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

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

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 
• How to write a good literature review 
• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• Frequently asked questions 

What is a literature review?

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

What is the purpose of literature review?

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

• Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 
• Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 
• Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 
• Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 
• Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 
• Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

How to write a good literature review

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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Writing a Literature Review

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

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

For each publication, ask yourself:

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

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

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

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

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

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

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

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

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How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts. 

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

• Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
• Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
• Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly. 

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences. 

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

• Abstract - Brief summary of the contents of the article
• Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
• Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
• Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
• Results - What was found in the course of the study
• Discussion - What do the results mean
• Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

• Next: What Is the Literature >>
• Last Updated: Jan 11, 2024 9:48 AM
• URL: https://libguides.wesleyan.edu/litreview

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• CAREER FEATURE
• 04 December 2020
• Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

You can also search for this author in PubMed   Google Scholar

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

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

Interviews have been edited for length and clarity.

Updates & Corrections

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

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

Article   Google Scholar  

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

Article   PubMed   Google Scholar  

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

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

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Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

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

How To Write An A-Grade Literature Review

3 straightforward steps (with examples) + free template.

By: Derek Jansen (MBA) | Expert Reviewed By: Dr. Eunice Rautenbach | October 2019

Quality research is about building onto the existing work of others , “standing on the shoulders of giants”, as Newton put it. The literature review chapter of your dissertation, thesis or research project is where you synthesise this prior work and lay the theoretical foundation for your own research.

Long story short, this chapter is a pretty big deal, which is why you want to make sure you get it right . In this post, I’ll show you exactly how to write a literature review in three straightforward steps, so you can conquer this vital chapter (the smart way).

Overview: The Literature Review Process

• Understanding the “ why “
• Finding the relevant literature
• Cataloguing and synthesising the information
• Outlining & writing up your literature review
• Example of a literature review

But first, the “why”…

Before we unpack how to write the literature review chapter, we’ve got to look at the why . To put it bluntly, if you don’t understand the function and purpose of the literature review process, there’s no way you can pull it off well. So, what exactly is the purpose of the literature review?

Well, there are (at least) four core functions:

• For you to gain an understanding (and demonstrate this understanding) of where the research is at currently, what the key arguments and disagreements are.
• For you to identify the gap(s) in the literature and then use this as justification for your own research topic.
• To help you build a conceptual framework for empirical testing (if applicable to your research topic).
• To inform your methodological choices and help you source tried and tested questionnaires (for interviews ) and measurement instruments (for surveys ).

Most students understand the first point but don’t give any thought to the rest. To get the most from the literature review process, you must keep all four points front of mind as you review the literature (more on this shortly), or you’ll land up with a wonky foundation.

Okay – with the why out the way, let’s move on to the how . As mentioned above, writing your literature review is a process, which I’ll break down into three steps:

• Finding the most suitable literature
• Understanding , distilling and organising the literature
• Planning and writing up your literature review chapter

Importantly, you must complete steps one and two before you start writing up your chapter. I know it’s very tempting, but don’t try to kill two birds with one stone and write as you read. You’ll invariably end up wasting huge amounts of time re-writing and re-shaping, or you’ll just land up with a disjointed, hard-to-digest mess . Instead, you need to read first and distil the information, then plan and execute the writing.

Step 1: Find the relevant literature

Naturally, the first step in the literature review journey is to hunt down the existing research that’s relevant to your topic. While you probably already have a decent base of this from your research proposal , you need to expand on this substantially in the dissertation or thesis itself.

Essentially, you need to be looking for any existing literature that potentially helps you answer your research question (or develop it, if that’s not yet pinned down). There are numerous ways to find relevant literature, but I’ll cover my top four tactics here. I’d suggest combining all four methods to ensure that nothing slips past you:

Method 1 – Google Scholar Scrubbing

Google’s academic search engine, Google Scholar , is a great starting point as it provides a good high-level view of the relevant journal articles for whatever keyword you throw at it. Most valuably, it tells you how many times each article has been cited, which gives you an idea of how credible (or at least, popular) it is. Some articles will be free to access, while others will require an account, which brings us to the next method.

Method 2 – University Database Scrounging

Generally, universities provide students with access to an online library, which provides access to many (but not all) of the major journals.

So, if you find an article using Google Scholar that requires paid access (which is quite likely), search for that article in your university’s database – if it’s listed there, you’ll have access. Note that, generally, the search engine capabilities of these databases are poor, so make sure you search for the exact article name, or you might not find it.

Method 3 – Journal Article Snowballing

At the end of every academic journal article, you’ll find a list of references. As with any academic writing, these references are the building blocks of the article, so if the article is relevant to your topic, there’s a good chance a portion of the referenced works will be too. Do a quick scan of the titles and see what seems relevant, then search for the relevant ones in your university’s database.

