purpose of literature review in research

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What is the Purpose of a Literature Review?

4-minute read

• 23rd October 2023

If you’re writing a research paper or dissertation , then you’ll most likely need to include a comprehensive literature review . In this post, we’ll review the purpose of literature reviews, why they are so significant, and the specific elements to include in one. Literature reviews can:

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

A literature review is a critical summary and evaluation of the existing research (e.g., academic journal articles and books) on a specific topic. It is typically included as a separate section or chapter of a research paper or dissertation, serving as a contextual framework for a study. Literature reviews can vary in length depending on the subject and nature of the study, with most being about equal length to other sections or chapters included in the paper. Essentially, the literature review highlights previous studies in the context of your research and summarizes your insights in a structured, organized format. Next, let’s look at the overall purpose of a literature review.

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Literature reviews are considered an integral part of research across most academic subjects and fields. The primary purpose of a literature review in your study is to:

Provide a Foundation for Current Research

Since the literature review provides a comprehensive evaluation of the existing research, it serves as a solid foundation for your current study. It’s a way to contextualize your work and show how your research fits into the broader landscape of your specific area of study.  

Define Key Concepts and Theories

The literature review highlights the central theories and concepts that have arisen from previous research on your chosen topic. It gives your readers a more thorough understanding of the background of your study and why your research is particularly significant .

Demonstrate Critical Evaluation 

A comprehensive literature review shows your ability to critically analyze and evaluate a broad range of source material. And since you’re considering and acknowledging the contribution of key scholars alongside your own, it establishes your own credibility and knowledge.

Show How Research and Methodologies Have Evolved

Another purpose of literature reviews is to provide a historical perspective and demonstrate how research and methodologies have changed over time, especially as data collection methods and technology have advanced. And studying past methodologies allows you, as the researcher, to understand what did and did not work and apply that knowledge to your own research.  

Identify Gaps in Existing Research

Besides discussing current research and methodologies, the literature review should also address areas that are lacking in the existing literature. This helps further demonstrate the relevance of your own research by explaining why your study is necessary to fill the gaps.

Support Your Argument

A good literature review should provide evidence that supports your research questions and hypothesis. For example, your study may show that your research supports existing theories or builds on them in some way. Referencing previous related studies shows your work is grounded in established research and will ultimately be a contribution to the field.  

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• University of Texas Libraries

Literature Reviews

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

What is a Literature Review?

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

A literature review should: 

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

From  S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

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

Larayne Dallas : Engineering

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

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

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

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

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

Frequently asked questions

What is the purpose of a literature review.

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.

Frequently asked questions: Academic writing

A rhetorical tautology is the repetition of an idea of concept using different words.

Rhetorical tautologies occur when additional words are used to convey a meaning that has already been expressed or implied. For example, the phrase “armed gunman” is a tautology because a “gunman” is by definition “armed.”

A logical tautology is a statement that is always true because it includes all logical possibilities.

Logical tautologies often take the form of “either/or” statements (e.g., “It will rain, or it will not rain”) or employ circular reasoning (e.g., “she is untrustworthy because she can’t be trusted”).

You may have seen both “appendices” or “appendixes” as pluralizations of “ appendix .” Either spelling can be used, but “appendices” is more common (including in APA Style ). Consistency is key here: make sure you use the same spelling throughout your paper.

The purpose of a lab report is to demonstrate your understanding of the scientific method with a hands-on lab experiment. Course instructors will often provide you with an experimental design and procedure. Your task is to write up how you actually performed the experiment and evaluate the outcome.

In contrast, a research paper requires you to independently develop an original argument. It involves more in-depth research and interpretation of sources and data.

A lab report is usually shorter than a research paper.

The sections of a lab report can vary between scientific fields and course requirements, but it usually contains the following:

• Title: expresses the topic of your study
• Abstract: summarizes your research aims, methods, results, and conclusions
• Introduction: establishes the context needed to understand the topic
• Method: describes the materials and procedures used in the experiment
• Results: reports all descriptive and inferential statistical analyses
• Discussion: interprets and evaluates results and identifies limitations
• Conclusion: sums up the main findings of your experiment
• References: list of all sources cited using a specific style (e.g. APA)
• Appendices: contains lengthy materials, procedures, tables or figures

A lab report conveys the aim, methods, results, and conclusions of a scientific experiment . Lab reports are commonly assigned in science, technology, engineering, and mathematics (STEM) fields.

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .

If you’ve gone over the word limit set for your assignment, shorten your sentences and cut repetition and redundancy during the editing process. If you use a lot of long quotes , consider shortening them to just the essentials.

If you need to remove a lot of words, you may have to cut certain passages. Remember that everything in the text should be there to support your argument; look for any information that’s not essential to your point and remove it.

To make this process easier and faster, you can use a paraphrasing tool . With this tool, you can rewrite your text to make it simpler and shorter. If that’s not enough, you can copy-paste your paraphrased text into the summarizer . This tool will distill your text to its core message.

Revising, proofreading, and editing are different stages of the writing process .

• Revising is making structural and logical changes to your text—reformulating arguments and reordering information.
• Editing refers to making more local changes to things like sentence structure and phrasing to make sure your meaning is conveyed clearly and concisely.
• Proofreading involves looking at the text closely, line by line, to spot any typos and issues with consistency and correct them.

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 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.

Avoid citing sources in your abstract . There are two reasons for this:

• The abstract should focus on your original research, not on the work of others.
• The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

• To help potential readers determine the relevance of your paper for their own research.
• To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.

In a scientific paper, the methodology always comes after the introduction and before the results , discussion and conclusion . The same basic structure also applies to a thesis, dissertation , or research proposal .

Depending on the length and type of document, you might also include a literature review or theoretical framework before the methodology.

Whether you’re publishing a blog, submitting a research paper , or even just writing an important email, there are a few techniques you can use to make sure it’s error-free:

• Take a break : Set your work aside for at least a few hours so that you can look at it with fresh eyes.
• Proofread a printout : Staring at a screen for too long can cause fatigue – sit down with a pen and paper to check the final version.
• Use digital shortcuts : Take note of any recurring mistakes (for example, misspelling a particular word, switching between US and UK English , or inconsistently capitalizing a term), and use Find and Replace to fix it throughout the document.

If you want to be confident that an important text is error-free, it might be worth choosing a professional proofreading service instead.

Editing and proofreading are different steps in the process of revising a text.

Editing comes first, and can involve major changes to content, structure and language. The first stages of editing are often done by authors themselves, while a professional editor makes the final improvements to grammar and style (for example, by improving sentence structure and word choice ).

Proofreading is the final stage of checking a text before it is published or shared. It focuses on correcting minor errors and inconsistencies (for example, in punctuation and capitalization ). Proofreaders often also check for formatting issues, especially in print publishing.

The cost of proofreading depends on the type and length of text, the turnaround time, and the level of services required. Most proofreading companies charge per word or page, while freelancers sometimes charge an hourly rate.

For proofreading alone, which involves only basic corrections of typos and formatting mistakes, you might pay as little as $0.01 per word, but in many cases, your text will also require some level of editing , which costs slightly more.

It’s often possible to purchase combined proofreading and editing services and calculate the price in advance based on your requirements.

There are many different routes to becoming a professional proofreader or editor. The necessary qualifications depend on the field – to be an academic or scientific proofreader, for example, you will need at least a university degree in a relevant subject.

For most proofreading jobs, experience and demonstrated skills are more important than specific qualifications. Often your skills will be tested as part of the application process.

To learn practical proofreading skills, you can choose to take a course with a professional organization such as the Society for Editors and Proofreaders . Alternatively, you can apply to companies that offer specialized on-the-job training programmes, such as the Scribbr Academy .

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You can find all the citation styles and locales used in the Scribbr Citation Generator in our publicly accessible repository on Github .

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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.

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
• URL: https://guides.lib.uconn.edu/literaturereview

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

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

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

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

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

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

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

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

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

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

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

You can use boolean operators to help narrow down your search:

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

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

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

For each publication, ask yourself:

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

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

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

It is often written as part of a dissertation , thesis, research paper , or proposal .

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

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

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

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

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What Is A Literature Review?

A plain-language explainer (with examples).

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

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

Literature Review 101

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

What is a literature review?

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

Reviewing the literature

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

The literature review chapter

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

What’s the purpose of a literature review?

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

Purpose #1 – Demonstrate your topic knowledge

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

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

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

Purpose #3 – Lay the foundation for your conceptual framework

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

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

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

Purpose #4 – To inform your methodology

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

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

How do I find articles for my literature review?

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

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

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

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

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

Need a helping hand?

How should I structure my literature review?

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

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

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

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

Example of a literature review

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

Wrapping Up

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

Psst… there’s more!

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

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16 Comments

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

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

This website is amazing, it really helps break everything down. Thank you, I would have been lost without it.

This is review is amazing. I benefited from it a lot and hope others visiting this website will benefit too.

Timothy T. Chol [email protected]

Thank you very much for the guiding in literature review I learn and benefited a lot this make my journey smooth I’ll recommend this site to my friends

This was so useful. Thank you so much.

Hi, Concept was explained nicely by both of you. Thanks a lot for sharing it. It will surely help research scholars to start their Research Journey.

The review is really helpful to me especially during this period of covid-19 pandemic when most universities in my country only offer online classes. Great stuff

Great Brief Explanation, thanks

So helpful to me as a student

GradCoach is a fantastic site with brilliant and modern minds behind it.. I spent weeks decoding the substantial academic Jargon and grounding my initial steps on the research process, which could be shortened to a couple of days through the Gradcoach. Thanks again!

This is an amazing talk. I paved way for myself as a researcher. Thank you GradCoach!

Well-presented overview of the literature!

This was brilliant. So clear. Thank you

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Libraries | Research Guides

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

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

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

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

• Next: Planning the Review >>
• Last Updated: Jan 17, 2024 10:05 AM
• URL: https://libguides.northwestern.edu/literaturereviews

Reference management. Clean and simple.

What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

Literature Reviews

What is a literature review.

• Literature Review Process

Purpose of a Literature Review

• Choosing a Type of Review
• Developing a Research Question
• Searching the Literature
• Searching Tips
• ChatGPT [beta]
• Documenting your Search
• Using Citation Managers
• Concept Mapping
• Writing the Review
• Further Resources

The Library's Subject Specialists are happy to help with your literature reviews!  Find your Subject Specialist here . 

If you have questions about this guide, contact Librarian  Jamie Niehof ([email protected]).

A literature review is an overview of the available research for a specific scientific topic. Literature reviews summarize existing research to answer a review question, provide context for new research, or identify important gaps in the existing body of literature.

An incredible amount of academic literature is published each year, by estimates over two million articles .

Sorting through and reviewing that literature can be complicated, so this Research Guide provides a structured approach to make the process more manageable.

THIS GUIDE IS AN OVERVIEW OF THE LITERATURE REVIEW PROCESS:

• Getting Started (asking a research question | defining scope)
• Organizing the Literature
• Writing the Literature Review (analyzing | synthesizing)

A  literature search  is a systematic search of the scholarly sources in a particular discipline. A  literature review   is the analysis, critical evaluation and synthesis of the results of that search. During this process you will move from a review  of  the literature to a review  for   your research.   Your synthesis of the literature is your unique contribution to research.

WHO IS THIS RESEARCH GUIDE FOR?

— those new to reviewing the literature

— those that need a refresher or a deeper understanding of writing literature reviews

You may need to do a literature review as a part of a course assignment, a capstone project, a master's thesis, a dissertation, or as part of a journal article. No matter the context, a literature review is an essential part of the research process. 

WHAT IS THE PURPOSE OF A LITERATURE REVIEW?

A literature review is typically performed for a specific reason. Even when assigned as an assignment, the goal of the literature review will be one or more of the following:

• To communicate a project's novelty by identifying a research gap

• An overview of research issues , methodologies or results relevant to field
• To explore the  volume and types of available studies
• To establish familiarity with current research before carrying out a new project
• To resolve conflicts amongst contradictory previous studies

Reviewing the literature helps you understand a research topic and develop your own perspective.

A LITERATURE REVIEW IS NOT :

• An annotated bibliography – which is a list of annotated citations to books, articles and documents that includes a brief description and evaluation for each entry
• A literary review – which is a critical discussion of the merits and weaknesses of a literary work
• A book review – which is a critical discussion of the merits and weaknesses of a particular book
• Next: Choosing a Type of Review >>
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Conducting a literature review: why do a literature review, why do a literature review.

• How To Find "The Literature"
• Found it -- Now What?

Besides the obvious reason for students -- because it is assigned! -- a literature review helps you explore the research that has come before you, to see how your research question has (or has not) already been addressed.

You identify:

• core research in the field
• experts in the subject area
• methodology you may want to use (or avoid)
• gaps in knowledge -- or where your research would fit in

It Also Helps You:

• Publish and share your findings
• Justify requests for grants and other funding
• Identify best practices to inform practice
• Set wider context for a program evaluation
• Compile information to support community organizing

Great brief overview, from NCSU

Want To Know More?

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• Last Updated: Dec 8, 2023 10:11 AM
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Organizing Your Social Sciences Research Paper

• 5. The Literature Review
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
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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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Literature Review: Purpose of a Literature Review

• Literature Review
• Purpose of a Literature Review
• Work in Progress
• Compiling & Writing
• Books, Articles, & Web Pages
• Types of Literature Reviews
• Departmental Differences
• Citation Styles & Plagiarism
• Know the Difference! Systematic Review vs. Literature Review

The purpose of a literature review is to:

• Provide a foundation of knowledge on a topic
• Identify areas of prior scholarship to prevent duplication and give credit to other researchers
• Identify inconstancies: gaps in research, conflicts in previous studies, open questions left from other research
• Identify the need for additional research (justifying your research)
• Identify the relationship of works in the context of their contribution to the topic and other works
• Place your own research within the context of existing literature, making a case for why further study is needed.

Videos & Tutorials

VIDEO: What is the role of a literature review in research? What's it mean to "review" the literature? Get the big picture of what to expect as part of the process. This video is published under a Creative Commons 3.0 BY-NC-SA US license. License, credits, and contact information can be found here: https://www.lib.ncsu.edu/tutorials/litreview/

Elements in a Literature Review

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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: 
• How to write a good literature review 
• 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: 
• 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.

What is the purpose of literature review?

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

• 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. 
• 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. 
• 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. 
• 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. 
• 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. 
• 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: 

a. Habitat Loss and Species Extinction:

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. 

b. Range Shifts and Phenological Changes:

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. 

c. Ocean Acidification and Coral Reefs:

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. 

d. Adaptive Strategies and Conservation Efforts:

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. 

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. 

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. 

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 literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

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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Research Methods

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

Literature Review

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

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

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

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

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

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

A literature review is important because it:

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

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

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

Not an essay 

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

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

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

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

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

Systematic review or meta-analysis?

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

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

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

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

Not all systematic reviews contain meta-analysis. 

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

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

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

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

• << Previous: Getting Started
• Next: Research Design >>
• Last Updated: Aug 21, 2023 4:07 PM
• URL: https://guides.lib.udel.edu/researchmethods

How to write a Literature Review: Purpose of a literature review

• Literature review process
• Purpose of a literature review
• Evaluating sources
• Managing sources
• Request a literature search
• Selecting the approach to use
• Quantitative vs qualitative method
• Summary of different research methodologies
• Research design vs research methodology
• Diagram: importance of research
• Attributes of a good research scholar

Books on writing a literature review

Conducting your literature review 

by Susanne Hempel

The purpose of a literature review

Conducting a literature review is a means of demonstrating the  author’s knowledge  about a particular field of study, including vocabulary, theories, key variables and phenomena, and its methods and history. Conducting a literature review also informs the student of the  influential researchers and research groups  in the field (Randolph, 2009).

Literature reviews:

• report on  knowledge and ideas  that have been established on a particular topic, including their  strengths and weaknesses  while they allow you to discover the agreed academic opinion on the topic while at the same time letting you find out the disagreements on the same subject.
• position your research project within the body of literature and thereby  provide perspective  for the reader.
• demonstrate  your knowledge  of the subject area.
• determine what each source contributes to the topic.
• understand the  relationship between the various contributions , identify and (if possible) resolve contradictions, and determine gaps or unanswered questions.
• justify your  choice of research design ; for instance, your choice of qualitative over quantitative approaches, or your method of data analysis.
• clarify how your work fills a  gap  in the scholarly literature.

