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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.

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

Open Google Slides Download PowerPoint

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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• 04 December 2020
• Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

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Literature reviews are important resources for scientists. They provide historical context for a field while offering opinions on its future trajectory. Creating them can provide inspiration for one’s own research, as well as some practice in writing. But few scientists are trained in how to write a review — or in what constitutes an excellent one. Even picking the appropriate software to use can be an involved decision (see ‘Tools and techniques’). So Nature asked editors and working scientists with well-cited reviews for their tips.

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doi: https://doi.org/10.1038/d41586-020-03422-x

Interviews have been edited for length and clarity.

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Correction 09 December 2020 : An earlier version of the tables in this article included some incorrect details about the programs Zotero, Endnote and Manubot. These have now been corrected.

Hsing, I.-M., Xu, Y. & Zhao, W. Electroanalysis 19 , 755–768 (2007).

Article   Google Scholar  

Ledesma, H. A. et al. Nature Nanotechnol. 14 , 645–657 (2019).

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Brahlek, M., Koirala, N., Bansal, N. & Oh, S. Solid State Commun. 215–216 , 54–62 (2015).

Choi, Y. & Lee, S. Y. Nature Rev. Chem . https://doi.org/10.1038/s41570-020-00221-w (2020).

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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

What is the purpose of literature review , a. habitat loss and species extinction: , b. range shifts and phenological changes: , c. ocean acidification and coral reefs: , d. adaptive strategies and conservation efforts: .

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 

Frequently asked questions 

What is a literature review .

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field.

Find academic papers related to your research topic faster. Try Research on Paperpal

3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example 

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:  

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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How to write a good literature review 

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review 

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:  

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:  

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:  

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:  

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:  

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:  

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?  

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research | Cite feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface. It also allows you auto-cite references in 10,000+ styles and save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

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• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references in 10,000+ styles into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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Writing a Literature Review

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

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1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

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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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Research Methods

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• Literature Review Research
• Research Design
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Literature Review

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

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

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

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

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

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

A literature review is important because it:

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

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

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

Not an essay 

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

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

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

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

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

Systematic review or meta-analysis?

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

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

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

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

Not all systematic reviews contain meta-analysis. 

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

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

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

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

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Scholarly Articles: How can I tell?

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The literature review section of an article is a summary or analysis of all the research the author read before doing his/her own research. This section may be part of the introduction or in a section called Background. It provides the background on who has done related research, what that research has or has not uncovered and how the current research contributes to the conversation on the topic. When you read the lit review ask:

• Does the review of the literature logically lead up to the research questions?
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The lit review is also a good place to find other sources you may want to read on this topic to help you get the bigger picture.

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A literature review of fault detection and diagnostic methods in three-phase voltage-source inverters.

1. Introduction

• Voltage-source inverters (VSI): This is already applied in the field of EVs and intelligent renewable energy systems because of its ease of implementation, robustness, and high speed.
• Current-source inverters (CSI): CSIs are used only when a constant current output is required; nonetheless, the CSI is reasonable for certain motor drivers.
• Impedance-source inverters (ZSI): This employs an alternate impedance network to step up the DC voltage before conversion, allowing optimal power extraction from low-voltage sources or sources such as photovoltaic panels.
• Multilevel inverters: These inverters use several voltages to obtain a sinusoidal waveform to the best of their ability. They minimize harmonic distortion, increase overall efficiency, and improve the power quality.
• Hybrid multilevel inverters: Hybrid multilevel inverters outperform VSIs and CSIs but have features from both. These have uses in medium-voltage drives and renewable energy systems.

2. VSI Faults Overview

2.1. power switch, 2.1.1. open fault (f1) [ 83 ], 2.1.2. short fault (f2) [ 84 ], 2.1.3. gate misfiring (f3) [ 83 ], 2.2. anti-parallel diode, 2.2.1. open fault (f4), 2.2.2. short fault (f5), 2.3. link capacitor, 2.3.1. open fault (f6), 2.3.2. short fault (f7) [ 86 ], 2.4. input port, 2.4.1. single line-ground s.c. (f8), 2.4.2. line-line s.c. (f9), 2.5. output port, 2.5.1. single line-ground s.c. (f10), 2.5.2. double line-ground s.c. (f11), 2.5.3. line-line s.c. (f12), 2.6. sensor (f13), 2.6.1. bias fault [ 87 ], 2.6.2. gain fault [ 87 ], 2.6.3. drift fault [ 87 ], 2.6.4. sensor noise [ 87 ], 2.6.5. short circuit and open circuit [ 88 ], 2.6.6. freezing [ 88 ], 3. evaluation indicators of fdd approaches.

• Robustness and Adaptability: The capability of performing a task without failure, covering a wide range of situations, and performing effectively, even with load variation, transients, and noisy environments. This is in addition to the adaptation when minor changes may occur in the system, including component degradation and external changes.
• Computational Complexity: This is the complexity of the operation and the effort required by the algorithm for the detection and diagnosing processes. This mainly depends on the complication level of the mathematical functions and the decision-making operation.
• Detection Speed: In general, the duration of fault detection is significantly influenced by the complexity of the algorithm. The faster the detection speed is, the better the FDD approach will be. The detection speed is an important indicator for selecting effective methods from those that need more time to detect fault occurrence.
• False-Positive Rate (FPR): The FPR is a ratio of pure negative classes that have been classified and known to be negative or positive.
• False-Negative Rate (FNR): the FNR is equivalent to the ratio of the actual positive fault detection (true positive) that has been classified by the system as negative (false negative).

4. VSI FDD Methods

4.1. open switch, 4.1.1. spectrogram [ 27 , 28 , 90 ], 4.1.2. current trajectory using park’s transform [ 29 , 30 ], 4.1.3. normalized load current [ 31 ], 4.1.4. clark’s transform [ 32 ], 4.1.5. fuzzy logic [ 33 ], 4.1.6. sliding-window counting based on phase voltages [ 34 ], 4.1.7. artificial neural networks [ 35 ], 4.1.8. wavelet-nf [ 36 ], 4.1.9. model reference adaptive system (mras) [ 37 ], 4.2. short-switch fault.

• False gate triggering signal;
• Sudden overcurrent value;
• Overvoltage;
• Damage in the anti-parallel internal or external diode;
• Disturbance due to high dv/dt value.

4.2.1. Voltage Space Patterns [ 44 ]

4.2.2. s-transform [ 45 , 46 ], 4.2.3. di/dt feedback control [ 47 ], 4.2.4. gate signal [ 48 , 49 ], 4.2.5. transient current [ 50 , 51 ], 4.2.6. bond wire [ 52 , 53 ], 4.3. gate misfiring fault.

• Missing pulse;
• Intermittent pulse;
• Fire-through.

4.4. Anti-Parallel Diode Fault

4.5. electrolytic capacitor fault.

• Voltage smoothing at the DC-link bus;
• Filtering high-frequency components that can minimize the harmonics in the chain;
• Maintaining steady voltage and current levels for the reliable and stable operation of the VSI.

4.5.1. Evidence Reasoning Rule (ER) [ 59 ]

4.5.2. recursive least square (rls) [ 61 ], 4.5.3. thermal modeling [ 63 ], 4.5.4. transient current [ 64 ], 4.5.5. anfis [ 65 ], 4.5.6. capacitance estimation using ann [ 66 , 67 ], 4.6. sensor fault, 4.6.1. parity space [ 72 , 73 ], 4.6.2. observer [ 74 , 75 ], 4.6.3. adaptive observer [ 76 , 77 , 78 ], 4.6.4. time-adaptive with elm [ 79 ], 4.6.5. extended kalman filter [ 80 , 81 ], 4.6.6. wavelet [ 82 ], 5. results interpretation, 6. conclusions.

• What is the basis on which various FDD methods can be compared?
• Which of the FDD approaches are deemed to be most efficient for each type of fault?
• What is the current literature in the field of FDD?

Author Contributions

Conflicts of interest.

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Ajra, Y.; Hoblos, G.; Al Sheikh, H.; Moubayed, N. A Literature Review of Fault Detection and Diagnostic Methods in Three-Phase Voltage-Source Inverters. Machines 2024 , 12 , 631. https://doi.org/10.3390/machines12090631

Ajra Y, Hoblos G, Al Sheikh H, Moubayed N. A Literature Review of Fault Detection and Diagnostic Methods in Three-Phase Voltage-Source Inverters. Machines . 2024; 12(9):631. https://doi.org/10.3390/machines12090631

Ajra, Youssef, Ghaleb Hoblos, Hiba Al Sheikh, and Nazih Moubayed. 2024. "A Literature Review of Fault Detection and Diagnostic Methods in Three-Phase Voltage-Source Inverters" Machines 12, no. 9: 631. https://doi.org/10.3390/machines12090631

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• Published: 09 September 2024

Effect of negative pressure wound therapy on the incidence of deep surgical site infections after orthopedic surgery: a meta-analysis and systematic review

• Huan Liu 1 , 2 ,
• Ge Zhang 1 , 3 ,
• An Wei 1 , 3 ,
• Hao Xing 1 , 2 ,
• Changsheng Han 1 , 3 &
• Zhengqi Chang 1  

Journal of Orthopaedic Surgery and Research volume  19 , Article number:  555 ( 2024 ) Cite this article

56 Accesses

Metrics details

This meta-analysis aimed to explore the impact of prophylactic negative pressure wound therapy (NPWT) on the occurrence of deep surgical site infections (SSIs) following orthopedic surgery.