Method 4 – Dissertation Scavenging

Similar to Method 3 above, you can leverage other students’ dissertations. All you have to do is skim through literature review chapters of existing dissertations related to your topic and you’ll find a gold mine of potential literature. Usually, your university will provide you with access to previous students’ dissertations, but you can also find a much larger selection in the following databases:

• Open Access Theses & Dissertations
• Stanford SearchWorks

Keep in mind that dissertations and theses are not as academically sound as published, peer-reviewed journal articles (because they’re written by students, not professionals), so be sure to check the credibility of any sources you find using this method. You can do this by assessing the citation count of any given article in Google Scholar. If you need help with assessing the credibility of any article, or with finding relevant research in general, you can chat with one of our Research Specialists .

Alright – with a good base of literature firmly under your belt, it’s time to move onto the next step.

Need a helping hand?

Step 2: Log, catalogue and synthesise

Once you’ve built a little treasure trove of articles, it’s time to get reading and start digesting the information – what does it all mean?

While I present steps one and two (hunting and digesting) as sequential, in reality, it’s more of a back-and-forth tango – you’ll read a little , then have an idea, spot a new citation, or a new potential variable, and then go back to searching for articles. This is perfectly natural – through the reading process, your thoughts will develop , new avenues might crop up, and directional adjustments might arise. This is, after all, one of the main purposes of the literature review process (i.e. to familiarise yourself with the current state of research in your field).

As you’re working through your treasure chest, it’s essential that you simultaneously start organising the information. There are three aspects to this:

• Logging reference information
• Building an organised catalogue
• Distilling and synthesising the information

I’ll discuss each of these below:

2.1 – Log the reference information

As you read each article, you should add it to your reference management software. I usually recommend Mendeley for this purpose (see the Mendeley 101 video below), but you can use whichever software you’re comfortable with. Most importantly, make sure you load EVERY article you read into your reference manager, even if it doesn’t seem very relevant at the time.

2.2 – Build an organised catalogue

In the beginning, you might feel confident that you can remember who said what, where, and what their main arguments were. Trust me, you won’t. If you do a thorough review of the relevant literature (as you must!), you’re going to read many, many articles, and it’s simply impossible to remember who said what, when, and in what context . Also, without the bird’s eye view that a catalogue provides, you’ll miss connections between various articles, and have no view of how the research developed over time. Simply put, it’s essential to build your own catalogue of the literature.

I would suggest using Excel to build your catalogue, as it allows you to run filters, colour code and sort – all very useful when your list grows large (which it will). How you lay your spreadsheet out is up to you, but I’d suggest you have the following columns (at minimum):

• Author, date, title – Start with three columns containing this core information. This will make it easy for you to search for titles with certain words, order research by date, or group by author.
• Categories or keywords – You can either create multiple columns, one for each category/theme and then tick the relevant categories, or you can have one column with keywords.
• Key arguments/points – Use this column to succinctly convey the essence of the article, the key arguments and implications thereof for your research.
• Context – Note the socioeconomic context in which the research was undertaken. For example, US-based, respondents aged 25-35, lower- income, etc. This will be useful for making an argument about gaps in the research.
• Methodology – Note which methodology was used and why. Also, note any issues you feel arise due to the methodology. Again, you can use this to make an argument about gaps in the research.
• Quotations – Note down any quoteworthy lines you feel might be useful later.
• Notes – Make notes about anything not already covered. For example, linkages to or disagreements with other theories, questions raised but unanswered, shortcomings or limitations, and so forth.

If you’d like, you can try out our free catalog template here (see screenshot below).

2.3 – Digest and synthesise

Most importantly, as you work through the literature and build your catalogue, you need to synthesise all the information in your own mind – how does it all fit together? Look for links between the various articles and try to develop a bigger picture view of the state of the research. Some important questions to ask yourself are:

• What answers does the existing research provide to my own research questions ?
• Which points do the researchers agree (and disagree) on?
• How has the research developed over time?
• Where do the gaps in the current research lie?

To help you develop a big-picture view and synthesise all the information, you might find mind mapping software such as Freemind useful. Alternatively, if you’re a fan of physical note-taking, investing in a large whiteboard might work for you.

Step 3: Outline and write it up!

Once you’re satisfied that you have digested and distilled all the relevant literature in your mind, it’s time to put pen to paper (or rather, fingers to keyboard). There are two steps here – outlining and writing:

3.1 – Draw up your outline

Having spent so much time reading, it might be tempting to just start writing up without a clear structure in mind. However, it’s critically important to decide on your structure and develop a detailed outline before you write anything. Your literature review chapter needs to present a clear, logical and an easy to follow narrative – and that requires some planning. Don’t try to wing it!