Writing a literature review also allows you to:

• gain expertise in the ability to scan the literature on a particular topic efficiently, and
• hone your skills in identifying and analysing unbiased and valid data on various topics or fields of study.

Source: Randolph, J.J. 2009.  A guide to writing the dissertation literature review .  Practical Assessment, Research & Evaluation . 14 (13): 1-13.

A literature review is meant to help you to ...

Source: Hart, C. 1998. Doing a literature review: releasing the social science research imagination.  London: Sage, p 27.

S helf No: 300.72 HART

Video clips from the Internet

Click on the  links  below for video clips on how to write literature reviews:

• Honours & Postgraduate Diplomas workshop - Writing the Literature Review - Dr Thuli Shandu Phetla (Unisa)
• Literature Review: step by step guide to writing an effective literature review
• How to write a Literature Review in 30 minutes or less 
• How to Write a Literature Review in 3 Simple Steps
• Literature Review in 5 mins

Books on writing a liteature review

Doing a systematic literature review in legal scholarship 

by Marnix Snel and Janaína de Moraes

340.072 SNEL

Doing a literature review in nursing, health and social care 

by  Michael Coughlan & Patricia Cronin

610.73072 COUG

7 steps to a comprehensive literature review : a multimodal & cultural approach

by Anthony J. Onwuegbuzie & Rebecca Frels

001.42 ONWU

Writing the literature review : a practical guide 

by Sara Efrat Efron & Ruth Ravid

808.02 EFRO

• << Previous: Literature review process
• Next: Evaluating sources >>
• Last Updated: Dec 7, 2023 1:32 PM
• URL: https://libguides.unisa.ac.za/literature_review

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Reviewing literature for research: Doing it the right way

Shital amin poojary.

Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India

Jimish Deepak Bagadia

In an era of information overload, it is important to know how to obtain the required information and also to ensure that it is reliable information. Hence, it is essential to understand how to perform a systematic literature search. This article focuses on reliable literature sources and how to make optimum use of these in dermatology and venereology.

INTRODUCTION

A thorough review of literature is not only essential for selecting research topics, but also enables the right applicability of a research project. Most importantly, a good literature search is the cornerstone of practice of evidence based medicine. Today, everything is available at the click of a mouse or at the tip of the fingertips (or the stylus). Google is often the Go-To search website, the supposed answer to all questions in the universe. However, the deluge of information available comes with its own set of problems; how much of it is actually reliable information? How much are the search results that the search string threw up actually relevant? Did we actually find what we were looking for? Lack of a systematic approach can lead to a literature review ending up as a time-consuming and at times frustrating process. Hence, whether it is for research projects, theses/dissertations, case studies/reports or mere wish to obtain information; knowing where to look, and more importantly, how to look, is of prime importance today.

Literature search

Fink has defined research literature review as a “systematic, explicit and reproducible method for identifying, evaluating, and synthesizing the existing body of completed and recorded work produced by researchers, scholars and practitioners.”[ 1 ]

Review of research literature can be summarized into a seven step process: (i) Selecting research questions/purpose of the literature review (ii) Selecting your sources (iii) Choosing search terms (iv) Running your search (v) Applying practical screening criteria (vi) Applying methodological screening criteria/quality appraisal (vii) Synthesizing the results.[ 1 ]

This article will primarily concentrate on refining techniques of literature search.

Sources for literature search are enumerated in Table 1 .

Sources for literature search

PubMed is currently the most widely used among these as it contains over 23 million citations for biomedical literature and has been made available free by National Center for Biotechnology Information (NCBI), U.S. National Library of Medicine. However, the availability of free full text articles depends on the sources. Use of options such as advanced search, medical subject headings (MeSH) terms, free full text, PubMed tutorials, and single citation matcher makes the database extremely user-friendly [ Figure 1 ]. It can also be accessed on the go through mobiles using “PubMed Mobile.” One can also create own account in NCBI to save searches and to use certain PubMed tools.

PubMed home page showing location of different tools which can be used for an efficient literature search

Tips for efficient use of PubMed search:[ 2 , 3 , 4 ]

Use of field and Boolean operators

When one searches using key words, all articles containing the words show up, many of which may not be related to the topic. Hence, the use of operators while searching makes the search more specific and less cumbersome. Operators are of two types: Field operators and Boolean operators, the latter enabling us to combine more than one concept, thereby making the search highly accurate. A few key operators that can be used in PubMed are shown in Tables ​ Tables2 2 and ​ and3 3 and illustrated in Figures ​ Figures2 2 and ​ and3 3 .

Field operators used in PubMed search

Boolean operators used in PubMed search

PubMed search results page showing articles on donovanosis using the field operator [TIAB]; it shows all articles which have the keyword “donovanosis” in either title or abstract of the article

PubMed search using Boolean operators ‘AND’, ‘NOT’; To search for articles on treatment of lepra reaction other than steroids, after clicking the option ‘Advanced search’ on the home page, one can build the search using ‘AND’ option for treatment and ‘NOT’ option for steroids to omit articles on steroid treatment in lepra reaction

Use of medical subject headings terms

These are very specific and standardized terms used by indexers to describe every article in PubMed and are added to the record of every article. A search using MeSH will show all articles about the topic (or keywords), but will not show articles only containing these keywords (these articles may be about an entirely different topic, but still may contain your keywords in another context in any part of the article). This will make your search more specific. Within the topic, specific subheadings can be added to the search builder to refine your search [ Figure 4 ]. For example, MeSH terms for treatment are therapy and therapeutics.

PubMed search using medical subject headings (MeSH) terms for management of gonorrhea. Click on MeSH database ( Figure 1 ) →In the MeSH search box type gonorrhea and click search. Under the MeSH term gonorrhea, there will be a list of subheadings; therapy, prevention and control, click the relevant check boxes and add to search builder →Click on search →All articles on therapy, prevention and control of gonorrhea will be displayed. Below the subheadings, there are two options: (1) Restrict to medical subject headings (MeSH) major topic and (2) do not include MeSH terms found below this term in the MeSH hierarchy. These can be used to further refine the search results so that only articles which are majorly about treatment of gonorrhea will be displayed

Two additional options can be used to further refine MeSH searches. These are located below the subheadings for a MeSH term: (1) Restrict to MeSH major topic; checking this box will retrieve articles which are majorly about the search term and are therefore, more focused and (2) Do not include MeSH terms found below this term in the MeSH hierarchy. This option will again give you more focused articles as it excludes the lower specific terms [ Figure 4 ].

Similar feature is available with Cochrane library (also called MeSH), EMBASE (known as EMTREE) and PsycINFO (Thesaurus of Psychological Index Terms).

Saving your searches

Any search that one has performed can be saved by using the ‘Send to’ option and can be saved as a simple word file [ Figure 5 ]. Alternatively, the ‘Save Search’ button (just below the search box) can be used. However, it is essential to set up an NCBI account and log in to NCBI for this. One can even choose to have E-mail updates of new articles in the topic of interest.

Saving PubMed searches. A simple option is to click on the dropdown box next to ‘Send to’ option and then choose among the options. It can be saved as a text or word file by choosing ‘File’ option. Another option is the “Save search” option below the search box but this will require logging into your National Center for Biotechnology Information account. This however allows you to set up alerts for E-mail updates for new articles

Single citation matcher

This is another important tool that helps to find the genuine original source of a particular research work (when few details are known about the title/author/publication date/place/journal) and cite the reference in the most correct manner [ Figure 6 ].

Single citation matcher: Click on “Single citation matcher” on PubMed Home page. Type available details of the required reference in the boxes to get the required citation

Full text articles

In any search clicking on the link “free full text” (if present) gives you free access to the article. In some instances, though the published article may not be available free, the author manuscript may be available free of charge. Furthermore, PubMed Central articles are available free of charge.

Managing filters

Filters can be used to refine a search according to type of article required or subjects of research. One can specify the type of article required such as clinical trial, reviews, free full text; these options are available on a typical search results page. Further specialized filters are available under “manage filters:” e.g., articles confined to certain age groups (properties option), “Links” to other databases, article specific to particular journals, etc. However, one needs to have an NCBI account and log in to access this option [ Figure 7 ].

Managing filters. Simple filters are available on the ‘search results’ page. One can choose type of article, e.g., clinical trial, reviews etc. Further options are available in the “Manage filters” option, but this requires logging into National Center for Biotechnology Information account

The Cochrane library

Although reviews are available in PubMed, for systematic reviews and meta-analysis, Cochrane library is a much better resource. The Cochrane library is a collection of full length systematic reviews, which can be accessed for free in India, thanks to Indian Council of Medical Research renewing the license up to 2016, benefitting users all over India. It is immensely helpful in finding detailed high quality research work done in a particular field/topic [ Figure 8 ].

Cochrane library is a useful resource for reliable, systematic reviews. One can choose the type of reviews required, including trials

An important tool that must be used while searching for research work is screening. Screening helps to improve the accuracy of search results. It is of two types: (1) Practical: To identify a broad range of potentially useful studies. Examples: Date of publication (last 5 years only; gives you most recent updates), participants or subjects (humans above 18 years), publication language (English only) (2) methodological: To identify best available studies (for example, excluding studies not involving control group or studies with only randomized control trials).

Selecting the right quality of literature is the key to successful research literature review. The quality can be estimated by what is known as “The Evidence Pyramid.” The level of evidence of references obtained from the aforementioned search tools are depicted in Figure 9 . Systematic reviews obtained from Cochrane library constitute level 1 evidence.

Evidence pyramid: Depicting the level of evidence of references obtained from the aforementioned search tools

Thus, a systematic literature review can help not only in setting up the basis of a good research with optimal use of available information, but also in practice of evidence-based medicine.

Source of Support: Nil.

Conflict of Interest: None declared.

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• Volume 24, Issue 2
• Five tips for developing useful literature summary tables for writing review articles
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• http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 1 , 2 ,
• http://orcid.org/0000-0002-7839-8130 Parveen Ali 3 , 4
• 1 Memorial University of Newfoundland , St John's , Newfoundland , Canada
• 2 Swat College of Nursing , Pakistan
• 3 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
• 4 Sheffield University Interpersonal Violence Research Group , Sheffield University , Sheffield , UK
• Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St John's, NL A1C 5C4, Canada; ay6133{at}mun.ca

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

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Introduction

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

Tip 1: provide detailed information about frameworks and methods

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

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

Tip 2: include strengths and limitations for each article

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

Tip 3: write conceptual contribution of each reviewed article

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

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

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

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

Tip 5: create your personalised template for literature summaries

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

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

• Aromataris E ,
• Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

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

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

• Open access
• Published: 01 December 2023

Compassion fatigue in healthcare providers: a scoping review

• Anna Garnett 1 ,
• Lucy Hui 2 ,
• Christina Oleynikov 1 &
• Sheila Boamah 3  

BMC Health Services Research volume  23 , Article number:  1336 ( 2023 ) Cite this article

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The detrimental impacts of COVID-19 on healthcare providers’ psychological health and well-being continue to affect their professional roles and activities, leading to compassion fatigue. The purpose of this review was to identify and summarize published literature on compassion fatigue among healthcare providers and its impact on patient care. Six databases were searched: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Ovid), CINAHL, Scopus, Web of Science, for studies on compassion fatigue in healthcare providers, published in English from the peak of the pandemic in 2020 to 2023. To expand the search, reference lists of included studies were hand searched to locate additional relevant studies. The studies primarily focused on nurses, physicians, and other allied health professionals. This scoping review was registered on Open Science Framework (OSF), using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping review. From 11,715 search results, 24 met the inclusion criteria. Findings are presented using four themes: prevalence of compassion fatigue; antecedents of compassion fatigue; consequences of compassion fatigue; and interventions to address compassion fatigue. The potential antecedents of compassion fatigue are grouped under individual-, organization-, and systems-level factors. Our findings suggest that healthcare providers differ in risk for developing compassion fatigue in a country-dependent manner. Interventions such as increasing available personnel helped to minimize the occurrence of compassion fatigue. This scoping review offers important insight on the common causes and potential risks for compassion fatigue among healthcare providers and identifies potential strategies to support healthcare providers’ psychological health and well-being.

• What do we already know about this topic? The elevated and persistent mental stress associated with the COVID-19 pandemic predisposed healthcare providers (HCP) to various psychological conditions such as compassion fatigue. Declines in health providers’ mental health has been observed to negatively impact their professional performance and the quality of patient care.

• How does your research contribute to the field? This review provides an overview of the prevalence of compassion fatigue among HCPs across the globe during the COVID-19 pandemic. The main risk factors for compassion fatigue include younger age, female sex, being either a physician or a nurse, high workload, extensive work hours, and limited access to personal protective equipment (PPE). Negative behavioral intention towards patients has been identified to be a consequence of compassion fatigue. Interventions such as the provision of emotional support, increased monitoring for conditions such as stress and burnout, and increasing available personnel helped to minimize the occurrence of compassion fatigue.

• What are your research’s implications towards theory, practice, or policy? While the public health emergency associated with the COVID-19 pandemic has ended, the impact on human health resources persists. The findings of this review can inform policy decisions and implementation of evidence-based strategies to prevent, manage, and lessen the negative effects of compassion fatigue on HCPs and its subsequent impacts on patient care.

Peer Review reports

Introduction

The 2019-novel coronavirus disease (COVID-19) outbreak spread rapidly and by January 30 th , 2022 was formally proclaimed a global health emergency despite being first identified just over a month prior [ 1 ]. Although there have been five other global health emergencies associated with disease outbreaks since 2009, none has matched the scale and scope of the COVID-19 pandemic [ 2 ]. In the short-term the rapid increase in patients requiring acute care services presented unprecedented challenges for health systems. Care provision and infection control strategies were hampered by capacity limitations, staffing shortfalls and supply chain challenges [ 3 ]. As a result, healthcare providers (HCPs) encountered mounting levels of strain which have continued with little reprieve for the duration of and beyond the global COVID-19 pandemic. Limited access to personal protective equipment (PPEs) exacerbated transmission of the virus, compounding healthcare providers’ fears of contracting and spreading COVID-19 among their peers, patients and families [ 4 , 5 , 6 , 7 ]. HCPs also contracted COVID-19, became seriously ill and died with global estimates of HCP death between January 2020 and May 2021 being over 100,000. With time, the number of absences, extended sick leaves and staff turnovers increased [ 7 , 8 ]. The combination of short staffing, frequent changes to workflow and continuous care provision to patients who were gravely ill and had high mortality amplified the toll on health care providers [ 8 , 9 ]. While no longer a global health emergency, there continue to be COVID-19 cases and deaths. As of July 14, 2023 there were 767,972,961 COVID-19 cases and 6,950,655 deaths globally [ 10 ].

HCPs around the globe who treated severe COVID-19 cases, a process which necessitated in-depth compassionate engagement, became vulnerable to developing compassion fatigue as a result of their continued and in-depth involvement in the care of these severely ill patients and their families [ 11 ]. Compassion fatigue is defined as a composite of two measurements: burnout (sustained employment-related stress that compromises an individual’s desire to work) and secondary trauma (the development of traumatic symptoms resulting from the protracted exposure to the suffering of others) [ 12 , 13 ]. An individual experiencing compassion fatigue has a reduced ability for showing compassion to others, resulting from the prolonged exposure to witnessing the suffering of others without being able to relieve one’s anguish despite having the desire to do so [ 9 ]. Individuals experiencing compassion fatigue may express a range of behaviors such as increased work absences or declines in the ability to engage in work-related tasks such as decision-making. Burnout and secondary trauma are suggested to be mediated by compassion satisfaction—the pleasure that comes from helping behavior [ 11 , 12 ].

