted rigorously and reported clearly. This facilitates the replication of findings and the assessment of conclusions; while PRISMA primarily focuses on quantitative research , it has extensions like PRISMA-ScR that can apply to qualitative research . Researchers also use the Cochrane Handbook for Systematic Literature Reviews (Higgins et al., 2023) which focuses on detailed guidelines for doing systematic reviews of healthcare interventions.

Systematic reviews are often used in evidence-based research and practice, particularly in environmental science, healthcare, and social sciences. Researchers undertake these reviews to identify gaps in current evidence and suggest areas for further investigation. They are essential in developing guidelines and informing policies by providing nuanced and detailed evaluations of experiences, perceptions, and contextual factors.

Qualitative systematic reviews support grant applications by demonstrating the current state of qualitative knowledge and the need for further exploration. Organizations employ a systematic review methodology to improve practices and interventions. Public health professionals rely on qualitative systematic reviews to assess the effectiveness of interventions and shape strategies that consider the socio-cultural contexts. Regularly updating these reviews ensures that the synthesized qualitative evidence remains current, aiding in more informed and effective decision-making in various disciplines.

Systematic literature reviews differ from other types of reviews in their methodology, scope, and rigour. They follow a structured approach with clear research questions, predefined criteria, comprehensive search strategies, and systematic data extraction. Other reviews, like narrative reviews , are more flexible and less structured, often lacking predefined criteria and systematic searches.

Systematic reviews aim to cover all relevant studies on a specific question. In contrast, other reviews may focus on a narrower study scope and include studies selectively, reflecting the author's perspective. Systematic reviews also employ a systematic search strategy to cover multiple databases and grey literature sources such as government or technical reports, reducing the risk of cherry-picking studies.

Rigor is another key difference. Systematic reviews critically appraise the quality of included studies and often use statistical methods (in the case of quantitative research ) or thematic analysis to synthesize findings. Other reviews do not usually include formal quality assessments and rely more on narrative synthesis.

Reproducibility is a hallmark of systematic reviews. They document their process in detail, allowing others to replicate the study. Other reviews often lack this detailed methodology, making replication difficult and leading to potential inconsistencies.

Transparency is crucial in systematic reviews, with published protocols, documented search strategies, and clear study selection processes. Guidelines like the PRISMA checklist (Page et. al 2020) ensure thorough reporting. Other reviews do not usually follow strict guidelines and may not fully disclose their methods and criteria.

The primary objective of systematic reviews is to provide high-quality evidence, informing clinical practice, policy-making, and further research. Other reviews aim to offer overviews or summaries of the literature, providing insights and perspectives rather than systematic evidence synthesis.

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To effectively conduct a systematic literature review, it is crucial to follow a structured set of instructions that encompass comprehensive planning, rigorous methodology, and meticulous documentation. The following steps are recommended when conducting a systematic literature review:

Define the research question : Clearly state the research question(s) you intend to answer, ensuring it is specific, open-ended, and suitable for detailed exploration. This will guide all subsequent steps. For example, "How do adolescents perceive the impact of social media on their mental health?" Break down the main question into sub-questions, such as: What are the positive and negative perceptions of social media among adolescents? How do adolescents describe their emotional responses to social media interactions? What coping strategies do adolescents use to manage social media-induced stress?

Develop a protocol : Outline the methodology and criteria for your review in a detailed protocol to ensure transparency. Include background information, rationales, and clearly stated objectives. Define inclusion and exclusion criteria based on the study population, context, data collection methods, and outcomes of interest. Identify and list the databases you will search, such as PubMed , PsycINFO , and Scopus . Develop keywords and search strings using Boolean operators. Create a data extraction form to capture relevant data from each study. Optionally, register your protocol with a platform like PROSPERO for enhanced transparency.

Conduct a comprehensive literature search : Perform a thorough search across identified databases using developed keywords and search strategy. Document the search process meticulously, including search dates, databases searched, and the number of records retrieved. This ensures a comprehensive capture of relevant studies related to your research question.

Screen and select studies : Apply the inclusion and exclusion criteria to filter studies. Start with an initial screening of titles and abstracts, followed by a full-text review of remaining studies for final inclusion. Document reasons for exclusion at each stage to ensure transparency and consistency.

Assess the quality of studies : Use standardized tools, such as the Critical Appraisal Skills Programme (CASP) for qualitative studies to assess the quality of qualitative studies . Evaluate aspects like credibility, transferability, dependability, and confirmability. Ensure consistency and document the process and outcomes.

Extract data : Develop a data extraction form to systematically capture relevant data from each included study, such as study design, participant characteristics, data collection methods, themes, and findings. Use qualitative data analysis software such as ATLAS.ti for coding and theme identification.

Analyze and synthesize data : Identify and synthesize key themes and patterns across studies. Conduct a meta-synthesis to integrate findings and provide a comprehensive understanding of the research question. Ensure a thorough synthesis to highlight variations and commonalities across studies.

Report findings : Follow a structured format including an introduction, methods, results, discussion, and conclusion. Adhere to PRISMA guidelines (Page et. al 2020) for transparent reporting. Use tables, figures, and flow diagrams to illustrate findings and the study selection process.

Discuss implications : Interpret the findings within the context of existing literature, acknowledging limitations and suggesting areas for future research. Provide recommendations based on gathered evidence.

Update and maintain the review : Consider periodic updates as new studies become available to ensure findings remain current. Set up database alerts to stay informed about new research.

A systematic literature review rigorously answers specific research questions by evaluating and synthesizing evidence from multiple studies, providing comprehensive context and background information. Unlike other literature reviews, systematic review protocols follow a structure with predefined criteria, ensuring exhaustive and reproducible results. They adhere to guidelines like PRISMA (Page et. al 2020) for thorough reporting and trustworthy conclusions. Systematic reviews are essential in healthcare and social sciences because they help identify evidence gaps and inform policies. Regular updates keep the evidence current, supporting effective decision-making across various disciplines.

Page M J, McKenzie J E, Bossuyt P M, Boutron I, Hoffmann T C, Mulrow C D et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372 :n71 doi:10.1136/bmj.n71

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023.

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• Open access
• Published: 25 July 2024

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review

• Ali Mohammad Mosadeghrad 1 ,
• Mahnaz Afshari 2 ,
• Parvaneh Isfahani 3 ,
• Farahnaz Ezzati 4 ,
• Mahdi Abbasi 4 ,
• Shahrzad Akhavan Farahani 4 ,
• Maryam Zahmatkesh 5 &
• Leila Eslambolchi 4  

BMC Health Services Research volume  24 , Article number:  841 ( 2024 ) Cite this article

136 Accesses

Metrics details

Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies.

Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software.

Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems.

Conclusions

The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

Peer Review reports

The health system is a complex network that encompasses individuals, groups, and organizations engaged in policymaking, financing, resource generation, and service provision. These efforts collectively aim to safeguard and enhance people health, meet their expectations, and provide financial protection [ 1 ]. The World Health Organization's (WHO) framework outlines six foundational building blocks for a robust health system: governance and leadership, financing, workforce, infrastructure along with technologies and medicine, information systems, and service delivery. Strengthening these elements is essential for health systems to realize their objectives of advancing and preserving public health [ 2 ].

Effective governance in health systems encompasses the organization of structures, processes, and authority, ensuring resource stewardship and aligning stakeholders’ behaviors with health goals [ 3 ]. Financial mechanisms are designed to provide health services without imposing financial hardship, achieved through strategic fund collection, management and allocation [ 4 , 5 ]. An equitable, competent, and well-distributed health workforce is crucial in delivering healthcare services and fulfilling health system objectives [ 2 ]. Access to vital medical supplies, technologies, and medicines is a cornerstone of effective health services, while health information systems play a pivotal role in generating, processing, and utilizing health data, informing policy decisions [ 2 , 5 ]. Collectively, these components interact to offer quality health services that are safe, effective, timely, affordable, and patient-centered [ 2 ]

The WHO, at the 1978 Alma-Ata conference, introduced primary health care (PHC) as the fundamental strategy to attain global health equity [ 6 ]. Subsequent declarations, such as the one in Astana in 2018, have reaffirmed the pivotal role of PHC in delivering high-quality health care for all [ 7 ]. PHC represents the first level of contact within the health system, offering comprehensive, accessible, community-based care that is culturally sensitive and supported by appropriate technology [ 8 ]. Essential care through PHC encompasses health education, proper nutrition, access to clean water and sanitation, maternal and child healthcare, immunizations, treatment of common diseases, and the provision of essential drugs [ 6 ]. PHC aims to provide protective, preventive, curative, and rehabilitative services that are as close to the community as possible [ 9 ].