Naturally, you won’t always follow the plan to the letter, but without a detailed outline, you’re more than likely going to end up with a disjointed pile of waffle , and then you’re going to spend a far greater amount of time re-writing, hacking and patching. The adage, “measure twice, cut once” is very suitable here.

In terms of structure, the first decision you’ll have to make is whether you’ll lay out your review thematically (into themes) or chronologically (by date/period). The right choice depends on your topic, research objectives and research questions, which we discuss in this article .

Once that’s decided, you need to draw up an outline of your entire chapter in bullet point format. Try to get as detailed as possible, so that you know exactly what you’ll cover where, how each section will connect to the next, and how your entire argument will develop throughout the chapter. Also, at this stage, it’s a good idea to allocate rough word count limits for each section, so that you can identify word count problems before you’ve spent weeks or months writing!

PS – check out our free literature review chapter template…

3.2 – Get writing

With a detailed outline at your side, it’s time to start writing up (finally!). At this stage, it’s common to feel a bit of writer’s block and find yourself procrastinating under the pressure of finally having to put something on paper. To help with this, remember that the objective of the first draft is not perfection – it’s simply to get your thoughts out of your head and onto paper, after which you can refine them. The structure might change a little, the word count allocations might shift and shuffle, and you might add or remove a section – that’s all okay. Don’t worry about all this on your first draft – just get your thoughts down on paper.

Once you’ve got a full first draft (however rough it may be), step away from it for a day or two (longer if you can) and then come back at it with fresh eyes. Pay particular attention to the flow and narrative – does it fall fit together and flow from one section to another smoothly? Now’s the time to try to improve the linkage from each section to the next, tighten up the writing to be more concise, trim down word count and sand it down into a more digestible read.

Once you’ve done that, give your writing to a friend or colleague who is not a subject matter expert and ask them if they understand the overall discussion. The best way to assess this is to ask them to explain the chapter back to you. This technique will give you a strong indication of which points were clearly communicated and which weren’t. If you’re working with Grad Coach, this is a good time to have your Research Specialist review your chapter.

Finally, tighten it up and send it off to your supervisor for comment. Some might argue that you should be sending your work to your supervisor sooner than this (indeed your university might formally require this), but in my experience, supervisors are extremely short on time (and often patience), so, the more refined your chapter is, the less time they’ll waste on addressing basic issues (which you know about already) and the more time they’ll spend on valuable feedback that will increase your mark-earning potential.

Literature Review Example

In the video below, we unpack an actual literature review so that you can see how all the core components come together in reality.

Let’s Recap

In this post, we’ve covered how to research and write up a high-quality literature review chapter. Let’s do a quick recap of the key takeaways:

• It is essential to understand the WHY of the literature review before you read or write anything. Make sure you understand the 4 core functions of the process.
• The first step is to hunt down the relevant literature . You can do this using Google Scholar, your university database, the snowballing technique and by reviewing other dissertations and theses.
• Next, you need to log all the articles in your reference manager , build your own catalogue of literature and synthesise all the research.
• Following that, you need to develop a detailed outline of your entire chapter – the more detail the better. Don’t start writing without a clear outline (on paper, not in your head!)
• Write up your first draft in rough form – don’t aim for perfection. Remember, done beats perfect.
• Refine your second draft and get a layman’s perspective on it . Then tighten it up and submit it to your supervisor.

Psst… there’s more!

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

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38 Comments

Thank you very much. This page is an eye opener and easy to comprehend.

This is awesome!

I wish I come across GradCoach earlier enough.

But all the same I’ll make use of this opportunity to the fullest.

Thank you for this good job.

Keep it up!

You’re welcome, Yinka. Thank you for the kind words. All the best writing your literature review.

Thank you for a very useful literature review session. Although I am doing most of the steps…it being my first masters an Mphil is a self study and one not sure you are on the right track. I have an amazing supervisor but one also knows they are super busy. So not wanting to bother on the minutae. Thank you.

You’re most welcome, Renee. Good luck with your literature review 🙂

This has been really helpful. Will make full use of it. 🙂

Thank you Gradcoach.

Really agreed. Admirable effort

thank you for this beautiful well explained recap.

Thank you so much for your guide of video and other instructions for the dissertation writing.

It is instrumental. It encouraged me to write a dissertation now.

Thank you the video was great – from someone that knows nothing thankyou

an amazing and very constructive way of presetting a topic, very useful, thanks for the effort,

It is timely

It is very good video of guidance for writing a research proposal and a dissertation. Since I have been watching and reading instructions, I have started my research proposal to write. I appreciate to Mr Jansen hugely.

