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• Research for Development Outputs

How to do a rigorous, evidence-focused literature review in international development - A Guidance Note

Building on previous reflections on the utility of systematic reviews in international development research, this paper describes an approach to carrying out a literature review that adheres to some of the core principles of ‘full’ systematic reviews, but that also contains space within the process for innovation and reflexivity. We discuss all stages of the review process, but pay particular attention to the retrieval phase, which, we argue, should consist of three interrelated tracks – important for navigating difficult ‘information architecture’. We end by clarifying what it is in particular that sets this approach apart from fuller systematic reviews, as well as with some broader thoughts on the nature of ‘the literature review’ within international development and the social sciences more generally. The paper should thus be seen as sitting somewhere between a practical toolkit for those wishing to undertake a rigorous, evidence-focused review and a series of reflections on the role, purpose and application of literature reviews in policy research.

Hagen-Zanker, J.; Mallett, R. How to do a rigorous, evidence-focused literature review in international development - A Guidance Note. ODI, London, UK (2013) 27 pp.

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The British Council’s cultural relations approach to development encourages work with people and communities closest to local contexts, fosters partnerships and relationships building on equal terms, and promotes trust and understanding for social cohesion and inclusive growth worldwide. It also recognises the transformative power of arts and culture in contributing to more inclusive and creative economies and societies for sustainable development.

Areas of work that are included in this approach include skills development, creative enterprise, creative hubs and communities, digital practice, cultural heritage, intercultural dialogue and socially-engaged arts.

As part of evidencing this way of working, we commissioned a study to assess literature and documentation in the area of culture and development and to provide a methodology that can be used in the creation of policy and planning of future interventions.  

This study, Culture and Development: Towards an Interdisciplinary Methodology (February 2019), was written by J.P. Singh, Professor of International Commerce and Policy at George Mason University, USA. A foreword has been prepared by François Matarasso, writer, researcher and community arts worker and author of A Restless Art: How participation won and why it matters . Appendices have been contributed by Dr Evangelos Chrysagis, Professor Edward Hollis and Professor Candace Jones. The study has been delivered by the University of Edinburgh and published by George Mason University.

The literature review is divided into 4 parts:

• A survey of the literature on culture and development
• Human well-being and culture
• A cultural infrastructure and value-chain perspective
• Proposals for a methodology for culture and development

The review is interdisciplinary, drawing from anthropology, cultural studies, economics, post-colonial history and literatures, international relations, political science, and sociology.

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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• Finding Literature Reviews

Sage Research Methods

Dr. Eric Jensen, Professor of Sociology at the University of Warwick, and Dr. Charles Laurie, Director of Research at Verisk Maplecroft, explain how to write a literature review and why researchers need to do so.

The steps of how to write a literature review discussed in the video include the following:

• How Do You Conduct a Literature Review?
• How Do You Find and Organize Sources of Information?
• How Do You Assess These Sources of Information?
• How Do You Write up Your Findings?
• How Do You Identify Gaps in Literature?

Other sources for Writing Literature Reviews

• Owl Purdue - Writing a Literature Review Provides a general overview of how to write a literature review.

What's a Literature Review?

• Acquire a better understanding of the current state of knowledge in a particular discipline or field of study, providing context for a research project.
• Identify key concepts, theories, methodologies, and other findings related to their research topic, which helps researchers in build theoretical frameworks based on established theories and concepts.
• Identify gaps in a disciplinary area where there is a lack of research or conflicting findings, and highlight major questions that should be addressed in further literature.

Types of Literature Reviews

• Narrative literature reviews provide a general, qualitative summary of the literature. Narrative reviews focus on only a few studies that describe a topic of interest and are not systematic. Undergraduates writing research papers for the first time are usually assigned to write this type of review.
• Systematic reviews  follow a structured and rigorous methodology to systematically gather, analyze, and synthesize all relevant studies on a specific topic of literature. Systematic reviews use specific criteria to decide what literature to include in the review. Systematic reviews are primarily used in the medical and psychological literature.
• Meta-analyses  combine empirical statistical analysis research and data from multiple studies. The terms meta-analysis and systematic review are often used interchangeably.
• Scoping reviews map the literature in a broad sense to identify key themes and gaps. Unlike systematic reviews, which have a narrow focus, scoping reviews are broader in scope and explore a diversity of the available literature in a given field.

Resources for Locating Literature Reviews

Published literature reviews of all types are found in a variety of research databases. It is important to search different databases to locate relevant reviews. Regardless of the databases used, the following searches can be helpful:

• " literature review " OR " review of the literature " AND " your research topic/question/key terms "
• " systematic review " AND " your research topic/question/key terms "  
• " meta analysis " OR " meta-analysis " AND " your research topic/question/key terms "
• " scoping review " AND " your research topic/question/key terms "
• Annual Reviews The Annual Reviews series of publications provides literature review articles that analyze the most significant scholarly research published within the preceding year. These article-length reviews are authored by leading scholars and cover over 40 different subject disciplines in the social, behavioral, and hard sciences.
• JSTOR Started as a grant-funded project at the University of Michigan, JSTOR is now a  premier scholarly digital research database primarily for the humanities and social sciences. In addition to journal articles, users can access ebooks, book chapters, images, and primary source documents.  JSTOR contains the full text of more than 2,300 journals from 1,000 publishers, with publication dates ranging from 1665 to 2015 (for specific titles). Journals are available in more than 60 disciplines in the humanities, social sciences, sciences, and mathematics. Note:  The majority of journals in JSTOR have an embargo period or "Moving Wall" delay of 3 to 5 years. This means there is a gap in the availability of current issues of most JSTOR journals.
• The International Bibliography of the Social Sciences (IBSS) The International Bibliography of the Social Sciences (IBSS) is compiled by the British Library of Political and Economic Science at the London School of Economics. It provides access to scholarly literature in the social sciences, covering various disciplines, including sociology, political science, anthropology, economics, geography, and more. It includes over 3 million bibliographic references to journal articles, books, book reviews, and selected book chapters back to 1951.
• Project Muse Project Muse provides online access to many scholarly journals, books, and other academic resources in the humanities, social sciences, and arts. It is also a leading provider of digital humanities content. Project MUSE offers access to diverse, high-quality, peer-reviewed journals from renowned university presses, scholarly societies, and academic publishers. It also covers various disciplines, including literature, history, philosophy, political science, sociology, cultural studies, etc. Some institutions subscribe to the Project Muse Premium Collection, which contains over 700 scholarly journals from over 100 publishers on various subjects.
• Dissertations & Theses Global ProQuest Dissertations & Theses Global is a comprehensive collection of academic theses and dissertations students submit as part of their university studies. Each dissertation or thesis provides a literature review section, offering a critical assessment of the sources used to write the work.
• Science Direct Science Direct provides a large collection of Social Sciences and Humanities journals and books, highlighting historical context, current developments, theories, applications, trends, and more.
• Social Science Citation Index™ (Web of Science) Social Sciences Citation Index™ provides access to a wide range of scholarly literature in the social sciences, including sociology, psychology, political science, anthropology, economics, and education, among others. Contains over 3,400 journals across 58 social sciences disciplines, as well as selected items from 3,500 of the world’s leading scientific and technical journals. More than 9.37 million records and 122 million cited references date back from 1900 to the present.
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Literature review

A general guide on how to conduct and write a literature review.

Please check course or programme information and materials provided by teaching staff, including your project supervisor, for subject-specific guidance.

What is a literature review?

A literature review is a piece of academic writing demonstrating knowledge and understanding of the academic literature on a specific topic placed in context.  A literature review also includes a critical evaluation of the material; this is why it is called a literature review rather than a literature report. It is a process of reviewing the literature, as well as a form of writing.

To illustrate the difference between reporting and reviewing, think about television or film review articles.  These articles include content such as a brief synopsis or the key points of the film or programme plus the critic’s own evaluation.  Similarly the two main objectives of a literature review are firstly the content covering existing research, theories and evidence, and secondly your own critical evaluation and discussion of this content. 

Usually a literature review forms a section or part of a dissertation, research project or long essay.  However, it can also be set and assessed as a standalone piece of work.

What is the purpose of a literature review?

…your task is to build an argument, not a library. Rudestam, K.E. and Newton, R.R. (1992) Surviving your dissertation: A comprehensive guide to content and process. California: Sage, p49.

In a larger piece of written work, such as a dissertation or project, a literature review is usually one of the first tasks carried out after deciding on a topic.  Reading combined with critical analysis can help to refine a topic and frame research questions.  Conducting a literature review establishes your familiarity with and understanding of current research in a particular field before carrying out a new investigation. After doing a literature review, you should know what research has already been done and be able to identify what is unknown within your topic.

When doing and writing a literature review, it is good practice to:

• summarise and analyse previous research and theories;
• identify areas of controversy and contested claims;
• highlight any gaps that may exist in research to date.

Conducting a literature review

Focusing on different aspects of your literature review can be useful to help plan, develop, refine and write it.  You can use and adapt the prompt questions in our worksheet below at different points in the process of researching and writing your review.  These are suggestions to get you thinking and writing.

Developing and refining your literature review (pdf)

Developing and refining your literature review (Word)

Developing and refining your literature review (Word rtf)

Writing a literature review has a lot in common with other assignment tasks.  There is advice on our other pages about thinking critically, reading strategies and academic writing.  Our literature review top tips suggest some specific things you can do to help you submit a successful review.

Literature review top tips (pdf)

Literature review top tips (Word rtf)

Our reading page includes strategies and advice on using books and articles and a notes record sheet grid you can use.

Reading at university

The Academic writing page suggests ways to organise and structure information from a range of sources and how you can develop your argument as you read and write.

Academic writing

The Critical thinking page has advice on how to be a more critical researcher and a form you can use to help you think and break down the stages of developing your argument.

Critical thinking

As with other forms of academic writing, your literature review needs to demonstrate good academic practice by following the Code of Student Conduct and acknowledging the work of others through citing and referencing your sources.  

Good academic practice

As with any writing task, you will need to review, edit and rewrite sections of your literature review.  The Editing and proofreading page includes tips on how to do this and strategies for standing back and thinking about your structure and checking the flow of your argument.

Editing and proofreading

Guidance on literature searching from the University Library

The Academic Support Librarians have developed LibSmart I and II, Learn courses to help you develop and enhance your digital research skills and capabilities; from getting started with the Library to managing data for your dissertation.

Searching using the library’s DiscoverEd tool: DiscoverEd

Finding resources in your subject: Subject guides

The Academic Support Librarians also provide one-to-one appointments to help you develop your research strategies.

1 to 1 support for literature searching and systematic reviews

Advice to help you optimise use of Google Scholar, Google Books and Google for your research and study: Using Google

Managing and curating your references

A referencing management tool can help you to collect and organise and your source material to produce a bibliography or reference list. 

Referencing and reference management

Information Services provide access to Cite them right online which is a guide to the main referencing systems and tells you how to reference just about any source (EASE log-in may be required).

Cite them right

Published study guides

There are a number of scholarship skills books and guides available which can help with writing a literature review.  Our Resource List of study skills guides includes sections on Referencing, Dissertation and project writing and Literature reviews.