A systematic search was conducted across Medline, Embase, Cochrane Library, and Web of Science databases for articles concerning NPWT in patients who underwent orthopedic surgery up to May 20, 2024. Using Stata 15.0, the combined odds ratios (ORs) were calculated with either a random-effects model or a fixed-effects model, depending on the heterogeneity values.

From a total of 440 publications, studies that utilized NPWT as the experimental group and conventional dressings as the control group were selected to analyze their impact on SSIs. Ultimately, 32 studies met the inclusion criteria. These included 12 randomized controlled trials and 20 cohort studies, involving 7454 patients, with 3533 of whom received NPWT and 3921 of whom were treated with conventional dressings. The results of the meta-analysis demonstrated that the NPWT group had a lower incidence of deep SSIs in orthopedic surgeries than did the control group [OR 0.64, 95% CI (0.52, 0.80), P  = 0.0001]. Subgroup analysis indicated a notable difference for trauma surgeries [OR 0.65, 95% CI (0.50, 0.83), P  = 0.001], whereas joint surgeries [OR 0.65, 95% CI (0.38, 1.12), P  = 0.122] and spine surgeries [OR 0.61, 95% CI (0.27, 1.35), P  = 0.221] did not show significant differences. Additionally, when examined separately according to heterogeneity, trauma surgeries exhibited a significant difference [OR 0.50, 95% CI (0.31, 0.80), P  = 0.004].

The results of our study indicate that the prophylactic use of NPWT reduces the incidence of deep SSIs following orthopedic trauma surgery when compared to the use of conventional dressings. We postulate that the prophylactic application of NPWT in patients at high risk of developing complications from bone trauma may result in improved clinical outcomes and an enhanced patient prognosis.

Introduction

The field of orthopedic surgery encompasses the full range of activities related to the prevention, diagnosis, and treatment of musculoskeletal system diseases and injuries, across the entire lifespan [ 1 ]. However, postsurgical complications, especially deep SSIs, remain a significant challenge [ 1 ]. Deep SSIs, such as deep wound infections, periprosthetic joint infections (PJI), and osteomyelitis, are common and serious issues [ 2 , 3 , 4 ]. For instance, a meta-analysis on spinal surgery reported a 1.5% incidence of deep SSIs and a 12–25% recurrence rate [ 5 ]. In another study, the incidence of deep SSIs after repairing periprosthetic knee fractures was alarmingly high at 88% [ 6 ]. Despite timely and appropriate management, deep SSIs can lead to severe outcomes, including multiple surgeries, permanent joint dysfunction, removal of the internal fixator, and even death in extreme cases [ 7 , 8 ]. Additionally, these infections often result in longer hospital stays and higher healthcare costs, placing a substantial financial burden on patients and healthcare systems [ 1 , 9 ]. Therefore, the most cost-effective strategy for preventing deep SSIs is to identify risk factors early and intervene promptly.

NPWT is widely used for various wound types and has shown significant efficacy in promoting wound healing and preventing infections. Mechanistically, NPWT works by stabilizing wounds, reducing bacterial loads, decreasing edema, modulating the immune response, stimulating granulation tissue formation, inducing angiogenesis, and enhancing blood circulation [ 10 , 11 , 12 ]. There is substantial evidence that NPWT significantly reduces surgical wound complications and prevents postoperative infections, both in clean and contaminated wounds, compared to traditional dressings [ 13 , 14 ].

Many studies have explored the impact of NPWT on reducing the incidence of deep postoperative orthopedic infections, but the findings regarding its effectiveness vary across different studies. While some research shows that NPWT significantly lowers deep infection rates [ 15 , 16 ], other studies have not found notable benefits [ 17 , 18 ]. These conflicting findings underscore the urgent need for more thorough and detailed analyses to uncover the true effectiveness of prophylactic NPWT. To better understand NPWT's role in preventing SSIs in orthopedics, this study conducted a meta-analysis and systematic review, providing clinicians with insights into the effects of prophylactic NPWT on the incidence of deep SSIs after orthopedic surgery.

Information and methods

The program has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviews will strictly follow these guidelines [ 19 ].

Literature search

A search was conducted on Medline, Embase, Cochrane Library, and Web of Science for cohort studies and case–control studies analyzing multifactorial risk factors for orthopedic SSIs up to May 20, 2024. The search employed subject terms and free-text keywords including orthopedics, surgical site infections, and negative pressure wound therapy. Specific search strategies are detailed in the supplementary material.

Inclusion and exclusion criteria

Inclusion criteria: 1. Research articles on the effectiveness of NPWT versus conventional dressings for treating orthopedic SSIs, particularly those involving deep SSIs. 2. Conformance with the diagnostic standards for deep SSIs [ 20 ].

Excluded studies consisted of conference abstracts, meta-analyses, protocols, letters, duplicate publications, systematic reviews, and animal experiments. Figure  1 depicts the entire study process.

Demonstrates the entire retrieval process

Studies were included without restrictions on size or type, and no language limitations were applied.

Data extraction

H.L and G.Z conducted a thorough screening of the literature for data extraction. This involved reviewing titles, abstracts, and full-text articles. Any discrepancies regarding inclusion were resolved through ZQ.C. Strict adherence to inclusion and exclusion criteria was maintained during the screening process. Extracted data included the first author's name, year of publication, country, study design, sample size, gender distribution, and age demographics. Cross-checking of extracted data was performed to ensure consistency.

Quality evaluation

The quality of the randomized controlled trials included in the study was assessed using the RoB 2 (Risk of Bias 2) tool, an updated iteration of the Cochrane Risk of Bias Tool for Randomized Trials [ 21 ]. Each study was evaluated against specific criteria and categorized into one of three levels of bias risk:Low: Assigned when all quality criteria were fully met. Unclear: Assigned when one or more criteria were partially met or unclear. High: Assigned when one or more criteria were not met or included. Three aspects of case–control and cohort studies were evaluated using the Newcastle–Ottawa Scale (NOS) [ 22 ]: selection of study population (4 points), comparability between groups (2 points), and assessment of exposure factors or outcome measures (3 points). Scores on the scale ranged from 0 to 9, with ≤ 4 indicating low quality, 5–6 moderate quality, and ≥ 7 high quality. Weighted Cohen's kappa coefficients were used to measure the consistency of the evaluations, the results of which can be found in Table  1 . Any disagreements that arise between the two assessors during the assessment process are resolved through discussion or consultation with a third party to reach a final decision.

Statistical analyses

The data were analyzed using Stata version 15.0 to compute combined odds ratios (OR) and their respective 95% confidence intervals (CI). The suitable model for calculating combined OR values was chosen following the assessment of heterogeneity using the Q-test and the I 2 statistic. When I 2 was greater than 50%, a random-effects model was applied, whereas for I 2 values of 50% or lower, a fixed-effects model was utilized. Sensitivity analyses involved conducting a one-by-one exclusion test for studies with I 2 exceeding 50%. Publication bias across the literature was evaluated using Egger's test, with statistical significance set at α = 0.05. Results were deemed statistically significant if P was less than 0.05.

Literature search and selection process

Medline, Embase, the Cochrane Library, and Web of Science were systematically searched for studies investigating the impact of NPWT on orthopedic SSIs. Literature management was conducted using EndNote 21. Initially, 440 documents were retrieved, and after 139 duplicates were removed, 301 unique documents remained. Following the exclusion criteria and screening of titles and abstracts, 48 documents were selected for full-text review. Ultimately, 32 papers met the inclusion criteria and were included in the analysis.

Basic characteristics of included literature

The analysis included a total of 32 studies [ 17 , 18 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], consisting of 12 randomized controlled trials and 20 cohort studies. These studies encompassed 17 articles on trauma surgery, 11 on joint surgeries, and 4 on spinal surgeries. Overall, the research involved 7545 patients, with 3582 undergoing NPWT and 3963 receiving conventional dressings. Detailed descriptions of the included studies are provided in Table  2 .

Among 32 included articles, randomized controlled trials were assessed using the Cochrane Risk of Bias Tool for Randomized Trials, and the specific risk of bias evaluations are shown in Fig.  2 . Cohort studies were appraised using the Newcastle–Ottawa Scale (NOS), revealing one study scoring 6, while the remaining articles scored between 7 and 9, indicating overall high quality among the included studies. The detailed results of the quality assessment are outlined in Table  3 .

Evaluation of bias across 11 randomized controlled studies

Meta-analysis

Orthopedic area.