I learn a lot from your videos. Very comprehensive and detailed.

Thank you for sharing your knowledge. As a research student, you learn better with your learning tips in research

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Literature Reviews

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

What is a Literature Review?

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

A literature review should: 

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

From  S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

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Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

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

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

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Organizing Your Social Sciences Research Paper

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

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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

• Does the review of the literature logically lead up to the research questions?
• Do the authors review articles relevant to their research study?
• Do the authors show where there are gaps in the literature?

The lit review is also a good place to find other sources you may want to read on this topic to help you get the bigger picture.

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Literature Review: Conducting & Writing

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Sample Lit Reviews from Communication Arts

Have an exemplary literature review.

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Have you written a stellar literature review you care to share for teaching purposes?

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COVID-19’s impact on drug overdose fatalities and urgent mental health care demand in the US

• Original Paper
• Published: 25 April 2024

Cite this article

• Izuru Inose 1 &
• Yoshiyasu Takefuji   ORCID: orcid.org/0000-0002-1826-742X 1  

The purpose of this study is to scrutinize the repercussions of the COVID-19 pandemic on the incidence of drug overdose fatalities in the US.

The study utilizes datasets from the CDC and employs a linear regression model to calculate the time-series of excessive deaths spanning from 2020 to 2022. An extensive literature review focusing on overdoses during the pandemic period is also conducted.

The findings reveal that the influence of COVID-19 on overdose fatalities in 2020, 2021, and 2022 were 1.18, 1.36, and 1.38 times higher, respectively. The observed demand for urgent mental health care has seen a lesser decline compared to the overall need for emergency services.

Conclusions

This study offers critical insights into the correlation between the COVID-19 pandemic and drug overdose deaths in the US, which could serve as a valuable resource for future research and policy-making decisions. Consequently, it is imperative for emergency departments to be equipped and ready to deliver crucial care for adolescents confronted with mental health crises.

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Izuru Inose & Yoshiyasu Takefuji

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COVID-19 significantly impacted drug overdose deaths from 2020 to 2022.

Largest impact and excessive deaths with drug overdose occurred in 2022.

Impacts of COVID-19 on overdose deaths in 2020, 2021, and 2022 were 1.18, 1.36, 1.38.

Urgent mental health care demand remains high; readiness is crucial.

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Inose, I., Takefuji, Y. COVID-19’s impact on drug overdose fatalities and urgent mental health care demand in the US. Health Technol. (2024). https://doi.org/10.1007/s12553-024-00876-1

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Microblading reaction as a manifestation of systemic sarcoidosis: two case reports and a review of the literature

• Eva Klara Merzel Šabović   ORCID: orcid.org/0000-0002-1634-1868 1 , 2 ,
• Mateja Starbek Zorko 1 , 2 ,
• Violeta Hosta 1 ,
• Borut Žgavec 1 &
• Vid Bajuk 1 , 2  

Journal of Medical Case Reports volume  18 , Article number:  221 ( 2024 ) Cite this article

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Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Sarcoidosis often poses a diagnostic challenge owing to its nonspecific or mild clinical features. In 20–35% of cases, sarcoidosis initially presents on skin. However, skin lesions commonly mimic dermatological conditions. Therefore, it is important to not underestimate the skin manifestations and perform histopathological examinations to make a timely diagnosis.

Case presentation

We present two cases of 33-year-old Caucasian female patients with orange–red macules and plaques that developed in the eyebrow area 1 and 6 years after microblading, respectively. Histopathological examination confirmed a diagnosis of sarcoidosis. The lymph nodes and lungs were also affected in both patients.

Our two reports suggest that an esthetic procedure involving dermal or subcutaneous injection of foreign materials can trigger the development of cutaneous and systemic sarcoidosis. However, this relationship has not been described yet. Physicians should, therefore, be aware of this complication to properly evaluate and treat such patients in a timely manner.

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Introduction

Sarcoidosis is a complex disease with unknown etiology and pathogenesis. Several factors may contribute to the development of sarcoidosis, such as a genetic predisposition with certain human leukocyte antigen (HLA) genotypes [ 1 ] and/or environmental factors, such as mycobacterial or propionibacterial organisms [ 2 ]. In addition, there is evidence suggesting an autoimmune or immune-mediated genesis of the disease [ 3 ]. In sarcoidosis, both the innate and adaptive immune systems are involved, highlighting the complexity of the pathogenesis of sarcoidosis [ 4 ]. Nevertheless, the specific causes that trigger the development of the granulomatous/fibrotic process in sarcoidosis remain unknown [ 4 ]. The prevalence of sarcoidosis varies by geographic location, with Scandinavian countries having the highest prevalence of 140–160 per 100,000 persons, while the prevalence in South Korea, Taiwan, and Japan is 1–5 per 100,000 [ 5 ].