Global health systems, however, have faced significant disruptions from various shocks and crises [ 10 ], with the COVID-19 pandemic being a recent and profound example. The pandemic has stressed health systems worldwide, infecting over 775 million and claiming more than 7.04 million lives as of April 13th, 2024 [ 11 ]. Despite the pandemic highlighting the critical role of hospitals and intensive care, it also revealed the limitations of specialized medicine when not complemented by a robust PHC system [ 12 ].

The pandemic brought to light the vulnerabilities of PHC systems, noting a significant decrease in the use of primary care for non-emergency conditions. Routine health services, including immunizations, prenatal care, and chronic disease management, were severely impacted [ 13 ]. The challenges—quarantine restrictions, fears of infection, staffing and resource shortages, suspended non-emergency services, and financial barriers—reduced essential service utilization [ 14 ]. This led to an avoidance of healthcare, further exacerbating health inequalities and emphasizing the need for more resilient PHC systems [ 15 , 16 , 17 ].

Resilient PHC systems are designed to predict, prevent, prepare, absorb, adapt, and transform when facing crises, ensuring the continuity of routine health services [ 18 ]. Investing in the development of such systems can not only enhance crisis response but also foster post-crisis transformation and improvement. This study focuses on identifying global interventions and strategies to cultivate resilient PHC systems, aiding policymakers and managers in making informed decisions in times of crisis.

In 2023, we conducted a scoping review to collect and synthesize evidence from a broad spectrum of studies addressing the COVID-19 pandemic. A scoping review allows for the assessment of literature's volume, nature, and comprehensiveness, and is uniquely inclusive of both peer-reviewed articles and gray literature—such as reports, white papers, and policy documents. Unlike systematic reviews, it typically does not require a quality assessment of the included literature, making it well-suited for rapidly gathering a wide scope of evidence [ 19 ]. Our goal was to uncover the breadth of solutions aimed at bolstering the resilience of the PHC system throughout the COVID-19 crisis. The outcomes of this review are intended to inform the development of a model that ensures the PHC system's ability to continue delivering not just emergency services but also essential care during times of crisis.

We employed Arksey and O'Malley's methodological framework, which consists of six steps: formulating the research question, identifying relevant studies, selecting the pertinent studies, extracting data, synthesizing and reporting the findings, and, where applicable, consulting with stakeholders to inform and validate the results [ 20 ]. This comprehensive approach is designed to capture a wide range of interventions and strategies, with the ultimate aim of crafting a robust PHC system that can withstand the pressures of a global health emergency

Stage 1: identifying the research question

Our scoping review was guided by the central question: "Which strategies and interventions have been implemented to enhance the resilience of primary healthcare systems in response to the COVID-19 pandemic?" This question aimed to capture a comprehensive array of responses to understand the full scope of resilience-building activities within PHC systems.

Stage 2: identifying relevant studies

To ensure a thorough review, we conducted systematic searches across multiple databases, specifically targeting literature up to December 31st, 2022. The databases included PubMed, Web of Science, Scopus, Magiran, and SID. We also leveraged the expansive reach of Google Scholar. Our search strategy incorporated a bilingual approach, utilizing both English and Persian keywords that encompassed "PHC," "resilience," "strategies," and "policies," along with the logical operators AND/OR to refine the search. Additionally, we employed Medical Subject Headings (MeSH) terms to enhance the precision of our search. The results were meticulously organized and managed using the Endnote X8 citation manager, facilitating the systematic selection and review of pertinent literature.

Stage 3: selecting studies

In the third stage, we meticulously vetted our search results to exclude duplicate entries by comparing bibliographic details such as titles, authors, publication dates, and journal names. This task was performed independently by two of our authors, LE and MA, who rigorously screened titles and abstracts. Discrepancies encountered during this process were brought to the attention of a third author, AMM, for resolution through consensus.

Subsequently, full-text articles were evaluated by four team members—LE, MA, PI, and SHZ—to ascertain their relevance to our research question. The selection hinged on identifying articles that discussed strategies aimed at bolstering the resilience of PHC systems amidst the COVID-19 pandemic Table 1 .

We have articulated the specific inclusion and exclusion criteria that guided our selection process in Table 2 , ensuring transparency and replicability of our review methodology

Stage 4: charting the data

Data extraction was conducted by a team of six researchers (LE, MA, PI, MA, FE, and SHZ), utilizing a structured data extraction form. For each selected study, we collated details including the article title, the first author’s name, the year of publication, the country where the study was conducted, the employed research methodology, the sample size, the type of document, and the PHC strengthening strategies described.

In pursuit of maintaining rigorous credibility in our study, we adopted a dual-review process. Each article was independently reviewed by pairs of researchers to mitigate bias and ensure a thorough analysis. Discrepancies between reviewers were addressed through discussion to reach consensus. In instances where consensus could not be reached, the matter was escalated to a third, neutral reviewer. Additionally, to guarantee thoroughness, either LE or MA conducted a final review of the complete data extraction for each study.

Stage 5: collating, summarizing and reporting the results

In this stage, authors LE, MZ, and MA worked independently to synthesize the data derived from the selected studies. Differences in interpretation were collaboratively discussed until a consensus was reached, with AMM providing arbitration where required.

We employed a framework thematic analysis, underpinned by the WHO's health system building blocks model, to structure our findings. This model categorizes health system components into six foundational elements: governance and leadership; health financing; health workforce; medical products, vaccines, and technologies; health information systems; and service delivery [ 2 ]. Using MAXQDA 10 software, we coded the identified PHC strengthening strategies within these six thematic areas.

Summary of search results and study selection

In total, 4315 articles were found by initial search. After removing 397 duplicates, 3918 titles and abstracts were screened and 3606 irrelevant ones were deleted. Finally, 167 articles of 312 reviewed full texts were included in data synthesis (Fig.  1 ). Main characteristics of included studies are presented in Appendix 1.

PRISMA Flowchart of search process and results

Characteristics of studies

These studies were published in 2020 (18.6%), 2021 (36.5%) and 2022 (44.9%). They were conducted in 48 countries, mostly in the US (39 studies), the UK (16 studies), Canada (11 studies), Iran (10 studies) and Brazil (7 studies) as shown in Fig.  2 .

Distribution of reviewed studies by country

Although the majority of the reviewed publications were original articles (55.1 %) and review papers (21 %), other types of documents such as reports, policy briefs, analysis, etc., were also included in this review (Fig.  3 ).

An overview of the publication types

Strengthening interventions to build a resilient PHC system

In total, 194 interventions were identified for strengthening the resilience of PHC systems to respond to the COVID-19 pandemic. They were grouped into six themes of PHC governance and leadership (46 interventions), PHC financing (21 interventions), PHC workforce (37 interventions), PHC infrastructures, equipment, medicines and vaccines (30 interventions), PHC information system (21 interventions) and PHC service delivery (39 interventions). These strategies are shown in Table 3 .

This scoping review aimed to identify and categorize the range of interventions employed globally to strengthen the resilience of primary healthcare (PHC) systems in the face of the COVID-19 pandemic. Our comprehensive search yielded 194 distinct interventions across 48 countries, affirming the significant international efforts to sustain healthcare services during this unprecedented crisis. These interventions have been classified according to the WHO’s six building block model of health systems, providing a framework for analyzing their breadth and depth. This review complements and expands upon the findings from Pradhan et al., who identified 28 interventions specifically within low and middle-income countries, signaling the universality of the challenge and the myriad of innovative responses it has provoked globally [ 178 ].