A total of 32 studies were included in the meta-analysis. The heterogeneity test (I 2  = 37.8%, P  = 0.016) indicated that a fixed-effects model was suitable for the analysis. NPWT significantly decreased the occurrence of deep SSIs in postoperative orthopedic patients [OR 0.64, 95% CI (0.52, 0.80), P  = 0.0001]. The detailed results can be found in Fig.  3 and Table  4 .

Forest plot depicting the impact of prophylactic NPWT versus conventional dressing on infection rates at deep orthopedic surgical sites

Subgroup analyses

The 32 studies were further analyzed in subgroups based on different types of surgeries: 17 studies focused on orthopedic trauma, 11 on joint surgeries, and 4 on spinal surgeries. The results indicated a significant reduction in the incidence of deep SSIs in trauma surgeries [OR 0.65, 95% CI (0.50, 0.83), P  = 0.001]. However, the differences were not statistically significant for joint surgeries [OR 0.65, 95% CI (0.38, 1.12), P  = 0.122] or spinal surgeries [OR 0.61, 95% CI (0.27, 1.35), P  = 0.221]. The detailed results are shown in Fig.  4 and Table  4 .

Forest plots depicting subgroup analyses categorized by various types of surgical procedures

Orthopedic trauma area

In the subgroup analysis of patients who underwent orthopedic trauma surgery, where heterogeneity was observed at 58.2%, a random-effects model was applied to analyze 17 relevant studies. The analysis demonstrated a significant reduction in the occurrence of deep SSIs with NPWT in patients who underwent orthopedic trauma surgery [OR 0.50, 95% CI (0.31, 0.80), P  = 0.004]. The detailed findings are presented in Fig.  5 and Table  4 .

Forest plot analyzed separately for the orthopedic trauma field

Reanalysis: results after excluding costa 2020

Because the Costa 2020 study constituted 27.56% of the weighting in the overall analysis and that publication bias for orthopedic trauma surgery ( P  = 0.051) was tantamount to the level of statistical significance, a reanalysis was conducted to exclude the Costa 2020 study to ascertain its impact on the results of the analysis. The results of the reanalysis are presented below:

The incidence of deep SSIs in postoperative orthopedic patients remained significantly lower after the exclusion of the Costa 2020 study, with a statistically significant difference [OR 0.57, 95% CI (0.44, 0.73), P  = 0.000]. The discrepancy was marginal in comparison to the outcomes of the analyses that incorporated the Costa 2020 study. Please refer to Fig.  6 and Table  4 for further details.

Forest plot depicting the impact of prophylactic NPWT versus conventional dressing on infection rates at deep orthopedic surgical sites, after the exclusion of the Costa 2020 study

Following the exclusion of the Costa 2020 study, the incidence of deep SSIs in postoperative patients undergoing orthopedic trauma surgery remained significantly lower, with a statistically significant difference (OR 0.45, 95% CI (0.26, 0.77), P  = 0.004). This difference was relatively minor in comparison to the results of the analyses that included the Costa 2020 study. Please refer to Fig.  7 and Table  4 for further details.

Forest plot analyzed separately for the orthopedic trauma field, after the exclusion of the Costa 2020 study

Publication bias

The Egger test was applied to the entire field of orthopedic surgery and orthopedic trauma surgery to assess publication bias. The results indicated that there was no publication bias in either orthopedic surgery ( P  = 0.109) or orthopedic trauma surgery ( P  = 0.051) as the P-values were greater than 0.05. After removing Costa 2020, the results remained unchanged with both orthopedic surgery ( P  = 0.340) and orthopedic trauma surgery ( P  = 0.143) having P -values greater than 0.05, suggesting that there was no significant publication bias.

This meta-analysis examined the effect of NPWT on the incidence of deep SSIs. Across the included studies, the incidence of deep SSIs in the NPWT group ranged from 0 to 23%. NPWT was found to be effective in reducing the incidence of deep SSIs following orthopedic surgery compared to conventional dressing therapy. However, this result requires further interpretation. Subgroup analyses revealed that prophylactic NPWT significantly reduced deep SSIs only in the orthopedic trauma area, with no significant differences observed in the spine and joint areas. Furthermore, as the Costa 2020 study constituted 27.56% of the overall analysis and the publication bias for orthopedic trauma surgery ( P  = 0.051) was nearly at the level of statistical significance, we conducted a new meta-analysis and test for publication bias, excluding the Costa 2020 study, and compared the results with those of the previous analysis. The results of the comparison demonstrated no significant alteration in the outcomes of the two analyses, indicating that the analyses remain robust even with the inclusion of the Costa 2020 study.

NPWT is widely recognized as being able to prevent and treat infections and may be associated with several potential mechanisms for preventing deep infections [ 53 ]. Firstly, the vacuum-enclosed membrane provided by NPWT provides a physical barrier on the surface of the wound, which prevents the invasion of external bacteria [ 54 ]. Secondly, NPWT can promote wound healing through its negative pressure effect. Mechanistically, NPWT enhances local blood perfusion and promotes granulation tissue production, while stabilizing the wound environment through protein regulation and inflammatory cytokine clearance, all of which provide an optimal environment for wound healing [ 55 , 56 , 57 , 58 ]. Recently, some researchers have found that NPWT also promotes wound healing by upregulating IL-17 expression [ 59 ]. Finally, NPWT can disrupt bacterial biofilms. The use of implants in orthopedic surgery creates conditions for the formation of bacterial biofilms, and some studies have reported that bacterial biofilms contain up to 97% water, and NPWT can expel the water in the biofilm through the effect of sustained negative pressure to necrose the bacteria in the biofilm, which may reduce the chance of bacterial aggregation on the surface of the implant and the reconstruction of the biofilm [ 60 ].

It is noteworthy that NPWT also plays a regulatory role in local immunity, a function that may be linked to the mechanistic action of the ion channel protein Piezo1. NPWT provides mechanical forces, particularly traction forces, which may be detected by Piezo1 and transformed into electronic and chemical signals, ultimately regulating cellular functions [ 61 ]. Studies have shown that NPWT enhances neutrophil recruitment and modulates neutrophil immune function, possibly through a mechanism involving Piezo1 [ 62 ]. Nevertheless, the precise way NPWT impacts immunoregulation remains unclear and warrants further research.

Our findings reveal that NPWT significantly reduces the incidence of deep infections in bone trauma surgeries. The study included various complex procedures, such as pelvic fracture surgery, acetabular fracture repair, and open fracture surgeries. These surgeries often involve challenging conditions that require advanced surgical skills, longer operative times, and cause more severe damage to the surrounding soft tissues and blood supply [ 16 ]. Unlike joint and spine surgeries, trauma surgeries frequently involve open wounds, which not only increase the risk of infection but also add to the complexity of the procedure [ 63 ]. Larger surgical wounds lead to longer healing times and increased exudate at the surgical site, allowing NPWT to fully promote wound healing and utilize negative pressure suction to reduce deep SSIs.

Our results are consistent with findings from previous meta-analyses. For instance, studies by Zhang et al. [ 16 ], Marc et al. [ 64 ], and Xie et al. [ 15 ] have all demonstrated that NPWT effectively reduces the occurrence of deep SSIs. However, not all research aligns with our findings. Studies by Li et al. [ 65 ] and Qian et al. [ 66 ] reported no significant difference between the NPWT group and the conventional dressing group in preventing deep SSIs. This disparity may be attributed to variations in sample size and types of surgeries conducted in the studies. Specifically, Li et al. included only four studies with a total of 744 patients to analyze the effect of prophylactic NPWT on the incidence of deep SSIs after orthopedic trauma surgery. The smaller number of studies and small sample size may have resulted in a decrease in the robustness of the results, which, in turn, led to findings that were inconsistent with those of our study. Qian et al. included six studies with a total of 2344 patients to analyze the effect of prophylactic NPWT on the incidence of deep SSIs after open lower extremity fracture surgery. Limiting the study to open lower extremity fracture surgery may have limited the generalisability of the results, which in turn may have led to inconsistencies with our findings. Zhang et al., Xie et al., and our study, in contrast to previous studies, did not limit the type of surgery, and the patients included in the analyses numbered over 3000. By employing a larger sample size and an unrestricted approach to surgery, our study enhances the reliability and generalizability of the results. This allows us to validate the effectiveness of NPWT in large sample sizes and diverse patient populations.

The findings from our study regarding joint did not demonstrate a significant difference between the two treatment modalities, which aligns with the results reported by Kim et al. [ 67 ]. In their meta-analysis, Kim and colleagues analyzed nine studies focusing on total hip and knee arthroplasty to evaluate the impact of NPWT on deep SSIs, and they also observed no significant differences. Unlike bone trauma surgery, joint surgeries typically involve cleaner surgical environments, shorter operative times, lower complexity, and less tissue trauma. These factors may limit the ability of NPWT to provide its full range of benefits in joint surgeries.