Sarcoidosis is most commonly present in a mild form. However, in some cases, it can also be lethal, primarily because of the cardiac involvement. It is characterized by noncaseating granulomatous inflammation, which most commonly affects the lungs, lymph nodes, eyes, and skin [ 6 ]. The etiology of this condition is still not entirely understood. Sarcoidosis is believed to be triggered by exposure to extrinsic antigens in immunogenetically susceptible individuals [ 7 ]. According to previous studies, extrinsic antigens are the most common microbial agents and environmental substances [ 8 ]. In the developed world, there are growing reports of esthetic procedures with dermal infiltration, which might act as an extrinsic agent triggering sarcoidosis in predisposed individuals [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Here, we present two cases of a 33-year-old female patient who presented with orange–red maculopapular lesions in the eyebrow area after microblading. To date, only one case of cutaneous sarcoidosis after microblading has been reported [ 17 ]. However, no cases of systemic sarcoidosis after microblading, as in our two cases, have been reported.

A 33-year-old Caucasian female patient presented with orange–red slightly infiltrated plaques in the eyebrow region that had been present for 3 years (Fig.  1 ). The plaques occurred 1 year after semipermanent tattooing—microblading, which had been performed only once. The skin was thoroughly examined, and the skin lesions were present only in the eyebrow area. First, allergic contact dermatitis was suspected and excluded using patch testing. Owing to the specific color of the lesions, a sarcoid granulomatous reaction was suspected. A thorough occupational and travel history was obtained, with no evidence of external influences that might cause sarcoidosis. Family history was negative for sarcoidosis. Her medical history was otherwise unremarkable. However, she reported a breast augmentation procedure that had been performed two years before the appearance of the skin lesions. A biopsy of the skin lesions revealed granulomatous dermatitis with epithelioid (sarcoid) granulomas (Fig.  2 ). Accordingly, sarcoidosis was suspected and the patient was referred for laboratory workup and chest radiography. Laboratory workup results were unremarkable with normal C-reactive protein (< 5 mg/L), normal angiotensin-converting enzyme (0.50 µkat/L), normal levels of serum calcium (2.37 mmol/L), magnesium (0.71 mmol/L), potassium (4.9 mmol/L), and sodium (137 mmol/L). However, chest radiography revealed hilar lymphadenopathy and reticulonodular opacities in the lungs, consistent with grade II sarcoidosis. She denied any pulmonary symptoms. Additionally, the patient was examined for other manifestations of sarcoidosis, which were excluded by other specialists. She was referred to a pulmonologist who performed an additional examination that revealed the progressive nature of pulmonary sarcoidosis with initial fibrosis. The patient required systemic treatment with prednisolone at an initial dose of 16 mg daily. After three months of systemic treatment with prednisolone 16 mg daily and topical treatment with momethasone 1 mg/g cream twice weekly, resolution of the cutaneous lesions was observed (Fig.  3 ). During the 2-year follow-up period in which she received continuous systemic prednisolone, we observed no recurrence of the skin lesions despite the gradual reduction of the prednisolone dose to 6 mg every other day. In addition, the reticular pulmonary changes regressed.

The first case of a female patient with mildly infiltrated erythematous plaques in the eyebrow area with a typical orange hue

Histopathological examination of the first patient showing granulomatous dermatitis with epithelioid (sarcoid) granulomas

Resolution of cutaneous lesions in the first patient after 3 months of treatment with systemic corticosteroids

A 33-year-old Caucasian female patient presented with orange–red mildly infiltrated plaques in the eyebrow area that lasted for three months (Fig.  4 ). Upon thorough examination no other skin lesions were observed. She underwent microblading for 6 consecutive years, after which skin lesions developed. As in the first case, thorough occupational and travel histories were taken, and were unremarkable for external agents that could trigger sarcoidosis. Family history was also negative for sarcoidosis. Owing to the red–orange color of the lesions, a sarcoid granulomatous reaction was suspected and confirmed upon histopathological examination (Fig.  5 ). Laboratory workup revealed elevated erythrocyte sedimentation (34 mm/h), elevated C-reactive protein (13 mg/L), elevated angiotensin-converting enzyme (1.46 µkat/L), elevated chitotriosidase (480 nmol/h ml), and hypercalciuria (4.7 mmol/L) with a urine calcium/creatinine ratio of 0,96. Normal levels of serum calcium (2.23 mmol/L), magnesium (0.71 mmol/L), potassium (4.4 mmol/L), and sodium (139 mmol/L) were observed, however level of phosphate (0.50 mmol/L) was decreased. Furthermore, chest radiography revealed hilar lymphadenopathy and reticulonodular opacities in the lungs, which was consistent with sarcoidosis. The patient was referred to a pulmonologist who performed additional examinations and confirmed grade II sarcoidosis. However, owing to its non-progressive nature without fibrosis, treatment was not initiated at the time. Additional workup was performed for other manifestations of sarcoidosis; however, in addition to the skin, lungs, lymph nodes, and endocrine organs (hypercalciuria), other organs were not involved. Moreover, a high-resolution computed tomography scan performed 6 months after the initial diagnosis revealed resolution of sarcoidosis lesions in the lungs. For cutaneous involvement, she was prescribed mometasone furoate cream once daily for 10 days and then twice weekly as a maintenance treatment. However, no improvement was initially noted in the eyebrow area. After remission of pulmonary sarcoidosis and upon a 1-year follow-up visit, significant improvement of the skin was observed—only slight erythema of eyebrows persisted.