The review highlights the critical role of governance and leadership in PHC resilience. Effective organizational structure changes, legal reforms, and policy development were crucial in creating adaptive healthcare systems capable of meeting the dynamic challenges posed by the pandemic. These findings resonate with the two strategies of effective leadership and coordination emphasized by Pradhan et al. (2023), and underscore the need for clear vision, evidence-based policy, and active community engagement in governance [ 178 ]. The COVID-19 pandemic posed significant challenges for PHC systems globally. A pivotal response to these challenges was the active involvement of key stakeholders in the decision-making process. This inclusivity spanned across the spectrum of general practitioners, health professionals, health managers, and patients. By engaging these vital contributors, it became possible to address their specific needs and to design and implement people-centered services effectively [ 41 , 42 , 43 ].

The development and implementation of collaborative, evidence-informed policies and national healthcare plans were imperative. Such strategies required robust leadership, bolstered by political commitment, to ensure that the necessary changes could be enacted swiftly and efficiently [ 41 , 45 ]. Leaders within the health system were called upon to foster an environment of good governance. This entailed promoting increased participation from all sectors of the healthcare community, enhancing transparency in decision-making processes, and upholding the principles of legitimacy, accountability, and responsibility within the health system [ 10 ]. The collective aim was to create a more resilient, responsive, and equitable healthcare system in the face of the pandemic's demands.

In the wake of the COVID-19 pandemic, governments were compelled to implement new laws and regulations. These were designed to address a range of issues from professional accreditation and ethical concerns to supporting the families of healthcare workers. Additionally, these legal frameworks facilitated the integration of emerging services such as telemedicine into the healthcare system, ensuring that these services were regulated and standardized [ 38 , 40 , 61 ]. A key aspect of managing the pandemic was the establishment of effective and transparent communication systems for patients, public health authorities, and the healthcare system at large [ 60 , 61 ]. To disseminate vital information regarding the pandemic, vaccination programs, and healthcare services, authorities leveraged various channels. Public media, local online platforms, and neighborhood networks were instrumental in keeping the public informed about the ongoing situation and available services [ 53 , 60 , 86 ]. For health professionals, digital communication tools such as emails and WhatsApp groups, as well as regular meetings, were utilized to distribute clinical guidelines, government directives, and to address any queries they might have had. This ensured that healthcare workers were kept up-to-date with the evolving landscape of the pandemic and could adapt their practices accordingly [ 60 , 144 ].

Healthcare facilities function as complex socio-technical entities, combining multiple specialties and adapting to the ever-changing landscape of healthcare needs and environments [ 179 ]. To navigate this dynamic, policy makers must take into account an array of determinants—political, economic, social, and environmental—that influence health outcomes. Effective management of a health crisis necessitates robust collaboration across various sectors, including government bodies, public health organizations, primary healthcare systems, and hospitals. Such collaboration is not only pivotal during crisis management but also during the development of preparedness plans [ 63 ]. Within the health system, horizontal collaboration among departments and vertical collaboration between the Ministry of Health and other governmental departments are vital. These cooperative efforts are key to reinforce the resilience of the primary healthcare system. Moreover, a strong alliance between national pandemic response teams and primary healthcare authorities is essential to identifying and resolving issues within the PHC system [ 29 ]. On an international scale, collaborations and communications are integral to the procurement of essential medical supplies, such as medicines, equipment, and vaccines. These international partnerships are fundamental to ensuring that health systems remain equipped to face health emergencies [ 63 ].

To ensure the PHC system's preparedness and response capacity was at its best, regular and effective monitoring and evaluation programs were put in place. These included rigorous quarterly stress tests at the district level, which scrutinized the infrastructure and technology to pinpoint the system’s strengths and areas for improvement [ 43 ]. Furthermore, clinical audits were conducted to assess the structure, processes, and outcomes of healthcare programs, thereby enhancing the quality and effectiveness of the services provided [ 63 ]. These evaluation measures were crucial for maintaining a high standard of care and for adapting to the ever-evolving challenges faced by the PHC system.

Financial strategies played a critical role in enabling access to essential health services without imposing undue financial hardship. Various revenue-raising, pooling, and purchasing strategies were implemented to expand PHC financing during the pandemic, illustrating the multifaceted approach needed to sustain healthcare operations under strained circumstances [ 9 , 19 ].

In response to the COVID-19 pandemic, the Indian government took decisive action to bolster the country's healthcare infrastructure. By enhancing the financial capacity of states, the government was able to inject more funds into the Primary Health Care (PHC) system. This influx of resources made it possible to introduce schemes providing free medications and diagnostic services [ 50 ]. The benefits of increased financial resources were also felt beyond India's borders, enabling the compensation of health services in various forms. In Greece, it facilitated the monitoring and treatment of COVID-19 through in-person, home-based, and remote health services provided by physicians in private practice. Similarly, in Iran, the financial boost supported the acquisition of basic and para-clinical services from the private sector [ 21 , 65 ]. These measures reflect a broader international effort to adapt and sustain health services during a global health crisis.

The COVID-19 pandemic presented a formidable challenge to the PHC workforce worldwide. Healthcare workers were subjected to overwhelming workloads and faced significant threats to both their physical and mental well-being. To build resilience in the face of this crisis, a suite of interventions was implemented. These included recruitment strategies, training and development programs, enhanced teamwork, improved protective measures, comprehensive performance appraisals, and appropriate compensation mechanisms, as documented in Table 3 . To address staffing needs within PHC centers, a range of professionals including general practitioners, nurses, community health workers, and technical staff were either newly employed or redeployed from other healthcare facilities [ 63 ]. Expert practitioners were positioned on the frontlines, providing both in-person services and telephone consultations, acting as gatekeepers in the health system [ 49 , 63 ]. Support staff with technological expertise played a crucial role as well, assisting patients in navigating patient portals, utilizing new digital services, and conducting video visits [ 102 ]. Furthermore, the acute shortage of healthcare workers was mitigated by recruiting individuals who were retired, not currently practicing, or in training as students, as well as by enlisting volunteers. This strategy was key to bolstering the workforce and ensuring continuity of care during the pandemic [ 109 ].

During the pandemic, new training programs were developed to prepare healthcare staff for the evolving demands of their roles. These comprehensive courses covered a wide array of critical topics, including the correct use of personal protective equipment (PPE), the operation of ventilators, patient safety protocols, infection prevention, teamwork, problem-solving, self-care techniques, mental health support, strategies for managing stress, navigating and applying reliable web-based information, emergency response tactics, telemedicine, and direct care for COVID-19 patients [ 74 , 95 , 100 , 108 , 110 , 112 , 117 ].

Acknowledging the psychological and professional pressures faced by the primary healthcare workforce, health managers took active measures to safeguard both the physical and mental well-being of their employees during this challenging period [ 124 ]. Efforts to protect physical health included monitoring health status, ensuring vaccination against COVID-19, and providing adequate PPE [ 63 , 72 ]. To address mental health, a variety of interventions were deployed to mitigate anxiety and related issues among frontline workers. In Egypt, for instance, healthcare workers benefited from psychotherapy services and adaptable work schedules to alleviate stress [ 126 ]. Singapore employed complementary strategies, such as yoga, meditation, and the encouragement of religious practices, to promote relaxation among staff [ 133 ]. In the United States, the Wellness Hub application was utilized as a tool for employees to enhance their mental health [ 132 ]. In addition to health and wellness initiatives, there were financial incentives aimed at motivating employees. Payment protocols were revised, and new incentives, including scholarship opportunities and career development programs, were introduced to foster job satisfaction and motivation among healthcare workers [ 63 ].