In the context of spinal surgery, our findings showed no significant difference between the two treatment groups. There is limited literature on deep SSIs in spinal procedures, and no meta-analysis has specifically explored the impact of prophylactic NPWT on these infections. Although a meta-analyze has reported that prophylactic NPWT effectively reduces SSIs after spinal surgery, our research suggests that prophylactic NPWT does not offer any significant advantage over conventional dressings in preventing deep SSIs [ 68 ]. This might be due to the deep and complex nature of spinal wounds, as well as the thicker soft tissue coverage involved. The presence of substantial subcutaneous tissue and intricate incisions may reduce the effectiveness of the negative pressure applied by NPWT. Additionally, in cases where there is surgical contamination or inadequate wound irrigation, bacterial biofilm formation on internal fixation devices can occur. Given the deeper location of these biofilms, NPWT may be less effective at disrupting them. As a result, NPWT's effectiveness in such cases may be limited. Future high-quality randomized controlled trials are needed to confirm these findings.

Several independent risk factors have been identified as contributing to the development of deep SSIs following bone trauma surgery. These include older age, diabetes, smoking, extended surgical duration, and open injuries [ 7 , 69 , 70 , 71 , 72 , 73 , 74 ]. We recommend the prophylactic application of NPWT for patients presenting with these risk factors to lower the likelihood of deep infections. For patients experiencing superficial SSIs, utilizing NPWT as a treatment method could potentially prevent the progression of these infections into deeper SSIs. This is because NPWT can remove superficial bacteria along with exudate through its suction mechanism, thereby reducing the possibility of bacterial penetration into deeper tissues. However, there is a lack of conclusive evidence linking superficial site infections to an increased risk of deeper infections. For instance, research by Patterson et al. [ 75 ] indicates that deep infections rarely follow superficial infections after surgical fixation of the tibial plateau and distal tibial fractures. Given the economic considerations surrounding NPWT, its use has been somewhat restricted. Further research is required to elucidate the connection between superficial and deep SSIs, thereby providing a stronger theoretical foundation for the clinical use of NPWT.

In conclusion, our study revealed that NPWT effectively reduced the incidence of deep SSIs following orthopedic surgery compared with conventional dressings. However, subgroup analyses revealed a significant difference only in patients who underwent orthopedic trauma surgery. We suggest that prophylactic NPWT in high-risk orthopedic trauma patients may yield significant clinical benefits and improve patient outcomes. To validate the effect of NPWT on deep SSIs after spine surgery, rigorous randomized controlled trials are necessary. Furthermore, further research is needed to elucidate the specific mechanisms by which NPWT influences immune modulation in these contexts. The connection between superficial and deep SSIs warrants additional investigation.

Limitations

There are several limitations to this meta-analysis. First, an overrepresentation of studies focused on orthopedic trauma surgery may bias the overall results in favor of NPWT's effect on reducing deep SSIs in this specific field. Second, the limited number of studies pertaining to spine surgery may compromise the accuracy of our findings in that context. Third, the literature reviewed in this study did not specifically categorize PJI, making it impossible to distinguish between acute and chronic PJI. This limitation hindered our ability to analyze variations in the effectiveness of prophylactic NPWT across different types of PJI. Future research should aim to clearly define and differentiate between PJI types to more precisely evaluate the impact of NPWT. Finally, the inclusion of retrospective studies with varying follow-up durations introduces potential biases related to interviewer bias.

Availability of data and materials

Data is provided within the manuscript or supplementary information files.

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Huan Liu was involved in study design, selection, analysis, report writing and manuscript review. Ge Zhang was involved in in study design, selection and report writing Hao Xing, An Wei and Changsheng Han participated in information retrieval and manuscript review. Zhengqi Chang contributed to the design, selection, analysis, report writing and manuscript review. All authors read and approved the final manuscript.

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Liu, H., Zhang, G., Wei, A. et al. Effect of negative pressure wound therapy on the incidence of deep surgical site infections after orthopedic surgery: a meta-analysis and systematic review. J Orthop Surg Res 19 , 555 (2024). https://doi.org/10.1186/s13018-024-05038-7

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

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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Emotion Regulation and Academic Burnout Among Youth: a Quantitative Meta-analysis

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• Published: 10 September 2024
• Volume 36 , article number  106 , ( 2024 )

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• Ioana Alexandra Iuga   ORCID: orcid.org/0000-0001-9152-2004 1 , 2 &
• Oana Alexandra David   ORCID: orcid.org/0000-0001-8706-1778 2 , 3  

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Emotion regulation (ER) represents an important factor in youth’s academic wellbeing even in contexts that are not characterized by outstanding levels of academic stress. Effective ER not only enhances learning and, consequentially, improves youths’ academic achievement, but can also serve as a protective factor against academic burnout. The relationship between ER and academic burnout is complex and varies across studies. This meta-analysis examines the connection between ER strategies and student burnout, considering a series of influencing factors. Data analysis involved a random effects meta-analytic approach, assessing heterogeneity and employing multiple methods to address publication bias, along with meta-regression for continuous moderating variables (quality, female percentage and mean age) and subgroup analyses for categorical moderating variables (sample grade level). According to our findings, adaptive ER strategies are negatively associated with overall burnout scores, whereas ER difficulties are positively associated with burnout and its dimensions, comprising emotional exhaustion, cynicism, and lack of efficacy. These results suggest the nuanced role of ER in psychopathology and well-being. We also identified moderating factors such as mean age, grade level and gender composition of the sample in shaping these associations. This study highlights the need for the expansion of the body of literature concerning ER and academic burnout, that would allow for particularized analyses, along with context-specific ER research and consistent measurement approaches in understanding academic burnout. Despite methodological limitations, our findings contribute to a deeper understanding of ER's intricate relationship with student burnout, guiding future research in this field.

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Introduction

The transitional stages of late adolescence and early adulthood are characterized by significant physiological and psychological changes, including increased stress (Matud et al., 2020 ). Academic stress among students has long been studied in various samples, most of them focusing on university students (Bedewy & Gabriel, 2015 ; Córdova Olivera et al., 2023 ; Hystad et al., 2009 ) and, more recently, high school (Deb et al., 2015 ) and middle school students (Luo et al., 2020 ). Further, studies report an exacerbation of academic stress and mental health difficulties in response to the COVID-19 pandemic (Guessoum et al., 2020 ), with children facing additional challenges that affect their academic well-being, such as increasing workloads, influences from the family, and the issue of decreasing financial income (Ibda et al., 2023 ; Yang et al., 2021 ). For youth to maintain their well-being in stressful academic settings, emotion regulation (ER) has been identified as an important factor (Santos Alves Peixoto et al., 2022 ; Yildiz, 2017 ; Zahniser & Conley, 2018 ).

Emotion regulation, referring to”the process by which individuals influence which emotions they have, when they have them, and how they experience and express their emotions” (Gross, 1998b ), represents an important factor in youth’s academic well-being even in contexts that are not characterized by outstanding levels of stress. Emotion regulation strategies promote more efficient learning and, consequentially, improve youth’s academic achievement and motivation (Asareh et al., 2022 ; Davis & Levine, 2013 ), discourage academic procrastination (Mohammadi Bytamar et al., 2020 ), and decrease the chances of developing emotional problems such as burnout (Narimanj et al., 2021 ) and anxiety (Shahidi et al., 2017 ).

Approaches to Emotion Regulation

Numerous theories have been proposed to elucidate the process underlying the emergence and progression of emotional regulation (Gross, 1998a , 1998b ; Koole, 2009 ; Larsen, 2000 ; Parkinson & Totterdell, 1999 ). One prominent approach, developed by Gross ( 2015 ), refers to the process model of emotion regulation, which lays out the sequential actions people take to regulate their emotions during the emotion-generative process. These steps involve situation selection, situation modification, attentional deployment, cognitive change, and response modulation. The kind and timing of the emotion regulation strategies people use, according to this paradigm, influence the specific emotions people experience and express.

Recent theories of emotion regulation propose two separate, yet interconnected approaches: ER abilities and ER strategies. ER abilities are considered a higher-order process that guides the type of ER strategy an individual uses in the context of an emotion-generative circumstance. Further, ER strategies are considered factors that can also influence ER abilities, forming a bidirectional relationship (Tull & Aldao, 2015 ). Researchers use many definitions and classifications of emotion regulation, however, upon closer inspection, it becomes clear that there are notable similarities across these concepts. While there are many models of emotion regulation, it's important to keep from seeing them as competing or incompatible since each one represents a unique and important aspect of the multifaceted concept of emotion regulation.

Emotion Regulation and Emotional Problems

The connection between ER strategies and psychopathology is intricate and multifaceted. While some researchers propose that ER’s effectiveness is context-dependent (Kobylińska & Kusev, 2019 ; Troy et al., 2013 ), several ER strategies have long been attested as adaptive or maladaptive. This body of work suggests that certain emotion regulation strategies (such as avoidance and expressive suppression) demonstrate, based on findings from experimental studies, inefficacy in altering affect and appear to be linked to higher levels of psychological symptoms. These strategies have been categorized as ER difficulties. In contrast, alternative emotion regulation strategies (such as reappraisal and acceptance) have demonstrated effectiveness in modifying affect within controlled laboratory environments, exhibiting a negative association with clinical symptoms. As a result, these strategies have been characterized as potentially adaptive (Aldao & Nolen-Hoeksema, 2012a , 2012b ; Aldao et al., 2010 ; Gross, 2013 ; Webb et al., 2012 ).