The second case of a female patient with mildly infiltrated erythematous plaques in the eyebrow area with a typical orange hue

Histopathological examination of the second patient showing granulomatous dermatitis with epithelioid (sarcoid) granuloma

Sarcoidosis is a disease that remains largely unknown. The most frequent question bothering both physicians and patients is its trigger. This question is particularly important because sarcoidosis is not very rare [ 5 ]. Sarcoidosis is more common in women, and its onset is often in the third or fourth decade of life [ 7 ].

Diagnosis is often delayed owing to nonspecific or mild clinical features. Sarcoidosis affects multiple organs. The most frequently involved organs were the lungs (90% of patients), lymph nodes, and eyes (60%). Sarcoidosis can also affect other organs, such as the liver and spleen, heart (20–27%), endocrine and exocrine organs (hypercalciuria and hypercalcemia in 10% of patients), nervous system (10%), bones (1–13%), upper respiratory tract (2%), and kidneys owing to renal calculi formation [ 18 ]. Skin involvement is present in 20–35% of patients [ 7 ].

Dermatologists are in a unique position to make a timely diagnosis since skin manifestations are often a presenting feature. Sarcoidosis can present with specific or nonspecific skin lesions. Specific lesions show granulomatous inflammation on biopsy, whereas nonspecific lesions manifest only as inflammatory reactions without granuloma formation [ 6 ]. The most common skin manifestations include maculopapular, plaque-like, and subcutaneous lesions and erythema. It may also present as lupus pernio or with rarer, nonspecific forms, such as psoriasiform, annular, lichenoid, verrucous, photodistributed, and ichthyosiform [ 7 ].

Sarcoidosis is thought to develop in immunogenetically susceptible individuals after exposure to extrinsic antigens. Extrinsic antigens are the most common microbial or environmental triggers [ 7 ]. Mycobacterium and Propionibacterium are the most common microbial triggers [ 8 ]. Among the environmental triggers, people who worked in areas with mold or were exposed to insecticides were more likely to develop sarcoidosis [ 19 ]. Both patients denied having lived or worked in places with mold and had unremarkable travel histories. The first patient worked as a cashier, and the second as a nurse.

In modern times, people, especially in developed countries, are less likely to be exposed to potential contaminants at work or at home but are more likely to undergo esthetic procedures. According to increasing reports in literature, esthetic procedures could serve as an extrinsic trigger for the clinical manifestation of sarcoidosis in immunogenetically susceptible individuals, as suspected in our two cases. Granulomatous reactions have been observed after tattooing [ 10 , 14 , 15 , 16 ], microneedling [ 11 , 12 , 13 ], injection of botulinum toxin [ 20 , 21 ], and injection of dermal fillers [ 9 , 22 ]. Interestingly, there is also a case report of cutaneous and pulmonary sarcoidosis after breast augmentation [ 23 ].

Microblading is a popular esthetic procedure used primarily for eyebrow restoration; however, it has also gained popularity for some dermatologic conditions, including alopecia totalis and madarosis owing to hypothyroidism or chemotherapy. Microblading is a superficial micropigmentation procedure in which pigments are introduced deep into the papillary dermis. The results are semipermanent and last 12–18 months [ 24 ]. Granulomas rarely develop at microblading sites [ 24 ]. In a recent review article, 21 cases of sarcoidosis were noted after permanent tattooing but only 1 after microblading. In the case of sarcoidosis that developed after microblading, only the skin was affected [ 17 ]. Interestingly, both patients were found to have systemic sarcoidosis. Therefore, microblading probably triggered the development of sarcoidosis in both patients. As the pigment deposit in microblading is shallower and presumably not dispersible compared to classic tattooing, resolution of granulomatous inflammation is probably more likely than in sarcoidosis after classical tattooing [ 17 , 24 ].