Study skills guides

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• Published: 12 March 2024

Mental health and psychosocial interventions in the context of climate change: a scoping review

• Siqi Xue 1 ,
• Alessandro Massazza 2 ,
• Samia C. Akhter-Khan 3 ,
• Britt Wray 4 ,
• M. Ishrat Husain 1 , 5 &
• Emma L. Lawrance 6 , 7 , 8  

npj Mental Health Research volume  3 , Article number:  10 ( 2024 ) Cite this article

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• Health care
• Planetary science

The evidence on the impacts of climate change on mental health and wellbeing is growing rapidly. The objective of this scoping review is to understand the extent and type of existing mental health and psychosocial interventions aimed at addressing the mental health and psychosocial impacts of climate change. A scoping review methodology was followed. MEDLINE, PsycINFO, and Web of Science databases were searched from inception to May 2022. Comprehensive gray literature search, including expert consultation, was conducted to identify interventions for which peer-reviewed academic literature may not yet be available. Data on intervention type, setting, climate stressor, mental health outcome, evaluation, and any other available details were extracted, and results were summarized narratively. Academic literature search identified 16 records and gray literature search identified a further 24 records. Altogether, 37 unique interventions or packages of interventions were identified. The interventions act at the levels of microsystem, mesosystem, exosystem, and macrosystem through diverse mechanisms. While most interventions have not been formally evaluated, promising preliminary results support interventions in low- and middle-income-country settings disproportionately affected by climate disasters. Interventions from multidisciplinary fields are emerging to reduce psychological distress and enhance mental health and wellbeing in the context of climate change. This scoping review details existing evidence on the interventions and summarizes intervention gaps and lessons learned to inform continued intervention development and scale-up interventions.

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The clinical implications of climate change for mental health

Tara J. Crandon, Cybele Dey, … Fiona J. Charlson

A systematic review of the effects of chronic, slow-onset climate change on mental health

Kate Burrows, Christy A. Denckla, … Sarah R. Lowe

Climate change affects multiple dimensions of well-being through impacts, information and policy responses

W. Neil Adger, Jon Barnett, … Sergio Jarillo

Introduction

Climate change is increasingly recognized as a public health emergency 1 , 2 . Beyond its well-recognized physical health consequences, the crisis impacts mental health in profound ways 1 , 3 , 4 , 5 . Climate events have been associated with worsened psychiatric mortality outcomes, including depression, post-traumatic stress disorder (PTSD), and suicide 6 . Various population groups have been identified as being particularly at-risk, including children and youth, older adults, pregnant women, people living with chronic illnesses, and racialized communities 6 , 7 . Indigenous groups worldwide have described feelings of sadness, anger, grief, fear, and helplessness from climate change-related forced migration, disrupted cultural continuity, and historical and ongoing disempowerment 8 .

Researchers in the climate change and mental health space acknowledge the intricate tension between recognizing the detrimental mental health impacts of climate change while not pathologizing culture-specific, expected, and adaptive responses to ongoing and anticipated threats. To encapsulate the nuanced range of experiences, new vocabulary, such as climate emotions, eco-anxiety, and ecological grief, have been introduced to literature 4 , 7 . Academics and third-sector organizations have also begun to identify protective coping mechanisms, including “active hope” and “meaning-focused coping” that emphasize acting in line with values, developing positive framings, and creating hope through action and trust in societal actors 9 , 10 , 11 .

Despite the accumulating evidence on climate-related mental health and/or psychological responses and coping strategies, little is known about evidence-based interventions to mitigate the negative consequences and support individuals and their communities. Of the 120 original studies identified in a scoping review on climate change and mental health research, the vast majority were cross-sectional studies quantifying the impact of climate change exposure on mental health outcomes 6 . The 8 studies related to interventions were primarily proposals and did not contain conclusive evidence. In another review on interventions for eco-anxiety, only 2 studies involved an empirical evaluation component, with the rest being conceptual or reflection papers 12 . The most comprehensive review to date identified 23 studies 13 , but did not differentiate between interventions implemented for a climate-related event and those for other settings (e.g., armed conflicts) theoretically relevant to the climate change context. The review was further limited to academic literature and interventions for preventing or treating known psychiatric disorders. As the World Health Organization (WHO) defines mental health as not the mere absence of a disorder but an overall state of wellbeing 14 , a broader conceptual framework could be helpful to recognize interventions that promote psychological strengths and emotional resilience in the face of climate stressors.

As increasing numbers of mental health interventions are being formally or informally developed and implemented in the context of climate change, there is a strong need to map out this space to facilitate knowledge exchange and identify best practices to scale-up support. Indeed, one of the global research priorities identified in a recent consensus building exercise is to “assess the appropriateness, feasibility, effectiveness, and scalability of mental health and psychosocial interventions (clinical and non-clinical) in the context of climate change” 15 . The current review aims to address this need by (1) focusing on existing interventions aimed at promoting mental health or mitigating the impacts on mental health; (2) considering broad mental health and wellbeing outcomes, which are not limited to predefined psychiatric diagnoses or newly described psychological states; and (3) incorporating a formal gray literature search process to identify interventions that have not been studied academically but are being implemented. The exploratory and flexible nature of a scoping review represents, therefore, an ideal methodology. To our knowledge, this is the first scoping review that aims to identify all such mental health and psychosocial interventions that have been implemented in the context of climate change.

The scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis 16 . The protocol was registered prospectively on March 9, 2022 and is available at: https://osf.io/dya94/ .

Inclusion criteria

The scoping review included records describing existing interventions that promote mental health or mitigate mental health impacts in the context of climate change. No restrictions were imposed on intervention target populations or geographical settings. All study designs were considered, given the a priori understanding that many interventions likely have not been formally evaluated through clinical trials. Further, given the interdisciplinary nature of the topic, records in the humanities and applied social sciences may not be easily categorizable into a study design conventional to medicine or public health.

Exclusion criteria

The scoping review excluded records describing interventions for humanitarian crises not directly related to climate change (e.g., earthquakes, nuclear disasters, acts of terrorism), or natural hazards (e.g., recurrent floods) not explicitly connected with climate change by the authors. Other ineligible records included general resources (e.g., videos, webinars, podcasts, newsletters, therapist directories) that do not have an active interventional or participatory component; private, stand-alone retreats or courses; and books or book chapters. Proposals and expert opinions on psychotherapeutic approaches, while valuable to inform intervention development, are not organized programs that have been expanded beyond the individual therapist’s practice or systematically evaluated or implemented; they were therefore excluded.

Academic literature search strategy

The academic literature search strategy combined three core constructs, “intervention”, “mental health” and “climate change”, the definitions of which are outlined in Table 1 . The search terms were first developed for MEDLINE (Supplementary File 1 ) and modified for other databases as required. MEDLINE, PsycINFO and Web of Science were carried out from inception to May 2, 2022. Reference lists of any included studies and relevant reviews were hand searched to identify additional articles.

Study selection

All identified citations were collated in EndNote X9 with duplicates removed, then uploaded into Rayyan.ai, an online tool for conducting systematic and scoping reviews 17 . Titles and abstracts were screened by one reviewer (SX), with a subset (10%) screened by a second reviewer (SAK). Full texts of potentially relevant studies were acquired and screened by SX, a subset (10%) of which was also screened by SAK. Any discrepancies in reviewer decisions were resolved via discussions with a third reviewer (EL/AM).

Gray literature search strategy

A comprehensive gray literature search was undertaken to capture interventions not published in peer-reviewed journals or evaluated in academic literature. The search strategy was informed by the methodology and best-practice guidelines by Godin et al. 18 and Pollock et al. 18 , 19 , and involved four distinct steps: (1) targeted database search; (2) Google search; (3) targeted website search; and (4) key stakeholder consultation. The first three steps were carried out in May 2022 and the consultations took place between June-July 2022. Details of the gray literature search strategy can be found in Supplementary File 2 .

Data extraction

For academic literature, data were collected concerning the records (authors, publication year, study design) and nature of the interventions (delivery country/location; target population; climate stressor; mental health and wellbeing outcomes; evaluation outcomes; and any other available details, such as theoretical framework, intervention length, cost, facilitator characteristics, delivery methods, and involvement of stakeholders in co-designing the intervention). Best efforts were made to extract the same categories of data from gray literature. As the content from organizations may be trademarked, direct quotations from websites were at times extracted to best reflect the intervention description as intended. Data were presented in tabular form and analyzed narratively in accordance with their relevance to the review objectives.

Data presentation

Results are presented by clustering interventions according to Bronfenbrenner’s ecological theory 20 , 21 . The theory describes one’s ecological environment at four levels: microsystem (individual and immediate home environment); mesosystem (peer groups and social networks); exosystem (institutions, the media, and local government), and the macrosystem (policies, laws, and overarching social structures). Bronfenbrenner’s theory has been widely applied in public mental health research given its embracing of the complex interplay between individual and contextual factors. We believe categorizing the interventions at the different levels would allow for a clear conceptual map of where work has been done and where more work is needed, and the presentation of most pertinent information to relevant stakeholders (e.g., policymakers).

Overview of academic literature findings

In total, 5126 unique records were identified (5107 from databases and 19 from backward citation hand search) (Fig. 1 ). Among the 194 records reviewed in full, 16 met inclusion criteria and were included in the review (Table 2 ). The 16 studies described 13 unique stand-alone interventions or packages of interventions across Asia, Europe, North America and the Caribbean, Oceania, and Sub-Saharan Africa. Among the studies, 7 (44%) were conducted in LMIC settings. All studies were published in or after 2009, with half (50%) having been published within the past 3 years (2019–2022).

PRISMA flow diagram.

Climate stressors included general climatic change, wildfires, droughts, cyclones, typhoons, and floods. Targeted mental health outcomes included psychological distress, psychiatric symptoms (depression, anxiety, PTSD), and broader psychological wellbeing measures such as emotional strength, emotional self-efficacy, confidence in the future, and general mental and spiritual wellness. Nine (56%) studies involved a type of design (e.g., RCT, quasi-experimental, pre-post) aimed to quantitatively evaluate the interventions, and 7 (44%) reported effectiveness results. Eleven (69%) studies mentioned a co-design process, during which local stakeholders were consulted for the needs assessment, intervention design, and/or cultural adaptation of the intervention.

Description of interventions from academic literature

Five microsystem interventions were identified that primarily focus on individual-level emotions, behaviors, and psycho-emotional resilience.

In Nigeria, where increasingly frequent floods are being attributed to climate change, an evaluation of a rational emotive behavior therapy (REBT) program was conducted 22 . REBT is a short-term therapy related to cognitive behavioral therapy (CBT) and encourages participants to actively dispute irrational beliefs after experiencing an undesirable triggering event. REBT was delivered over 20 sessions to 49 flood victims with clinical depression by professional therapists. In comparison to the waitlist control group, the intervention group was found to have significantly decreased depression symptoms as measured by the Hamilton Depression Scale ( F (1,97) = 208.935, p  = 0.001, ηp 2  = 0.69) and by the Goldberg’s Depression Scale ( F (1,97) = 34.842, p  = 0.001, ηp 2  = 0.27) and at 3-month follow-up.