As the pandemic shifts from being a global health emergency to an endemic disease, there continues to be concern for HCP health and well-being [ 14 , 15 , 16 ]. The increased and chronic nature of the stress experienced during and beyond the COVID-19 pandemic has heightened HCPs risk for a range of negative psychological impacts such as depression, fearfulness, grief and post-traumatic stress disorder (PTSD) [ 17 ]. Prior infectious disease outbreaks (SARS-CoV-1, H1N1, MERS-CoV, Ebola) are also associated with an increased prevalence of declining mental health in HCPs [ 18 ]. A growing body of research on the COVID-19 pandemic highlights the range of psychological symptoms HCPs developed following their sustained exposure to COVID-19 including burnout, feelings of isolation, insomnia, grief, emotional exhaustion, depression, post-traumatic stress and depersonalization, some of which have persisted over time [ 14 , 17 , 19 , 20 , 21 , 22 ]. The consequences of HCPs’ declining psychological health and well-being has had impacts on the quality of patient care and indirectly on patient outcomes through inadequate staffing [ 18 ]. Compromises in HCPs’ ability to provide optimal clinical care can have serious consequences, including the worsening of patient conditions and the increased transmission of the infection from patients to others in the hospital [ 18 ]. In addition, compassion fatigue may be exacerbated by the COVID-19 pandemic, potentially leading to moral injury, decreased productivity, increased turnover, and reduced quality of care [ 23 ]. Moreover, a growing body of literature suggests that challenges across health systems will persist although COVID-19 is no longer a global health emergency [ 24 , 25 ]. As such, it is important to have a fulsome understanding of COVID-19’s toll on HCPs and tailor health system strategies accordingly.

As health care systems continue to experience a health human resources crisis, it is important to identify and understand the prevalence of compassion fatigue, identify contributing factors, and increase understanding of the consequences and actions that can be taken to address compassion fatigue among HCPs. While there has been in an increase in the body of published literature on the health and well-being of HCPs since the onset of the COVID-19 pandemic, there continues to be a knowledge gap mapping the incidence of compassion fatigue, its resultant impact on HCP well-being, and its potential influence on patient care provision [ 11 , 17 ]. A comprehensive review of the literature on compassion fatigue among HCPs can inform policy and practice initiatives to improve the current health human resources crisis experienced by many health systems. It may also aid in identifying prospective research foci.

The purpose of this scoping review was to synthesize and provide a synopsis of the literature on compassion fatigue among HCPs during the COVID-19 pandemic and to understand its broader impact. The review was guided by the following question: What is the current state of knowledge on compassion fatigue among HCPs over the course of COVID-19?

Project registration

This scoping review was registered under Open Science Framework. A project outline was submitted including the study hypotheses, design, and data collection procedures. The DOI for the registered project is as follows: https://doi.org/10.17605/OSF.IO/F4T7N . In addition, a scoping review protocol for this review has been published in a peer-reviewed journal ( https://doi.org/10.1136/bmjopen-2022-069843 ).

Study design

A systematic scoping review strategy was chosen to explore the existing body of literature pertaining to the research topic. The objective of a scoping review is to identify relevant literature on a given topic, without focusing on evaluating research quality or conducting a thorough analysis of selected studies, as systematic reviews typically do. Current gaps in research and directions for future research can be identified by means of summarizing emerging literature on compassion fatigue in HCPs.

The current scoping review used two methodological tools, namely the Arksey and O’Mally scoping review framework as well as the Joanna Briggs Institute Critical Appraisal Tools. The Arksey and O’Malley framework comprises five stages, which include: (1) formulating the research question; (2) identifying relevant studies; (3) selecting studies for inclusion; (4) extracting and organizing the data; and (5) collating, summarizing, and reporting the findings [ 26 ]. While scoping reviews typically do not require article appraisal, all articles were evaluated by one author (CO) using the methodology established by the Joanna Briggs Institute (JBI) to enhance the overall quality of the review [ 27 ]. No articles were excluded based on their quality, in accord with the Arksey and O’Malley framework [ 26 ].

Stage I: Identifying the research question(s)

The research objective and question were drafted by the authors (AG, LH, CO, SB) and can be found in the previous section under “Research aim”.

Stage II: Identifying relevant studies

As outlined by the JBI methodology, a three-step approach was used to identify relevant studies. These steps include: (1) conducting a preliminary search of at least two suitable databases; (2) identifying relevant keywords and index terms to perform a secondary search across all chosen databases; and (3) manually examining the reference lists of the included articles to discover additional relevant studies [ 28 ]   (p11) .

Preliminary literature search

To establish the criteria for inclusion and exclusion, an initial and restricted search was conducted on the subject of interest. The preliminary literature exploration encompassed three scholarly electronic databases: MEDLINE (Ovid), Scopus, and Web of Science. The search employed the keywords “compassion fatigue” and incorporated the timeframe March 1, 2020, to June 15, 2022, so that the most impactful waves of the COVID-19 pandemic were represented in the included literature, resulting in 1519, 2489, and 2246 studies, from the respective databases. These three databases were selected due to their likelihood of yielding results relevant to the research topic. To construct a comprehensive search strategy, a collection of keywords and index terms were identified from the titles and abstracts of relevant articles. The search strategy was further refined in collaboration with a social science librarian.

Structured search strategy

A systematic search was conducted across six scholarly electronic databases: MEDLINE (Ovid), Embase (Ovid), CINAHL, Scopus, and Web of Science. These databases were deliberately chosen to encompass a broad range of relevant findings within the current knowledge landscape regarding the research topic. The systematic search of the literature commenced once the scoping review was peer reviewed and revisions were addressed by the authors. Using the selected vocabulary and Boolean connectors as shown in Table 1 , a string of relevant search terms was developed. The search strategy was adapted accordingly for each individual database (e.g., Medical Subject Headings [MeSH] terms for MEDLINE [Ovid]). In the final stage of the search strategy, the reference lists of all included studies were manually examined to identify additional relevant studies.

Inclusion criteria

The inclusion criteria for this review was formulated using the PCC (Population, Concept, Context) mnemonic developed by JBI (Table 1 ). The participants included in this review were HCPs who were employed across healthcare systems during the COVID-19 pandemic (e.g., physicians, registered nurses, nurse practitioners, physician assistants, and licensed clinical social workers). The concept explored in this review focused on compassion fatigue among HCPs working in healthcare systems during the COVID-19 pandemic. The context of the study encompassed various care settings where HCPs carry out their professional activities across different clinical specialties (e.g., surgery, critical care, palliative care), as well as clinical settings (e.g., inpatient and outpatient). For the purposes of this scoping review, formal healthcare settings were broadly classified as those that provided health services and were situated within and administered by healthcare institutions.

This scoping review only included articles published in English. A time filter was applied to encompass studies conducted between 2020 to 2023, spanning the period from the onset of the COVID-19 pandemic to the present. A range of study designs were included in the review (i.e., experiments, quasi-experimental studies, analytical observational studies, descriptive observational studies, mixed-methods studies, and qualitative studies).

Exclusion criteria

Through the past two decades, compassion fatigue has been defined in different ways, sometimes being considered synonymous with burnout and secondary traumatic stress, or as an outcome resulting from both components [ 12 , 13 ]. Yet recently, it has been suggested that compassion fatigue is a focal concept related to the management of traumatic situations whereas burnout is a general concept that may have multiple contributors [ 26 ]. Due to the conceptual ambiguity surrounding compassion fatigue, articles that solely examine the components of compassion fatigue, such as burnout and secondary trauma, without directly addressing compassion fatigue itself, were excluded from consideration.

Studies that failed to meet the inclusion criteria or lacked full-text availability were excluded from the review. Additionally, editorials, letters to the editor, commentaries, and reviews were also excluded as they did not offer sufficient information for addressing the research questions.

Stage III: Study selection

After the full database searches were conducted, all identified citations were compiled and uploaded into Covidence. Any duplicate citations were automatically excluded.

Three reviewers (LH, CO, AG) independently screened the titles and abstracts of the identified studies to assess their eligibility according to the pre-established inclusion and exclusion criteria. Subsequently, the full texts of 736 selected studies were evaluated to arrive at the final list of articles for data extraction. The reasons for excluding specific studies were documented. Throughout the process, any disagreements that arose at each stage of study selection were resolved through discussions with a third reviewer (AG, SB).

The outcomes of the study selection process were presented in a flow diagram adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines (Fig.  1 ) [ 29 ]. Additionally, all the included studies underwent an assessment of their risk of bias (quality) using established critical appraisal tools from the Joanna Briggs Institute (JBI) for Evidence Synthesis [ 30 ]. Although not mandatory for scoping reviews, appraisals of study quality will contribute to the subsequent implications and future steps stemming from this scoping review [ 31 ]. The JBI provides critical appraisal checklists for various study designs, encompassing experimental, quasi-experimental, randomized controlled trials, observational, and qualitative study designs. One reviewer (CO) conducted the assessments of all the included studies, and a second reviewer (AG) verified the evaluations. Any discrepancies that arose were discussed and resolved in consultation with both reviewers. In line with the methodology of scoping reviews, no studies were excluded based on their quality assessments, ensuring a comprehensive understanding of the current state of the literature on compassion fatigue among HCPs during the COVID-19 pandemic. A summary of the quality assessments were presented in the results section of the review, while the full appraisals can be found in Additional file 1 .

PRISMA flow chart [ 28 ]

Stage IV: Data extraction

To facilitate data extraction aligned with the research objectives, a data-extraction template was developed by one reviewer (LH). This template encompassed various aspects of the included studies (i.e., authors, publication year, study populations, country, study design, aims, sample size, assessment instruments, risk factors, protective factors, consequences of compassion fatigue, and measures to prevent/manage/reduce compassion fatigue). Utilizing Covidence, two independent reviewers (LH, CO) extracted the relevant data from the studies included in the final list of citations.

Stage V: Risk of bias

Standardized tools developed by the Joanna Briggs Institute for respective study types were used to assess risk of bias (quality) for all studies included in the review [ 27 ]. The study appraisals were conducted by one reviewer (CO) and reviewed by another reviewer (AG). Any discrepancies were discussed and resolved together. While no studies were excluded based on the appraisal scores to ensure a comprehensive presentation of the available literature on compassion fatigue among healthcare providers, the findings for the risk of bias assessments are summarized in the results section and the full appraisals are presented in Additional file 1 .

Stage VI: Collating, summarizing, and reporting the results

To summarize and synthesize the findings, the study followed a three-step approach proposed by Levac et al. [ 32 ]: (1) collating and analyzing the collected data; (2) reporting the results and outcomes to address the study objectives; and (3) discussing the potential implications that findings hold for future research and policy considerations [ 31 ]. The review process adhered to the PRISMA Extension for Scoping Reviews checklist, which provided guidance for conducting the review and reporting the findings [ 26 ].

Search results

Figure  1 displays the PRISMA-ScR flowchart of the scoping review search strategy. The search and reference list initially yielded 11,715 studies. Of these, 5769 were excluded as duplicates. Following the title and abstract screening of the remaining studies, 5179 studies were excluded as they met the exclusion criteria. Finally, the full-texts of the remaining 736 studies were screened, and 712 were excluded as they did not meet the inclusion criteria. In total, 24 eligible studies were included in the review for further analysis.

Risk of bias of included studies

The complete assessment of risk of bias of all 24 included studies is available in Additional file 1 . Within the two mixed-methods studies risk of bias primarily stemmed from the quantitative strand of the studies with a lack of clarity provided about study inclusion criteria, study setting, and identification of confounding factors [ 29 ]. Other sources of bias in other quantitative studies were vagueness around the criteria used for outcome measurement [ 30 ] and only one study identified potential cofounding factors along with strategies to manage them [ 31 ]. Further shortcomings related to the failure to provide transparency around the use of valid and reliable outcome measures [ 23 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Within qualitative studies not all provided information about the researchers’ theoretical stance [ 29 , 41 , 43 ] and two studies did not provide documentation of ethics approval for the conducted research [ 43 , 44 ]. One included case report met most assessment criteria for risk of bias although more description of assessment, post-assessment condition and adverse events were warranted [ 45 ].

Characteristics of studies

Study characteristics are presented in Table 2 . Of the 24 eligible studies, 18 studies used quantitative methods [ 23 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 46 , 47 , 48 , 49 , 50 , 51 ], 3 studies used qualitative methods [ 43 , 44 , 45 ], and the remaining studies used mixed-methods approaches [ 29 , 41 , 52 ]. Additionally, 13 studies focused on the antecedents of compassion fatigue [ 23 , 29 , 33 , 34 , 35 , 36 , 40 , 41 , 42 , 45 , 46 , 47 , 48 ] and 5 studies examined the consequences of compassion fatigue [ 30 , 37 , 43 , 44 , 49 ]. Six studies were conducted in the United States, with the others being conducted in a range of countries including Ecuador, Spain, United Kingdom, Italy, Greece, Turkey, Iran, Uganda, Taiwan, Japan, Philippines, China, and India. These studies primarily focused on nurses, physicians, and other allied health professionals. The study samples included both male and female HCPs. Only one study focused exclusively on female HCPs [ 43 ].

A variety of assessment tools were used to measure compassion fatigue across included studies. Common tools included Compassion Fatigue Short Scale (CFSS) [ 33 , 47 , 48 ], Compassion Fatigue Scale (CFS) [ 30 , 49 ], Professional Quality of Life Scale Version 5 (ProQoL 5) [ 23 , 29 , 29 , 31 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 50 , 51 ], Work-Related Quality of Life Scale (WRQoL) [ 46 ], and Compassion Fatigue and Satisfaction Self-Test (CFST) [ 37 , 52 ] (Table 3 ).

The time period of the study period shows that most of the studies were conducted in the first six months of 2020, coinciding with the World Health Organization’s declaration of the COVID-19 outbreak as a pandemic [ 54 ]. No studies included in the review were conducted between March 2021 and May 2023 (Fig.  2 ).

The time trend of study periods on compassion fatigue in HCPs during the COVID-19 pandemic

Findings were synthesized and presented using the following 4 themes: (1) prevalence of compassion fatigue, (2) antecedents of compassion fatigue (individual-Level, organizational-Level, and systems-level factors), (3) consequences of compassion fatigue, and (4) interventions for compassion fatigue.

Theme 1: Prevalence of compassion fatigue

Of the studies reviewed, five measured the prevalence of compassion fatigue among HCPs during the COVID-19 pandemic [ 23 , 30 , 31 , 36 , 41 ]. In a study conducted in Spain, 306 out of 506 (60.4%) HCPs reported high levels of compassion fatigue while 170 (33.6%) showed moderate levels of compassion fatigue (ProQoL 5: M = 19.9, SD = 7.6) [ 36 ]. In a sample composed of 395 Ugandan frontline nurses, 49.11% of the nurses reported high levels of compassion fatigue, while 29.6% experienced moderate levels of compassion fatigue [ 23 ]. Over half of the nurses in the study (54.94%) reported direct exposure to COVID-19 cases. A study conducted in Greece found that in a sample of 105 nurses, the majority of nurses (51.4%) experienced moderate levels of compassion fatigue (ProQoL 5: M = 22.26, SD = 6.76) [ 41 ]. In a Taiwanese study of 503 HCPs, the majority of the participants (63.2%) experienced low levels of compassion fatigue (ProQoL 5: M = 20.9, SD = 7.6) [ 31 ]. Finally, in a Filipino sample composed of 270 frontline nurses, 61.4% of the nurses reported low levels of compassion fatigue (CFS: M = 2.213, SD = 0.979) [ 30 ].

Theme 2: Antecedents of compassion fatigue

Individual-level factors.

Age and sex were key factors associated with compassion fatigue among participant HCPs. Younger HCPs with less experience were more likely to experience mental health issues and conflicting feelings with regards to providing care to COVID-19 patients [ 23 , 29 , 44 , 46 ]. Seven studies included in the review determined that female HCPs were more likely than male HCPs to experience compassion fatigue [ 23 , 35 , 36 , 38 , 40 , 50 , 52 ]. Physicians were also reported to have higher levels of compassion fatigue compared to nurses in three studies [ 36 , 38 , 39 ]. While nursing assistants had higher levels of compassion fatigue when compared to nurses in one study (ProQol 5: Nursing assistants = 29.15 ± 6.94; Nurse = 25.68 ± 5.87) [ 29 ]. Furthermore, the risk was higher in permanent workers compared to temporary workers (ProQoL 5: Permanent = 2.48 ± 1.29; Temporary = 2.11 ± 1.15; P -value < 0.05) [ 35 ]. One included study determined that marital status and education levels were not correlated with compassion fatigue [ 23 ]. Psychiatric comorbidities such as past trauma, burnout, stress, anxiety, and depression exacerbated HCPs’ psychological well-being across a number of included studies [ 31 , 33 , 36 , 38 , 39 , 41 , 49 , 50 ]. Other psychological factors such as excessive empathetic engagement, sensitive sensory processes, and overidentification from frequent witnessing of patient suffering and deaths were found to aggravate the development of compassion fatigue [ 34 , 39 , 45 ]. The inability to cope with the rapidly evolving landscape of healthcare provision and a lack of self-care contributed to increased burden and blurring of role boundaries between professional and private lives [ 29 , 41 , 43 , 44 , 51 , 52 ]. One study that used Compassion Fatigue and Satisfaction Self-Tests and a questionnaire of personal and professional characteristics found that feelings of underappreciation, insufficient compensations, and social isolation incurred psychological burden on pediatric sub-specialists [ 52 ]. Additionally, a decrease in occupational hardiness, as measured by the Occupational Hardiness Questionnaire, increased the risk of compassion fatigue among HCPs in two studies [ 42 , 50 ]. Negative outcomes to the HCPs’ families and concerns revolving around their patients’ families also predicted higher risk of experiencing compassion fatigue [ 45 , 48 , 52 ]. Finally, HCPs’ fear of COVID-19 with regards to infection and transmission was identified as a predictor of compassion fatigue [ 29 , 40 , 43 , 44 , 47 ].