Common to all esthetic procedures associated with sarcoidosis appears to be infiltration of the dermis or subcutis with foreign substances that may serve as triggers for sarcoidosis. However, sarcoidosis is not always the cause of granulomatous reactions. Therefore, we propose the following clinical recommendation: when a patient presents with chronic lesions at the site of injection of foreign material, especially with skin lesions of orange–red color, the patient should be appropriately evaluated for sarcoidosis. Such an examination should initially include a biopsy, which should then guide us further toward sarcoidosis or another diagnosis. If the histopathologic examination reveals a granulomatous inflammatory infiltrate, we should exclude other diseases consisting of granulomatous inflammation, such as foreign body granulomas, infectious granulomas, and interstitial granulomatous dermatitis [ 7 , 25 ].

Treatment of patients with granulomatous reactions after dermal procedures consists of topical or oral corticosteroid therapy, or treatment with other oral immunosuppressants [ 14 ]. In patients with mild cutaneous sarcoidosis, topical or intralesional corticosteroids are used as the first-line therapy. In rapidly progressive extensive sarcoidosis or in cases of ineffective topical therapy, patients are treated with oral corticosteroids. Tumor necrosis factor-α (TNF-α) inhibitors are beneficial for treating recurrent skin lesions [ 26 ]. However, TNF-α inhibitors can sometimes even induce a paradoxical reaction with the development of a sarcoidosis-like reaction [ 27 ]. Other treatment options include antimalarials, methotrexate, tetracycline antibiotics, mycophenolate mofetil, and thalidomide [ 25 ]. Recently, treatment with Janus kinase inhibitors has been proposed to be effective [ 28 , 29 ]. Case studies have also shown a beneficial effect of treating skin lesions with psoralen plus ultraviolet A light phototherapy, photodynamic therapy, pulsed dye lasers, and CO 2 lasers [ 7 ].

Interestingly, our two cases differed significantly in the time interval between the triggering event (microblading procedure) and onset of cutaneous sarcoidosis. In the first patient, sarcoidosis manifested on the skin 1 year after the microblading procedure, whereas in the second patient, it occurred 6 years after the initial microblading procedure, which was followed by several repeated procedures in the following years. Our two cases raised some relevant questions and assumptions, even though they could not be fully explained and answered. For example, sarcoidosis may be triggered in susceptible individuals when a certain threshold for the accumulation of a foreign substance (ink) is reached. Implantation of other foreign substances, such as breast implants, as in our first patient, could increase susceptibility to cutaneous sarcoidosis triggered by microblading. This could explain why the first patient developed sarcoidosis after one procedure, whereas the second patient developed sarcoidosis after six microblading procedures. In addition, a progressive course of sarcoidosis with pulmonary fibrosis in the first patient could be a coincidence; however, it could be owing to the additive deleterious effects of multiple implanted foreign substances in addition to the effect of the long-term presence of the triggering substance, that is, the deposited skin pigment, in subsequent years. It is also unknown whether time-dependent pigment dispersion plays an important role. Therefore, long-term follow-up is required. It is difficult to predict whether skin changes will recur after discontinuation of systemic corticosteroid therapy in the first patient because local corticosteroids initially did not eliminate cutaneous sarcoidosis in the second patient. In this case, spontaneous remission of sarcoidosis was most likely the reason for the resolution of skin symptoms, which according to some reports, may be due to the high release of transforming growth factor β from alveolar macrophages [ 30 ]. However, this observation suggests that systemic corticosteroid treatment is required to treat cutaneous sarcoidosis. Therefore, more real-world data are required. However, the possibility of preexisting sarcoidosis and microblading as triggers of skin sarcoidosis in our two cases cannot be neglected. However, this assumption does not diminish the role of microblading in sarcoidosis development or progression.

In addition, it will be interesting to continue monitoring both patients, especially the first one treated with systemic corticosteroids because of progressive pulmonary involvement, to determine whether cutaneous lesions recur after treatment cessation. Depending on the transient effect of the microblading procedure, one might predict that the skin lesions will not recur; however, the pigment remains in the body because it is not eliminated from the tissues. It is difficult to predict whether the dispersed pigment acts as a trigger for sarcoidosis or not.

Because sarcoidosis most commonly affects women between the ages of 30 and 40 years, it is important to emphasize that physicians should educate all patients with sarcoidosis about potential skin complications after esthetic procedures involving infiltration of the dermis or subcutis. Other options, such as superficial peels or laser treatment, should be considered. However, further studies are needed to provide practical recommendations for esthetic procedures in patients with sarcoidosis. In addition, physicians and estheticians who perform esthetic procedures should be aware of the risk of sarcoidosis in patients with a predisposition. Prior to such procedures, patients should be adequately informed of this risk despite its rarity.