A long line of research highlights the divergent impact of putatively maladaptive and adaptive ER strategies on psychopathology and overall well-being (Gross & Levenson, 1993 ; Gross, 1998a ). Increased negative affect, increased physiological reactivity, memory problems (Richards et al., 2003 ), a decline in functional behavior (Dixon-Gordon et al., 2011 ), and a decline in social support (Séguin & MacDonald, 2018 ) are just a few of the negative effects that have consistently been linked to emotional regulation difficulties, which include but are not limited to the use of avoidance, suppression, rumination, and self-blame strategies. Additionally, a wide range of mental problems, such as depression (Nolen-Hoeksema et al., 2008 ), anxiety disorders (Campbell-Sills et al., 2006a , 2006b ; Mennin et al., 2007 ), eating disorders (Prefit et al., 2019 ), and borderline personality disorder (Lynch et al., 2007 ; Neacsiu et al., 2010 ) are connected to self-reports of using these strategies.

Conversely, putatively adaptive strategies, including acceptance, problem-solving, and cognitive reappraisal, have consistently yielded beneficial outcomes in experimental studies. These outcomes encompass reductions in negative emotional responses, enhancements in interpersonal relationships, increased pain tolerance, reductions in physiological reactivity, and lower levels of psychopathological symptoms (Aldao et al., 2010 ; Goldin et al., 2008 ; Hayes et al., 1999 ; Richards & Gross, 2000 ).

Notably, despite the fact that therapeutic techniquest for enhancing the use of adaptive ER strategies are core elements of many therapeutic approaches, from traditional Cognitive Behavioral Therapy (CBT) to more recent third-wave interventions (Beck, 1976 ; Hofmann & Asmundson, 2008 ; Linehan, 1993 ; Roemer et al., 2008 ; Segal et al., 2002 ), the association between ER difficulties and psychopathology frequently show a stronger positive correlation compared to the inverse negative association with adaptive ER strategies, as highlighted by Aldao and Nolen-Hoeksema ( 2012a ).

Pines & Aronson ( 1988 ) characterize burnout that arises in the workplace context as a state wherein individuals encounter emotional challenges, such as experiencing fatigue and physical exhaustion due to heightened task demands. Recently, driven by the rationale that schools are the environments where students engage in significant work, the concept of burnout has been extended to educational contexts (Salmela-Aro, 2017 ; Salmela-Aro & Tynkkynen, 2012 ; Walburg, 2014 ). Academic burnout is defined as a syndrome comprising three dimensions: exhaustion stemming from school demands, a cynical and detached attitude toward one's academic environment, and feelings of inadequacy as a student (Salmela-Aro et al., 2004 ; Schaufeli et al., 2002 ).

School burnout has quickly garnered international attention, despite its relatively recent emergence, underscoring its relevance across multiple nations (Herrmann et al., 2019 ; May et al., 2015 ; Meylan et al., 2015 ; Yang & Chen, 2016 ). Similar to other emotional difficulties, it has been observed among students from various educational systems and academic policies, suggesting that this phenomenon transcends cultural and geographical boundaries (Walburg, 2014 ).

The link between ER and school burnout can be understood through Gross's ( 1998a ) process model of emotion regulation. This model suggests that an individual's emotional responses are influenced by their ER strategies, which are adaptive or maladaptive reactions to stressors like academic pressure. Given that academic stress greatly influences school burnout (Jiang et al., 2021 ; Nikdel et al., 2019 ), the ER strategies students use to manage this stress may impact their likelihood of experiencing burnout. In essence, whether a student employs efficient ER strategies or encounters ER difficulties could influence their susceptibility to school burnout.

The exploration of ER in relation to student burnout has garnered attention through various studies. However, the existing body of research is not yet robust enough, and its outcomes are not universally congruent. Suppression, defined as efforts to inhibit ongoing emotional expression (Balzarotti et al., 2010 ), has demonstrated a positive and significant correlation with both general and specific burnout dimensions (Chacón-Cuberos et al., 2019 ; Seibert et al., 2017 ), with the exception of the study conducted by Yu et al., ( 2022 ), where there is a negative, but not significant association between suppression and reduced accomplishment. Notably, research by Muchacka-Cymerman and Tomaszek ( 2018 ) indicates that ER strategies, encompassing both dispositional and situational approaches, exhibit a negative relationship with overall burnout. Situational ER, however, displays a negative impact on dimensions like inadequacy and declining interest, particularly concerning the school environment.

Cognitive ER strategies such as reappraisal, positive refocusing, and planning are, generally, negatively associated with burnout, while self-blame, other-blame, rumination, and catastrophizing present a positive association with burnout (Dominguez-Lara, 2018 ; Vinter et al., 2021 ). It's important to note that these relationships have not been consistently replicated across all investigations. Inconsistencies in the findings highlight the complexity of the interactions and the potential influence of various contextual factors. Consequently, there remains a critical need for further research to thoroughly examine these associations and identify the factors contributing to the variability in results.

Existing Research

Although we were unable to identify any reviews or meta-analyses that synthesize the literature concerning emotion regulation strategies and student burnout, recent meta-analyses have identified the role of emotion regulation across pathologies. A recent network meta-analysis identified the role of rumination and non-acceptance of emotions to be closely related to eating disorders (Leppanen et al., 2022 ). Further, compared to healthy controls, people presenting bipolar disorder symptoms reported significantly higher difficulties in emotion regulation (Miola et al., 2022 ). Weiss et al. ( 2022 ) identified a small to medium association between emotion regulation and substance use, and a subsequent meta-analysis conducted by Stellern et al. ( 2023 ) confirmed that individuals with substance use disorders have significantly higher emotion regulation difficulties compared to controls. The study of Dawel et al. ( 2021 ) represents the many research papers asking the question”Cause or symptom” in the context of emotion regulation. The longitudinal study brings forward the bidirectional relationship between ER and depression and anxiety, particularly in the case of suppression, suggesting that suppressing emotions is indicative of and can predict psychological distress.

Despite the increasing research attention to academic burnout in recent years, the current body of literature primarily concentrates on specific groups such as medical students (Almutairi et al., 2022 ; Frajerman et al., 2019 ), educators (Aloe et al., 2014 ; Park & Shin, 2020 ), and students at the secondary and tertiary education levels (Madigan & Curran, 2021 ) in the context of meta-analyses and reviews. A limited number of recent reviews have expanded their focus to include a more diverse range of participants, encompassing middle school, graduate, and university students (Kim et al., 2018 , 2021 ), with a particular emphasis on investigating social support and exploring the demand-control-support model in relation to student burnout.

The significance of managing burnout in educational settings is becoming more widely acknowledged, as seen by the rise in interventions designed to reduce the symptoms of burnout in students. Specific interventions for alleviating burnout symptoms among students continue to proliferate (Madigan et al., 2023 ), with a focus on stress reduction through mindfulness-based strategies (Lo et al., 2021 ; Modrego-Alarcón et al., 2021 ) and rational-emotive behavioral techniques (Ogbuanya et al., 2019 ) to enhance emotion-regulation skills (Charbonnier et al., 2022 ) and foster rational thinking (Bresó et al., 2011 ; Ezeudu et al., 2020 ). This underscores the significance of emotion regulation in addressing burnout.

Despite several randomized clinical trials addressing student burnout and an emerging body of research relating emotion regulation and academic burnout, there's a lack of a systematic examination of how emotion regulation strategies relate to various dimensions of student burnout. This highlights the necessity for a systematic review of existing evidence. The current meta-analysis addresses the association between emotion regulation strategies and student burnout.

A secondary objective is to test the moderating effect of school level and female percentage in the sample, as well as study quality, in order to identify possible sources of heterogeneity among effect sizes. By analyzing the moderating effect of school level and gender, we may determine if the strength of the association between student burnout and emotion regulation is contingent upon the educational setting and participant characteristics. This offers information on the findings' generalizability to all included student demographics, including those in elementary, middle, and secondary education and of different genders. Additionally, the reliability and validity of meta-analytic results rely on the evaluation of research quality, and the inclusion of study quality rating allows us to determine if the observed association between emotion regulation and student burnout differs based on the methodological rigor of the included studies.

Materials and Methods

Study protocol.

The present meta-analysis has been carried out following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement (Moher et al., 2009 ). The protocol for the meta-analysis was pre-registered in PROSPERO (PROSPERO, 2022 CRD42022325570).

Selection of Studies

A systematic search was performed using relevant databases (PubMed, Web of Science, PsychINFO, and Scopus). The search was carried out on 25 May of 2023 using 25 key terms related to the variables of interest, such as: (a) academic burnout, (b) school burnout, (c) student burnout (d) education burnout, (d) exhaustion, (e) cynicism, (f) inadequacy, (g) emotion regulation, (h) coping, (i) self-blame, (j) acceptance, and (h) problem solving.