The resilience of PHC systems during the pandemic hinged on several key improvements. Enhancing health facilities, supplying medicines and diagnostic kits, distributing vaccines, providing medical equipment, and building robust digital infrastructure were all fundamental elements that contributed to the strength of PHC systems, as outlined in Table 3 . Safe and accessible primary healthcare was facilitated through various means. Wheelchair routes were created for patients to ensure their mobility within healthcare facilities. , dedicated COVID-19 clinics were established, mass vaccination centers were opened to expedite immunization, and mobile screening stations were launched to extend testing capabilities [ 23 , 33 , 63 , 140 ].

In Iran, the distribution and availability of basic medicines were managed in collaboration with the Food and Drug Organization, ensuring that essential medications reached those in need [ 89 ]. During the outbreak, personal protective equipment (PPE) was among the most critical supplies. Access to PPE was prioritized, particularly for vulnerable groups and healthcare workers, to provide a layer of safety against the virus [ 63 ]. Vaccines were made available at no cost, with governments taking active measures to monitor their safety and side effects, to enhance their quality, and to secure international approvals. Furthermore, effective communication strategies were employed to keep the public informed about vaccine-related developments [ 32 , 83 ].

These comprehensive efforts underscored the commitment to maintaining a resilient PHC system in the face of a global health every individual in the community could access healthcare services. To facilitate this, free high-speed Wi-Fi hotspots were established, enabling patients to engage in video consultations and utilize a range of e-services without the barrier of internet costs crisis. Significant enhancements were made to the digital infrastructure. This expansion was critical in ensuring that [ 30 , 54 ]. Complementing these measures, a variety of digital health tools were deployed to further modernize care delivery. Countries like Nigeria and Germany, for instance, saw the introduction of portable electrocardiograms and telemedical stethoscopes. These innovations allowed for more comprehensive remote assessments and diagnostics, helping to bridge the gap between traditional in-person consultations and the emerging needs for telemedicine [ 141 , 180 ].

Throughout the COVID-19 pandemic, targeted interventions were implemented to bolster information systems and research efforts, as outlined in Table 3 . Key among these was the advancement of a modern, secure public health information system to ensure access to health data was not only reliable and timely but also transparent and accurate [ 33 , 45 , 49 ]. The "Open Notes" initiative in the United States exemplified this effort, guaranteeing patient access to, and editorial control over, their health records [ 141 ]. Management strategies also promoted the "one-health" approach, facilitating the exchange of health data across various departments and sectors to enhance public health outcomes [ 10 ].

In addition to these information system upgrades, active patient surveillance and early warning systems were instituted in collaboration with public health agencies. These systems played a pivotal role in detecting outbreaks, providing precise reports on the incidents, characterizing the epidemiology of pathogens, tracking their spread, and evaluating the efficacy of control strategies. They were instrumental in pinpointing areas of concern, informing smart lockdowns, and improving contact tracing methods [ 33 , 63 , 72 ]. The reinforcement of these surveillance and warning systems had a profound impact on shaping and implementing a responsive strategy to the health crisis [ 10 ].

To further reinforce the response to the pandemic, enhancing primary healthcare (PHC) research capacity became crucial. This enabled healthcare professionals and policymakers to discern both facilitators and barriers within the system and to devise fitting strategies to address emerging challenges. To this end, formal advisory groups and multidisciplinary expert panels, which included specialists from epidemiology, clinical services, social care, sociology, policy-making, and management, were convened. These groups harnessed the best available evidence to inform decision-making processes [ 30 ]. Consequently, research units were established to carry out regular telephone surveys and to collect data on effective practices, as well as new diagnostic and therapeutic approaches [ 31 , 89 ]. The valuable insights gained from these research endeavors were then disseminated through trusted channels to both the public and policymakers, ensuring informed decisions at all levels [ 36 ].

The COVID-19 pandemic acted as a catalyst for the swift integration of telemedicine into healthcare systems globally. This period saw healthcare providers leverage telecommunication technologies to offer an array of remote services, addressing medical needs such as consultations, diagnosis, monitoring, and prescriptions. This transition was instrumental in ensuring care continuity and mitigating infection risks for both patients and healthcare workers, highlighting an innovative evolution in healthcare delivery [ 170 , 181 ].

Countries adapted to this new model of healthcare with varied applications: Armenia established telephone follow-ups and video consultations for remote patient care, while e-pharmacies and mobile health tools provided immediate access to medical information and services [ 29 ]. In France and the United States, tele-mental health services and online group support became a means to support healthy living during the pandemic [ 147 , 158 ] . New Zealand introduced the Aroha chatbot, an initiative to assist with mental health management [ 139 ].

The implementation and effectiveness of these telehealth services were not limited by economic barriers, as underscored by Pradhan et al. (2023), who noted the key role of telemedicine in low and middle-income countries. These countries embraced the technology to maintain health service operations, proving its global applicability and utility [ 178 ]. The widespread adoption of telemedicine, therefore, represents a significant and perhaps lasting shift in healthcare practice, one that has redefined patient care in the face of a global health crisis and may continue to shape the future of healthcare delivery [ 170 , 178 , 181 ].

The study highlighted PHC strengthening strategies in COVID-19 time . Notably, the adaptations and reforms spanned across governance, financing, workforce management, information system, infrastructural readiness, and service delivery enhancements. These interventions collectively contributed to the robustness of health systems against the sudden surge in demand and the multifaceted challenges imposed by the pandemic and resulted.

Significantly, the findings have broader implications for health policy and system design worldwide. The pandemic has highlighted the critical need for resilient health systems that are capable of not only responding to health emergencies but also maintaining continuity in essential services. The strategies documented in this review serve as a template for countries to fortify their health systems by embedding resilience into their PHC frameworks (Fig.  4 ). Future health crises can be better managed by learning from these evidenced responses, which emphasize the necessity of integrated, well-supported, and dynamically adaptable health care structures.

A model for strengthening the resilience of the primary health care system

Looking ahead, realist reviews could play a pivotal role in refining PHC resilience strategies. By understanding the context in which specific interventions succeed or fail, realist reviews can help policymakers and practitioners design more effective health system reforms, as echoed in the need for evidence-based planning in health system governance [ 9 ] ​​. These reviews offer a methodological advantage by focusing on the causality between interventions and outcomes, aligning with the importance of effective health system leadership and management [ 50 , 182 ] ​​. They take into account the underlying mechanisms and contextual factors, thus providing a nuanced understanding that is crucial for tailoring interventions to meet local needs effectively [ 28 , 86 ] ​​, ultimately leading to more sustainable health systems globally. This shift towards a more analytical and context-sensitive approach in evaluating health interventions, as supported by WHO's framework for action [ 2 , 10 ] ​​, will be crucial for developing strategies that are not only effective in theory but also practical and sustainable in diverse real-world settings.

Limitations and future research

In our comprehensive scoping review, we analyzed 167 articles out of a dataset of 4,315, classifying 194 interventions that build resilience in primary healthcare systems across the globe in response to pandemics like COVID-19. While the review's extensive search provides a sweeping overview of various strategies, it may not capture the full diversity of interventions across all regions and economies. Future research should focus on meta-analyses to evaluate the effectiveness of these interventions in greater detail and employ qualitative studies to delve into the specific challenges and successes, thus gaining a more nuanced understanding of the context. As the review includes articles only up to December 31, 2022, it may overlook more recent studies. Regular updates, a broader linguistic range, and the inclusion of a more diverse array of databases are recommended to maintain relevance and expand the breadth of literature, ultimately guiding more focused research that could significantly enhance the resilience of PHC systems worldwide.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

Primary Health Care

World Health Organization

Sustainable Development Goals

Universal Health Coverage

Personal Protective Equipment

General Practitioner

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Acknowledgments

We would like to thank Dr. Arshad Altaf for his invaluable comments on the earlier drafts of this work.

Funding for this project was provided by the World Health Organization Eastern Mediterranean Region.

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Health management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran

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Farahnaz Ezzati, Mahdi Abbasi, Shahrzad Akhavan Farahani & Leila Eslambolchi

Health Management, School of Business and Management, Royal Holloway University of London, London, UK

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LE, MA, MZ and AMM participated in the design of the study. LE, AMM, MA, MZ, PI, FE, MA and SHA undertook the literature review process. All authors drafted the manuscript. All authors read and approved the final manuscript.