In Haiti, a disaster-prone country susceptible to climate change effects, an integrated community intervention was developed to promote mental health and improve practical disaster preparedness 23 . The intervention was manualized and consisted of activities that promote mental health literacy and coping skills (e.g., progressive muscle relaxation), and increase household-level preparedness (e.g., developing emergency action plan, mapping community risks and resources). The intervention was delivered by local lay workers over 3 days to 144 individuals who recently experienced a hurricane and associated flooding. In comparison to the control group, intervention participants experienced fewer depression ( B  = −0.35, p  < 0.001), anxiety ( B  = 0.27, p  < 0.001), and PTSD ( B  = −0.46, p  < 0.001) symptoms, and increased mental health-focused help-giving intention ( B  = 2.62, p  < 0.001).

Several interventions identified themselves as resilience-building programs. In the Philippines, a six-module intervention Katatagan was developed in the aftermaths of the Super Typhoon Haiyan and evaluated in two settings 24 , 25 . In Tacloban City where trained paraprofessionals delivered the intervention, the 48 intervention participants experienced lower anxiety scores ( F (1,105) = 3.89, p  = 0.05, ηp 2  = 0.036), increased adaptive coping ( F (2.79,192.6) = 5.87, p  = 0.001, ηp 2  = 0.078), and increased individual resilience ( F (1,105) = 4.68, p  = 0.03, ηp 2  = 0.043) 24 in comparison to the control group. In the Samar Province, the intervention was delivered as part of a mission trip by Health Futures Incorporated (HFI). The 163 intervention participants improved in all self-efficacy domains, as measured by a locally constructed scale based on each Katatagan module, in comparison to the participants’ baseline. Reported effect sizes ranged from Cohen’s d  = 0.33 for Engaging in Positive Activities, Cohen’s d  = 0.51 for Managing Thoughts and Emotions, to Cohen’s d  = 0.83 for Seeking Solutions and Support 25 . Benefits were largest immediately post-intervention and decreased at six-month follow-up in both settings.

Skills for Life Adjustment and Resilience (SOLAR) is another resilience-building intervention that was piloted in Tuvalu, a small island developing state (SIDS) vulnerable to sea-level rise 26 . Forty-nine islanders impacted by Cyclone Pam and experiencing mental health symptoms participated in the lay-worker-delivered group intervention over 5 consecutive days. Module content included Skills for Healthy Living, Managing Strong Emotions, Getting Back into Life Following Disaster, Coming to Terms with Disaster, Managing Worry and Rumination, and Maintaining Healthy Relationships. In comparison to controls, participants experienced improvements in psychological distress (Glass’s d  = 1.106), PTSD symptoms (Glass’s d  = 1.575), and functional impairment (Glass’s d  = 1.316). Benefits were retained at six-month follow-up but were reduced compared to immediate post-intervention.

One review study narratively described an Environmental Health Clinic based at New York University 27 , 28 . Individuals concerned about environmental issues received “prescriptions” to participate in environmental projects, with the aim to channel anxiety to specific climate action. This intervention was used as an example of structured problem-based coping and no evaluation was available.

Four mesosystem interventions were identified that involve focuses beyond individual-level changes, and additionally target peer group relationships and local community identity and cohesion in relation to mental health and wellbeing.

Carbon Conversations is a UK-based third-sector initiative which allows individuals to reflect on difficult emotions around climate change, and in turn be better able to engage with carbon footprint reduction 29 . Groups of six to eight participants meet with two facilitators over six sessions and discuss themes pertaining to Climate Change and Low Carbon Futures, Energy in the Home, Travel and Transport, Food and Water, and Consumption and Waste. In an online survey to 113 group participants, 50% agreed or strongly agreed that taking part helped them “face their worries about climate change”. Semi-structured interviews further revealed themes that the intervention allowed participants a unique space to express and share difficult emotions around climate change, feel more empowered and in control, and engage with others with similar experiences.

In various parts of the world vulnerable to extreme weather and regional food security, multiple interventions involving community-level participatory activities have been developed. These include: (1) land restoration work and associated reflection exercises for youth living at the Arizona-Mexico border in the United States; (2) community garden hubs with tree-planting activities for low-income residents and people with chronic and mental health conditions in Australia; and (3) traditional fish camp activities and participatory research for indigenous youth of the Selkirk First Nation in Canada 30 , 31 , 32 . All interventions were designed in the context of climate change to improve psychological and/or spiritual wellbeing, and to promote connectedness among participants through shared identities. Internal program evaluations of the land restoration and community garden interventions both anecdotally suggest improved mental health outcomes among participants, though the specific evaluative methods and outcome measures were not reported.

Two packages of exosystem interventions were identified that involved the implementation of multi-pronged mental health services and mobilization of the media and local institutions.

In Sonoma County, California, the Sonoma Wildfire Mental Health Collaborative was established following the historic 2017 wildfires 33 , 34 . The Collective launched a package of interventions that included a trauma-informed yoga and meditation program, a mental health app targeting adolescent survivors, and a Skills for Psychological Recovery (SPR) training program for counselors and paraprofessionals. The package was coupled with a media campaign to raise post-disaster mental health awareness, destigmatize help-seeking, and promote available resources. Given small sample sizes, the evaluative study was unable to conclude the effects of the app or SPR training; a preliminary survey suggested that participants experienced short-term beneficial effects from the yoga and meditation program.

For the rural farming populations who face climate-related adversity in New South Wales, Australia, a government-funded Drought Mental Health Assistance Package (DMHAP) was implemented 35 , 36 . DMHAP consisted of mental health promotion (e.g., resource booklet development, community mental health forums, mental health first aid trainings) and early intervention (e.g., rural telephone support line, service network planning workshops). Following renewed funding, the extended Rural Adversity Mental Health Program (RAMHP) increased the number of dedicated drought mental health workers and introduced specific activities for priority groups, including women, youth, older farmers, and Aboriginal communities. The authors reported that given funding limitations, no formal outcome evaluation was carried out.

Two macrosystem interventions were identified that involved macro-level interventional components, primarily through poverty reduction to improve mental health and wellbeing outcomes.

In Bangladesh, a Red Cross Red Crescent humanitarian project was delivered to promote financial security and associated psychological benefits among river basin communities amidst the 2017 floods 37 . A forecast-based unconditional cash transfer of BDT 5000 (USD 60 equivalent) was distributed to 1039 poor households prior to a flood peak. Relative to the unassisted households, intervention households were less likely to have always felt anxiety and depression (43% vs 29%, p  = 0.015) and less likely to have always felt miserable or unhappy (61% vs 40%, p  < 0.01) since the flood. While these findings were triangulated with qualitative interviews, the authors noted that the intervention benefits were not sustained after a second flood peak in the same year.

In Ethiopia, a capacity-building intervention was developed for pastoral communities who face increasingly severe droughts, land changes, and food crises. The intervention included components to inspire motivation, build collective-action groups, and improve literacy and numeracy 38 . The macro-economic components specifically involved the promotion of microenterprises and distribution of donor grants for livestock trading. The study reported the creation of 59 primarily women-led collective-action groups, 11 of which received donor grants. Following a major drought, intervention participants who received both capacity building and donor grants in the Liben District scored much higher on study-defined mental health and wellbeing attributes than their peers. The attributes included better ability to recover from crisis (OR = 91.7, p  < 0.001), more confidence in the future (OR = 33.6, p  < 0.001), and better human health (OR = 19.2, p  < 0.001). The positive findings were replicated in the Moyale District with smaller effect sizes.

Overview of gray literature findings

Targeted database search, Google search, and targeted website search identified 14 records describing 14 organizations offering relevant stand-alone and/or packages of interventions. One of the interventions (Carbon Conversations) was already identified through academic literature. A list containing these interventions, along with the inclusion and exclusion criteria, was circulated to 30 international content experts for consultation; through snowballing, we were introduced to and contacted 6 additional experts. Of all individuals contacted, 26 (72%) responded to the gray literature search request, and 8 (31%) of the respondents were based in a LMIC setting. The content experts reviewed and confirmed the list of interventions and identified 11 additional records for inclusion (total records = 25; minus duplicate = 24) (Table 3 ).

All identified interventions are offered by an organization, and all but two were founded or based in a high-income country (HIC), primarily the US (46%) or the UK (33%). For the organizations that cited their founders, a large majority (11/12; 92%) of those founders are women.

The climate stressors addressed by interventions from the gray literature all involve general climatic changes and/or anticipated climate-related threats rather than specific climate-related disasters. Targeted mental health outcomes are independently defined by the organizations rather than by psychiatric diagnoses or standardized instruments, and many used emotion-based wordings such as “overwhelm”, “despair”, and “loneliness”. Five records (21%) described a co-design process involving local stakeholders.

Description of interventions from gray literature

The 24 interventions or packages of interventions acted at the levels of microsystem and mesosystem. No exosystem or macrosystem interventions were identified through gray literature. Of note, none of the interventions reported formal evaluation methods; a minority (12.5%) reported selected positive internal evaluation results.

Four microsystem interventions were identified that take a self-guided approach and support individuals to improve their own mental health and wellbeing in the context of climate change.

In the UK, a group of organizations, namely Climate Cares based at Imperial College London, Force of Nature and Common Vision worked with young people and environmental scientists to create a virtual intervention Hold This Space 39 . The interactive website guides youth to explore their feelings towards climate change, imagine the world they would like to see based on the latest science, and reflect on how to act on environmental issues most concerning to them. In consultation with youth advisors, mental health practitioners, and climate change professionals, Climate Cares also co-designed a 4-week activity-based physical journal 40 . The goal is to reduce the mental health impacts that can be associated with climate-related distress, build coping strategies, envision a desired future, and increase capability to take desired action. The Climate Journal Project based in the US is another intervention involving a journaling approach 41 . The organization created digital and printed journals and worksheets that target eco-anxiety and environmental grief. Individuals have the additional option of participating in virtually guided “journal circles”. Other self-guided activities and worksheets were identified through Eco-Anxious Stories, a Canada-based online platform 42 . In the “Sharing Our Stories” worksheet, individuals are prompted to answer questions such as “Where is eco-anxiety showing up in my life?” and “What does a meaningful response to this crisis look like and feel like?”

The rest of 20 gray literature records all acted at the level of the mesosystem and involve a group-based or outreach approach that harness the power of group dynamics and community building.

Many of the interventions function on the premise of offering a safe space for individuals to gather and make sense of their positive or negative climate emotions. As a quintessential example, Climate Cafés are decentralized, drop-in meetings for discussing the climate crisis and building collective psycho-emotional resilience – often over tea or coffee. The model of Climate Cafés is now adopted by many organizations globally with both in-person and virtual meetings available 43 , 44 , 45 . The Good Grief Network developed an intervention based on the 12-Step approach of Alcoholics Anonymous 46 . Trained peer facilitators deliver the 10-week group program for individuals interested in recognizing and exploring their eco-distress and being supported to move towards meaningful action. The Network’s website reports that over 90% of program participants feel more empowered and less alone, though the exact survey methods or number of surveyed participants are not available publicly. Other examples of facilitated discussions include All We Can Save Circles (10 structured sessions) 47 , Climate Emotions Conversations by Climate Awakening (3 available sessions per month) 48 , and The Rest of Activism (2 available sessions per week) 49 . A few interventions name their specific target audience: Conceivable Future “house parties” are intended for individuals who wish to discuss reproductive decisions and parenthood while facing an uncertain future 50 , and Globe and Psyche conversation meetings are intended for individuals working in psychotherapeutic and psycho-spiritual domains to reflect on professional identities and healings for others 51 .