Two studies identified social support from family, friends, peers, and hospital leadership as a crucial protective factor for compassion fatigue [ 43 , 52 ]. Coping mechanisms such as venting and exercising were found to help alleviate stress among HCPs [ 44 ]. Psychological qualities such as compassion satisfaction, professional satisfaction, resilience, vigor, and hardiness were found to help protect the psychological health of HCPs as well as reducing turnover intention and increasing perceived quality of care [ 30 , 34 , 36 , 37 , 39 , 40 , 42 , 46 , 50 ]. Self-care, self-awareness of limitations, and self-regulation of emotions were crucial for reducing risk of compassion fatigue in two studies comprised of physicians and nurses [ 44 , 50 ]. Lastly, spirituality, religiosity, and meditation also served as protective factors in three studies on compassion fatigue in HCPs [ 41 , 44 , 51 ].

Organizational-level factors

In five of the articles reviewed, increased workload [ 23 , 29 , 44 , 45 ], long working hours [ 23 , 29 , 44 , 45 ], and increased number of patients [ 50 ] were identified as common predictors of compassion fatigue. Furthermore, providing direct care to COVID-19 patients, which were often emotionally challenging cases, exacerbated the psychological risks to HCPs [ 23 , 36 , 46 , 48 , 50 ]. Chronic exposure to a dynamic work environment also increased the risk of compassion fatigue among HCPs [ 29 ]. Lack of access to suitable PPEs and lack of foresight from management and human resources teams regarding infection control guidelines contributed to HCPs’ distress [ 29 ]. Adjusting to the discomfort caused by wearing PPEs presented as a challenge to maintaining the efficiency of work activities [ 29 ]. Lastly, in two studies, HCPs identified that while there were plenty of wellness resources provided by healthcare organizations to support mindfulness, there was a lack of practical and pragmatic resources for social and emotional support, work-life balance, and remuneration [ 23 , 43 ].

Positive work conditions, such as a visible presence and engagement by leadership and management, as well as a positive work culture allowing HCPs to seek help without fear of judgment was found to be important protective factors against the development of compassion fatigue [ 44 ]. The social aspects of teamwork facilitated the sharing of feelings of trauma which in turn contributed to resilience and improved psychological well-being among HCPs in three studies [ 41 , 43 , 44 ]. One study observed that workplace wellness activities and a sense of feeling valued can prevent high levels of compassion fatigue [ 52 ]. Words of appreciation from supervisors boosted morale for some HCPs [ 44 ]. Attention to workplace safety in the form of PPEs and early access to vaccines alleviated the fear of infection [ 44 ]. Finally, two studies determined that adequate preparation and education to handle COVID-19 cases and increased autonomy decreased the risk of compassion fatigue and increased professional fulfillment [ 42 , 44 ].

Systems-level factors

Significant and frequently changing public health measures over the course of the pandemic presented a challenge as they were disruptive to workflow and resulted in uncertainty, feelings of inadequacy, and distress among HCPs across a range of geographical contexts [ 29 , 41 , 43 , 49 ]. Increases in the incidence of COVID-19 cases also contributed to a rise in the number of hospital admissions, aggravating HCPs’ workload [ 35 ]. Social-distancing policies precluded informal team interactions, such as sharing meals together, which posed a risk to HCPs’ psychological well-being by decreasing social support [ 43 , 52 ]. Transitions to tele-health also increased social isolation [ 43 ]. A theme that emerged was the negative impact of stigma on HCPs, with their proximity to contagion, as a possible risk factor [ 35 , 41 ]. Aggressive behaviors and verbal abuse from patients were sources of emotional stress for some HCPs [ 44 ]. Finally, negative peer pressure was identified as a barrier to HCPs engaging in self-care as they felt pressure to conform to sociocultural norms of an expected level of dedication [ 44 ]. In contrast to the impacts of stigma, a positive perception of one’s own profession is related to increased commitment and decreased compassion fatigue [ 46 ].

Theme 3: Consequences of compassion fatigue

The findings of one study suggested that compassion fatigue associated with HCP’s professional practice impacted their private lives, predicting greater parental burnout ( r  = 0.542), child abuse ( r  = 0.468), child neglect ( r  = 0.493), spouse conflict ( r  = 0.340), and substance abuse ( r  = 0.298) [ 48 ]. This study identified factors such as direct care of COVID-19 patients ( r  = 0.255), exposure to patient death and suffering due to COVID-19 ( r  = 0.281), and family income loss due to COVID-19 ( r  = 0.366) as risk factors for compassion fatigue [ 48 ]. Additionally, at an organizational-level, two studies conducted in 2020 and 2021 observed that Turkish and Filipino HCPs who reported compassion fatigue also reported lower job satisfaction and reduced professional commitment [ 30 , 46 ]. Consequently, elevated compassion fatigue also increased organizational turnover intent among Filipino HCPs (β = 0.301, P -value = 0.001) [ 30 ]. A study conducted in China found that compassion fatigue predicted negative behavioral intentions towards treating COVID-19 patients, as measured by the Attitude, Subjective Norms, and Behavioral Intention of Nurses toward Mechanically Ventilated Patients (ASIMP) questionnaire [ 33 ]. This suggests that quality of care may be adversely impacted [ 33 ]. Finally, an American study observed that compassion fatigue among HCPs was associated with deteriorating workplace culture [ 52 ].

• Patient care

The provision of care during the pandemic was impacted by the general lack of preparation for handling novel tasks experienced by many HCPs [ 23 ]. Findings from one study found that many HCPs (73%) experienced a shift in their clinical practice setting, for example, from in-personal care to virtual telehealth consults as a result of the pandemic [ 43 ]. HCPs also experienced an increase in the need to provide palliative care as a result of the negative health impacts of COVID-19, something they may have had limited prior experience with [ 43 ]. In a case study conducted in Japan, the physician reported feeling inexperienced with handling the psychological impact of the pandemic experienced by not only the patients but also the patients’ family [ 45 ]. The consequences of not being able to provide optimal care was found to exacerbate feelings of guilt, powerlessness, and frustration in HCPs [ 41 , 43 ]. In turn, study findings suggest that worsening compassion fatigue may reduce the quality of care provided by HCPs because it has been found to be a significant predictor of negative behavioral intention [ 30 , 33 , 40 , 52 ].

Theme 4: Interventions for compassion fatigue

Two studies in Japan and Uganda investigated potential interventions to support HCPs experiencing COVID-19 related compassion fatigue. On an individual-level, regularly engaging in self-care activities such as expressions of gratitude as well as learning how to recognize signs and symptoms of compassion fatigue were identified as crucial first steps in its management [ 45 , 52 ]. Emotional support from colleagues and mental health specialists was found to be effective in improving the mental health of a Japanese physician experiencing compassion fatigue [ 45 ]. Findings of two studies identified the need for a systematic approach to monitor the progression of psychological symptoms and providing tailored resources in a timely manner to HCPs to help ameliorate compassion fatigue and its consequences [ 29 , 45 ]. Suggested strategies included: facilitating regular consultations with each department [ 45 , 52 ], increasing the staffing number of HCPs in busy departments [ 23 , 45 ], and providing PPEs and vaccines in a timely manner [ 23 , 52 ]. Lastly, findings from two studies in Uganda and the United States suggested that increased remuneration may prevent or minimize compassion fatigue [ 23 , 52 ].

Key findings

This scoping review sought to provide a comprehensive summary of the literature published between January 2020 and May 2023 on the impact of the COVID-19 pandemic on compassion fatigue among HCPs and its subsequent impact on patient care. Most of the included studies were conducted in 2020 and used cross-sectional study designs. Given that the COVID-19 outbreak was declared a global health emergency in early 2020 [ 1 ], cross-sectional study designs were well-placed to provide prompt and important insights on compassion fatigue across the HCP population. Review findings were presented using four themes addressing the prevalence, antecedents, consequences, and consequences of compassion fatigue in HCPs. The prevalence of compassion fatigue was observed to vary across countries. The negative psychological outcomes reported by included studies were precipitated by individual-level factors such as age and occupational role; organizational-factors such as lack of access to PPE; and systems-level factors such as loss of social engagement and stigma. The consequences of compassion fatigue impacted HCPs’ personal and professional roles. Findings suggest an urgent need for policy makers, health managers, and team leaders to develop and implement strategies that target the potential root causes of compassion fatigue in HCPs.

Prevalence of compassion fatigue

Among the five studies that measured prevalence of compassion fatigue, results were highly variable across countries [ 23 , 30 , 31 , 36 , 41 ]. This may be attributed to differences in preparedness for infection containment and variability among health systems’ preparation and ability to respond to supply chain issues [ 53 ]. Taiwan provides an example of how digital technologies were adopted to improve disease surveillance and monitor medical supply chains [ 55 ]. Using the stringent Identify-Isolate-Inform model in conjunction with public mask-wearing and physical distancing, the spread of the disease was effectively contained in Taiwan [ 53 ]. Consequently, despite not enforcing lockdowns, Taiwan blocked the first wave of cases and slowed down subsequent outbreaks, which may contribute to the observed low prevalence of compassion fatigue among HCPs [ 56 ]. In the Philippines, responses to disease outbreaks varied across different municipalities and provinces [ 57 ]. Effective containment measures such as strict border control and early lockdowns in addition to plentiful medical supplies and personnel allowed certain regions to mount a strong response to this public health emergency, subsequently resulting in the observed low prevalence of compassion fatigue among HCPs [ 57 ]. In Uganda, there were generally low levels of preparedness with regards to the infection identification, PPE supply, access to hand-washing facilities, and establishment of isolation facilities [ 58 ]. This may have contributed to an overwhelmed healthcare system and overworked HCPs as the surge of cases was exacerbated by the shortage of disease containment resources [ 58 ]. In April 2020, Spain experienced the second highest infection incidence in the world [ 59 ]. The Spanish health system was overwhelmed by the abundance of patients due to lack of HCPs [ 60 ], hospital capacity, and material supplies [ 59 ]. An increase in compassion fatigue among HCPs was also observed in recent studies from Italy and Canada [ 61 , 62 ]. Overall, the various strategies used to address the resultant COVID-19-related public health crisis presented distinctive challenges to HCPs in different countries. Caution must be taken when interpreting the study findings given the contextual differences across various healthcare systems. The psychological burden and prevalence of compassion fatigue subsequently varied depending on the context.

Antecedents of compassion fatigue

The findings of this review suggest that individual characteristics such as age and occupational role are significant contributing factors to the development of compassion fatigue during COVID-19 [ 63 ]. Specifically, older HCPs were less likely to experience compassion fatigue than younger HCPs according to regression analyses [ 23 , 29 , 44 , 46 ]. This observation may be attributed to their increased work experience. Resilience was also positively linearly related to age [ 64 ]. Factors identified as potential contributors to the observed age-related advantage in wellbeing were access to job resources, better job security, work-life balance, and coping skills [ 64 ]. The compounding of stressors such as an increase in workload during the COVID-19 pandemic could have exacerbated the psychological health of younger HCPs. In the context of telework, older employees tended to create clear boundaries between work and non-work responsibilities [ 64 ]. The rise in telework among HCPs was mostly a consequence of the COVID-19 pandemic which may have increased the psychological burden on younger HCPs [ 65 ]. In addition, a study examining demographic predictors of resilience in nurses reported that younger nurses had less exposure to stress, and thus have fewer opportunities to develop skills in stress management [ 66 ]. As a result of these factors, the younger HCPs were at high risk for compassion fatigue during the COVID-19 pandemic. Interestingly, three of the included studies in this review also observed that physicians were at a higher risk of compassion fatigue compared to nurses [ 36 , 38 , 39 ]. This difference may be attributed to the burden of responsibility in relation to breaking bad news, a task that is often the physicians’ responsibility [ 67 ]. A study examining compassion fatigue in HCPs determined that conflict arising during patient interactions placed HCPs at a risk for compassion fatigue [ 68 ]. Delivery of bad or uncertain news also predicted a greater mental health burden in HCPs [ 68 ].

At the organizational level, findings from the studies included in this review identified that a lack of access to PPE was a contributor to compassion fatigue in HCPs during COVID-19 [ 29 , 52 ]. Specifically, one study reported that the fear of infection and transmission to patients, family, and friends added to the concern of HCPs working in high-risk environments [ 69 ]. This finding can potentially be explained by the increased vulnerability that HCPs experience following a lag in the provision of PPE. Several organizational factors were determined as potential barriers to the distribution of PPE; the unprecedented nature of the pandemic presented challenges for maintaining domestic inventories [ 70 ]. Disruptions to the PPE global supply chain also amplified the equipment shortage [ 70 ]. This finding highlights the importance of monitoring and ensuring that domestic health supplies are adequately stocked.

At the system level, loss of social engagement [ 43 , 52 ] and stigma [ 35 , 41 ] were identified in the studies included in the review as antecedents to compassion fatigue. Public policies such as social-distancing and occupancy capacity limits negatively impact social interactions which may explain the loss of social engagement in addition to worsening mental health well-being in HCPs [ 71 ]. As certain practices transition to telehealth, other studies have found increased mental fatigue and difficulty with maintaining empathetic rapport, which has important implications on patient care [ 72 , 73 ]. In addition, other studies have found that given the proximity of their role to contagion, stigma towards HCPs from patients increased during COVID-19 [ 74 , 75 ]. Consequently, the combinatorial experience of being socially isolated and stigmatized may worsen mental health outcomes [ 76 ]. This points to a need for increased access to support services for HCPs such as virtual communities.

Consequences of compassion fatigue

Review findings suggest that compassion fatigue impacted the private and professional lives of HCPs. The risk for parental burnout has increased across many occupations during the pandemic [ 77 ]. Factors related to low levels of social support, lack of leisure time, and greater parental responsibilities in face of education disruptions adds to the psychological burden of parents [ 77 ]. HCPs were placed in a unique position having to work in highly stressful environments while also balancing household responsibilities and increased challenges related to childcare [ 48 , 78 ]. This finding highlights a need for the provision of child support services for HCPs or a reduction in workload to alleviate the burden of parental and homecare responsibilities particularly in times of public health crises.

Beyond their private lives, this review has found that decreases in HCPs’ professional commitment due to compassion fatigue, may endanger the quality of patient care delivered [ 79 ]. In particular, this may be attributed to the surge in palliative care cases during the pandemic in conjunction with an unprepared workforce, creating psychological stress for HCPs [ 80 ]. In a study examining palliative care preparedness during the pandemic, a lack of core palliative care training and expertise among frontline HCPs [ 81 ] meant many felt emotionally unprepared to address cases with seriously ill patients [ 45 ]. An increased frequency of breaking bad news to patients’ families was associated with negative psychological outcomes [ 82 ]. Providing training on relevant communication skills may protect HCPs from compassion fatigue [ 83 , 84 ].

Implications

The findings of this review highlight the urgency to provide support for HCPs who may be at risk for compassion fatigue which could have subsequent impacts on the provision of patient care [ 85 ]. To address the antecedents of compassion fatigue, this scoping review has identified a need for increased staffing, recruitment, and retention efforts on the part of hospital human resources departments [ 23 , 45 ]. Interventions suggested by studies included in the review encompass the monitoring of psychological well-being among HCPs to inform timely provision of resources [ 29 , 45 ]. Specifically, structured debriefing, training on self-care routine, reduced workload, and normalization of trauma-related therapy are essential interventions [ 86 ]. Additionally, a study identified that fostering collaborative workplace culture encourages social and emotional support among staff [ 45 ]. Certain hospitals have adopted “wobble rooms” as a private unwinding and venting space for employees [ 87 ]. Studies have observed that interventions aimed at improving the well-being of HCPs resulted in enhanced quality and safety of care being delivered [ 75 ].