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Mosadeghrad, A.M., Afshari, M., Isfahani, P. et al. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res 24 , 841 (2024). https://doi.org/10.1186/s12913-024-11278-4

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• Volume 33, Issue 5
• Equitable and accessible informed healthcare consent process for people with intellectual disability: a systematic literature review
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• http://orcid.org/0000-0002-8498-7329 Manjekah Dunn 1 , 2 ,
• Iva Strnadová 3 , 4 , 5 ,
• Jackie Leach Scully 4 ,
• Jennifer Hansen 3 ,
• Julie Loblinzk 3 , 5 ,
• Skie Sarfaraz 5 ,
• Chloe Molnar 1 ,
• Elizabeth Emma Palmer 1 , 2
• 1 Faculty of Medicine & Health , University of New South Wales , Sydney , New South Wales , Australia
• 2 The Sydney Children's Hospitals Network , Sydney , New South Wales , Australia
• 3 School of Education , University of New South Wales , Sydney , New South Wales , Australia
• 4 Disability Innovation Institute , University of New South Wales , Sydney , New South Wales , Australia
• 5 Self Advocacy Sydney , Sydney , New South Wales , Australia
• Correspondence to Dr Manjekah Dunn, Paediatrics & Child Health, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia; manjekah.dunn{at}unsw.edu.au

Objective To identify factors acting as barriers or enablers to the process of healthcare consent for people with intellectual disability and to understand how to make this process equitable and accessible.

Data sources Databases: Embase, MEDLINE, PsychINFO, PubMed, SCOPUS, Web of Science and CINAHL. Additional articles were obtained from an ancestral search and hand-searching three journals.

Eligibility criteria Peer-reviewed original research about the consent process for healthcare interventions, published after 1990, involving adult participants with intellectual disability.

Synthesis of results Inductive thematic analysis was used to identify factors affecting informed consent. The findings were reviewed by co-researchers with intellectual disability to ensure they reflected lived experiences, and an easy read summary was created.

Results Twenty-three studies were included (1999 to 2020), with a mix of qualitative (n=14), quantitative (n=6) and mixed-methods (n=3) studies. Participant numbers ranged from 9 to 604 people (median 21) and included people with intellectual disability, health professionals, carers and support people, and others working with people with intellectual disability. Six themes were identified: (1) health professionals’ attitudes and lack of education, (2) inadequate accessible health information, (3) involvement of support people, (4) systemic constraints, (5) person-centred informed consent and (6) effective communication between health professionals and patients. Themes were barriers (themes 1, 2 and 4), enablers (themes 5 and 6) or both (theme 3).

Conclusions Multiple reasons contribute to poor consent practices for people with intellectual disability in current health systems. Recommendations include addressing health professionals’ attitudes and lack of education in informed consent with clinician training, the co-production of accessible information resources and further inclusive research into informed consent for people with intellectual disability.

PROSPERO registration CRD42021290548.

• Decision making
• Healthcare quality improvement
• Patient-centred care
• Quality improvement
• Standards of care

Data availability statement

Data are available upon reasonable request. Additional data and materials such as data collection forms, data extraction and analysis templates and QualSyst assessment data can be obtained by contacting the corresponding author.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjqs-2023-016113

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What is already known on this topic

People with intellectual disability are frequently excluded from decision-making processes and not provided equal opportunity for informed consent, despite protections outlined in the United Nations Convention on the Rights of Persons with Disabilities.

People with intellectual disability have the capacity and desire to make informed medical decisions, which can improve their well-being, health satisfaction and health outcomes.

What this review study adds

Health professionals lack adequate training in valid informed consent and making reasonable adjustments for people with intellectual disability, and continue to perpetuate assumptions of incapacity.

Health information provided to people with intellectual disability is often inaccessible and insufficient for them to make informed decisions about healthcare.

The role of support people, systemic constraints, a person-centred approach and ineffective healthcare communication also affect informed consent.

How this review might affect research, practice or policy

Health professionals need additional training on how to provide a valid informed consent process for people with intellectual disability, specifically in using accessible health information, making reasonable adjustments (e.g., longer/multiple appointments, options of a support person attending or not, using plain English), involving the individual in discussions, and communicating effectively with them.

Inclusive research is needed to hear the voices and opinions of people with intellectual disability about healthcare decision-making and about informed consent practices in specific healthcare settings.

Introduction

Approximately 1% of the world’s population have intellectual disability. 1 Intellectual disability is medically defined as a group of neurodevelopmental conditions beginning in childhood, with below average cognitive functioning and adaptive behaviour, including limitations in conceptual, social and practical skills. 2 People with intellectual disability prefer an alternative strength-based definition, reflected in the comment by Robert Strike OAM (Order of Australia Medal): ‘We can learn if the way of teaching matches how the person learns’, 3 reinforcing the importance of providing information tailored to the needs of a person with intellectual disability. A diagnosis of intellectual disability is associated with significant disparities in health outcomes. 4–7 Person-centred decision-making and better communication have been shown to improve patient satisfaction, 8 9 the physician–patient relationship 10 and overall health outcomes 11 for the wider population. Ensuring people with intellectual disability experience informed decision-making and accessible healthcare can help address the ongoing health disparities and facilitate equal access to healthcare.

Bodily autonomy is an individual’s power and agency to make decisions about their own body. 12 Informed consent for healthcare enables a person to practice bodily autonomy and is protected, for example, by the National Safety and Quality Health Service Standards (Australia), 13 Mental Capacity Act (UK) 14 and the Joint Commission Standards (USA). 15 In this article, we define informed consent according to three requirements: (1) the person is provided with information they understand, (2) the decision is free of coercion and (3) the person must have capacity. 16 For informed consent to be valid, this process must be suited to the individual’s needs so that they can understand and communicate effectively. Capacity is the ability to give informed consent for a medical intervention, 17 18 and the Mental Capacity Act outlines that ‘a person must be assumed to have capacity unless it is established that he lacks capacity’ and that incapacity can only be established if ‘all practicable steps’ to support capacity have been attempted without success. 14 These assumptions of capacity are also decision-specific, meaning an individual’s ability to consent can change depending on the situation, the choice itself and other factors. 17

Systemic issues with healthcare delivery systems have resulted in access barriers for people with intellectual disability, 19 despite the disability discrimination legislation in many countries who are signatories to the United Nations (UN) Convention on the Rights of Persons with Disabilities. 20 Patients with intellectual disability are not provided the reasonable adjustments that would enable them to give informed consent for medical procedures or interventions, 21 22 despite evidence that many people with intellectual disability have both the capacity and the desire to make their own healthcare decisions. 21 23

To support people with intellectual disability to make independent health decisions, an equitable and accessible informed consent process is needed. 24 However, current health systems have consistently failed to provide this. 21 25 To address this gap, we must first understand the factors that contribute to inequitable and inaccessible consent. To the best of our knowledge, the only current review of informed consent for people with intellectual disability is an integrative review by Goldsmith et al . 26 Many of the included articles focused on assessment of capacity 27–29 and research consent. 30–32 The review’s conclusion supported the functional approach to assess capacity, with minimal focus on how the informed consent processes can be improved. More recently, there has been a move towards ensuring that the consent process is accessible for all individuals, including elderly patients 33 and people with aphasia. 34 However, there remains a paucity of literature about the informed consent process for people with intellectual disability, with no systematic reviews summarising the factors influencing the healthcare consent process for people with intellectual disability.

To identify barriers to and enablers of the informed healthcare consent process for people with intellectual disability, and to understand how this can be made equitable and accessible.

A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) systematic literature review protocol. 35 The PRISMA 2020 checklist 36 and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) reporting guidelines were also followed. 37 The full study protocol is included in online supplemental appendix 1 .

Supplemental material

No patients or members of the public were involved in this research for this manuscript.