Studies of any design published in peer-reviewed journals were eligible for inclusion, provided they used empirical data to assess the relationship between student burnout and emotion regulation strategies. Only studies that employed samples of children, adolescents, and youth were eligible for inclusion. For the purpose of the current paper, we define youth as people aged 18 to 25, based on how it is typically defined in the literature (Westhues & Cohen, 1997 ).

Studies were excluded from the meta-analysis if they: (a) were not a quantitative study, (b) did not explore the relationship between academic burnout and emotion regulation strategies, (c) did not have a sample that can be defined as consisting of children and youth (Scales et al., 2016 ), (e) did not utilize Pearson’s correlation or measures that could be converted to a Pearson’s correlation, (f) include medical school or associated disciplines samples.

Statistical Analysis

For the data analysis, we employed Comprehensive Meta-Analysis 4 software. Anticipating significant heterogeneity in the included studies, we opted for a random effects meta-analytic approach instead of a fixed-effects model, a choice that acknowledges and accounts for potential variations in effect sizes across studies, contributing to a more robust and generalizable synthesis of the results. Heterogeneity among the studies was assessed using the I 2 and Q statistics, adhering to the interpretation thresholds outlined in the Cochrane Handbook (Deeks et al., 2023 ).

Publication bias was assessed through a multi-faceted approach. We first examined the funnel plot for the primary outcome measures, a graphical representation revealing potential asymmetry that might indicate publication bias. Furthermore, we utilized Duval and Tweedie's trim and fill procedure (Duval & Tweedie, 2000 ), as implemented in CMA, to estimate the effect size after accounting for potential publication bias. Additionally, Egger's test of the intercept was conducted to quantify the bias detected by the funnel plot and to determine its statistical significance.

When dealing with continuous moderating variables, we employed meta-regression to evaluate the significance of their effects. For categorical moderating variables, we conducted subgroup analyses to test for significance. To ensure the validity of these analyses, it was essential that there was a minimum of three effect sizes within each subgroup under the same moderating variable, following the guidelines outlined by Junyan and Minqiang ( 2020 ). In accordance with the guidance provided in the Cochrane Handbook (Schmid et al., 2020 ), our application of meta-regression analyses was limited to cases where a minimum of 10 studies were available for each examined covariate. This approach ensures that there is a sufficient number of studies to support meaningful statistical analysis and reliable conclusions when exploring the influence of various covariates on the observed relationships.

Data Extraction and Quality Assessment

In addition to the identification information (i.e., authors, publication year), we extracted data required for the effect size calculation for the variables relevant to burnout and emotion regulation strategies. Where data was unavailable, the authors were contacted via email in order to provide the necessary information. Potential moderator variables were coded in order to examine the sources of variation in study findings. The potential moderators included: (a) participants’ gender, (b), grade level (c) study quality, and (d) mean age.

The full-text articles were independently assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields tool (Kmet et al., 2004 ) by a pair of coders (II and SM), to ensure the reliability of the data, resulting in a substantial level of agreement (Cohen’s k  = 0.89). The disagreements and discrepancies between the two coders were resolved through discussion and consensus. If consensus could not be reached, a third researcher (OD) was consulted to resolve the disagreement.

The checklist items focused on evaluating the alignment of the study's design with its stated objectives, the methodology employed, the level of precision in presenting the results, and the accuracy of the drawn conclusions. The assessment criteria were composed of 14 items, which were evaluated using a 3-point Likert scale (with responses of 2 for "yes," 1 for "partly," and 0 for "no"). A cumulative score was computed for each study based on these items. For studies where certain checklist items were not relevant due to their design, those items were marked as "n/a" and were excluded from the cumulative score calculation.

Study Selection

The combined search terms yielded a total of 15,179 results. The duplicate studies were removed using Zotero, and a total of 8,022 studies remained. The initial screening focused on the titles and abstracts of all remaining studies, removing all documents that target irrelevant predictors or outcomes, as well as qualitative studies and reviews. Two assessors (II and SA) independently screened the papers against the inclusion and exclusion criteria. A number of 7,934 records were removed, while the remaining 88 were sought for retrieval. Out of the 88 articles, we were unable to find one, while another has been retracted by the journal. Finally, 86 articles were assessed for eligibility. A total of 20 articles met the inclusion criteria (see Fig.  1 ). Although a specific cutoff criterion for reliability coefficients was not imposed during study selection, the majority of the included studies had alpha Cronbach values for the instruments assessing emotion regulation and school burnout greater than 0.70.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of the study selection process

Data Overview

Among the included studies, four focused on middle school students, two encompassed high school student samples, and the remaining 14 articles involved samples of university students. The majority of the included studies had cross-sectional designs (17), while the rest consisted of 2 longitudinal studies and one non-randomized controlled pilot study. The percentage of females within the samples ranged from 46% to 88.3%, averaging 65%, while the mean age of participants ranged from 10.39 to 25. The investigated emotional regulation strategies within the included studies exhibit variation, encompassing other-blame, self-blame, acceptance, rumination, catastrophizing, putting into perspective, reappraisal, planning, behavioral and mental disengagement, expressive suppression, and others (see Table  1 for a detailed study presentation).

Study Quality

Every study surpasses a quality threshold of 0.60, and 75% of the studies achieve a score above the more conservative threshold indicated by Kmet et al. ( 2004 ). This indicates a minimal risk of bias in these studies. Moreover, 80% of the studies adequately describe their objectives, while the appropriateness of the study design is recognized in 50% of the cases, mostly utilizing cross-sectional designs. While 95% of the studies provide sufficient descriptions of their samples, only 10% employ appropriate sampling methods, with the majority relying on convenience sampling. Notably, there is just one interventional study that lacks random allocation and blinding of investigators or subjects.

In terms of measurement, 85% of the studies employ validated and reliable tools. Adequacy in sample size and well-justified and appropriate analytic methods are observed across all included studies. While approximately 50% of the studies present estimates of variance, a mere 30% of them acknowledge the control of confounding variables. Lastly, 95% of the studies provide results in comprehensive detail, with 60% effectively grounding their discussions in the obtained results. The quality assessment criteria and results can be consulted in Supplementary Material 4 .

Pooled Effects

A sensitivity analysis using standardized residuals was conducted. Provided that the residuals are normally distributed, 95% of them would fall within the range of -2 to 2. Residuals outside this range were considered unusual. We applied this cutoff in our meta-analysis to identify any outliers. The results of the analysis revealed that several relationships had standardized residuals falling outside the specified range. Re-analysis excluding these outliers demonstrated that our initial results were robust and did not significantly change in magnitude or significance. As a result, we have moved on with the analysis for the entire sample.

The calculated overall effects can be consulted in Table  2 . The correlation between ER difficulties and student burnout is a significant one, with significant positive associations between ER difficulties and overall burnout (k = 13), r  = 0.25 (95% CI = 0.182; 0.311), p  < 0.001, as well as individual burnout dimensions: cynicism (k = 9), r  = 0.28 (95% CI = 0.195; 0.353) p  < 0.001, lack of efficacy (k = 8), r  = 0.17 (95% CI = 0.023; 0.303), p  < 0.05 and emotional exhaustion (k = 11), r  = 0.27 (95% CI = 0.207; 0.335) p  < 0.001. Regarding the relationship between adaptive ER strategies and student burnout, a statistically significant result is observed solely between overall student burnout and adaptive ER (k = 17), r  = -14 (95% CI = -0.239; 0.046) p  < 0.005. The forest plots can be consulted in Supplementary Material 1 .

Heterogeneity and Publication Bias

Table 3 shows that all Q tests were significant, indicating that there is significant variation among the effect sizes of the individual studies included in the meta-analysis. Further, all I 2 indices are over 75%, ranging from 83.67% to 99.32%, which also indicates high heterogeneity (Borenstein et al., 2017 ). This consistently high level of heterogeneity indicates substantial variation in effect sizes, pointing to influential factors that significantly shape the outcomes of the included studies. Consequentially, subgroup and meta-regression analyses are to be carried out in order to unravel the underlying factors driving this pronounced heterogeneity. The results of the publication bias analysis are presented individually below and, additionally, you can consult the funnel plots included in Supplementary Material 2 .

Adaptive ER and School Burnout

Upon visual examination of the funnel plot, asymmetry to the right of the mean was observed. To validate this observation, a trim-and-fill analysis using Duval and Tweedie’s method was conducted, revealing the absence of three studies on the left side of the mean. The adjusted effect size ( r  = -0.17, 95% CI [0.27; 0.68]) resulting from this analysis was found to be higher than the initially observed effect size. Nevertheless, the application of Egger’s test did not yield a significant indication of publication bias ( B  = -5.34, 95% CI [-11.85; 1.16], p  = 0.10).