Strengths and limitations

There are both strengths and limitations in this review. Although some literature reviews focused on the psychological health status of HCPs (e.g., burnout, anxiety, depression), very few studies have specifically explored compassion fatigue. Reviews that considered the impact of the COVID-19 pandemic on HCPs were even more limited. It is known that compassion is a cornerstone of quality health care improvement and increases successful medical outcomes [ 88 , 89 , 90 ]. Nevertheless, prolonged exposure to distressing events by HCPs, such as patient death and suffering, results in the absorption of negative emotional responses and leads to the development of compassion fatigue [ 91 ]. This scoping review presents an extensive exploration of the current body of literature on compassion fatigue among HCPs during the COVID-19 pandemic. Another strength in this study lies in the transparency and reproducibility of the methodology. The scoping review protocol has been published in a peer-reviewed journal to establish high methodological standards for the final scoping review [ 92 ]. Additionally, the study plan was pre-registered with Open Science Framework to ensure commitment to the methodology. Double extraction was performed to ensure that a comprehensive descriptive summary of the studies was achieved.

Some limitations include the short time frame chosen for the included studies that were published since the COVID-19, which may have constrained the breadth and quality of the studies. Longitudinal studies may not be captured in the review as this study methodology requires a prolonged period of time to yield meaningful observations. More data is needed to support conclusions on the impact of compassion fatigue on patient care. Additionally, none of the studies included in the review were conducted between March 2021 and May 2023, which may miss out on meaningful trends in levels of compassion fatigue in HCPs. This scoping review only included literature published in English so studies published in other languages were not assessed. Additionally, no comparisons of compassion fatigue were made among the HCP groups in spite of potentially relevant differences such as patient exposure. There was also a lack of allied health profession representation, with the majority of the study population being nurses or physicians. Lastly, grey literature was not included in this scoping review which may delimitate the information included in the scoping review.

There were recurring themes related to limitations in the included research studies. Several studies identified sampling issues including small sample sizes, restricted sample frame, low response rate, and selection error [ 23 , 29 , 31 , 38 , 39 , 40 , 41 , 42 , 43 , 47 , 50 , 51 , 83 ]. Other studies have called for investigations into how different sociodemographic factors, other psychiatric diseases, health care settings, and workplace environment impact compassion fatigue in HCPs [ 38 , 39 , 47 , 48 , 83 ]. One study observed a lack of homogeneity in the sample due to an overrepresentation of female HCPs in the sample [ 38 ]. Lastly, many studies employed a cross-sectional study design which limits the interpretation of the data in terms of causality [ 23 , 30 , 31 , 34 , 42 , 47 , 48 , 50 ]. While there are limitations to the study, a comprehensive summary of existing literature may be useful to inform future research and policies.

Future research is needed to examine the longitudinal impacts of COVID-19 on compassion fatigue in HCPs. Moreover, research in this area could be strengthened by including a consultation phase with external experts on compassion fatigue to improve the robustness of the scoping review.

Conclusions

The COVID-19 pandemic presented a unique set of challenges to healthcare systems across the globe. This scoping review indicated that the prevalence of compassion fatigue was inconsistent across countries and may reflect the variability of pandemic preparedness among the individual countries. Primary risk factors for the development of compassion fatigue included being younger, female, a physician or nurse, and having limited access to PPE in conjunction with an excessive workload and prolonged work hours. The negative impacts of compassion fatigue were experienced at the individual and organizational level. The findings suggest there is a systemic need to assess, monitor and support health professionals’ well-being particularly during conditions of protracted health crises such as a pandemic. In addition, many health systems and sectors are facing a profound health human resources crisis and therefore ongoing efforts must be made to improve workplace environments and increase recruitment and retention efforts. Lastly, pandemic planning must include provisions to support health providers’ ability to safely do their jobs while also minimizing negative impacts to their health and well-being.

Availability of data and materials

All the material presented in the manuscript is owned by the authors and/or no permissions are required.

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Housing instability and cardiometabolic health in the United States: a narrative review of the literature

• Kristine D. Gu 1 , 2 ,
• Katherine C. Faulkner 3 &
• Anne N. Thorndike 3 , 2  

BMC Public Health volume  23 , Article number:  931 ( 2023 ) Cite this article

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Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.

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Housing instability is variably defined but generally encompasses difficulty paying rent, living in overcrowded conditions, moving frequently, spending the majority of household income on housing costs [ 1 ], or experiencing poor housing quality or unstable neighborhood environments [ 2 , 3 ]. It has been associated with decreased access to routine healthcare, increased acute care utilization, and poor self-rated and mental health [ 2 , 4 , 5 , 6 , 7 ], and is widely considered to be a fundamental social determinant of health. Housing instability disproportionately affects racial and ethnic minorities whose housing and economic opportunities have been restricted due to a history of discriminatory housing practices in the United States [ 8 ]. Rooted in structural racism, these practices forced minority groups such as Blacks and Hispanics into disadvantaged housing [ 9 ] and perpetuate residential racial segregation, which has been associated with poor health outcomes [ 10 ]. Housing instability is also a risk factor for homelessness, defined as lacking a regular nighttime residence or having a primary nighttime residence that is a temporary shelter or place not designed for sleeping [ 11 ]. While there is strong evidence that people experiencing homelessness have high rates of overweight and obesity [ 12 , 13 ], barriers to diabetes management and health care access [ 14 ], increased risk for uncontrolled diabetes [ 15 ], and higher cardiovascular disease morbidity and mortality [ 16 ], less is known about the impact of housing instability on cardiometabolic health. Although housing instability represents a less severe housing status compared to homelessness, its implications on both the health of individuals and families, as well as on racial and ethnic health disparities, have increasingly become a focus of public health research and policy efforts [ 8 , 10 ].

Several mechanisms linking housing affordability and both physical and mental health have been proposed in a recent systematic review by Downing and expanded upon by Rodgers et al. [ 17 , 18 ]. We draw upon three of these proposed mechanisms to help explain how housing instability in general may impact cardiometabolic health: 1) material budgeting and tradeoffs, 2) displacement and distribution into disadvantaged environments, and 3) psychosocial stress and mental health (Fig.  1 ). The first mechanism, material budgeting and trade-offs, occurs in response to high housing cost burden, as decreased financial resources lead to lower capacity to purchase or access health-promoting goods and services, such as healthy foods, medications, and healthcare. Financial restraints may also cause individuals to work longer hours or additional jobs, leaving less time for health-promoting behaviors, such as physical activity, sleep, or medical appointments [ 17 , 18 ]. In the second pathway of displacement and distribution, unaffordable housing costs and evictions or foreclosures can lead to forced moves, displacing households and distributing them into disadvantaged neighborhoods with multiple factors that can harm health, such as poor housing quality, environmental detriments like crime, pollution, and toxins, or decreased availability of healthy foods or safe recreation areas [ 17 , 18 , 19 ]. Finally, high housing cost burden, forced moves, or the perception of poor housing quality can lead to psychosocial stress, depression, and anxiety [ 20 ], which have been linked to obesity [ 21 , 22 , 23 , 24 ], cardiovascular disease [ 25 , 26 , 27 , 28 ], and diabetes [ 25 , 29 , 30 ].

Proposed pathways linking housing instability and cardiometabolic health (adapted from Downing and Rodgers et al. [ 17 , 18 ])

An emerging body of literature has examined associations between cardiometabolic health outcomes and various dimensions of housing instability. Due to a lack of a singular definition, measures of housing instability vary widely in the literature [ 2 , 20 , 31 ]. Housing stability is often considered to represent one of four core dimensions of housing, along with affordability, quality, and neighborhood environment, each representing a pathway by which housing affects health [ 32 , 33 , 34 ]. While these pathways are often distinctly delineated in the literature, there is significant overlap of each of these dimensions of the housing construct. In this review, we broadly define the term housing instability, which is often used interchangeably with the term housing insecurity, to include problems with housing stability, affordability, and quality. Table 1 provides a summary of definitions and descriptions of the various components that can be used as measures of housing instability, including degree of difficulty affording housing costs (i.e., housing cost burden), frequency of moves, forced moves due to eviction or foreclosure, living in overcrowded conditions, living with friends or relatives to spilt housing costs (i.e., doubling up [ 35 ]), or experiencing poor housing quality. Use of government rental assistance programs may also be considered an indicator of housing instability, given that the goal of these programs is to alleviate housing cost burden for low-income households. Additionally, each of these components can represent exposure variables assessed at the individual household level, or aggregated by populations located within a geographical area, such as a county or census block [ 17 ]. Individual-level studies have examined the effects of direct household exposure to housing instability using participant surveys, interviews, or other screening tools. Population-level studies of housing instability have assessed the impacts of overcrowding, housing cost burden, or eviction and foreclosure rates affecting populations located within geographical area, such as census-level foreclosure rates or proportion of total household income spent on housing costs, aggregated to the county level.

The purpose of this narrative review is to summarize the literature on the relationship between housing instability and cardiometabolic health. We synthesized evidence from 42 original research studies conducted in the United States examining the relationship between various individual- or population-level exposures of housing instability, including housing cost burden, frequent moves, overcrowding/doubling up, poor housing quality, rental assistance use, and foreclosures and evictions, and the cardiometabolic conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease in adult populations.

This review includes original research studies examining the relationship between housing instability and cardiometabolic health in US adult populations collected through a search of Pubmed and Scopus databases. Search terms included “cardiometabolic risk,” “overweight and obesity,” “hypertension,” diabetes and prediabetes,” “coronary disease,” “heart failure,” and “stroke,” in combination with “housing instability,” “housing insecurity,” “unstable housing,” “housing affordability,” “housing quality,” “housing conditions,” “foreclosures or mortgage possessions,” “evictions,” “rental assistance,” “housing assistance,” and “public housing.” These search terms yielded 394 English-language abstracts from the databases. We excluded animal studies, review articles, book chapters, editorials, commentaries, studies that focused on children, and literature examining the association between the built or neighborhood environment and cardiometabolic health, which has been comprehensively reviewed in prior literature [ 47 , 48 , 49 , 50 , 51 , 52 ]. We also excluded studies that focused exclusively on people experiencing homelessness as this area has been widely studied and reviewed and may have different implications for health outcomes and management of disease [ 35 ]. One hundred fifty abstracts remained after applying our exclusion criteria.

We reviewed these 150 abstracts to isolate studies examining the association between cardiometabolic health and the exposure variable of housing instability in the form of housing cost burden, frequent moves, overcrowding/doubling up, poor housing quality, or foreclosures or eviction. We also included studies exploring the exposure to government rental assistance programs, such as tenant-based (i.e., vouchers) and unit-based (i.e., public housing or project-based assistance) rent subsidies, as potential markers of current or recent housing instability. Forty articles met our inclusion criteria, with the remaining articles excluded as they did not specifically examine associations between housing instability as the exposure variable and the cardiometabolic conditions or outcomes of interest. While review articles were excluded from the results of our paper, we identified one additional article [ 53 ] absent from the database search after reading a pertinent review [ 43 ], and one article was identified during the peer review process [ 54 ]. We then grouped studies by cardiometabolic condition (overweight and obesity, hypertension, diabetes, and cardiovascular disease), and further categorized them based on whether the housing instability exposure represented an individual or population-level variable. Selected characteristics and key findings of the 42 included studies are provided in Table 2 .

Throughout the literature, there was significant variability in the methods used to measure housing instability as well as the terminology used to refer to similar concepts (e.g., “housing instability,” “housing insecurity,” or “unstable housing”). In the results, we include the housing terms used in the original research articles and describe how the housing exposure was measured in the study. A few studies included homelessness in the broader definition of housing instability [ 56 , 57 , 78 ] but most studies reviewed did not explicitly include people experiencing homelessness in their sample populations. Regarding housing quality, we only include studies which assessed the effects of the perception of poor housing quality (e.g., poor housing quality reported on a study survey). The perception of or dissatisfaction with inadequate housing quality has been linked to a feeling of limited control over one’s housing circumstance [ 20 ], which may have important implications on health. We exclude the large body of literature demonstrating associations of specific household environmental toxins (e.g., lead, air pollutants) or adverse conditions (e.g., cold indoor temperature) with poor respiratory and cardiometabolic health, as these relationships have been comprehensively reviewed in prior literature [ 92 , 93 , 94 , 95 , 96 , 97 ].

Overweight/obesity

Individual-level studies.

Seven quantitative studies explored the relationship between housing instability on the individual level and weight status. While none examined housing instability alone as a primary exposure variable, two studies assessed housing instability in combination with other measures of social determinants of health to represent a composite exposure of social risk. In a longitudinal cohort study of 11,543 adults in Massachusetts receiving care at a large safety net health system, authors demonstrated that within 3 months of the coronavirus disease-2019 (COVID-19) lockdown, men with food or housing insecurity (collected by an unspecified electronic health record [EHR] screening tool) had higher odds of at least a 5% weight gain (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.05, 1.97) compared to those without food or housing insecurity [ 73 ]. In a cross-sectional study of 33,550 adults receiving primary care at an academic medical center in New York, Heller et al. found that having three social needs (measured by a survey which included questions on housing quality and instability, as well as other social determinants of health such as food, utility, and transportation insecurity) was associated with higher prevalence of obesity (prevalence ratio [PR] 1.06, 95% CI 1.00–1.12) compared to having no needs [ 54 ].

Five studies explored the effect of government rental assistance on weight. A longitudinal cohort study by Fertig and Reingold using data from the Fragile Families and Child Wellbeing Study found that mothers moving into public housing between baseline and year one of follow-up had increased likelihood of being overweight at three-year follow-up compared to mothers eligible for but not yet living in public housing [ 62 ]. Another longitudinal cohort study of 116 adults receiving rental assistance, defined as use of public housing, other project-based housing including low-income housing tax credit, tenant-based housing (mostly vouchers), or state-assisted housing, between baseline and two-year follow-up, found moderate but not significant increases in body mass index (BMI) and obesity at two-year follow-up compared to the 1258 matched adults who were eligible for, but did not receive, rental assistance. In a sensitivity analysis excluding permanently disabled participants, authors found significantly higher obesity at two-year follow-up in the group receiving rental assistance, though this difference did not persist at four- or six-year follow-up [ 55 ]. Fertig and Reingold suggested that the increase in obesity associated with public housing residence may be due to factors in the neighborhood environment that promote weight gain, or due to increased financial resources created by housing subsidies that are then diverted to purchase of unhealthy food or excess calories [ 62 ].

The Moving to Opportunity (MTO) for Fair Housing Demonstration Program, a large, randomized housing mobility project by the US Department of Housing and Urban Development (HUD) intended to uncover the effects of neighborhood characteristics on social and health outcomes, showed similar associations with obesity. The MTO project randomized 4498 women with children living in public housing located in high-poverty census tracts of five large, urban US cities to one of three groups to receive: 1) housing vouchers usable for private-market housing located in low-poverty census tracts, and counseling to help with their housing search; 2) standard vouchers with no restrictions on where they could reside; and 3) no additional housing assistance (control). In an analysis of the MTO project, Ludwig et al. found that women from families in the low-poverty voucher group, who were given the opportunity to move out of public housing located in high-poverty census tracts into private-market housing located in low-poverty census tracts, had lower prevalence of BMI > 35 kg/m 2 (− 4.61%, 95% CI − 8.54%, − 0.69%) and BMI > 40 kg/m 2 (− 3.38%, 95% CI − 6.39%, − 0.36%) at a mean follow up of 12.6 years compared to the control group [ 71 ]. In contrast to these studies, a study by Kalousova using data from the Michigan Recession and Recovery Study found that there was no difference in BMI between adults receiving any type of rental assistance versus those eligible for but not receiving assistance [ 53 ].