Five identified organizations offer packages of interventions (e.g., facilitated workshops, events, trainings, online communities) under the same theoretical or philosophical premise. The Work That Reconnects (WTR) is a network based on Joanna Macy’s work, also known as Deep Ecology Work and Active Hope. The work’s philosophical premise follows a spiral sequence of four stages, “gratitude”, “honoring our pain for the world”, “seeing with fresh eyes”, and “going forth”, and is designed to be delivered in an interactive group setting 52 . The Deep Adaptation Forum is based on Jem Bendell’s work 53 , which recognizes the “breakdown” from climate change and aims to support individuals to prepare for and co-create a loving response to what Bendell describes as the “inevitable near term societal collapse”. The Resilient Activist is based on the “Five Essentials” principle (Reconnect to Nature, Respect All Life, Regreen Our Planet, Revamp Our Spending, and Replenish Our Resources) to maintain a healthy mindset and ease the emotional burden from climate change 45 . The Transition Network offers a variety of interventions (e.g., “Heart and Soul” groups) based on the Inner Transition principle, which posits that shifts in emotional and psychological dimensions are needed to make outer systemic changes towards healthier communities 54 . One Earth Sangha is a hub for spiritual-psychological participatory groups and events in response to climate change based on Buddhist teachings 55 .

Seven interventions involve outreach or capacity-building approaches to improve the participants’ mental health and wellbeing and/or that of their wider community. Force of Nature runs training programs for youth affected by eco-anxiety. The trained youth then have the opportunity to run group “anxiety-to-agency” workshops, and become speakers or consultants for businesses and educators on matters related to climate change 56 . The Resilience Project UK also offers a program for young people, who then become leaders of an 8-week Circle to co-design resilience-building programs for other youth 57 . Project InsideOut is an online hub with interactive tools and resources, allowing individuals who experience climate emotions to undergo an inner transformation before becoming “Guides” for others and leading climate action 58 . Eco-Anxious Stories, Climate Psychology Alliance, Circularity, and The Resource Innovation Group (TRIG) all list eco-anxiety outreach services (e.g., speaker hub, trainings, workshops, resource development) for schools, organizations, and communities 42 , 44 , 59 , 60 .

Only two identified interventions at this level are based in a LMIC setting. In Nigeria, The Eco-Anxiety in Africa Program (TEAP) is managed by Sustyvibes - a non-profit climate activism organization. Reported TEAP activities include the creation of virtual and physical spaces to stimulate dialogs on climate change and mental health (e.g., “Sustyparties” that use poetry and open mic settings to facilitate the sharing climate emotions) 61 . In Cameroon, the Ibanikom Climate Mental Health Literacy Project facilitated meetings for flood-affected communities, allowing participants to learn about the effects of climate change on mental health and co-develop local, small-scale culturally relevant integrated health and agriculture projects 62 .

The impact of climate change on mental health and wellbeing is a pressing global challenge. More information is critically needed to plan for the design, implementation, and scaleup of effective interventions that address the dual and interconnected crises of ecological breakdown and mental health and psychosocial wellbeing burden. The present scoping review represents one of the first comprehensive efforts to fulfill this research priority and identified a total of 40 records which describe 37 unique interventions across academic and gray literature. The interventions acted at the levels of individuals, groups, local media and institutions, and larger social structures, and involved diverse mechanisms of action including psychotherapy, resilience-building programs, nature-based activities, community strengthening networks, and climate activism projects (Fig. 2 ). The mental health and wellbeing targets included depression, anxiety, PTSD, emotional strength and resilience, and various climate emotions, stemming from both direct exposure to climate-related extreme events and awareness of climate change.

Identified interventions and their level of action based on Bronfenbrenner’s ecological theory as applied to public mental health research.

The academic literature search identified interventions implemented primarily in geographical areas at risk of extreme weather events, and the target populations were often residents of the areas. Interestingly, all studies that reported a formal evaluation methodology and intervention effectiveness results ( n  = 7) were conducted in a LMIC setting. Among these studies, 5 incorporated a co-design process, and all demonstrated promising initial results in reducing negative psychiatric symptoms and/or promoting positive mental health and wellbeing outcomes. It is well recognized that the climate crisis deepens pre-existing global inequities 63 ; it is therefore encouraging to see that current research efforts have been attentive to supporting the most disproportionately affected populations. However, several studies with a longitudinal evaluation component commented on reduced interventional effects at follow-up 24 , 25 , 26 . Furthermore, it is common for the LMIC-based interventions to be funded or run by international humanitarian organizations (e.g., Red Cross, HFI) rather than being integrated into the local system, and the potential for the sustainable implementation and scaleup of these interventions remain less certain.

In contrast to the academic literature findings, the gray literature search identified mostly interventions delivered by organizations founded or based in HICs. Few interventions commented on a theoretical framework for the mechanism of intervention. None were formally evaluated or have evaluative data publicly available, and therefore it is not possible to determine whether they are effective in addressing their targeted mental health and wellbeing outcomes or have any unintended impacts. It is further difficult to draw the line between non-profit and for-profit organizations, as various workshops and events depend on out-of-pocket payments from participants. This highlights additional sustainability and accessibility issues for individuals who are intersectionally disenfranchised by financial insecurity and mental health burden and may also limit their potential scalability to low-resource settings.

Overall, it appears that conceptual linkage for interventions at the intersection of climate change and mental health remains at a nascent stage, and most interventions are newly designed with scarce or anecdotal evidence. Most of the existing trials involve microsystem-level interventions (i.e., targeting individual emotions and behaviors) implemented in LMIC settings. Even then, the interventions are limited to a single study or country, and the findings have not been replicated. While there are many mesosystem-level interventions that leverage group dynamics, the overwhelming majority are based in HICs and have not been academically evaluated. There is a shortage of exo- and macrosystem interventions that mobilize local government and media or incorporate socioeconomic reforms and policy changes that may influence downstream mental health and wellbeing outcomes, though there is clear evidence for the potential co-benefits of climate policies for mental health and wellbeing 1 . There is, in general, also a lack of publicly available implementation information (e.g., training procedure of facilitators, implementation cost) for existing interventions, which would be key for scaleup.

Strengths and limitations

A strength of this review lies in its comprehensive conceptualization of mental health. To reflect that mental health is “an intrinsic part of our individual and collective health and wellbeing” 14 , the review included search terms such as “wellbeing”, “resilience” and “post-traumatic growth”. This open approach allowed us to identify interventions beyond the realms of clinical psychology or psychiatry and tap into fields such as international development, urban planning, and environmental public health. The resulting diverse findings suggest that climate mental health interventions are likely to require complex, multidisciplinary input. Another strength of this review is its incorporation of a rigorous gray literature review process, which involved a large panel of international content experts. The process allowed for the capturing of emerging interventions and those not formally evaluated. Moreover, the review sought to, beyond identifying interventions, determine which types of interventions are better supported by evidence, and where there are clear gaps for the evaluation of existing interventions and/or the design of new ones.

A limitation of the review is that the search terms were only in English, which likely influenced the outcome that all included academic literature articles were English-language ones. Potential relevant articles published in other languages describing local interventions may be omitted. Further, most of the identified gray literature interventions are based in HICs. While we purposively consulted content experts from LMICs, it is possible that the search was biased towards HIC-based content given the immediate professional network of the authors and given that HIC-based organizations are likely better resourced to host and publicize their interventions on websites. We recognize that there are likely many other local, grassroot initiatives that have not gained international traction, yet also provide safe, accessible, and community-relevant spaces for discussions and actions around climate change and mental health. Many Indigenous communities have historically and continue to implement cultural practices that care for the wellbeing of people and the non-human world. Additionally, without individually contacting the individual organizations, we cannot comment on whether the website information is accurate and up-to-date, or the scale of the intervention (e.g., how frequently the microsystem-level worksheets are being downloaded, how many individuals have participated in the mesosystem group interventions). Therefore, this review cannot claim to be an exhaustive search of all existing and active mental health and psychosocial interventions, but rather a best effort at describing and mapping out the present interventional space.

Recommendations for future research

Most of the existing evidence supports microsystem-level interventions in LMIC settings. For these interventions, studies using more robust study designs and involving more participants, as well as studies involving their adaptation to other geographical regions, would be helpful to better evaluate their larger-scale effectiveness and scalability. Implementation science would need to be applied to better assess the feasibility, acceptability, cost-effectiveness, and sustainability of the interventions. Ideally, the studies would also include a process evaluation component to better elicit why longitudinal effects may be reduced. This review further identified various mesosystem-level interventions in HIC settings, and there is potential for these interventional models to be studied using robust trial methodologies.

Regarding the development and piloting of new interventions, there is much room to explore exo- and macrosystem interventions in both LMICs and HICs. In our literature search, we identified three studies that may offer important insight. All were secondary analyses of the social impacts of climate interventions, which originally did not have a mental health focus (and hence did not meet our inclusion criteria and were not summarized narratively in our results). In one study based in Zimbabwe, it was found retrospectively that a biogas project contributed to community cohesion and empowerment 64 ; in another study based in China, planned relocation and sheltering was found to be protective against depression, anxiety, and PTSD symptoms among flood victims 65 . In contrast, a study conducted in six LMICs (Brazil, Cameroon, Indonesia, Peru, Tanzania, and Vietnam) concluded that the Reducing Emissions from Deforestation and Degradation (REDD+) initiative may have negatively impacted women’s wellbeing 66 . Suggested reasons for the wellbeing decline included unrealized expectations for REDD+ initiatives and limited advanced consideration of addressing gender inequality in REDD+ policies. The studies demonstrated that while macrosystem interventions aiming to improve social welfare and their larger environment likely offer additional psychological benefits, they may also have unintended consequences if mental health and wellbeing, and its relationship to factors such as participatory approaches and gender equity, is not considered at conception. The REDD+ study further highlighted the importance of involving underserved groups, such as women, in the intervention design, implementation, and decision-making stages, thereby empowering them with leadership roles and incorporating their own definitions and experiences of wellbeing. This point applies generally, and it is vital for the appropriateness and ultimately success of both the content and implementation of interventions that they are co-designed with the people for whom they are being created. Understandings of mental health and wellbeing, and the experiences of climate change vary across geographies and cultures, and it is important to not perpetuate colonial practices by imposing Western definitions and understandings universally 67 , 68 .

It has also been increasingly recognized that being in and feeling connected with nature is beneficial for human health, including mental health 69 , 70 , 71 . However, most of the existing studies are limited to cross-sectional assessments that outline the association between time spent in the natural environment and health benefits. Nature-based programs or eco-therapies, such as animal-assisted interventions, therapeutic horticulture, forest bathing, and social prescriptions that bring participants into nature do offer trial evidence, but many were developed or evaluated among specific populations (e.g., cancer patients, children), and have not yet been directly associated with climate change 72 , 73 , 74 , 75 , 76 . It would be of interest to further explore climate-informed nature engagement (e.g. “reciprocal restoration” or social prescribing interventions) 30 and their mental health and wellbeing outcomes.

Finally, disaster psychiatry offers much knowledge of interventions for individuals and communities surviving potentially traumatic events, and many lessons can be drawn regarding what works, where, and for whom. It is likely that climate change has contributed to the development of many natural hazards (e.g., Hurricane Katrina) which have been the object of study in disaster psychiatry 77 . However, as developed interventions typically have not factored in climate change - an unprecedented ongoing and growing crisis - they would likely need to be adapted to support individuals to cope with not only current but future stressors, and incorporate strategies such as proactive, forecast-based interventions, and disaster preparedness. The interventions would also likely benefit from collaborating across multiple bio-psychosocial fields to work preventatively and to address contextual factors.