Adaptive ER and Cynicism

Following a visual examination of the funnel plot, a symmetrical arrangement of effect sizes around the mean was apparent. This finding was contradicted by the application of Duval and Tweedie's trim-and-fill method, which revealed two missing studies to the right of the mean. The adjusted effect size ( r  = 0.04, 95% CI [-0.21; 0.13]) is smaller than the initially observed effect size. The application of Egger’s test did not yield a significant indication of publication bias ( B  = -2.187, 95% CI [-8.57; 4.19], p  = 0.43).

ER difficulties and Lack of Efficacy

The visual examination of the funnel plot revealed asymmetry to the right of the mean. This finding was validated by the application of Duval and Tweedie's trim-and-fill method, which revealed two missing studies to the left of the mean and a lower adjusted effect size ( r  = 0.08, 95% CI [-0.07; 0.23]), the effect becoming statistically non-significant. The application of Egger’s test did not yield a significant indication of publication bias ( B  = 7.76, 95% CI [-16.53; 32.05], p  = 0.46).

Adaptive ER and Emotional Exhaustion

The visual examination of the funnel plot revealed asymmetry to the left of the mean. The trim-and-fill method also revealed one missing study to the right of the mean and a lower adjusted effect size ( r  = 0.00, 95% CI [-0.13; 0.12]). The application of Egger’s test did not yield a significant indication of publication bias ( B  = 7.02, 95% CI [-23.05; 9.02], p  = 0.46).

Adaptive ER and Lack of Efficacy; ER difficulties and School Burnout, Cynicism, and Exhaustion

Upon visually assessing the funnel plot, a balanced distribution of effect sizes centered around the mean was observed. This observation is corroborated by the application of Duval and Tweedie's trim-and-fill method, which also revealed no indication of missing studies. The adjusted effect size remained consistent, and the intercept signifying publication bias was found to be statistically insignificant.

Moderator Analysis

We performed moderator analyses for the categorical variables, in the case of significant relationships that were uncovered in the initial analysis. These analyses were carried out specifically for cases where there were more than three effect sizes available within each subgroup that fell under the same moderating variable.

Students’ grade level was used as a categorical moderator. Pre-university students included students enrolled in primary and secondary education, while the university student category included tertiary education students. The results, presented in Table  4 , show that the moderating effect of grade level is not significant for the relationship between adaptive ER and overall school burnout Q (1) = 0.20, p  = 0.66. At a specific level, the moderating effect is significant for the relationship between ER difficulties and overall burnout Q (1) = 9.81, p  = 0.002, cynicism Q (1) = 16.27, p  < 0.001, lack of efficacy Q (1) = 15.47 ( p  < 0.001), and emotional exhaustion Q (1) = 13.85, p  < 0.001. A particularity of the moderator analysis in the relationship between ER difficulties and lack of efficacy is that, once the effect of the moderator is accounted for, the relationship is not statistically significant anymore for the university level, r  = -0.01 (95% CI = -0.132; 0.138), but significant for the pre-university level, r  = 0.33 (95% CI = 0.217; 0.439).

Meta-regressions

Meta-regression analyses were employed to examine how the effect size or relationship between variables changes based on continuous moderator variables. We included as moderators the female percentage (the proportion of female participants in each study’s sample) and the study quality assessed based on the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields tool (Kmet et al., 2004 ).

Results, presented in Table  5 , show that study quality does not significantly influence the relationship between ER and school burnout. The proportion of female participants in the study sample significantly influences the relationship between ER difficulties and overall burnout ( β , -0.0055, SE = 0.001, p  < 0.001), as well as the emotional exhaustion dimension ( β , -0.0049, SE = 0.002, p  < 0.01). Mean age significantly influences the relationship between ER difficulties and overall burnout ( β , -0.0184, SE = 0.006, p  < 0.01). Meta-regression plots can be consulted in detail in Supplementary Material 3 .

A post hoc power analysis was conducted using the metapower package in R. For the pooled effects analysis of the relationship between ER difficulties and overall school burnout, as well as with cynicism and emotional exhaustion, the statistical power was adequate, surpassing the recommended 0.80 cutoff. The analysis of the association between ER difficulties and lack of efficacy, along with the relationship between adaptive ER and school burnout, cynicism, lack of efficacy, and emotional exhaustion were greatly underpowered. In the case of the moderator analysis, the post-hoc power analysis indicates insufficient power. Please consult the coefficients in Table  6 .

The central goal of this meta-analysis was to examine the relationship between emotion-regulation strategies and student burnout dimensions. Additionally, we focused on the possible effects of sample distribution, in particular on participants’ age, education levels they are enrolled in, and the percentage of female participants included in the sample. The study also aimed to determine how research quality influences the overall findings. Taking into consideration the possible moderating effects of sample characteristics and research quality, the study aimed to offer a thorough assessment of the literature concerning the association between emotion regulation strategies and student burnout dimensions. A correlation approach was used as the current literature predominantly consists of cross-sectional studies, with insufficient longitudinal studies or other designs that would allow for causal interpretation of the results.

The study’s main findings indicate that adaptive ER strategies are associated with overall burnout, whereas ER difficulties are associated with both overall burnout and all its dimensions encompassing emotional exhaustion, cynicism, and lack of efficacy.

Prior meta-analyses have similarly observed that adaptive ER strategies tend to exhibit modest negative associations with psychopathology, while ER difficulties generally presented more robust positive associations with psychopathology (Aldao et al., 2010 ; Miu et al., 2022 ). These findings could suggest that the observed variation in the effect of ER strategies on psychopathology, as previously indicated in the literature, can also be considered in the context of academic burnout.

However, it would be an oversimplification to conclude that adaptive ER strategies are less effective in preventing psychopathology than ER difficulties are in creating vulnerability to it. Alternatively, as previously underlined, researchers should consider the frequency, flexibility, and variability in the way ER strategies are applied and how they relate to well-being and psychopathology. Further, it’s important to also address the possible directionality of the relationship. While the few studies that assume a prediction model for academic burnout and ER treat ER as a predictor for burnout and its dimensions (see Seibert et al., 2017 ; Vizoso et al., 2019 ), we were unable to identify studies that assume the role of burnout in the development of ER difficulties. Additionally, the studies identified that relate to academic burnout have a cross-sectional design that makes it even more difficult to pinpoint the ecological directionality of the relationship.

While the focus on the causal role of ER strategies in psychopathology and psychological difficulties is of great importance for psychological interventions, addressing a factor that merely reflects an effect or consequence of psychopathology will not lead to an effective solution. According to Gross ( 2015 ), emotion regulation strategies are employed when there is a discrepancy between a person's current emotional state and their desired emotional state. Consequently, individuals could be likely to also utilize emotion regulation strategies in response to academic burnout. Additionally, studies that have utilized a longitudinal approach have demonstrated that, in the case of spontaneous ER, people with a history of psychopathology attempt to regulate their emotions more when presented with negative stimuli (Campbell-Sills et al., 2006a , 2006b ; Ehring et al., 2010 ; Gruber et al., 2012 ). The results of Dawel et al. ( 2021 ) further solidify a bidirectional model that could and should be also applied to academic burnout research.

Following the moderator analysis, the results indicate that the moderating effect of grade level did not have a substantial impact on the relationship between adaptive ER and school burnout. In the context of this discussion, it is important to note that regarding the relationship between adaptive ER and overall burnout, there is an imbalance in the distribution of studies between the university and pre-university levels, which could potentially present a source of bias or error.

When it comes to the relationship between ER difficulties and burnout, the inclusion of the moderator exhibited notable significance, overall and at the dimensions’ level. Particularly noteworthy is the finding that, within the relationship involving ER difficulties and lack of efficacy, the inclusion of the moderator rendered the association statistically insignificant for university-level students, while maintaining significance for pre-university-level students. The outcomes consistently demonstrate larger effect sizes for the relationship between ER difficulties and burnout at the pre-university level in comparison to the university level. Additionally, the mean age significantly influences the relationship between ER difficulties and overall burnout.

These findings may imply the presence of additional variables that exert a varying influence at the two educational levels and as a function of age. There are several contextual factors that could be framing the current findings, such as parental education anxiety (Wu et al., 2022 ), parenting behaviors, classroom atmosphere (Lin & Yang, 2021 ), and self-efficacy (Naderi et al., 2018 ). As the level of independence drastically increases from pre-university to university, the influence of negative parental behaviors and attitudes can become limited. Furthermore, the university-level learning environment often provides a satisfying and challenging educational experience, with greater opportunities for students to engage in decision-making and take an active role in their learning (Belaineh, 2017 ), which can serve as a protective factor against student’s academic burnout (Grech, 2021 ). At an individual level, many years of experience in navigating the educational environment can increase youths’ self-efficacy in the educational context and offer proper learning tools and techniques, which can further influence various aspects of self-regulated learning, such as monitoring of working time and task persistence (Bouffard-Bouchard et al., 1991 ; Cattelino et al., 2019 ).

The findings of the meta-regression analysis suggest that the association between ER and school burnout is not significantly impacted by study quality. It’s important to interpret these findings in the context of rather homogenous study quality ratings that can limit the detection of significant impacts.