In a study using repeated, cross-sectional data from the National Health Interview Survey to examine racial differences in sleep and cardiometabolic health by government-assisted rental housing status, Gaston et al. compared the prevalence of overweight/obesity in Black versus White adults by sleep duration category (i.e., short sleepers, recommended sleepers, and long sleepers). The study found that among government-assisted renters, there were no racial differences in overweight/obesity prevalence in men across sleep duration categories. However, among unassisted renters, Black male short and recommended sleepers had higher prevalence of overweight and obesity compared to White male recommended sleepers. In women, Black short and recommended sleepers had higher prevalence of overweight/obesity regardless of housing status, though racial differences were more pronounced among those living in unassisted housing compared to government-assisted housing. Gaston et al. concluded that government-assisted housing narrowed the weight disparities seen in Black men with worse sleep compared to White men with recommended sleep durations; however, racial disparities persisted in women regardless of housing tenure. The authors noted that since women are often primary caregivers of families, these gender differences highlight an area that deserves future research given its potential implications on maternal and child health [ 64 ].

Population-level studies

Nine quantitative studies examined the association between population-level measures of housing instability and weight. Three studies found that housing cost burden was associated with higher obesity prevalence. A study by Rodgers et al. examining the association between housing cost burden (measured as the proportion of total household income spent on housing costs aggregated to the county level) and cardiovascular disease risk factors found that a one percent increase in median county-level household income spent on housing costs was associated with a 37% increase in the odds of obesity. This association was stronger both in renters compared to homeowners, and in men compared to women, when results were stratified by housing tenure and gender, respectively. The authors proposed that the higher obesity risk in men may be due to increased susceptibility to financial stress, or lower healthcare utilization, compared to women [ 18 ]. Using geographically weighted regression (GWR) which allows for measurement in spatial variation of regression models, Hohl and Lotfata found that obesity was positively associated with severe rent (defined as percentage of population spending > 50% of income on housing rent) and that the region in Chicago with the worst severe rent problem also had the highest obesity prevalence using a spatiotemporal clustering technique [ 88 ]. Similarly Lotfata and Tomal used multiscale geographically weighted regression to find that severe rent and eviction rates are the main housing determinants associated with obesity prevalence in Chicago [ 90 ].

Six studies investigating the association between population-level eviction or foreclosure rates and weight produced mixed results. Hazekamp et al. found that the prevalence of obesity, as well as other unhealthy behavior indicators (i.e., binge drinking, current smoking status, lack of leisure-time physical activity, and short sleep), was associated with census-level eviction rates in urban Illinois communities [ 87 ]. Another cross-sectional study found that foreclosures in 75 of the top 100 most populous metropolitan areas in the United States were independently associated with obesity prevalence [ 89 ]. A longitudinal study followed 2068 adults from the Framingham Offspring Cohort over four examination waves between 1987–2008 to assess the association between area-level foreclosures and blood pressure. Authors found that each additional foreclosed property located within 100 m of a person’s home occurring in the year preceding the study examination was associated with a 0.2 kg/m 2 increase in BMI and a 1.77 higher odds of being overweight (95% CI 1.02, 3.05) [ 80 ]. A cohort study of 59,854 adults receiving care at a Veterans Health Administration (VA) facility in metropolitan Chicago found no association between neighborhood foreclosures and BMI over six years of follow-up in the overall sample; however when restricting the sample to people who did not move over the study period, authors found that every 20 additional foreclosures was associated with a 0.03 kg/m 2 increase in BMI (95% CI 0.01, 0.06) [ 86 ]. In contrast, a study of 105,919 continuously insured adults with diabetes in Northern California did not find an association between census-level foreclosure and BMI, though authors noted that the relatively shorter study period of four years may not have been long enough to detect an effect [ 84 ]. A longitudinal study by Christine et al. using data from the Multi-ethnic Study of Atherosclerosis (MESA) also found that there was no association between a standard deviation increase in neighborhood foreclosure count (1.9 foreclosures per quarter mile) and mean difference in BMI over a five-year follow-up period [ 83 ].

• Hypertension

Literature regarding the association of hypertension with individual-level housing instability, housing affordability, or foreclosures was limited to five quantitative studies. Results from three studies examining measures of housing instability alone or in combination with other social determinants of health generally showed higher incidence and prevalence of hypertension. One longitudinal study of 4,342 Black and White young adults participating in the Coronary Artery Risk Development In Young Adults (CARDIA) study found no association of housing instability (measured by interview questions regarding overcrowding, frequent moves, or occupying a space without paying rent) and incident hypertension over 15 years of follow-up in the overall sample. When stratified by race and sex, however, authors found that women with housing instability were at higher risk of incident hypertension (incidence rate ratio [IRR] 4.7, 95% CI 2.4, 9.2) compared to stably housed white women. The authors explained these differences could be attributed to uneven distribution of social and environmental risk factors [ 79 ]. A cross-sectional study of 10,007 individuals participating in biennial Southeastern Pennsylvania Household Health Survey explored the relationship between hypertension and housing affordability, assessed as the level of difficulty paying rent. Authors found that among homeowners and renters, difficulty paying rent was associated with increased odds of poor self-rated health (adjusted OR 1.75, 95% CI 1.33, 2.29) and hypertension (adjusted OR 1.34, 95% CI 1.07, 1.69). Authors suggested these findings were related to the knowledge that those with housing unaffordability have a higher likelihood of delaying or skipping doctors’ visits or accessing medications, and this was supported by their results demonstrating that high housing costs were associated with cost-related healthcare nonadherence (adjusted OR 2.94, 95% CI 2.04, 4.25) and cost-related prescription medication nonadherence (adjusted OR 2.68, 95% CI 1.95, 3.70) [ 5 ]. The previously mentioned cross-sectional study by Heller et al. examining housing instability and quality in combination with other social needs found that having three social needs was associated with higher prevalence of hypertension (PR 1.15, 95% CI 1.09, 1.21) compared to having no needs [ 54 ].

One study examined the relationship between hypertension prevalence and individual-level foreclosures, and another investigated the effect of government rental assistance on hypertension prevalence. A case–control study by Pollack et al. found significantly higher rates of hypertension (adjusted OR 1.40, 95% CI 1.08, 1.81) and renal disease (adjusted OR 1.83, 95% CI 1.09, 3.06) among 404 adult homeowners who received a foreclosure notice (cases) compared to the 2020 adults in the control group who received care from the hospital system and lived in the same zone improvement plan (ZIP) code as cases. Authors also found that people experiencing foreclosure were more likely to have an ED visit, outpatient visit, and no-show appointment, but less likely to have a PCP visit in the 6 months prior to foreclosure notice, suggesting that health care utilization patterns shift in the time period leading up to a foreclosure event [ 74 ]. In the previously cited study by Gaston et al. examining racial differences in sleep and cardiometabolic health by government-assisted rental housing status, among those in unassisted housing, Black male short and recommended sleepers had higher prevalence of hypertension compared to White recommended sleepers, a difference was not seen among those receiving government-assisted housing. In women, the prevalence of hypertension was higher in Blacks compared to Whites across all sleep categories and rental assistance categories, with larger differences seen among unassisted residents, highlighting the importance of future research on gender differences in racial/ethnic health disparities [ 64 ].

Four quantitative population-based studies on the relationship between housing instability and hypertension produced mixed results. The study by Rodgers et al. cited previously found that each percentage point increase in county-level median percentage of household income spent on housing was associated with a 22% increase in the likelihood of incident hypertension (OR 1.22, 95% CI 1.06, 1.42) among renters and homeowners. When results were stratified by housing tenure and gender, this association was stronger in renters compared to homeowners, and in men compared to women, possibly owing to increased financial stressors and decreased healthcare use in men as previously mentioned. Additionally, among people with incident hypertension, a one unit increase in housing cost burden was associated with lower likelihood of antihypertensive medication use (OR 0.79, 95% CI 0.65, 0.97), suggesting that the financial strain from unaffordable housing may negatively affect access to health resources [ 18 ].

Three other studies examined the relationship between hypertension and population-level foreclosures. In a cross-sectional study, Chambers et al. found that renters participating in the Hispanic Community Health Study/Study of Latinos living in a high foreclosure risk area (based on census tract-level data) had a higher prevalence of hypertension (PR 1.25, 95% CI 1.08, 1.46) and hypercholesterolemia (PR 1.12, 95% CI 1.01, 1.24) compared to those in medium or low foreclosure risk areas [ 82 ]. In a longitudinal study exploring the relationship between hypertension and proximity to foreclosures in the Framingham Offspring Cohort in Massachusetts, Arcaya et al. found that each additional foreclosure located within 100 m of a participant’s home was associated with an increase in systolic blood pressure (SBP) of 1.71 mmHg (95% CI 0.18, 3.24) [ 81 ]. In contrast, the longitudinal study by Christine et al. found that an increase in neighborhood foreclosure count of 1.9 foreclosures per quarter mile was associated with a mean decrease in SBP of 0.27 mmHg (95% CI -0.49, -0.04). The authors of this study noted that the variation in their results compared to Arcaya et al. may have been due to differences in measures of foreclosure, different statistical methods, or true variation in different locations. The authors further hypothesized that the stigma associated with foreclosure changed over time, recognizing that the study by Arcaya et al. overlapped with the housing crisis in the mid-2000s [ 83 ]. Ultimately, the mixed associations between foreclosures and hypertension in these studies demonstrate that the relationship is complex and depends on several multi-level factors.

A relatively larger body of literature (16 quantitative, 3 qualitative studies) exists on housing instability and diabetes outcomes. These studies examined multiple diabetes-related outcomes, including incidence and prevalence, disease control, healthcare utilization, healthcare quality, and self-care behaviors. Two studies analyzed the relationship between housing instability and diabetes incidence or prevalence. A longitudinal study by Schootman et al. of 998 African American adults living in St. Louis, Missouri, found that those reporting fair or poor housing quality (measured by survey questions regarding cleanliness inside building, physical condition of interior, condition of furnishings, condition of exterior of building, and global rating) had higher risk of incident diabetes compared to those reporting good or excellent conditions (cleanliness inside building, OR 1.78, 95% CI 1.03, 3.07; physical condition inside building, OR 2.53, 95% CI 1.47, 4.34; condition of furnishings inside building, OR 2.20, 95% CI 1.29, 3.75; condition of the outside of the building, OR 2.39, 95% CI 1.40, 4.08; overall condition of the dwelling, OR 1.78, 95% CI 1.02, 3.09) [ 75 ]. In a cross-sectional study investigating the association between housing instability and diabetes prevalence among white, Asian, and Native Hawaiian/other Pacific Islanders (NHOPIs) in Hawaii, Stupplebeen found that NHOPIs with housing insecurity, measured using a survey question on housing cost burden, had higher adjusted odds of diabetes (adjusted OR 1.85, 95% CI 1.13, 3.01) than those with housing security [ 76 ].

Two studies investigated the association between housing instability and diabetes control. In a study of 411 patients with diabetes from four clinics within a practice-based research network in Massachusetts, Berkowitz et al. found in unadjusted analyses that patients with housing instability (measured using survey questions assessing housing status, including homelessness, evictions, frequent moves, or doubling up) were more likely to have poor diabetes control (defined as a composite measure of hemoglobin A1c (HbA1c) > 9% (74.9 mmol/mol), low-density lipoprotein (LDL) cholesterol > 100 mg/dL (2.6 mmol/L), or blood pressure > 140/90 mmHg), but this difference was no longer statistically significant after adjusting for covariates [ 35 , 56 ]. Similarly, a study of 274,123 adults with type 2 diabetes receiving care at Kaiser Permanente Northern California found that having at least one address change (a potential indicator of housing instability) was associated with higher chance of uncontrolled diabetes (HbA1c > 9% [74.9 mmol/mol], ARR 1.12, 95% CI 1.09, 1.15) and lower chance of controlled diabetes (HbA1c < 8% [63.9 mmol/mol], ARR 0.95, 95% CI 0.94, 0.96) [ 77 ].

Three cross-sectional studies assessed the association of housing instability on healthcare utilization in people with diabetes. In the same study by Berkowitz et al. cited above, housing instability was associated with a higher number of outpatient visits after adjusting for covariates (IRR 1.31, 95% CI 1.14, 1.51) [ 56 ]. A separate cross-sectional study by Berkowitz et al. examined 1087 nationally-representative, non-homeless, safety-net clinic patients with self-reported diabetes and found that unstable housing (measured using survey responses regarding housing cost burden, frequent moves, and doubling up) was associated with increased diabetes-related emergency department (ED) visits or hospitalizations (adjusted OR 5.17, 95% CI 2.08, 12.87) [ 35 ]. The Thomas et al. study mentioned above also found that having at least one address was associated with higher chance of ED visits (ARR 1.25, 95% CI 1.23, 1.27) [ 77 ].

Three cross-sectional studies examined diabetes care quality or self-care behaviors. A cross-sectional study of 16,091 employed adults with type 2 diabetes found that housing insecurity (measured using survey responses related to housing cost burden) was associated with decreased likelihood of having a physician visit (adjusted OR 0.58, 95% CI 0.37, 0.92), HbA1c assessment (adjusted OR 0.45, 95% CI 0.26, 0.78), or eye exam (adjusted OR 0.61, 95% CI 0.44, 0.83) [ 72 ]. In contrast, Gold et al. examined diabetes guideline-recommended care quality in a cross-sectional study of 73,484 community health center patients with diabetes and found that overall care quality was similar in those with housing insecurity (measured using an unspecified EHR screening tool), except for being less likely to have an up-to-date LDL screening [ 65 ]. Vijayaraghavan et al. found that among 711 low-income participants with diabetes, housing instability (ordered into five categories from most to least stable based on survey responses), was significantly associated with decreased diabetes self-efficacy, measured using the validated Self-Efficacy for Diabetes Scale [ 78 ].

Four studies assessed housing instability in combination with other adverse social determinants of health to determine the association between a composite measure of unmet basic needs and diabetes prevalence or diabetes-related outcomes. In Heller et al.’s large cross-sectional study mentioned previously, authors found that among adults receiving primary care at an academic medical center in New York, those with three social needs (measured by a survey which included questions on housing quality and instability) was associated with higher prevalence of diabetes (p-trend < 0.001) compared to no needs [ 54 ]. Similarly, a cross-sectional study of 5846 adults with type 2 diabetes receiving care from a hospital system based in Bronx, New York found that compared to having no social needs, having three or more needs (based on the same survey used in Heller et al.’s study) was associated with a higher likelihood (adjusted OR 1.59, 95% CI 1.26, 2.00) of uncontrolled diabetes, defined as HbA1c ≥ 9.0% (74.9 mmol/mol). Authors also found that having housing issues (which included problems with both housing quality and housing instability) was associated with higher likelihood of uncontrolled diabetes ( p  < 0.05) [ 59 ]. A cross-sectional study of 4043 adult patients with diabetes receiving care at Kaiser Permanente Northwest found that having one or more unmet basic needs (based on a survey which included questions about housing stability and affordability) was associated with an increased odds of having a HbA1c > 8% (63.9 mmol/mol), more outpatient and ED visits, and more delayed refills of diabetes medications compared to having no needs [ 63 ]. A study examining the cumulative association of various social risk factors including housing, food, financial, and utility insecurity in 579 adults with diabetes found that those with three or four social risk factors had a greater likelihood of cost-related medication non-adherence, diabetes distress, and anxiety or depression compared to those with no social risks [ 69 ].

The association of public housing or government rental assistance with diabetes-related measures was examined in four studies. In the same analysis of the MTO project cited previously, Ludwig et al. found that women from families in the low-poverty voucher group, who were given the opportunity to move out of public housing located in high-poverty census tracts into private-market housing located in low-poverty census tracts, had lower prevalence (− 4.31%, 95% CI − 7.82%, − 0.80%) of HbA1c ≥ 6.5% (47.5 mmol/mol) at a mean follow up of 12.6 years compared to those who received no additional housing assistance [ 71 ]. A study using the National Health and Nutrition Examination Survey (NHANES) survey data from 1999–2016 comparing 795 adults receiving either project-based housing ( n  = 450) or housing vouchers ( n  = 345) to 255 adults not yet receiving assistance but remained on the waitlist, found that those receiving project-based housing had lower HbA1c levels compared to the waitlist group, but the differences were not statistically significant. The authors did find, however, that residence in project-based housing was associated with a lower prevalence (− 3.7%, 95% CI − 7.0, 0.0%) of uncontrolled diabetes, defined as HbA1c ≥ 9.0% (74.9 mmol/mol), compared to the waitlist group [ 61 ]. A longitudinal cohort study by Lim et al. found that residence in New York City public housing was associated with higher prevalence of stable housing pattern (PR 1.16, 95% CI 1.07, 1.25), based on number of address changes over the 12-year follow-up period, but not with reduced diabetes risk (relative risk [RR] 1.11, 95% CI 0.83, 1.48). Among those experiencing housing instability, living in public housing was associated with a higher risk of diabetes compared to not living in public housing. The authors proposed that one potential mechanism for this finding could be that relocation from one public housing unit to another may cause stress via disruption of social cohesion and support [ 70 ]. In the study by Gaston et al., among those in unassisted housing, Black male short sleepers had higher prevalence of diabetes compared to White recommended sleepers, a difference that was not seen among those in government-assisted housing. In women, compared to White recommended sleepers, Black short sleepers had higher prevalence of diabetes in either rental assistance category [ 64 ]. As mentioned previously, this finding suggests that rental assistance appears to attenuate racial disparities in diabetes prevalence for men but not women.