Implications for policy and practice

Multiple studies identified in this review did not successfully carry out an evaluative component despite having the intent, primarily due to limited funding and/or resources to recruit a larger sample size. This reflects a need to invest in and better support the evaluation of mental health and psychosocial interventions in the context of climate change, such that resources can be channeled into best evidence-based practices. When these practices are identified, a streamlined process is needed for their integration into the local health and social care systems, particularly in low-resource settings using existing infrastructures such as community groups. Consideration of participation cost is crucial, such that individuals from all socioeconomic backgrounds can be included and benefit.

For the work that is being done informally or in a community-led manner, including the gray literature interventions identified here and emerging ones we are aware of anecdotally, should be convened, collated, and showcased in an accessible manner. For example, an “online hub” of currently available interventions and case studies of best practices could promote shared learning and evidence-based investment, while minimizing the likelihood of duplicated efforts 78 .

Conclusions

There is growing awareness of the detrimental effects of climate change on mental health and psychosocial wellbeing. In response to this evidence-base and lived experiences globally, interventions have been designed to promote mental health and wellbeing as well as to manage the detrimental impacts. This scoping review identified interventions acting at the microsystem, mesosystem, exosystem, and macrosystem levels. While most interventions have not been evaluated, existing studies, primarily on protecting mental health in the context of climate-related disasters in LMICs, show preliminary promising results. More evaluative studies using robust trial designs are needed, especially those involving implementation research. Future interventions are recommended to consider at conception the definition of wellbeing, the interests of underserved groups, co-design, equitable access, and sustainability.

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Acknowledgements

We would like to thank the following individuals who acted as expert consultants in the gray literature search stage: Kenneth Yongabi Anchang (Cameroon), John Aruta (Philippines), Helen Berry (Australia), Mike Campbell (Barbados), Fiona Charlson (Australia), Susan Clayton (USA), Julian Eaton (UK), Mohamed Elshazly (Egypt), Brandon Gray (Switzerland), Natalie Greaves (Barbados), Renzo Guinto (Philippines), Katie Hayes (Canada), Jo Hamilton (UK), Asha Hans (India), Zeinab Hijazi (USA), Juan Segundo Peña Loray (Spain), Raj Mariwala (India), Catriona Mellor (UK), Rebecca Nestor (UK), Sena Salcedo (Philippines), Jennifer Uchendu (Nigeria), and Sacha Wright (UK). We would like to thank Jura Augustinavicius for reviewing and providing comments for the protocol.

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Siqi Xue & M. Ishrat Husain

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E.L. and A.M. conceptualized the study in discussion with S.X. S.X. conducted the literature review. S.A.K. acted as a second reviewer for a portion of the abstracts and full texts. B.W. contributed to the gray literature search, and E.L. and A.M. resolved any conflict decisions. S.X. conducted data analysis and wrote the original draft of the manuscript. All authors contributed to the review and editing of subsequent drafts. S.X. received supervision from E.L. (Imperial College London), A.M. (London School of Hygiene & Tropical Medicine) and M.I.H. (University of Toronto).

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Xue, S., Massazza, A., Akhter-Khan, S.C. et al. Mental health and psychosocial interventions in the context of climate change: a scoping review. npj Mental Health Res 3 , 10 (2024). https://doi.org/10.1038/s44184-024-00054-1

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Empowering education development through AIGC: A systematic literature review

• Published: 29 February 2024

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• Xiaojiao Chen 1 ,
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As an exemplary representative of AIGC products, ChatGPT has ushered in new possibilities for the field of education. Leveraging its robust text generation and comprehension capabilities, it has had a revolutionary impact on pedagogy, learning experiences, personalized education and other aspects. However, to date, there has been no comprehensive review of AIGC technology’s application in education. In light of this gap, this study employs a systematic literature review and selects 134 relevant publications on AIGC’s educational application from 4 databases: EBSCO, EI Compendex, Scopus, and Web of Science. The study aims to explore the macro development status and future trends in AIGC’s educational application. The following findings emerge: 1) In the AIGC’s educational application field, the United States is the most active country. Theoretical research dominates the research types in this domain; 2) Research on AIGC’s educational application is primarily published in journals and academic conferences in the fields of educational technology and medicine; 3) Research topics primarily focus on five themes: AIGC technology performance assessment, AIGC technology instructional application, AIGC technology enhancing learning outcomes, AIGC technology educational application’s Advantages and Disadvantages analysis, and AIGC technology educational application prospects. 4) Through Grounded Theory, the study delves into the core advantages and potential risks of AIGC’s educational application, deconstructing the scenarios and logic of AIGC’s educational application. 5) Based on a review of existing literature, the study provides valuable future agendas from both theoretical and practical application perspectives. Discussing the future research agenda contributes to clarifying key issues related to the integration of AI and education, promoting more intelligent, effective, and sustainable educational methods and tools, which is of great significance for advancing innovation and development in the field of education.

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Review article, implementation of water energy food-health nexus in a climate constrained world: a review for south africa.

• 1 Council for Scientific and Industrial Research (CSIR), Climate Services Research Group, Pretoria, South Africa
• 2 Sustainable and Smart Cities and Regions Research Unit, Department of Urban and Regional Planning, Faculty of Engineering and Built Environment, South Africa School for Climate Studies, University of Johannesburg, Johannesburg, South Africa
• 3 Department of Agricultural Economics, University of Stellenbosch, Stellenbosch, South Africa
• 4 Department of Geography and Environmental Sciences, University of Venda, Thohoyandou, South Africa
• 5 Department of Botany and Zoology, School of Climate Studies, University of Stellenbosch, Stellenbosch, South Africa

In recent years, the Water-Energy-Food (WEF) nexus has gained significant attention in global research. Spatial inequality in water-energy-food security (WEF) and its impact on public health and how this is affected by climate change remains a grand adaptation challenge. South Africa is extremely vulnerable and exposed to the impacts of climate change due to its socio-economic and environmental context. While alternative nexus types have garnered interest, this paper pioneers an extension of the conventional WEF framework to encompass health, giving rise to the Water-Energy-Food-Health (WEF-H) nexus. Despite a plethora of WEF nexus studies focused on South Africa, a substantial knowledge gap persists due to the lack of a comprehensive overview of the enablers and barriers to realizing the WEF-H nexus. South Africa boasts diverse policies related to water, energy, food, and health; however, their alignment remains an ongoing challenge. This study seeks to bridge this critical gap by conducting an exhaustive review of existing literature. Its primary aim is to delve into the intricate mechanisms that either facilitate or impede the actualization of the WEF-H nexus in South Africa. By synthesizing insights from a wide array of literature sources, this research strives to illuminate the challenges and opportunities stemming from the integration of health considerations into the established WEF nexus framework. This exploration holds immense significance, not only for unraveling the multifaceted interactions between these pivotal sectors but also for guiding policy development and decision-making processes in South Africa towards a more holistic and sustainable approach to resource management.

1 Introduction

Despite three decades of democracy, South Africa still struggles with the legacy of apartheid, including extreme inequality across racial and regional lines ( Klug, 2021 ), widening gulfs between the rich and poor ( Naidoo, 2005 ; Sibanda and Batisai, 2021 ) compounded with increased frequency of climate-induced hazards. The 1994 transition to majority rule in South Africa aimed to reduce socio-economic inequality, expand basic services, and embrace human rights principles as the foundation of constitutional solutions ( Klug, 2021 ). Access to water, food, health, and energy services are basic human rights, but the struggle for these rights continues to echo the popular struggles of the apartheid era. The South African government is committed to eliminating poverty and reducing inequality by 2030, as set out in its key national policy documents, e.g., National Development Plan 2030 ( NPC, 2011 ) and National Climate Change Response Policy (NCCRP) ( DEA, 2011 ) as well as the international agenda for Sustainable Development Goals (SDGs) to which the government has subscribed. Despite the government’s valiant efforts, many South Africans continue to face socio-economic challenges and the ramifications of climate change ( Naidoo, 2005 ; Sibanda and Batisai, 2021 ). This reality is particularly pronounced among the country’s black African population.

Like many developing countries, South Africa faces the challenge of balancing economic growth with environmental sustainability, what Simpson coined “reconciling growth with planetary boundaries” ( Simpson and Jewitt, 2019 ). This means developing the economy in a way that is equitable, inclusive, and does not irreversibly damage renewable resources or fail to realize the full potential of non-renewable resources. However, South Africa’s political economy has tended to prioritise an economic approach that transfers problems to a wide range of sectors. For example, mining rights often trump conservation of strategic water resource areas, agriculture lands and even human health considerations. As a result, tensions are growing between the increasing demand for, and use of natural resources (e.g., water, land, and energy) to support development and the availability and quality of those resources.

Coupled with its developmental challenges, the country is also water-stressed, with climate change ( Nhamo et al., 2020 ) further compounding existing socio-economic challenges. Escalating food prices ( Simpson and Jewitt, 2019 ) are leaving a large portion of the population highly food insecure, unable to meet their basic nutritional needs. Even more urgent and complex is the issue of the ailing energy system. Eskom, the national power utility has failed to meet the energy demand resulting in frequent power outages ( Baker and Phillips, 2019 ; International Energy Agency, 2022 ) and increased rationing of the available energy ( Lawrence, 2020 ).

South Africa has many policies related to water, food, and energy, which aim to make these sectors more sustainable. However, many stakeholders are increasingly recognizing the importance of managing the complex interactions between water, energy and food (WEF). The WEF nexus, an approach that considers these three sectors together, has been suggested as a governance solution to complex resource management challenges ( Srigiri and Dombrowsky, 2022 ). This paper examines the implementation of the WEF-H nexus in a country case study, with a focus on the key bottlenecks and enablers. The paper acknowledges that more than a decade after the introduction of the WEF Nexus as a governance ( Keskinen et al., 2016 ), analytical ( Nhamo et al., 2020 ) and ideological tool, the transition from “nexus thinking” to “nexus doing” remains essential to foster appropriate policy development, effective decision-making and practical implementation, in the context of water, energy, food, and health interlinkages.

The paper explores developments in the WEF-H nexus through an extensive literature review, unpacking its complexity and challenges within the South African context, and examining the key ingredients for successful implementation.

2 Understanding the nexus concept

The term “nexus” is central to the WEF-H Nexus, and it refers to a polycentric approach to problem solving ( Srigiri and Dombrowsky, 2022 ). As such, the nexus concept is a useful framework ( Keskinen et al., 2016 ) for action that brings together multiple actors and institutions at different levels of governance to address complex challenges. It is both an analytical tool and a discourse centred on the theory of polycentricity ( Thiel, 2016 ) and polycentric governance ( Ostrom, 2010 ) which means that power and decision-making are distributed across multiple centres.

In simpler terms, a nexus approach is a systems-based way of thinking about complex problems by considering how different sectors are connected and how decisions made in one sector can impact on others. This may be especially useful for identifying the inter-relatedness and interdependencies between sectors when making decisions about projects, strategies, policies and investment options in complex socio-environmental systems ( DeLaurentis and Callaway, 2004 ). It aims to integrate research, management and governance across sectors and scales. The nexus approach assumes that there are biophysical and environmental limits to the degree to which resources can be exploited or pollutants can be absorbed, and that exceeding these limits will have potentially catastrophic impacts, either now or in the future.