Search strategy

A search strategy was developed to identify articles about intellectual disability, consent and healthcare interventions, described in online supplemental appendix 2 . Multiple databases were searched for articles published between January 1990 to January 2022 (Embase, MEDLINE, PsychINFO, PubMed, SCOPUS, Web of Science and CINAHL). These databases include healthcare and psychology databases that best capture relevant literature on this topic, including medical, nursing, social sciences and bioethical literature. The search was limited to studies published from 1990 as understandings of consent have changed since then. 38 39 This yielded 4853 unique papers which were imported into Covidence, a specialised programme for conducting systematic reviews. 40

Study selection

Citation screening by abstract and titles was completed by two independent researchers (MD and EEP). Included articles had to:

Examine the informed consent process for a healthcare intervention for people with intellectual disability.

Have collected more than 50% of its data from relevant stakeholders, including adults with intellectual disability, families or carers of a person with intellectual disability, and professionals who engage with people with intellectual disability.

Report empirical data from primary research methodology.

Be published in a peer-reviewed journal after January 1990.

Be available in English.

Full text screening was completed by two independent researchers (MD and EEP). Articles were excluded if consent was only briefly discussed or if it focused on consent for research, capacity assessment, or participant knowledge or comprehension. Any conflicts were resolved through discussion with an independent third researcher (IS).

Additional studies were identified through an ancestral search and by hand-searching three major journals relevant to intellectual disability research. Journals were selected if they had published more than one included article for this review or in previous literature reviews conducted by the research team.

Quality assessment

Two independent researchers (MD and IS) assessed study quality with the QualSyst tool, 41 which can assess both qualitative and quantitative research papers. After evaluating the distribution of scores, a threshold value of 55% was used, as suggested by QualSyst 41 to exclude poor-quality studies but capture enough studies overall. Any conflicts between the quality assessment scores were resolved by a third researcher (EEP). For mixed-method studies, both qualitative and quantitative quality scores were calculated, and the higher value used.

Data collection

Two independent researchers (MD and JH) reviewed each study and extracted relevant details, including study size, participant demographics, year, country of publication, study design, data analysis and major outcomes reported. Researchers used standardised data collection forms designed, with input from senior researchers with expertise in qualitative research (IS and EEP), to extract data relevant to the review’s research aims. The form was piloted on one study, and a second iteration made based on feedback. These forms captured data on study design, methods, participants, any factors affecting the process of informed consent and study limitations. Data included descriptions and paragraphs outlining key findings, the healthcare context, verbatim participant quotes and any quantitative analyses or statistics. Missing or unclear data were noted.

Data analysis

A pilot literature search showed significant heterogeneity in methodology of studies, limiting the applicability of traditional quantitative analysis (ie, meta-analysis). Instead, inductive thematic analysis was chosen as an alternative methodology 42 43 that has been used in recent systematic reviews examining barriers and enablers of other health processes. 44 45 The six-phase approach described by Braun and Clarke was used. 46 47 A researcher (MD) independently coded the extracted data of each study line-by-line, with subsequent data grouped into pre-existing codes or new concepts when necessary. Codes were reviewed iteratively and grouped into categories, subthemes and themes framed around the research question. Another independent researcher (JH) collated and analysed the data on study demographics, methods and limitations. The themes were reviewed by two senior researchers (EEP and IS).

Qualitative methods of effect size calculations have been described in the literature, 48 49 which was captured in this review by the number of studies that identified each subtheme, with an assigned frequency rating to compare their relative significance. Subthemes were given a frequency rating of A, B, C or D if they were identified by >10, 7–9, 4–6 or <3 articles, respectively. The overall significance of each theme was estimated by the number of studies that mentioned it and the GRADE framework, a stepwise approach to quality assessment using a four-tier rating system. Each study was evaluated for risk of bias, inconsistency, indirectness, imprecision and publication bias. 50 51 Study sensitivity was assessed by counting the number of distinct subthemes included. 52 The quality of findings was designated high, moderate or low depending on the frequency ratings, the QualSyst score and the GRADE scores of studies supporting the finding. Finally, the relative contributions of each study were evaluated by the number of subthemes described, guided by previously reported methods for qualitative reviews. 52

Co-research

The findings were reviewed by two co-researchers with intellectual disability (JL and SS), with over 30 years combined experience as members and employees of a self-advocacy organisation. Guidance on the findings and an easy read summary was produced in line with best-practice inclusive research 53 54 over multiple discussions. Input from two health professional researchers (MD and EEP) provided data triangulation and sense-checking of findings.

Twenty-three articles were identified ( figure 1 ): 14 qualitative, 6 quantitative and 3 mixed-methods. Two papers included the same population of study participants: McCarthy 55 and McCarthy, 56 but had different research questions. Fovargue et al 57 was excluded due to a quality score of 35%. Common quality limitations were a lack of verification procedures to establish credibility and limited researcher reflexivity. No studies were excluded due to language requirements (as all were in English) or age restrictions (all studies had majority adult participants).

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PRISMA 2020 flowchart for the systematic review. 36

Studies were published from 1999 to 2020 and involved participant populations from the UK (n=18), USA (n=3), Sweden (n=1) and Ireland (n=1). Participant numbers ranged from 9 to 604 (median 21), and participants included people with intellectual disability (n=817), health professionals (n=272), carers and support people (n=48), and other professionals that work with people with intellectual disability (n=137, community service agency directors, social workers, administrative staff and care home staff). Ages of participants ranged from 8 to 84 years, though only Aman et al 58 included participants <18 years of age. This study was included as the article states very few children were included. Studies examined consent in different contexts, including contraception and sexual health (6/23 articles), 58–60 medications (5/23 articles), 58–62 emergency healthcare, 63 cervical screening, 64 community referrals, 58–61 65 mental health, 66 hydrotherapy, 64 blood collection 67 and broad decision-making consent without a specific context. 65 68–71 A detailed breakdown of each study is included in online supplemental appendix 3 .

Six major themes were identified from the studies, summarised in figure 2 . An overview of included studies showing study sensitivity, effect size, QualSyst and GRADE scores is given in online supplemental appendix 4 . Studies with higher QualSyst and GRADE scores contributed more to this review’s findings and tended to include more subthemes; specifically, Rogers et al , 66 Sowney and Barr, 63 Höglund and Larsson, 72 and McCarthy 55 and McCarthy. 56 Figure 3 gives the easy read version of theme 1, with the full easy read summary in online supplemental appendix 5 .

Summary of the identified six themes and subthemes.

Theme 1 of the easy read summary.

Theme 1—Health professionals’ attitudes and lack of education about informed consent

Health professionals’ attitudes and practices were frequently (18/21) identified as factors affecting the informed consent process, with substantial evidence supporting this theme. Studies noted the lack of training for health professionals in supporting informed consent for people with intellectual disability, their desire for further education, and stereotypes and discrimination perpetuated by health professionals.

Lack of health professional education on informed consent and disability discrimination legislation

Multiple studies reported inconsistent informed consent practices, for various reasons: some reported that health professionals ‘forgot’ to or ‘did not realise consent was necessary’, 63 73 but inconsistent consent practices were also attributed to healthcare providers’ unfamiliarity with consent guidelines and poor education on this topic. Carlson et al 73 reported that only 44% of general practitioners (GPs) were aware of consent guidelines, and there was the misconception that consent was unnecessary for people with intellectual disability. Similarly, studies of psychologists 66 and nurses 63 found that many were unfamiliar with their obligations to obtain consent, despite the existence of anti-discrimination legislation. People with intellectual disability describe feeling discriminated against by health professionals, reflected in comments such as ‘I can tell, my doctor just thinks I’m stupid – I'm nothing to him’. 74 Poor consent practices by health professionals were observed in Goldsmith et al , 67 while health professionals surveyed by McCarthy 56 were unaware of their responsibility to provide accessible health information to women with intellectual disability. Improving health professional education and training was suggested by multiple studies as a way to remove this barrier. 63 65–67 69 73

Lack of training on best practices for health professions caring for people with intellectual disability