Finally, there were three qualitative studies examining both provider and patient perspectives on housing instability and diabetes management. A study on the perspective of providers practicing in Southeastern Appalachian Ohio found that providers cited patients’ housing insecurity, lack of access to providers, lack of access to transportation, food insecurity and financial insecurity as barriers to diabetes care [ 57 ]. Two other qualitative studies found that patients with diabetes viewed housing access as an important influence on their diabetes self-management and ability to afford diabetes-related expenses [ 67 ] and that transitions to rent-assisted housing may support diabetes self-management [ 68 ].

Two quantitative studies examined the relationship between neighborhood-level housing foreclosure and diabetes control. The longitudinal study by Christine et al. used data from the MESA cohort to examine fasting glucose levels and found that an increase in neighborhood foreclosure count of 1.9 foreclosures per quarter mile was associated with an increase in mean fasting glucose of 0.26 mg/dL (0.014 mmol/L; 95% CI 0.04, 0.46) [ 83 ]. A longitudinal study by Downing et al. found no statistically significant relationship between changes in foreclosure rate per census-block group and change in annual mean HbA1c level among 105,930 adults with diabetes receiving care at a large integrated healthcare system in Northern California, suggesting that increased foreclosure rates did not worsen glycemic control in this population [ 85 ].

• Cardiovascular disease

Literature examining the association between housing instability and cardiovascular disease (i.e., coronary heart disease, heart failure, and stroke) was limited to four quantitative studies. Three studies analyzed the relationship between individual-level housing instability and cardiovascular disease measures, and one examined the association between cardiovascular disease and government rental assistance use. A study of 2,952,605 Medicare beneficiaries hospitalized for acute myocardial infarction (MI) or congestive heart failure (termed the index admission) found that those with housing instability (defined in this study as two or more unique residential addresses on EHR claims data) had higher odds of hospital readmission within 30 days of discharge from index admission [ 66 ]. A large cross-sectional study using data from the Behavioral Risk Factor Surveillance System (BRFSS) to evaluate the independent effects of chronic illness on food and housing insecurity, found that having self-reported cardiovascular disease (i.e., MI, angina, or coronary heart disease) was associated with increased odds of having housing insecurity (OR 1.69, 95% CI 1.07, 2.66), measured using a survey question related to housing cost burden. This study found no association between stroke and housing insecurity. The authors posited that patients experiencing stroke may have more functional limitations that require them to move in with or closer to family members, which in turn increases their level of support and potentially decreases their risk of housing insecurity. In contrast, those with cardiac disease may have higher pharmaceutical costs for medications and decreased likelihood of relocating closer to or moving in with family members compared to patients experiencing stroke, leaving them susceptible to adverse social determinants of health like housing insecurity [ 60 ]. The study by Stupplebeen found that among NHOPIs, those with housing insecurity had higher adjusted odds of self-reported MI, angina, coronary heart disease, or stroke [ 76 ].

Chambers and Rosenbaum compared cardiovascular disease-related outcomes across three government rental assistance groups (public housing residents, housing vouchers recipients, and people eligible for but not receiving housing assistance) in the cross-sectional Affordable Housing as an Obesity Mediating Environment (AHOME) study of 371 Latino adults. This study found lower odds of cardiovascular disease (defined as having at least one cardiovascular disease [CVD]-related outcome of heart attack, stroke, or hypertension) for those not receiving housing assistance (OR 0.394, 95% CI 0.204, 0.761) and those using housing vouchers (OR 0.527, 95% CI 0.280, 0.992), compared to residents of public housing. They also found that the prevalence of CVD was similar for those using housing vouchers and those not receiving housing assistance. Overall, these findings suggested a potential benefit of housing vouchers use over public housing [ 58 ].

Only one study explored the relationship between population-level housing instability and cardiovascular disease. A large cross-sectional study by Segar et al. using data from the American Heart Association’s Get With The Guidelines-Heart Failure registry compared hospital length of stay for heart failure by various social determinants of health and race. This study found that housing instability (measured in this study by ZIP code-level neighborhood/residential characteristics including percentage of housing vacancy, mobile homes, or overcrowding) was associated with longer length of stay for both Black and White adults [ 91 ].

Conclusions

Our review of the literature found generally adverse associations between housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. There is moderate evidence to suggest that housing instability is associated with higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease, worse hypertension and diabetes control, and higher acute health care utilization among those with diabetes and cardiovascular disease. Most studies included in this narrative review were cross-sectional which do not allow for conclusions to be drawn about the causal direction of these associations. The longitudinal cohort studies produced inconsistent results, and only a few studies leveraged natural experiments to assess the impact of governmental rental assistance use on health outcomes. We found no randomized studies that tested interventions to address housing instability and improve cardiometabolic health.

Through the lens of the conceptual framework proposed in Fig.  1 , we can categorize some of the evidence from this narrative review to help understand which pathways may be the best targets for housing policies and interventions aimed at improving cardiometabolic health outcomes. Several studies have shown that housing cost burden is associated with cost-related nonadherence, both to prescription medications and health care visits [ 5 , 18 , 69 ], highlighting the importance of the material budgeting and trade-off pathway in which high housing costs lead to increased financial strain, thereby leaving fewer resources to address health-related needs. While qualitative studies in this review are limited, they have demonstrated that transition to a more stable and affordable housing situation such as subsidized housing frees up financial resources to allow patients to afford health-related expenses [ 67 , 68 ]. Those with housing instability may also work longer hours or take on additional jobs to offset housing cost burden, leading to decreased time to devote to their health [ 18 ]. Additional research is needed to further understand whether obtaining affordable housing through subsidized housing programs can improve adherence and increase patient’s capacity to engage in health promoting behaviors by allowing patients to free up financial resources and time for their health needs.

The second pathway of residential displacement and distribution to poor quality housing and disadvantaged environments may also serve as a crucial target for interventions and policies to improve the health of those with housing instability. The studies in this review which examined the health implications associated with specific types of government rental assistance support the idea that displacement and resultant redistribution of families into disadvantaged neighborhoods can have detrimental health effects. While the overarching purpose of government rental assistance is to alleviate housing cost burden and theoretically improve housing stability, a few studies suggest that transition into subsidized housing, and particularly public housing, is associated with worse cardiometabolic health outcomes [ 55 , 58 , 62 ]. Although transition into public housing may provide housing stability [ 70 ], the associated adverse health outcomes may be explained by the fact that public housing units tend to be located in racially segregated areas with high socioeconomic deprivation and limited neighborhood resources [ 62 , 98 ] which have been tied to poor cardiometabolic health [ 99 , 100 ]. The MTO demonstration project, a landmark housing mobility study leveraging a natural experimental design, further supported this phenomenon by showing that lifting families out of high-poverty neighborhoods through tenant-based vouchers led to less severe obesity and uncontrolled diabetes [ 71 ]. Another study included in this review found that adults receiving tenant-based housing assistance had lower odds of cardiovascular disease compared to those living in public housing [ 58 ], suggesting that there may be a benefit of housing voucher programs over unit-based subsidies. Tenant-based assistance allows tenants to rent in the private market which may provide families with more flexibility to choose homes located in better neighborhoods and built environments (i.e., physical characteristics of neighborhoods where people live, work, and recreate), compared to subsidies that are tied specific units and may be located in disadvantaged areas. Housing units located in these areas may suffer from poor housing quality due to lack of community resources and investment, as suggested by another MTO analysis by Nguyen et al. which found that those moving out of public housing in high-poverty areas to private-market housing located in low-poverty areas improved housing quality (i.e. fewer problems with housing units such as broken windows, problems with heating, or pests) compared to those who remained in public housing. While it is well-established that the neighborhood and built environment are associated with cardiometabolic health [ 47 , 48 , 49 , 50 , 51 , 52 ], this group of literature suggests that housing quality and neighborhood environment appear to be intimately linked to rental assistance type and clearly play important roles in cardiometabolic health outcomes [ 49 , 52 , 71 ]. Further research, ideally in the form of additional natural experiments, is needed to test differences in cardiometabolic health outcomes by rental assistance type and neighborhood environment, which in turn will help inform policymakers’ prioritization of housing assistance programs.

The third pathway of psychosocial stress and mental health may also help to explain the adverse associations between housing instability and cardiometabolic health. Stress can increase not only in response to one’s own experience of financial strain or a forced move, but also at the population level through observing neighbors’ experiences of residential displacement in areas with high foreclosure and eviction rates, which can contribute to decreased social cohesion and neighborhood disinvestment. In addition to stress, other mental health conditions such as depression, anxiety, and substance use disorder have been linked to housing instability and other frequently coexisting adverse social determinants of health like food insecurity [ 18 , 54 , 69 , 77 ]. Efforts to reduce the psychosocial stress and address mental health diagnoses tied to housing instability therefore may improve overall cardiometabolic health, especially since stress, anxiety, and depression have been associated with increased obesity [ 21 , 23 , 24 ], metabolic syndrome [ 22 ], diabetes [ 25 , 29 , 30 ], and cardiovascular disease [ 25 , 26 , 27 , 28 ]. Future research should further define this relationship given its role as an important mediator in the pathway towards improved cardiometabolic health.

While a few themes emerged from our review of this body of literature, a major barrier that precludes further definitive conclusions is the heterogeneity in both the measures used to capture housing instability as an exposure, as well as the cardiometabolic measures examined as outcomes. Housing instability as a construct is variably defined in the literature and can encompass many elements including housing cost burden, overcrowding and doubling up, poor housing quality, frequent moves, forced moves due to evictions or foreclosures, and use of government rental assistance, each of which was measured in various ways throughout this body of literature. Furthermore, each element does not exist in isolation, but rather families often experience multiple housing stressors simultaneously, which likely have more detrimental effects on health than one alone [ 20 ]. In addition to the myriad of housing instability measures, the cardiometabolic health outcomes examined in this body of literature also varied widely, spanning domains of disease prevalence and control, healthcare utilization, guideline-recommended care quality, self-management behaviors, and qualitative assessments of provider and patient perspectives on housing and health. Overall, the heterogeneity of current research makes it challenging to identify the most effective housing interventions or policies to improve various aspects of cardiometabolic health.

Although our understanding of the mechanisms driving the adverse associations between housing instability and cardiometabolic health has continued to grow, the complexity of this relationship leaves many gaps in our knowledge and makes it difficult to endorse specific housing policies or programs. Instead, we believe these knowledge gaps highlight potential areas for further research. Given that randomized controlled housing interventions may be difficult, costly, and possibly unethical to design and implement, we recommend that researchers leverage natural experiments to examine the potential impact of new or existing housing policies or programs on cardiometabolic health. Specifically, natural experiments can assess whether programs or policies intended to alleviate housing cost burden, prevent displacement of households into disadvantaged neighborhoods, or address the stress and mental health conditions associated with housing instability have positive effects on cardiometabolic health. This future research will help stakeholders and policymakers focus efforts on existing housing programs, or identify opportunities for new policies in these domains, with the collective goal of improving cardiometabolic health equity.

Availability of data and materials

Not applicable.

Abbreviations

Affordable Housing as an Obesity Mediating Environment

Body mass index

Behavioral Risk Factor Surveillance System

Coronary Artery Risk Development In Young Adults

Confidence interval

Coronavirus disease-2019

Emergency department

Electronic health record

Geographically weighted regression

Hemoglobin A1c

Incidence rate ratio

Low-density lipoprotein

Multi-ethnic Study of Atherosclerosis

Myocardial infarction

Moving to Opportunity for Fair Housing Demonstration Program

National Health and Nutrition Examination

Native Hawaiian/other Pacific Islanders

Prevalence ratio

Relative risk

Systolic blood pressure

Veterans Health Administration

Zone improvement plan

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KDG receives NIH Training Grant support (T32DK007028). KCF and ANT receive NIH R01 grant support (DK124145). ANT receives  NIH K24 grant support (HL163073).

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Gu, K.D., Faulkner, K.C. & Thorndike, A.N. Housing instability and cardiometabolic health in the United States: a narrative review of the literature. BMC Public Health 23 , 931 (2023). https://doi.org/10.1186/s12889-023-15875-6

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MINI REVIEW article

The impact of virtual reality on student engagement in the classroom–a critical review of the literature.

• 1 Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand
• 2 Melbourne Graduate School of Education, The University of Melbourne, Melbourne, VIC, Australia
• 3 Graduate Department, Xi’an Physical Education University, Xi’an, China
• 4 College of Commerce and Tourism, Hunan Vocational College for Nationalities, Yueyang, China
• 5 Graduate Department, Sehan University, Yeongam County, Republic of Korea

Objective: The purpose of this review is to identify the impact of virtual reality (VR) technology on student engagement, specifically cognitive engagement, behavioral engagement, and affective engagement.

Methods: A comprehensive search of databases such as Google, Scopus, and Elsevier was conducted to identify English-language articles related to VR and classroom engagement for the period from 2014 to 2023. After systematic screening, 33 articles were finally reviewed.

Results: The use of VR in the classroom is expected to improve student engagement and learning outcomes, and is particularly effective for students with learning disabilities. However, introducing VR into middle school education poses several challenges, including difficulties in the education system to keep up with VR developments, increased demands on students’ digital literacy, and insufficient proficiency of teachers in using VR.

Conclusion: To effectively utilize VR to increase student engagement, we advocate for educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to increase student engagement and instructional effectiveness.

Introduction

In recent years, virtual reality (VR) has emerged as a transformative technology in education, providing new avenues for immersive and interactive learning experiences ( Pottle, 2019 ). At its core, VR offers a departure from the tangible, allowing users to delve into an environment transcending conventional reality ( Brooks, 1999 ; Jeong et al., 2019 ). VR’s essence is captured in three pillars: presence, interactivity, and immersion ( Lee et al., 2017 ). Presence grants users access to previously unreachable 3D landscapes, facilitating a unique, experiential insight ( Poux et al., 2020 ). Interactivity kindles user curiosity, enabling dynamic engagements within the virtual milieu ( Steuer et al. 1995 ; Huvila, 2013 ; Song et al., 2023 ). Immersion pushes the boundaries of conventional experiences, reviving or manifesting phenomena outside the realm of everyday life ( Sanchez-Vives and Slater, 2005 ; Poux et al., 2020 ).

The introduction of VR in education might increase student engagement, which is closely related to the cognitive, behavioral, and affective dimensions of the engagement model ( Wang and Degol, 2014 ). Cognitive engagement underscores the depth of students’ attention, comprehension, and retention ( Wang and Degol, 2014 ). Behavioral engagement is observable, characterized by consistent attendance and active classroom participation ( Wang and Degol, 2014 ). Affective engagement delves into the emotional realm, encompassing motivation, passion, and learning efficacy ( Wang and Degol, 2014 ).

Existing literature emphasizes the importance of virtual reality technology in promoting full student engagement in cognitive, behavioral, and affective dimensions, and states that the application of virtual reality technology in education has become a trend ( Mystakidis et al., 2021 ). Some literature shows that higher education institutions are increasingly adopting VR, with adoption rates as high as 46% at US universities and 96% at United Kingdom universities ( United Kingdom Authority, 2019 ; Agbo et al., 2021 ). In addition, the establishment of dedicated VR laboratories at leading universities such as Harvard University and Colorado State University underscores the commitment to using VR for educational innovation and advancement ( Reid, 1987 ; Leidner and Jarvenpaa, 1995 ). This literature shows that the widespread use of VR in education has attracted the attention of a growing number of researchers and educators, with a particular interest in the impact of VR in the classroom in terms of students’ cognitive, behavioral, and affective engagement.