Moreover, it is understood that there are complex feedbacks within and between sectors ( Mutanga et al., 2016 ), often resulting in non-linear responses, and tipping points beyond which systems cannot easily recover ( Cabrera et al., 2008 ). The nexus approach allows for a more holistic understanding of (un-)intended consequences of policies, technologies and practices whilst highlighting areas of opportunity for further exploration ( Trist, 1981 ; Mutanga et al., 2016 ). It aims to enhance resource-use efficiency (resource-use getting more from less) and political cohesion by reducing resource trade-offs and increasing synergies. The nexus concept needs to be interdisciplinary and transdisciplinary, accepting a plurality of views ( Geels, 2004 ). It is also participatory, requiring stakeholders to engage with researchers in jointly deriving potential solutions. Given the above dimensions, resource-use remains clear that no single definition can be used to define nexus and its applications, it remains an evolving concept. What is clear though is that it forms the basis within which the WEF nexus is defined and understood.

3 The water-energy-food-health (WEF-H) nexus approach

The Water-Energy-Food-Health (WEF-H) Nexus is a complex concept with no single agreed-upon definition or framework. It is often used to describe the interconnectedness of these four sectors, and how challenges in one sector can have cascading impacts on the others ( Rasul and Sharma, 2016 ). The number of sectors included in the Nexus can vary, depending on the discipline or perspective and can sometimes add additional lenses such as livelihoods, ecosystems, and climate change ( Keskinen et al., 2016 ). For example, those in the water sector may refer to the Nexus as WEF, while those in the energy sector may refer to it as EWF. The agriculture sector may define it as FEW, and the health sector may add the ‘H’ ( Nhamo et al., 2020 ). This lack of common understanding can make it difficult to collaborate and develop effective policies and solutions.

Despite the lack of consensus on a definition, the WEF-H Nexus is a useful concept for understanding the complex challenges facing our world. It can be used as an analytical tool, a conceptual framework, or a discourse ( Keskinen et al., 2016 ). Instead of passively acknowledging the existence of the WEF-H nexus, this paper argues that it is a critical driver of resilience in both our economy and society. Recognizing its interconnectedness demands proactive measures – not just awareness, but concrete policies and actions. By effectively managing this complex system, we can harness its synergies and mitigate challenges, ensuring the WEF-H nexus becomes a potent force for resilience in the face of interconnected water, energy, food, and health concerns.

Nexus studies equip us with the knowledge and tools to tackle complex challenges head-on. By delving into resource efficiency, institutional dynamics, and policy integration, they provide a roadmap for action through methods like integrated models and stakeholder engagement. The WEF-H nexus is not just a concept; it's a powerful framework for shaping a sustainable future.

For example, it enables consideration of ways to:

i. Address energy security without impacting further on food or water resources.

ii. Improve water security without increasing the energy burden of water management.

iii. Create a more circular system by integrating food production with water and energy utilization. Wastewater can be treated and reused for irrigation, renewable energy can power agricultural processes, and food waste can be converted into biofuels or compost.

iv. Encourage sustainable food production practices that prioritize nutrient-rich crops and diversified diets which can contribute to improved public health and reduced malnutrition.

v. Create new green jobs in renewable energy, resource recovery, and precision agriculture, thereby meeting job creation ambitions in a sluggish agricultural economy without overextending water and energy resources.

The four most important interfaces in the water-energy-food-health (WEF-H) nexus are:

• Water which plays a vital role in both food and energy production, and for sustaining the ecosystems that support agriculture and other economic activities that are critical for food security.

• Energy, which is required for food production (especially irrigation) and for water supply, including the extraction, purification, and distribution of water.

• The role of food production as a consumer of land, energy, and water as well as their interlinkage with health.

• Health which is an intrinsic component of the WEF-H nexus, as the wellbeing of individuals is intricately linked to the quality and availability of water, the energy required for sustenance, and the nutritional aspects of food production. Recognition of the interconnections between addressing the challenges and opportunities within this interconnected system.

Agriculture, which is responsible for growing food, is a major user of water (more than 70% of all water use globally) and energy ( Rasul and Sharma, 2016 ). Agriculture and food production also affect the water sector through land degradation, changes in runoff, and disruption of groundwater discharge (Shinde, 2017). Recognizing the intricate connections within the Water-Energy-Food-Health (WEF-H) nexus is paramount. Health, as a crucial facet of this nexus, is intricately linked to the availability and quality of water, the energy required for sustenance, and the nutritional aspects of food production. A holistic understanding of these interdependencies is essential for comprehensive and sustainable management within the WEF-H nexus.

4 Taxonomy of nexus approaches

According to Bian & Liu, (2021) , there are four globally recognized nexus types:

• Water-energy: This nexus focuses on the interconnectedness of water and energy systems. For example, energy production often requires large amounts of water for cooling, while water distribution and treatment require energy ( Wilson et al., 2021 ).

• Water-food: This nexus focuses on the connections between water resources and agriculture. Agriculture, particularly irrigation, is a major consumer of water resources. Consequently, fluctuations in water availability directly impact food production.

• Water-energy-food: This nexus adopts a holistic approach, bringing together the three core elements of water, energy, and food. It underscores the need for integrated planning and management, recognizing the interconnectedness and interdependence of these essential domains.

• Water-energy and climate: In this context, the nexus signifies the interplay between water, energy, and climate factors. It acknowledges the substantial influence of climate change on water resources, energy production, and food security. For instance, altered precipitation patterns can disrupt water availability, and extreme weather events have the potential to damage energy infrastructure and disrupt food supply chains. The discussion aims to clarify that the nexus represents the combination of these sectors, emphasizing the importance of a comprehensive understanding and strategic planning within the broader WEF-H context.

In recent years, additional nexus types have emerged:

• The Water-energy-food-ecosystems (WEFE) nexus: This nexus recognizes the pivotal role of ecosystems in shaping and sustaining the interconnections among water, energy, and food systems. Ecosystems provide indispensable services, including clean water, pollination, climate regulation, and biodiversity, which underpin the functionality of water, energy, and food systems ( De Roo et al., 2021 ). The WEFE nexus highlights the profound interdependence between ecosystems and the essential sectors of water, energy, and food. It emphasises the need for holistic, integrated resource management approaches that recognize the intrinsic value of ecosystems in sustaining human wellbeing and promoting environmental resilience.

• Nuwayhid and Mohtar, 2022 contends that Water-Energy-Food-Health (WEF-H) nexus is a comprehensive framework that explores the intricate relationships between water resources, energy production, food systems, and public health. Unlike the WEFE which advances ecosystems as a critical physical component this nexus advances the health wellbeing. Equally it recognizes that changes in one domain can have significant impacts on the others though with an inherent interlinkage between physical components and human wellbeing. For instance, water is crucial for human survival and agricultural production, while energy is essential for water treatment and food processing. Similarly, food quality and availability directly affect public health. This approach underscores the need for integrated, sustainable strategies in resource management and policymaking, emphasizing that decisions in one sector can have far-reaching consequences for the others. By embracing the WEF-H nexus, stakeholders can better address complex challenges related to resource scarcity, environmental sustainability, and community wellbeing through collaborative and innovative solutions refer to ( Figure 1 ).

• Another nexus type, the water-energy-food-biodiversity-health (WEFBH) nexus, encompasses the complex interdependencies between water utilization, energy generation, food supply chains, and environmental and public health ( Hirwa et al., 2021 ).

Figure 1 . WEF-H nexus adaptation framework.

The interrelationships between the nexuses are illustrated in Figure 1 . Essentially the framework for WEF-H Nexus not only captures the traditional WEF but encapsulates the health dimension as an equal sectoral lens to the nexus thus providing a holistic dimension. Policy framing is broadened to include issues around “healthy water,” “sustainable energy for health,” and “nutritious food for wellbeing.” Health metrics can be tracked alongside traditional WEF indicators to monitor the Nexus’s impact on health and identify areas needing improvement. Moreover, the nexus adaptation framework recognizes that the nexus is influenced by several exogenous factors including the impact of climate change, the policy sphere, institutional mechanisms as well as the financial mechanisms all of which have an inherent effect on each of the sectors identified in this nexus.

Building on the foundation of previous nexus typologies that excluded health, the Water-Energy-Food-Health (WEF-H) nexus is a powerful tool at the socio-political level. It can alleviate tensions caused by poor coordination among non-state actors and inadequate service provision by the state. The WEF-H nexus also presents a unique opportunity to shift the focus from governance challenges to community empowerment, fostering self-reliance and sustainability. This empowerment includes showcasing alternative livelihood possibilities.

Furthermore, the WEF-H nexus has the potential to bridge the gap created by inequitable partnerships, whether rooted in gender, wealth disparities, racial divides, educational levels, or social statuses which have become pervasive in South African society. The nexus approach can contribute to what we term “societal hope,” instilling a profound belief within communities that they can chart a course away from hopelessness, even in the face of governance inefficiencies and limited access to opportunities. The principles thereof illustrated in Figure 1 include environmental stewardship which advocates for investment in sustaining ecosystems services, social equity, resource use efficiency as well as the integrative perspective. These principles provide a foundation for merging effective pathways for successful implementation of NEXUS.

The adaptability of the Water-Energy-Food-Health (WEF-H) nexus, in contrast to other aspects of the economy, lies in its capacity to cater to communities with varying levels of knowledge and information. Unlike traditional economic frameworks, the WEF-H nexus is inherently versatile, offering a more inclusive approach that accommodates diverse communities. This adaptability stems from its comprehensive consideration of interconnected elements, allowing for nuanced solutions that address the complex and dynamic challenges present in the realms of water, energy, food, and health. By embracing a holistic perspective and fostering collaboration among stakeholders, including academics, civil society organizations, the private sector, government bodies, and international partners, the WEF-H nexus creates a platform that encourages innovation and technological advancements across multiple sectors and scales.

The WEF-H nexus holds the most promise for regions facing significant development gaps or struggling with complex socio-economic issues. It offers a powerful, unified approach to tackling these challenges and unlocking new opportunities. We characterize the opportunity presented by the WEF-H nexus as “extraordinary” due to its unique capacity to simultaneously address multiple facets of development challenges. The extraordinary nature lies in the nexus’s holistic approach, integrating water, energy, food, and health considerations. This all-encompassing strategy allows for comprehensive and interconnected solutions, offering a more effective and sustainable response to the complex socio-economic challenges and developmental hurdles that regions may face. The extraordinary nature of this opportunity is underscored by the potential for transformative and inclusive development outcomes, some of which are illustrated on Figure 1 as sustainable adaptation outcomes.