A lack of training in caring for and communicating with people with intellectual disability was also described by midwives, 72 psychologists, 66 nurses, 63 pharmacists 61 and GPs. 56 72 75 Health professionals lacked knowledge about best practice approaches to providing equitable healthcare consent processes through reasonable adjustments such as accessible health information, 56 60 66 longer appointments times, 60 72 simple English 62 67 and flexible approaches to patient needs. 63 72

Health professionals’ stereotyping and assumptions of incapacity

Underlying stereotypes contributed to some health professionals’ (including nurses, 63 GPs 56 and physiotherapists 64 ) belief that people with intellectual disability lack capacity and therefore, do not require opportunities for informed consent. 56 64 In a survey of professionals referring people with intellectual disability to a disability service, the second most common reason for not obtaining consent was ‘patient unable to understand’. 73

Proxy consent as an inappropriate alternative

People with intellectual disability are rarely the final decision-maker in their medical choices, with many health providers seeking proxy consent from carers, support workers and family members, despite its legal invalidity. In McCarthy’s study (2010), 18/23 women with intellectual disability said the decision to start contraception was made by someone else. Many GPs appeared unaware that proxy consent is invalid in the UK. 56 Similar reports came from people with intellectual disability, 55 56 60 64 69 76 health professionals (nurses, doctors, allied health, psychologists), 56 63 64 66 77 support people 64 77 and non-medical professionals, 65 73 and capacity was rarely documented. 56 62 77

Exclusion of people with intellectual disability from decision-making discussions

Studies described instances where health professionals made decisions for their patients with intellectual disability or coerced patients into a choice. 55 72 74 76 77 In Ledger et al 77 , only 62% of women with intellectual disability were involved in the discussion about contraception, and only 38% made the final decision, and others stated in Wiseman and Ferrie 74 : ‘I was not given the opportunity to explore the different options. I was told what one I should take’. Three papers outlined instances where the choices of people with intellectual disability were ignored despite possessing capacity 65 66 69 and when a procedure continued despite them withdrawing consent. 69

Theme 2—Inadequate accessible health information

Lack of accessible health information.

The lack of accessible health information was the most frequently identified subtheme (16/23 studies). Some studies reported that health professionals provided information to carers instead, 60 avoided providing easy read information due to concerns about ‘offending’ patients 75 or only provided verbal information. 56 67 Informed consent was supported when health professionals recognised the importance of providing medical information 64 and when it was provided in an accessible format. 60 Alternative approaches to health information were explored, including virtual reality 68 and in-person education sessions, 59 with varying results. Overall, the need to provide information in different formats tailored to an individual’s communication needs, rather than a ‘one size fits all’ approach, was emphasised by both people with intellectual disability 60 and health professionals. 66

Insufficient information provided

Studies described situations where insufficient information was provided to people with intellectual disability to make informed decisions. For example, some people felt the information from their GP was often too basic to be helpful (Fish et al 60 ) and wanted additional information on consent forms (Rose et al 78 ).

Theme 3—The involvement of support people

Support people (including carers, family members and group home staff) were identified in 11 articles as both enablers of and barriers to informed consent. The antagonistic nature of these findings and lower frequency of subthemes are reflected in the lower quality assessments of evidence.

Support people facilitated communication with health professionals

Some studies reported carers bridging communication barriers with health to support informed consent. 63 64 McCarthy 56 found 21/23 of women with intellectual disability preferred to see doctors with a support person due to perceived benefits: ‘Sometimes I don’t understand it, so they have to explain it to my carer, so they can explain it to me easier’. Most GPs in this study (93%) also agreed that support people aided communication.

Support people helped people with intellectual disability make decisions

By advocating for people with intellectual disability, carers encouraged decision-making, 64 74 provided health information, 74 77 emotional support 76 and assisted with reading or remembering health information. 55 58 76 Some people with intellectual disability explicitly appreciated their support person’s involvement, 60 such as in McCarthy’s 55 study where 18/23 participants felt supported and safer when a support person was involved.

Support people impeded individual autonomy

The study by Wiseman and Ferrie 74 found that while younger participants with intellectual disability felt family members empowered their decision-making, older women felt family members impaired their ability to give informed consent. This was reflected in interviews with carers who questioned the capacity of the person with intellectual disability they supported and stated they would guide them to pick the ‘best choice’ or even over-ride their choices. 64 Studies of psychologists and community service directors described instances where the decision of family or carers was prioritised over the wishes of the person with intellectual disability. 65 66 Some women with intellectual disability in McCarthy’s studies (2010, 2009) 55 56 appeared to have been coerced into using contraception by parental pressures or fear of losing group home support.

Theme 4—Systemic constraints within healthcare systems

Time restraints affect informed consent and accessible healthcare.

Resource limitations create time constraints that impair the consent process and have been identified as a barrier by psychologists, 66 GPs, 56 hospital nurses 63 and community disability workers. 73 Rogers et al 66 highlighted that a personalised approach that could improve informed decision-making is restricted by inflexible medical models. Only two studies described flexible patient-centred approaches to consent. 60 72 A survey of primary care practices in 2007 reported that most did not modify their cervical screening information for patients with intellectual disability because it was not practical. 75

Inflexible models of consent

Both people with intellectual disability 76 and health professionals 66 recognised that consent is traditionally obtained through one-off interactions prior to an intervention. Yet, for people with intellectual disability, consent should ideally be an ongoing process that begins before an appointment and continues between subsequent ones. Other studies have tended to describe one-off interactions where decision-making was not revisited at subsequent appointments. 56 60 72 76

Lack of systemic supports

In one survey, self-advocates highlighted a lack of information on medication for people with intellectual disability and suggested a telephone helpline and a centralised source of information to support consent. 60 Health professionals also want greater systemic support, such as a health professional specialised in intellectual disability care to support other staff, 72 or a pharmacist specifically to help patients with intellectual disability. 61 Studies highlighted a lack of guidelines about healthcare needs of people with intellectual disabilities such as contraceptive counselling 72 or primary care. 75

Theme 5—Person-centred informed consent

Ten studies identified factors related to a person-centred approach to informed consent, grouped below into three subthemes. Health professionals should tailor their practice when obtaining informed consent from people with intellectual disability by considering how these subthemes relate to the individual. Each subtheme was described five times in the literature with a relative frequency rating of ‘C’, contributing to overall lower quality scores.

Previous experience with decision-making

Arscott et al 71 found that the ability of people with intellectual disability to consent changed with their verbal and memory skills and in different clinical vignettes, supporting the view of ‘functional’ capacity specific to the context of the medical decision. Although previous experiences with decision-making did not influence informed consent in this paper, other studies suggest that people with intellectual disability accustomed to independent decision-making were more able to make informed medical decisions, 66 70 and those who live independently were more likely to make independent healthcare decisions. 56 Health professionals should be aware that their patients with intellectual disability will have variable experience with decision-making and provide individualised support to meet their needs.

Variable awareness about healthcare rights

Consent processes should be tailored to the health literacy of patients, including emphasising available choices and the option to refuse treatment. In some studies, medical decisions were not presented to people with intellectual disability as a choice, 64 and people with intellectual disability were not informed of their legal right to accessible health information. 56

Power differences and acquiescence

Acquiescence by people with intellectual disability due to common and repeated experiences of trauma—that is, their tendency to agree with suggestions made by carers and health professionals, often to avoid upsetting others—was identified as an ongoing barrier. In McCarthy’s (2009) interviews with women with intellectual disability, some participants implicitly rejected the idea that they might make their own healthcare decisions: ‘They’re the carers, they have responsibility for me’. Others appeared to have made decisions to appease their carers: ‘I have the jab (contraceptive injection) so I can’t be blamed for getting pregnant’. 55 Two studies highlighted that health professionals need to be mindful of power imbalances when discussing consent with people with intellectual disability to ensure the choices are truly autonomous. 61 66

Theme 6—Effective communication between health professionals and patients

Implementation of reasonable adjustments for verbal and written information.