It is worth noting that although existing literature begins to discuss the impact of VR on student engagement, there are still shortcomings in determining the impact of VR on various dimensions of student engagement, which may limit our overall understanding of the topic. Therefore, further discussion is needed to more specifically identify the impact of VR on the various dimensions of student engagement to gain a more comprehensive and concrete understanding. To accomplish this, this review is guided by the following three questions: (1) What are the positive impacts of VR in education? (2) What are the challenges of VR in education? (3) What interventions can address these challenges? With this in mind, the article will first discuss the positive impact of VR on students’ cognitive, behavioral, and affective engagement to help readers understand its potential in education. It will then discuss the challenges facing VR to make constructive recommendations to address the problems in education.

Searching strategy

In our methods, we used critical review. According to Grant and Booth (2009) “an effective critical review presents, analyses and synthesizes material from diverse sources”(p.93). Critical perspectives were used to assess the potential of VR in reforming educational practices and improving teaching and learning outcomes. The purpose of this article was to collect literature on the impact of VR on student engagement. Therefore, this article summarizes the previous studies as follows. First, information was obtained from Google, Scopus, and Elsevier databases: “virtual reality,” “cognitive engagement,” “affective engagement,” “behavioral engagement” and “learning outcomes.” The search was limited to articles published between January 2014 and December 2023 in English. The first search used all combinations of the above keywords and, after an initial review, produced 97 potentially relevant articles (Google: 92, Scopus: 3, Elsevier: 2).

In the second phase, secondary terms such as “affect,” “challenge,” and “education” were added, reducing the number of studies to 63 (Google:60, Scopus:1, Elsevier:2). Of these, 34 did not meet the criteria and were excluded. They were excluded because their target audience was teachers and did not discuss the impact of VR on student engagement from the student’s perspective. In the final stage, another 53 articles were excluded because they were repetitive and their purpose was to discuss either technology or engagement, or both. Finally, their full texts were reviewed to determine if their work fits the focus of this article 20 articles (Google: 17, Scopus: 1, Elsevier: 2) qualified for final review, covered a sample on the impact of VR on student engagement, and were included in the analysis.

Inclusion and exclusion criteria

To ensure the quality of the literature, we selected only peer-reviewed journal articles published in English in the last decade. The main purpose of this article was to review the impact of VR on student engagement. Therefore, we selected only review articles on the impact of VR on student engagement in educational settings. Articles that were not written in English did not discuss the impact on engagement from a student perspective, and were published beyond the previously established time and language were excluded. In addition, a selection of articles was identified and assessed by manually searching the references of articles related to the topic, of which 13 met the eligibility criteria. Therefore, 13 additional articles were added to the 20 identified. In total, 33 articles that met these eligibility criteria were included and reviewed here. Full-text versions of the articles were obtained, with each article being reviewed and confirmed as appropriate by the authors. Finally, to maximize transparency and traceability, we list the rationale and relevant evidence for all articles included (see Table 1 ). The process of article selection followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement ( Moher et al., 2009 ; see Figure 1 ). Figure 1 illustrates the process of article selection.

Table 1 . Publications reviewed in full text with reasons for inclusion or exclusion.

Figure 1 . PRISMA flow diagram for article selection.

The review found that the number of publications increased each year from 2014 to 2023, indicating the continued interest of researchers in exploring the impact of VR on student engagement. When reviewing the impact of VR on student engagement, Wang and Degol’s (2014) article had the most citations at 450, suggesting that the article had a strong impact in the area of student use of VR in the classroom. The majority of articles had only 10 or fewer citations, which may have indicated that these articles were relatively new or had less impact in the field. It was worth noting that more recently published articles, such as Rzanova et al. (2023) , did not have enough time to accumulate citations, so their impact on the field may not have been fully reflected in current citations.

To summarize, the differences in the number of citations for these articles highlighted their different levels of influence in the area of VR’s impact on student engagement. However, there were some limitations to the review methods. For example, some articles might not have fully reflected their impact on the field in the current citations due to their short time frames, which might have resulted in less comprehensive findings. Furthermore, the literature included was small, and in the future consideration would be given to expanding the search of literature and databases, such as PubMed and Web of Science databases, as well as expanding the search with keywords, such as “students’ attitudes toward VR.” In addition, the inclusion and exclusion criteria might have limited the generalizability of the results of the review, and therefore more caution was needed when generalizing the results of the review.

The positive impact of VR on education

This section will discuss the impact of VR on students’ cognitive, behavioral, and affective engagement participation. It is important in the field of education. Radianti et al. (2020) noted that student engagement in educational settings was critical to learning outcomes and classroom climate. Yuan and Wang (2021) further noted that the combined effects of cognitive, behavioral, and affective engagement could directly impact student learning outcomes and classroom contextual experiences. Therefore, a deeper understanding of the impact of VR on these three dimensions of engagement can provide valuable insights into educational practices and help educators better optimize classroom environments and teaching methods.

First, Papanastasiou et al. (2019) noted that VR immersive learning experiences promoted students’ cognitive engagement and aided in understanding complex and abstract knowledge. That is, through immersive learning, students can understand and remember what they have learned in greater depth and increase cognitive engagement. Pellas (2016) also found that VR encouraged students to learn through self-directed inquiry and move away from traditional teacher-centered instruction. Pellas (2016) further explained that, through VR scenario reenactments and simulations, students could engage in real-world unavailable learning experiences such as exploring historical sites and visiting distant planets. This means that such learning experiences enable students to explore knowledge in deeper and more varied ways, thus increasing cognitive engagement. Similarly, Maples-Keller et al. (2017) showed that VR was beneficial in engaging different types of students in learning, particularly for at-risk students, including those with learning difficulties, anxiety disorders, and other mental illnesses. VR provided personalized and adaptive learning environments that helped students improve cognitive engagement and achievement ( Maples-Keller et al., 2017 ). In summary, VR facilitates understanding of complex knowledge and promotes cognitive engagement for different types of students through immersive learning experiences and self-directed inquiry learning.

Secondly, Pirker and Dengel (2021) demonstrated that VR could promote student behavioral engagement. They discussed the potential of immersive VR in education through an in-depth analysis of 64 articles. They showed that “learning tasks in 3-D VLEs can foster intrinsic motivation for and engagement with the learning content” (p.77). Sun and Peng (2020) also suggested that by combining classical educational concepts with VR, such as Confucianism’s promotion of teaching for fun, students were better able to engage in learning activities. For example, Rzanova et al. (2023) found that the use of VR in the teaching of poetry to create the scenarios depicted in the verses enabled students to actively participate in classroom activities. Similarly, Freina and Ott (2015) also found that by simulating real school escape scenarios in VR, students could take on different roles to perform escape drills, and this sense of behavioral engagement can help students better master escape techniques and enhance safety awareness. These articles seem to echo that VR helps to enhance student behavioral engagement.

It is worth noting that there is debate about whether VR has a positive impact on student behavioral engagement. Proponents noted that students’ hands-on experience and exploration in virtual environments stimulated interest and behavioral engagement ( Wong et al., 2010 ; Allcoat and Von Mühlenen, 2018 ). This view suggests that VR provides an immersive learning experience that enhances students’ motivation and promotes deeper engagement in classroom activities. However, contrary findings exist, suggesting that the use of VR may have some negative effects. For example, students might have become addicted to the virtual world and neglected their real-life tasks and responsibilities, thus affecting their behavior in the classroom ( Cheng et al., 2015 ; Greenwald et al., 2018 ; Makransky et al., 2019 ). In addition, some other scholars noted that there might have been a gap between learning experiences in virtual environments and real-world learning experiences, which might have affected students’ ability to acquire and apply knowledge ( Makransky and Petersen, 2021 ). These conflicting results remind us that these complexities and diversities need to be taken into account when evaluating the role of VR technology in improving student engagement in the classroom.

Finally, scholars such as Wu et al. (2013) , Schutte and Stilinović (2017) , and Yuen et al. (2011) found that VR helped to promote student affective engagement. For example, Schutte and Stilinović (2017) found that contexts provided by VR for children with emotional impairments or disabilities taught them skills in communicating with people and managing their emotions, thus fostering empathy. This implies that VR may stimulate affective engagement. Wu et al. (2013) and Yuen et al. (2011) also found that VR provided opportunities for affective interaction, enabling students to interact with characters in the virtual environment. In language learning, for example, practicing through conversations with virtual characters could help students improve their oral expression ( Dhimolea et al., 2022 ). This means that affective interactions may increase students’ affective engagement with the learning content. Similarly, Misak (2018) noted that VR allowed students to role-play in virtual literature and experience the affective portrayed in the story. In other words, affective experiences may deepen students’ understanding of literary works and increase affective engagement. This literature seems to reflect that VR can promote student affective engagement.

In general, VR positively impacts students’ cognitive, behavioral, and affective engagement. In terms of cognitive engagement, VR can facilitate students’ cognitive engagement with learning materials and better understanding of abstract and complex knowledge by creating immersive situations. In terms of behavioral engagement, VR stimulates active student engagement and action through interactive learning. Although there is debate about whether VR has a positive impact on student behavioral engagement, literature has demonstrated the positive impact of VR on student behavioral engagement. In terms of affective engagement, VR promotes students’ emotional engagement by triggering affective resonance through affective experience and affective interaction. This full engagement helps students improve their learning and develop empathy.

The following section discusses the challenges faced when introducing VR in education. Through understanding these challenges, we can better understand the problems in the education system and make some constructive suggestions to help address them.

The challenge of VR in education

Despite the positive impact of VR on students’ cognitive, behavioral, and affective engagement, there are still two challenges to introducing VR into middle education, namely the difficulty of the educational system in keeping up with VR developments and the lack of teacher proficiency in VR use ( Islam et al., 2015 ; Zhong, 2017 ; Abich et al., 2021 ). For example, Islam et al. (2015) observed that the pace of technological advancement, including VR, outpaced the ability of the education system to adapt. This phenomenon is due to the slow reform of the education system, which takes time for the acceptance and adoption of emerging technologies ( Islam et al., 2015 ). To this end, the education sector may take longer to standardize the syllabus, resulting in students not having immediate access to VR ( Zhong, 2017 ). In other words, students may not have the opportunity to experience VR in the classroom until the education department completes the standardization process. Sahlberg (2016) further stated that while reform and standardization in the education sector took time, once VR and the education system evolved in tandem, students benefited from an education that matched the VR of the day.

Other scholars observed that VR education faced several challenges in developing digital literacy in students ( Aviram and Eshet-Alkalai, 2006 ; Sahlberg, 2016 ). According to Reddy et al. (2020) , “digital literacy is a set of skills required by 21st Century individuals to use digital tools to support the achievement of goals in their life situations” (p. 66). Digital literacy encompasses the assessment of digital technologies, critical thinking, and the ability to create and express oneself digitally ( Reddy et al., 2020 ). For example, Tsivitanidou et al. (2021) and Necci et al. (2015) emphasized the need for students to identify the differences between the results of simulation experiments and real experiments and to assess the reliability and accuracy of simulation experiments. In other words, students need to judge the plausibility of the results of simulation experiments and interpret and evaluate those results in real-world situations.

Similarly, Farmer and Farmer (2023) found that digital literacy required students to master VR painting and sculpting tools to create art. This involved learning to select appropriate colors and textures and creating three-dimensional effects with VR tools ( Skulmowski et al., 2021 ). Meanwhile, Andone et al. (2018) further noted that students also needed to learn to share and present their work to others in virtual reality. This observation seems to reflect the high demand for students’ creativity, technical skills, and expressive abilities when introducing VR into education. In sum, while the development of VR education benefits students’ learning in conjunction with VR, there are challenges to students’ digital literacy and the technological adaptability of the education system.

In addition, teachers’ lack of proficiency in the use of VR is another major challenge in introducing VR into middle education. For example, Abich et al. (2021) found that teachers might lack proficiency in the operation and application of VR, which might result in teachers not being able to fully utilize VR to supplement instruction. Jensen and Konradsen (2018) claimed that “for HMDs to become a relevant tool for instructors they must have the ability to produce and edit their content” (p.1525). This means that teachers need to spend time familiarizing themselves with HMDs and related software to create, edit, and customize content to meet their specific instructional needs. Similarly, Fransson et al. (2020) discussed the challenges of teachers operating VR equipment and software. They interviewed 28 teachers to understand teachers’ challenges with implementing helmet display VR in educational settings. Fransson et al. (2020) indicated that there might be a technological threshold and learning curve for teachers in controlling and operating VR devices, which might affect the effective use of VR for teaching and learning.

While teachers may lack familiarity with VR, there are solutions to this challenge. For example, Alfalah (2018) noted that proper training and support could help teachers make the most of VR to supplement instruction. That is, teacher training can provide teachers with the technical knowledge and operational skills they need to familiarize themselves with how VR equipment and software work. To this end, Alfalah (2018) found the impact of providing teachers with VR training in schools. They used a quantitative approach by distributing a questionnaire online to 30 IT teachers. Alfalah (2018) indicated that “technology training may be maximized for the integration of VR technology” (P.2634). This finding seems to reflect that proper teacher training and support can be effective in helping teachers overcome the operational and application of VR technology’s difficulties.

In sum, prior literature has shown that introducing VR into middle school education faces several challenges. First, the rapid development of technology makes the educational system keep up with VR, resulting in a disconnect between the educational curriculum and VR. Second, there may be a lack of proficiency in students’ digital literacy and teachers’ handling and application of VR. However, these challenges are not insurmountable. With proper training and support, teachers can make full use of VR to supplement their teaching and learning to realize the potential of VR in education. It is worth noting that through the literature we have found that in practice, due to the rapid development of technology and the limitations of the educational system, achieving a complete balance may take some time and effort. Therefore, considering how to address the gap between the speed of VR development and the education system to better integrate and apply VR in education makes sense.

This article describes the impact of VR on student cognitive, behavioral, and affective engagement and the challenges posed by VR education. The literature review finds that using VR in the classroom can positively impact student engagement and learning outcomes. An interesting finding is that VR can be a promising tool for providing education to students with learning disabilities. For example, the previous literature review section describes how for students with learning difficulties, anxiety disorders, and other mental illnesses, VR can provide personalized and adaptive learning environments that can help students improve cognitive engagement and academic performance. And, for children with emotional disorders or disabilities, VR provides contexts that can teach them skills for communicating with others and managing their emotions, thereby developing empathy and stimulating affective engagement.

However, the potential problems with incorporating VR in middle education are the difficulty of the education system in keeping up with VR developments, the higher demands of student digital literacy, and the lack of teacher proficiency in the use of VR. These challenges require educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to improve student engagement and teaching effectiveness.

Author contributions

XL: Writing – original draft, Writing – review & editing. BL: Conceptualization, Writing – original draft, Writing – review & editing. ZNY: Writing – original draft, Writing – review & editing. ZY: Funding acquisition, Supervision, Writing – original draft, Writing – review & editing. MZ: Funding acquisition, Writing – original draft, Writing – review & editing, Supervision.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the General Topics of China’s Hunan Province Social Science Achievement Evaluation Committee Fund [Grant no. XSP2023JYC123].

Acknowledgments

We are deeply appreciative of the editors and reviewers of this journal for their unwavering dedication and contributions that have shaped the publication of this article. Their constructive feedback and invaluable insights were instrumental in bringing this piece to fruition. We extend our heartfelt thanks to the readers with a keen interest in virtual reality technology. It is our sincere hope that this article will inspire enriched discussions within the academic community about the potential and nuances of using virtual reality in educational contexts.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: virtual reality technology, cognitive engagement, affective engagement, behavioral engagement, learning outcomes

Citation: Lin XP, Li BB, Yao ZN, Yang Z and Zhang M (2024) The impact of virtual reality on student engagement in the classroom–a critical review of the literature. Front. Psychol . 15:1360574. doi: 10.3389/fpsyg.2024.1360574

Received: 23 December 2023; Accepted: 22 March 2024; Published: 10 April 2024.

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Copyright © 2024 Lin, Li, Yao, Yang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Zhi Yang, [email protected] ; Mingshu Zhang, [email protected]

† These authors have contributed equally to this work and share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.