5 Key characteristics of the water-energy-food-health (WEF-H) nexus approach

The WEF-H nexus approach is inherently accessible and requires no demystification. It is conceptually straightforward and designed to be inclusive, catering to individuals of all backgrounds and levels of expertise. Recognizing that, for the general public, concepts such as the WEF nexus and the WEF-H nexus may benefit from some explanation, we emphasize the fundamental nature of this approach. It relates to some of the most essential human needs: water, energy, food, and health. In this paper, we have identified ten salient characteristics that are recognized by many scholars and in the literature on the WEF-H nexus, aiming to enhance clarity and promote a more inclusive understanding:

a. Multi-sectoral focus : The WEF-H approach unites a diverse range of stakeholders around a common set of goals, providing a platform for intentional and focused interaction. This cross-sectional coordination promotes convergence of perspectives and facilitates collaborative solutions.

b. Interconnectedness : WEF-H nexus broadens the understanding of interlinkages ( Simpson and Jewitt, 2019 ) recognizing the interdependencies ( Leck et al., 2015 ) between sectors i.e., water, food, and energy.

c. Social embeddedness. Beyond the physical/environmental connections of the nexus approach is the ability to recognize the social interactions among actors which may be referred to as social embeddedness interactions ( Srigiri and Dombrowsky, 2022 ). WEF thus considers the political and cognitive factors that are central to policy change within sectors ( Weitz et al., 2017 ).

d. Complexity : The multifaceted nature and interactions between and within different subsystems ( Mutanga et al., 2016 ) create complex dimensions that must be addressed. As a result, there is no one-size-fits-all model to deal with WEF-related issues ( Simpson and Jewitt, 2019 ). Instead, time-bound and place-bound solutions are encouraged.

e. Governance modes : Scholars studying the WEF nexus agree that integrative coordination across sectors, actors and levels of governance is essential, given the interconnected nature of the nexus ( Welsch et al., 2015 ). It is important to note that the WEF-H nexus approach does not seek to replace focus and attention on actions (planning, investments, implementation, etc.) related to related to water, energy, food and health. Rather, it aims to break down the siloed approach to managing these resources and promote coherent and balanced planning and implementation.

f. Holistic Approach : WEF-H nexus is a holistic approach that is consistent with well-established analytical frameworks such as Institutional analysis and development (IAD) framework ( Ostrom, 2010 ) value chain analysis ( Villamayor-Tomas et al., 2015 ), network of adjacent action situations (NAAS) ( Srigiri and Dombrowsky, 2022 ), multi-criteria decision-making models (MCDM) ( Kumar et al., 2017 ), Integrative Model ( Nhamo et al., 2020 ), as well as systems dynamics models ( Wen et al., 2022 ). All these tools share a common structure for solving complex decision and planning problems, but their application and impact vary across sectors.

g. Implementation : WEF-H nexus implementation is not an event, rather, it is a process that requires access to information about on-going plans and activities to ensure building-on and complementing those activities.

6 Barriers/bottlenecks for implementing nexus

The WEF-H is anchored in prioritizing the management of the four interconnected resources (water, energy, food, and health) in a sustainable way. However, implementing this nexus comes with different barriers and bottlenecks that hinder progress (detailed below and in Table 1 ).

Table 1 . Identified bottlenecks drawn from literature and recommendations for implementing WEF-H Nexus.

South Africa currently lacks a singular policy document that explicitly addresses the Water-Energy-Food-Health (WEF-H) nexus. This does not necessarily imply a lack of commitment but reflects the intricate task of navigating trade-offs and resource constraints. This, position reflects the broader global context where numerous nations are yet to formulate comprehensive policies on the WEF-H nexus. In many instances, the implementation of WEF-H activities remains imbalanced, with sectors such as water, energy, food, and health often managed in a sectoral or “silo” approach ( Nhamo et al., 2018 ). Despite the acknowledgment of the WEF-H nexus approach, these sectors frequently treat resources independently, guided by institutional structures ( Adom et al., 2022 ). The reluctance to enforce integrative policies is a complex challenge influenced by trade-offs embedded across sectors, particularly in resource-limited countries. South Africa, being a water-scarce nation, has ambitious plans to transition from coal-based to renewable energy, including hydropower ( Pegels, 2010 ; Ololade et al., 2017 ). This puts pressure on the water sector which has to prioritise maintaining the supply of its limited water resource to water provision, energy generation and agricultural production (the latter has a very high-water consumption factor of 62% due to irrigation ( Adom et al., 2022 ).

The reluctance to enforce integrative policies, driven by trade-offs across sectors in resource-limited countries like South Africa, poses significant challenges. As a water-scarce nation with ambitious plans for transitioning to renewable energy, the pressure on the water sector is pronounced ( Rasul and Sharma, 2016 ).

Global climate change, and climate variability exacerbates the challenges of WEF-nexus in South Africa. Increasing aridity has a direct knock-on effect on food security ( Schreiner and Baleta, 2015 ; Mabhaudhi et al., 2016 ), leading to hunger and a decline in the supply of nutritious food ( Wlokas, 2008 ). Extreme weather events such as floods and heat waves also cause health issues such as food and waterborne diseases and heat stroke ( Mabhaudhi et al., 2019 ) and exacerbates land degradation, especially of agricultural lands ( Wlokas, 2008 ).

Water and land are key natural resources that are already under pressure from competing interests. Climate change exacerbates these challenges, as it increases the demand for resources. In regions where land and water are limited, an upsurge in multi-service projects aiming to tackle food insecurity and promote clean energy could exacerbate competition for these vital resources.

The lack of dedicated funding to provide integrated solutions is another reason why the sectoral approach persists, as the implementation of the nexus requires significant investment. The current funding landscape in South Africa prioritizes individual WEF sectors, with cross-sectoral funding streams being scarce ( Mabhaudhi et al., 2018 ). This siloed approach creates several challenges among which includes:

• Competing priorities: Crises like the COVID-19 pandemic necessitate diverting limited resources to immediate needs like health and hunger alleviation ( Wlokas, 2008 ; Mabhaudhi et al., 2019 ). This can exacerbate other critical issues like energy insecurity and poverty, further hindering progress on the WEF-H nexus.

• Limited impact: Sector-specific funding often fails to account for the interconnected nature of the WEF-H nexus, hindering the development of holistic solutions that address multiple challenges simultaneously.

The implementation of the WEF-H nexus requires innovative technologies and robust data, yet South Africa faces significant limitations:

• Data scarcity and comparability: Data availability is limited, and existing data often suffers from inconsistencies in spatial scales and temporal trends, hindering effective analysis and planning.

• Technological lag: Access to and expertise in innovative technologies like smart agriculture and early warning systems is limited, impeding the development of solutions to address challenges like climate change and disease outbreaks.

• Amid unpredictable extreme weather events and the prevalence of diseases, there is also a lack of innovative technologies tailored to alleviate the resultant impacts imposed by these events. Even though they come at a hefty cost, technologies such as smart agriculture (to alleviate a 15% decline in agricultural yields by 2050 if global warming increased by 2°C ( Mabhaudhi et al., 2019 )), early warming or detection systems and cutting edge health facilities are a necessity for an integrated response. Another bottleneck in this is that these innovative and sophisticated technologies require, trained personnel to operate them, which is still a scarce skill in the country.

Lack of functional, effective, efficient, and equitable partnerships or collaborations to drive implementation is another barrier. The implementation of the WEF-H nexus requires partnerships as individual experts rarely have expertise across all its dimensions. All this comes with effective communication across all relevant stakeholders including communities, technicians and government officials to promote dialogue among partners towards balancing the decision-making process. At the moment there is ambiguity regarding the roles of communities and relevant stakeholders in the implementation of the nexus framework (D. Naidoo et al., 2021 ). Some of the stakeholders are also in need of capacity development and awareness which hinders collaboration and results in a lack of stakeholder involvement in the nexus framework ( Adom et al., 2022 ). For instance, about 73% of the participants in an interview study agreed that there are major gaps within stakeholder engagement in the nexus ( Adom et al., 2022 ).

The WEF-H nexus faces the challenge of navigating complex political and socio-cultural landscapes, where historical biases towards isolated sectors hinder balanced implementation. Achieving consensus across spheres and sectors requires addressing these challenges and fostering equitable development.

By design, the implementation of the WEF-H programme ideally requires a long period of time. It is possible that while implementing the WEF-H programme, the breadth and coverage of activities of WEF-H approach lend themselves to unintended delays that derail achievement of outcomes and impact. Pressured by the short terms in government, politicians and decision-makers may face pressure to show immediate results to meet political or economic agendas. This can lead to biased prioritization of short-term goals at the expense of the more comprehensive long-term goals of the nexus. Developing and revising policies to effectively enforce the WEF-H nexus demands meticulous consideration of numerous factors, inherently leading to a time-intensive process.

Getting the private sector to actively contribute to the implementation of the WEF-H nexus is another bottleneck. The focus of the private sector is profit. ‘What is in it for us’ has been the dominant and acceptable main focus of the private sector. The private sector is risk averse. Waiting for, encouraging, or coercing the government to absorb the inherent transactional risks has been one of the approaches that the private has used to minimize their exposure and ensure their profitability and sustainability. Despite these basic attributes of the private sector, it is evident that most sections of the private sector are looking for opportunities where they can make a positive societal impact. The WEF-H nexus provides such an opportunity. This leaves us with the question: Why has the private sector not seized the opportunities to implement the WEF-H nexus, especially in communities wherein they operate? Is it likely that there are actions inherent in the implementation of the WEF-H nexus that are laden with risks that the private sector is not willing to absorb?

7 Enablers for implementing the WEF-H nexus

Several ingredients for transitioning from “nexus thinking” to “nexus doing” are required for a successful implementation of the WEF-H nexus. This approach holds immense potential to provide lucrative opportunities for South Africa. This paper adapts the scaling framework and classify the nexus under a three-pronged scaling principles system consisting of (i) scaling up, (ii) scaling deep, and (iii) scaling out as illustrated in Figure 2 . Scaling up focusses on enabling factors that are policy and institutionally oriented, while scaling deep focus on culture and beliefs and scaling out centers on factors impacting greater numbers, the replication and dissemination of information on the WEF-H nexus. This results in an increased number of people or communities impacted. Lastly, scaling deep looks at enabling factors impacting on the cultural roots including aspects such as changing relationships, culture, and beliefs.

Figure 2 . Nexus enabling principles.

For this procedural and transformative transition to happen, several enabling factors have been identified in the literature which foster the adoption and implementation of the WEF-H nexus. The first factor identified is the investment in Capacity Development. To unlock the full potential of the WEF-H nexus, robust capacity development initiatives are required across stakeholders, encompassing government agencies, researchers, and local communities ( Chibarabada et al., 2022 ). These initiatives should encompass comprehensive training programs and knowledge-sharing platforms aimed at enhancing the understanding of nexus interlinkages. By equipping stakeholders with the necessary skills and insights, we empower them to make informed decisions that align with the holistic goals of the WEF-H nexus, thus catalyzing its effectiveness ( Ramos et al., 2022 ). Local communities can also benefit from educational programs on sustainable water and energy practices, alongside leadership development workshops to empower them to participate in decision-making processes.

Secondly, mobilization of finance is also an imperative factor when it comes to the WEF-H nexus implementation. Securing finances is pivotal to translating the WEF-H nexus from theory into impactful practice, regardless of the chosen institutional approach ( Hejnowicz et al., 2022 ). Southern Africa has witnessed a surge in research projects and publications concerning the nexus since 2013 ( Naidoo et al., 2021 ). For instance, the Southern African Development Community-European Union (SADC-EU) nexus dialogue-funded project has been instrumental in driving the WEF nexus from abstract research to tangible action across southern Africa. This initiative has led to the organization of numerous workshops, symposia, and science-policy dialogues within the region. Such financial commitments not only facilitate research and data generation but also provide the necessary resources for practical interventions and policy implementations that promote the sustainable integration of water, energy, food, and health systems.