The current results underline that the correlation between ER difficulties and both overall burnout and the emotional exhaustion dimension is significantly influenced by the percentage of female participants in the study sample. Previous research has shown that girls experience higher levels of stress, as well as higher expectations concerning their school performance, which can originate not only intrinsically, but also from external sources such as parents, peers, and educators (Östberg et al., 2015 ). These heightened expectations and stress levels may contribute to the gender differences in how emotion regulation difficulties are associated with school burnout.

The results of this meta-analysis suggest that most of the included studies present an increased level of methodological quality, reaching or surpassing the quality thresholds previously established. These encouraging results indicate a minimal risk of bias in the selected research. Moreover, it’s notable that a sizable proportion of the included studies clearly articulate their research objectives and employ well-established measurement tools, that would accurately capture the constructs of interest. There are still several areas of improvement, especially with regard to variable conceptualization and sampling methods, highlighting the importance of maintaining methodological rigor in this area of research.

Significant Q tests and I 2 identified in the case of several analyses indicate a strong heterogeneity among the effect sizes of individual studies in the meta-analysis's findings. This variability suggests that there is a significant level of diversity and variation among the effects observed in the studies, and it is improbable that this diversity is solely attributable to random chance. Even with as few as 10 studies, with 30 participants in the primary studies, the Q test has been demonstrated to have good power for identifying heterogeneity (Maeda & Harwell, 2016 ). Recent research (Mickenautsch et al., 2024 ), suggests that the I 2 statistic is not influenced by the number of studies and sample sizes included in a meta-analysis. While the relationships between Adaptive ER—cynicism, ER difficulties—cynicism, Adaptive ER—lack of efficacy, and ER difficulties—lack of efficacy are based on a limited number of studies (8–9 studies), it's noteworthy that the primary study sample sizes for these relationships are relatively large, averaging above 300. This suggests that despite the small number of studies, the robustness of the findings may be supported by the substantial sample sizes, which can contribute to the statistical power of the analysis.

However, it's essential to consider potential limitations such as range restriction or measurement error, which could impact the validity of the findings. Despite these considerations, the combination of substantial primary study sample sizes and the robustness of the Q test provides a basis for confidence in the results.

The results obtained when publication bias was examined using funnel plots, trim-and-fill analyses, and Egger's tests were varying across different outcomes. In the case of adaptive emotion regulation (ER) and school burnout, no evidence of publication bias was found, suggesting that the observed effects are likely robust. The trim-and-fill analysis, however, indicated the existence of missing studies for adaptive ER and cynicism, potentially influencing the initial effect size estimate. For ER difficulties and lack of efficacy, the adjustment for missing studies in the trim-and-fill analysis led to a non-significant effect. Additionally, adaptive ER and emotional exhaustion displayed a similar pattern with the trim-and-fill method leading to a lower, non-significant effect size. This indicates the need for additional studies to be included in future meta-analyses. According to the Cochrane Handbook (Higgins et al., 2011 ), the results of Egger’s test and funnel plot asymmetry should be interpreted with caution, when conducted on fewer than 10 studies.

The results of the post-hoc power analysis reveal that the relationship between ER difficulties and cynicism, as well as emotional exhaustion, meets the threshold of 0.80 for statistical power, as suggested by Harrer et al. ( 2022 ). This implies that our study had a high likelihood of detecting significant associations between ER difficulties and these specific outcomes, providing robust evidence for the observed relationships. However, for the relationship between ER difficulties and overall burnout, the power coefficient falls just below the indicated threshold. While our study still demonstrated considerable power to detect effects, the slightly lower coefficient suggests a marginally reduced probability of detecting significant associations between ER difficulties and overall burnout.

The power coefficients for the remaining post-hoc analyses are fairly small, which suggests that there is not enough statistical power to find meaningful relationships. This shows that there might not have been enough power in our investigation to find significant correlations between the variables we sought to investigate. Even if these analyses' power coefficients are lower than ideal, it's important to consider the study's limitations and implications when interpreting the results.

Limitations and Future Directions

One important limitation of our meta-analysis is represented by the small number of studies included in the analysis. Smaller meta-analyses could result in less reliable findings, with estimates that could be significantly influenced by outliers and inclusion of studies with extreme results. The small number of studies also interferes with the interpretation of both Q and I 2 heterogeneity indices (von Hippel, 2015 ). In small sample sizes, it may be challenging to detect true heterogeneity, and the I 2 value may be imprecise or underestimate the actual heterogeneity.

The studies included in the current meta-analysis focused on investigating how individuals generally respond to stressors. However, it's crucial to remember that people commonly use various ER strategies based on particular contexts, or they could even combine ER strategies within a single context. This adaptability in ER strategies reflects the dynamic and context-dependent nature of emotional regulation, where people draw upon various tools and approaches to effectively manage their emotions in different circumstances.

Given the heterogeneity of studies that investigate ER as a context-dependent phenomenon in the context of academic burnout, as well as the diverse nature of these existing studies, it becomes imperative for future research to consider a number of key aspects. First and foremost, future studies should aim to expand the body of literature on this topic by conducting more research specifically focusing on the context-dependent and flexible nature of ER in the context of academic burnout and other psychopathologies. Taking into account the diversity of educational environments, curricula, and student demographics, these research initiatives should also include a wide range of academic contexts.

Furthermore, it is advisable for researchers to implement a uniform methodology for assessing and documenting ER strategies. This consistency in measurement will simplify the process of comparing results among different studies, bolster the reliability of the data, and pave the way for more extensive and comprehensive meta-analyses.

Insufficient research that delves into the connection between burnout and particular emotional regulation (ER) strategies, such as reappraisal or suppression, has made it unfeasible to conduct a meaningful analysis within the scope of the current meta-analysis, that could further bring specificity as to which ER strategies could influence or be affected in the context of academic burnout. Consequentially, the expansion of the inclusion criteria for future meta-analyses should be considered, along with the replication of the current meta-analysis in the context of future publications on this topic.

Future interventions aimed at addressing academic burnout should adopt a tailored approach that takes into consideration age or school-level influences, as well as gender differences. Implementing prevention programs in pre-university educational settings can play a pivotal role in equipping children and adolescents with vital emotion regulation skills and stress management strategies. Additionally, it is essential to provide additional support to girls, recognizing their unique stressors and increased academic expectations.

Implications

Our meta-analysis has several implications, both theoretical and practical. Firstly, the meta-analysis extends the understanding of the relationship between emotion regulation (ER) strategies and student burnout dimensions. Although the correlational and cross-sectional nature of the included studies does not allow for drawing causal implications, the results represent a great stepping stone for future research. Secondly, the results highlight the intricacy of ER strategies and their applicability in educational contexts. Along with the identified differences between preuniversity and university students, this emphasizes the importance of developmental and contextual factors in ER research and the necessity of having an elaborate understanding of the ways in which these strategies are used in various situations and according to individual particularities. The significant impact of the percentage of female participants on the relationship between ER strategies and academic burnout points to the need for gender-sensitive approaches in ER research. On a practical level, our results suggest the need for targeted interventions aimed at the specific needs of different educational levels and age groups, as well as gender-specific strategies to address ER difficulties.

In conclusion, the findings of the current meta-analysis reveal that adaptive ER strategies are associated with overall burnout, while ER difficulties are linked to both overall burnout and its constituent dimensions, including emotional exhaustion, cynicism, and lack of efficacy. These results align with prior research in the domain of psychopathology, suggesting that adaptive ER strategies may be more efficient in preventing psychopathology than ER difficulties are in creating vulnerability to it, or that academic burnout negatively influences the use of adaptive ER strategies in the youth population. As an alternative explanation, it might also be that the association between ER strategies, well-being, and burnout can vary based on the context, frequency, flexibility, and variability of their application. Furthermore, our study identified the moderating role of grade level and the sample’s gender composition in shaping these associations. The academic environment, parental influences, and self-efficacy may contribute to the observed differences between pre-university and university levels and age differences.

Despite some methodological limitations, the current meta-analysis underscores the need for context-dependent ER research and consistent measurement approaches in future investigations of academic burnout and psychopathology. The heterogeneity among studies may suggest variability in the relationship between emotion regulation and student burnout across different contexts. This variability could be explained through methodological differences, assessment methods, and other contextual factors that were not uniformly accounted for in the included studies. The included studies do not provide insights into changes over time as most studies were cross-sectional. Future research should aim to better understand the underlying reasons for the observed differences and to reach more conclusive insights through longitudinal research designs.

Overall, this meta-analysis contributes to a deeper understanding of the intricate relationship between ER strategies and student burnout and serves as a good reference point for future research within the academic burnout field.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This work was supported by two grants awarded to the corresponding author from the Romanian National Authority for Scientific Research, CNCS—UEFISCDI (Grant number PN-III-P4-ID-PCE-2020-2170 and PN-III-P2-2.1-PED-2021-3882)

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Iuga, I.A., David, O.A. Emotion Regulation and Academic Burnout Among Youth: a Quantitative Meta-analysis. Educ Psychol Rev 36 , 106 (2024). https://doi.org/10.1007/s10648-024-09930-w

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