Simple language was always preferred by people with intellectual disability. 60 67 Other communication aids used in decision-making included repetition, short sentences, models, pictures and easy read brochures. 72 Another reasonable adjustment is providing the opportunity to ask questions, which women with intellectual disability in McCarthy’s (2009) study reported did not occur. 55

Tailored communication methods including non-verbal communication

Midwives noted that continuity of care allows them to develop rapport and understand the communication preferences of people with intellectual disability. 72 This is not always possible; for emergency nurses, the lack of background information about patients with intellectual disability made it challenging to understand their communication preferences. 63 The use of non-verbal communication, such as body language, was noted as underutilised 62 66 and people with intellectual disability supported the use of hearing loops, braille and sign language. 60

To the best of our knowledge, this is the first systematic review investigating the barriers and enablers of the informed consent process for healthcare procedures for people with intellectual disability. The integrative review by Goldsmith et al 26 examined capacity assessment and shares only three articles with this systematic review. 69 71 73 Since the 2000s, there has been a paradigm shift in which capacity is no longer considered a fixed ability that only some individuals possess 38 39 but instead as ‘functional’: a flexible ability that changes over time and in different contexts, 79 reflected in Goldsmith’s review. An individual’s capacity can be supported through various measures, including how information is communicated and how the decision-making process is approached. 18 80 By recognising the barriers and enablers identified in this review, physicians can help ensure the consent process for their patients with intellectual disability is both valid and truly informed. This review has highlighted the problems of inaccessible health information, insufficient clinical education on how to make reasonable adjustments and lack of person-centred trauma-informed care.

Recommendations

Health professionals require training in the informed consent process for people with intellectual disability, particularly in effective and respectful communication, reasonable adjustments and trauma-informed care. Reasonable adjustments include offering longer or multiple appointments, using accessible resources (such as easy read information or shared decision-making tools) and allowing patient choices (such as to record a consultation or involve a support person). Co-researchers reported that many people with intellectual disability prefer to go without a support person because they find it difficult to challenge their decisions and feel ignored if the health professional only talks to the support person. People with intellectual disability also feel they cannot seek second opinions before making medical decisions or feel pressured to provide consent, raising the possibility of coercion. These experiences contribute to healthcare trauma. Co-researchers raised the importance of building rapport with the person with intellectual disability and of making reasonable adjustments, such as actively advocating for the person’s autonomy, clearly stating all options including the choice to refuse treatment, providing opportunities to contribute to discussions and multiple appointments to ask questions and understand information. They felt that without these efforts to support consent, health professionals can reinforce traumatic healthcare experiences for people with intellectual disability. Co-researchers noted instances where choices were made by doctors without discussion and where they were only given a choice after requesting one and expressed concern that these barriers are greater for those with higher support needs.

Co-researchers showed how these experiences contributed to mistrust of health professionals and poorer health outcomes. In one situation, a co-researcher was not informed of a medication’s withdrawal effects, resulting in significant side-effects when it was ceased. Many people with intellectual disability describe a poor relationship with their health professionals, finding it difficult to trust health information provided due to previous traumatic experiences of disrespect, coercion, lack of choice and inadequate support. Many feel they cannot speak up due to the power imbalance and fear of retaliation. Poor consent practices and lack of reasonable adjustments directly harm therapeutic alliances by reducing trust, contribute to healthcare trauma and lead to poorer health outcomes for people with intellectual disability.

Additional education and training for health professionals is urgently needed in the areas of informed consent, reasonable adjustments and effective communication with people with intellectual disability. The experiences of health professionals within the research team confirmed that there is limited training in providing high-quality healthcare for people with intellectual disability, including reasonable adjustments and accessible health information. Co-researchers also suggested that education should be provided to carers and support people to help them better advocate for people with intellectual disability.

Health information should be provided in a multimodal format, including written easy read information. Many countries have regulation protecting the right to accessible health information and communication support to make an informed choice, such as UK’s Accessible Information Standard, 81 and Australia’s Charter of Health Care Rights, 24 yet these are rarely observed. Steps to facilitate this include routinely asking patients about information requirements, system alerts for an individual’s needs or routinely providing reasonable adjustments. 82 Co-researchers agreed that there is a lack of accessible health information, particularly about medications, and that diagrams and illustrations are underutilised. There is a critical need for more inclusive and accessible resources to help health professionals support informed consent in a safe and high-quality health system. These resources should be created through methods of inclusive research, such as co-production, actively involving people with intellectual disability in the planning, creation, and feedback process. 53

Strengths and limitations

This systematic review involved two co-researchers with intellectual disability in sense-checking findings and co-creating the easy read summary. Two co-authors who are health professionals provided additional sense-checking of findings from a different stakeholder perspective. In future research, this could be extended by involving people with intellectual disability in the design and planning of the study as per recommendations for best-practice inclusive research. 53 83

The current literature is limited by low use of inclusive research practices in research involving people with intellectual disability, increasing vulnerability to external biases (eg, inaccessible questionnaires, involvement of carers in data collection, overcompliance or acquiescence and absence of researcher reflexivity). Advisory groups or co-research with people with intellectual disability were only used in five studies. 58 60 68 74 76 Other limitations include unclear selection criteria, low sample sizes, missing data, using gatekeepers in patient selection and predominance of UK-based studies—increasing the risk of bias and reducing transferability. Nine studies (out of 15 involving people with intellectual disability) explicitly excluded those with severe or profound intellectual disability, reflecting a selection bias; only one study specifically focused on people with intellectual disability with higher support needs. Studies were limited to a few healthcare contexts, with a focus on consent about sexual health, contraception and medications.

The heterogeneity and qualitative nature of studies made it challenging to apply traditional meta-analysis. However, to promote consistency in qualitative research, the PRISMA and ENTREQ guidelines were followed. 36 37 Although no meta-analyses occurred, the duplication of study populations in McCarthy 2009 and 2010 likely contributed to increased significance of findings reported in both studies. Most included studies (13/23) were published over 10 years ago, reducing the current relevance of this review’s findings. Nonetheless, the major findings reflect underlying systemic issues within the health system, which are unlikely to have been resolved since the articles were published, as the just-released final report of the Australian Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability highlights. 84 There is an urgent need for more inclusive studies to explore the recommendations and preferences of people with intellectual disability about healthcare choices.

Informed consent processes for people with intellectual disability should include accessible information and reasonable adjustments, be tailored to individuals’ needs and comply with consent and disability legislation. Resources, guidelines and healthcare education are needed and should cover how to involve carers and support people, address systemic healthcare problems, promote a person-centred approach and ensure effective communication. These resources and future research must use principles of inclusive co-production—involving people with intellectual disability at all stages. Additionally, research is needed on people with higher support needs and in specific contexts where informed consent is vital but under-researched, such as cancer screening, palliative care, prenatal and newborn screening, surgical procedures, genetic medicine and advanced therapeutics such as gene-based therapies.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1
• Data supplement 2
• Data supplement 3
• Data supplement 4
• Data supplement 5

Contributors MD, EEP and IS conceived the idea for the systematic review. MD drafted the search strategy which was refined by EEP and IS. MD and EEP completed article screening. MD and IS completed quality assessments of included articles. MD and JH completed data extraction. MD drafted the original manuscript. JL and SS were co-researchers who sense-checked findings and were consulted to formulate dissemination plans. JL and SS co-produced the easy read summary with MD, CM, JH, EEP and IS. MD, JLS, EEP and IS reviewed manuscript wording. All authors critically reviewed the manuscript and approved it for publication. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. MD is the guarantor responsible for the overall content of this manuscript.

Funding This systematic literature review was funded by the National Health & Medical Research Council (NHMRC), Targeted Call for Research (TCR) into Improving health of people with intellectual disability. Research grant title "GeneEQUAL: equitable and accessible genomic healthcare for people with intellectual disability". NHMRC application ID: 2022/GNT2015753.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Linked Articles

• Editorial It is up to healthcare professionals to talk to us in a way that we can understand: informed consent processes in people with an intellectual disability Jonathon Ding Richard Keagan-Bull Irene Tuffrey-Wijne BMJ Quality & Safety 2024; 33 277-279 Published Online First: 30 Jan 2024. doi: 10.1136/bmjqs-2023-016830

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