Decision Support Systems and Frameworks are also a necessary ingredient. The development of robust decision support systems and frameworks is paramount in navigating the complex terrain of the WEF-H nexus ( Nhamo et al., 2020 ). These technological tools serve as indispensable guides for systematic analysis of intricate nexus linkages, enabling policymakers to scrutinize diverse scenarios and their potential ramifications on water, energy, food, and health systems. Decision support systems are the linchpin of informed and effective decision-making within the multifaceted landscape of the WEF-H nexus, fostering data-driven, evidence-based solutions that optimize resource allocation, minimize vulnerabilities, and bolster resilience across these interconnected sectors.

Innovative Policy Frameworks have also been identified as one of the enabling factors ( Naidoo et al., 2021 ). The dynamic nature of the WEF-H nexus necessitates adaptive and forward-thinking policy frameworks capable of accommodating its complexity. These policies should transcend sectoral boundaries, encouraging seamless integration and collaboration while emphasizing sustainability and resilience. The shared resources within the SADC region highlight the importance of harmonizing existing policies and linking them, as illustrated by the Revised Regional Indicative Strategic Development Plan. Such initiatives promote holistic resource management, acknowledge the interdependence of different sectors, and pave the way for comprehensive, cross-cutting policies that effectively address the WEF-H nexus’s challenges.

Regional Cooperation is also an important enabling factor that has been identified within the literature ( Decoppet et al., 2023 ) . Recognizing that environmental and resource challenges often transcend national borders, robust regional cooperation is essential. Collaborative efforts between South Africa and neighboring countries can effectively address shared WEF-H nexus issues, enhancing stability and mutual benefits while ensuring harmonized resource management. Given the overarching nature of environmental and resource challenges, regional cooperation may serve as a fundamental pillar in addressing the complexities of the WEF-H nexus. The SADC regional integration framework (Saurombe, 2010) could transcend beyond trade to include developmental trajectories that have a bearing on WEF-H nexus. South Africa’s geographical proximity to neighboring countries accentuates the necessity for collaborative endeavors. By forging strategic partnerships and alliances with neighboring nations, South Africa and other member states can collectively tackle shared WEF-H nexus challenges that transcend political borders. Such collaborative efforts foster stability, mutual benefit, and regional cohesion. Whether it is addressing transboundary water management, cross-border energy initiatives, harmonizing agricultural practices, or jointly responding to health crises, regional cooperation can yield synergistic solutions that are more effective and sustainable than isolated efforts within national boundaries. Additionally, regional cooperation can lead to enhanced resilience in the face of resource-related uncertainties and bolster collective capacity for responding to emerging WEF-H nexus issues.

Political will is another important enabling factor that fosters the adoption and implementation of the WEF-H nexus. A bedrock of strong political will is fundamental to prioritize the WEF-H nexus and commit to sustainable resource management and public health. Such commitment provides the foundation for integrated policies and action plans that genuinely address the nexus’s intricate challenges. A robust and unwavering political will stands as the cornerstone of meaningful progress within the WEF-H nexus. National leaders hold the key to prioritizing this integrated approach, committing to sustainable resource management, and safeguarding public health. Their dedication paves the way for the development and implementation of comprehensive policies and action plans that genuinely confront the intricate challenges posed by the nexus. It sends a resounding message that these issues are of paramount importance, transcending political cycles and short-term interests, and underscoring a commitment to the long-term wellbeing of both the environment and the populace.

Another necessary ingredient noted in the literature is the clear demarcation of WEF-H operational boundaries: Defining distinct operational boundaries for WEF-H initiatives is crucial as it ensures that roles, responsibilities, and accountabilities are well-understood, preventing overlaps or gaps in resource management, and fostering efficient and effective governance. This not only prevents wasteful overlaps and dangerous gaps in resource management but also fosters efficient and effective governance. By delineating the boundaries of action and influence, stakeholders can coordinate their efforts more effectively, resulting in streamlined operations and more impactful outcomes.

360-Degree stakeholder engagement that leaves no one behind is also another important enabling factor. This underscores the principle of inclusivity’s paramount importance is recognized. Engaging all stakeholders, including marginalized communities, is essential for equitable resource allocation and access ( Bruns et al., 2022 ; Hejnowicz et al., 2022 ). Such comprehensive engagement ensures that diverse perspectives and needs are considered. Engaging all stakeholders, without exception, is not only a moral imperative but also a strategic necessity. This comprehensive involvement ensures that the benefits and burdens of resource management are equitably distributed. Marginalized communities, often disproportionately affected by environmental and health challenges, must have their voices heard and their needs addressed. Inclusivity makes the WEF-H nexus genuinely holistic, drawing on a wealth of perspectives and insights to inform more equitable and effective policies and actions. To operationalize this approach, we propose several pathways for engaging all relevant stakeholders in the WEF-H nexus. Firstly, the establishment of inclusive platforms, such as community forums and online portals, can facilitate ongoing communication and collaboration. Secondly, targeted outreach and awareness campaigns can ensure that marginalized communities are actively involved. Thirdly, leveraging technology, such as mobile applications and social media, can enhance accessibility and engagement. Additionally, incorporating participatory approaches, like co-design sessions and citizen science initiatives, fosters a sense of ownership among stakeholders.

Unlocking the full potential of the WEF-H Nexus, demands breaking down siloed governance. Effective collaboration among government departments, private sector entities, civil society organizations, and academia creates a fertile ground for innovation which enables the sharing of knowledge, identify synergies, and address challenges holistically ( Lazaro et al., 2022 ). Imagine a fertile ecosystem where engineers, farmers, policymakers, and community leaders, all contribute to cross-pollination of ideas. This is the power of a multidisciplinary approach to the WEF-H nexus, where collaboration sparks innovation and ensures no facet is overlooked. From policy blueprints to grassroots implementation, every strand contributes to a more comprehensive and impactful solution, ultimately leading to more sustainable and equitable outcomes for food, water, energy, and health.

Establishment of open access databases and encouraging data sharing can also positively impact on the adoption and the implementation of the WEF-H nexus. Data transparency and sharing are cornerstones of the WEF-H nexus approach. Open access databases facilitate the exchange of information, supporting evidence-based decision-making and research that can drive sustainable resource management and public health improvements ( Mabhaudhi et al., 2021 ). Open access databases facilitate the seamless exchange of information among stakeholders, underpinning evidence-based decision-making, and research. With access to comprehensive and up-to-date data, policymakers and researchers can identify trends, track progress, and make informed choices that drive sustainable resource management and improvements in public health.

Innovative Technology is another enabling factor positively impacting on the adoption and implementation of the WEF-H nexus. Examples of these cutting-edge technologies include, but are not limited to, precision agriculture techniques that optimize water use, the integration of renewable energy sources to power nexus-related activities, and advanced health monitoring systems. Embracing cutting-edge technology within the WEF-H nexus enhances monitoring, data collection, and resource management. This includes the adoption of technologies that promote efficient water use, harness renewable energy sources, advance sustainable agriculture practices, and facilitate health monitoring, thereby driving innovation and progress across the nexus. Embracing cutting-edge technology is a catalyst for progress across the WEF-H nexus. By harnessing innovative solutions, stakeholders can drive meaningful change. Technology enhances monitoring, data collection, and resource management, leading to more efficient and sustainable practices that benefit both the environment and public health. It also fosters a culture of innovation, inspiring continuous progress within the nexus.

8 Conclusion

The exploration of water-energy-food-health (WEF-H) remains key in broadening our understanding of the nexus complexity. This article contributes to the body of knowledge which reveals a paradigm-shifting approach to addressing the intricate interdependencies among these critical sectors. Integration of the health dimension goes beyond conventional WEF frameworks, as it introduces a comprehensive understanding of human wellbeing and resilience. The study contribute to the ongoing discourse surrounding the WEF nexus demonstrating the advantages of linking the health sector. By synthesizing insights from various disciplines, our work advances the understanding of how health interplays with water, energy, and food dynamics. This contribution positions the WEF-H nexus as an innovative solution to complex global challenges. To realize its full potential, there is a need for dedicated champions who can not only navigate the enablers and barriers outlined in this study but also translate concepts into actionable plans and sustainable programs. The success of the WEF-H nexus requires collaborative efforts from governments, stakeholders, and communities, providing a unique and impactful framework for addressing the multifaceted challenges at the intersection of water, energy, food, and health. South Africa, like many nations, aspires to build capable governance, but the complexity of the WEF-H nexus approach may strain government resources. The nexus approach acknowledges the existence of various policies, plans, systems, and programs, but also recognizes that their impact can be amplified when integrated into a cohesive implementation framework from the outset. This should not discourage governments to invest resources in the nexus approach but highlights the inherent challenges in aligning governance structures with its holistic nature.

While the Water-Energy-Food-Health (WEF-H) nexus presents a promising solution to urgent global challenges, its successful implementation necessitates meticulous planning, dedicated champions, and strategic governance. Recognizing the need for a nuanced approach, our paper emphasizes the imperative of capacity development, cross-sectoral collaboration, and the formulation of integrated governance frameworks. These elements are not merely suggested but they could be integral components that address the complexities involved. By strategically integrating these aspects into the implementation process, we ensure that the WEF-H nexus may be closer to reaching its full potential without imposing undue burdens on existing systems. Throughout the paper, we have enhanced the discussion, providing earlier argumentation to articulate the critical role of capacity development and integrated governance, thereby reinforcing the foundation for our proposed strategies.

In conclusion the WEF-H nexus presents an extraordinary opportunity to break the mold of traditional development paradigms. Its unprecedented focus on interconnectedness allows us to address multifaceted challenges from water scarcity, energy and food security to health disparities in a truly comprehensive manner. This holistic approach promises not just incremental progress, but a paradigm shift towards sustainable and equitable development.

Author contributions

SSM: Conceptualization, Writing–original draft, Writing–review and editing, Funding acquisition, Investigation, Project administration. BKM: Writing–review and editing, Funding acquisition, Project administration, Supervision. SM: Writing–review and editing. MSM: Writing–review and editing. FVS: Writing–review and editing. TL: Writing–review and editing. SN: Writing–review and editing. TT: Writing–review and editing. JJ: Writing–review and editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The author(s) acknowledge that the financial support for the research, authorship and publication of this article was received from the Department of Science and Innovation (DSI) through a CSIR Parliamentary Grant (P1EGC02).

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

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Keywords: WEF-H nexus, South Africa, enablers, barriers, policy alignment, sustainability

Citation: Mutanga SS, Mantlana BK, Mudavanhu S, Muthige MS, Skhosana FV, Lumsden T, Naidoo S, Thambiran T and John J (2024) Implementation of water energy food-health nexus in a climate constrained world: a review for South Africa. Front. Environ. Sci. 12:1307972. doi: 10.3389/fenvs.2024.1307972

Received: 06 October 2023; Accepted: 14 March 2024; Published: 25 March 2024.

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Copyright © 2024 Mutanga, Mantlana, Mudavanhu, Muthige, Skhosana, Lumsden, Naidoo, Thambiran and John. 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: Shingirirai S. Mutanga, [email protected]