As our two cases also demonstrated, dermal or subcutaneous infiltration with foreign material during esthetic procedures can trigger the manifestation of sarcoidosis. When esthetic procedures become increasingly popular, patients with chronic lesions at the injection site of the foreign material, especially macular, papular, or nodular lesions of orange–red color, should be appropriately evaluated for possible sarcoidosis. Such an examination should initially include a biopsy, which should guide the physician in the direction of either sarcoidosis or another diagnosis. In addition, all patients with sarcoidosis should be educated and warned of such complications before undergoing esthetic procedures.

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Eva Klara Merzel Šabović, Mateja Starbek Zorko, Violeta Hosta, Borut Žgavec & Vid Bajuk

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EKMŠ reviewed the literature, wrote the initial manuscript, and managed the first patient. MSZ assisted in preparation of the final manuscript. VH and BŽ confirmed the diagnosis, analyzed, and provided histopathological images. VB reviewed the literature, managed the second patient, and completed the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Eva Klara Merzel Šabović .

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Merzel Šabović, E.K., Starbek Zorko, M., Hosta, V. et al. Microblading reaction as a manifestation of systemic sarcoidosis: two case reports and a review of the literature. J Med Case Reports 18 , 221 (2024). https://doi.org/10.1186/s13256-024-04439-w

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Evidence of Disaster Planning by Home Care Providers: An Integrative Literature Review

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The increasing risk of disasters worldwide poses challenges both to health care infrastructures and to home care providers, who must maintain decentralised services for those in need of long-term care for as long as possible, even under adverse circumstances. However, both the kind of organisational precautions that home care providers consider in preparation for disasters and the available evidence on the effectiveness of these precautions remain largely unclear. An integrative literature review was thus performed via a systematic search of several international databases in order to identify original research on organisational disaster planning by home care providers and to determine the evidence base of this research. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Of the 286 results, 12 articles met the inclusion criteria and presented results from nine studies on disaster planning. Three overarching types of activities carried out by home care providers were identified inductively. The overall scientific quality of the studies was moderate, and none investigated the effectiveness of disaster planning by home care providers. Despite the variety of possible activities that home care providers already consider, evidence on how to make organisational disaster planning effective and sustainable remains lacking.

1. Introduction

Both the risk of various kinds of disasters and the multifaceted consequences of these events are expected to increase around the world in the coming years [ 1 ]. Despite having long been spared from such developments, Europe—and especially Germany—is now also increasingly affected by these risks due, for example, to progressing climate change, the unsustainable use of natural resources, degrading ecosystems, pandemics, and epidemics [ 2 ]. In 2015, the United Nations addressed this global challenge by adopting the Sendai Framework for Disaster Risk Reduction 2015–2030, which is an international agreement aimed at significantly reducing both damage to critical infrastructure and the disruption of essential services [ 3 ]. The framework aims to reach this goal via improved disaster management both in and between all sectors as well as via activities that are targeted at disaster preparedness at the national, local, and organisational levels. In order to implement the Sendai Framework, a German strategy for strengthening resilience to disasters was developed and published in 2022 [ 4 ].

One essential component of this German resilience strategy is to better prepare critical health care infrastructures. Although attention in this context is often directed towards acute and emergency care and hospitals, home care should not be forgotten. In 2016, 20% of households in the European Union with individuals who required assistance used some sort of professional home care service [ 5 ]. Demand for home care can be assumed to further increase in the future in connection with demographic, epidemiological, and societal developments, as well as via the encouragement of health and social policy initiatives [ 6 ]. The ongoing shift of patient groups and forms of treatment (e.g., mechanical ventilation, haemodialysis, palliative care) from the inpatient sector to patients’ homes is also contributing to the growing importance of home care [ 7 , 8 , 9 ]. Independent of the vast differences in provision structures as well as the role of skilled professionals and regulatory mechanisms [ 10 ], home care is an indispensable part of the health and social care systems in many countries. It is therefore critical to better prepare this vital infrastructure for future disasters.

As members of community-based organisations, home care providers play a central role in identifying hazards, developing preparedness plans, responding to disasters, disseminating information, and identifying vulnerable individuals [ 11 ]. People in need of home care—and especially those who are immobile, disoriented, severely ill, or technology-dependent—are exposed to special risks during disasters that include large-scale power outages, floods, storms, and epidemics. The vulnerability of this population has been demonstrated in previous disasters and studies. For example, deficits in preparedness, disruption of services in the event of a disaster, or reduced ability and preparedness to evacuate from their homes can lead to serious negative health impacts for people who rely on home care [ 7 , 8 , 12 ]. In order to ensure the safety of these vulnerable individuals and to maintain their decentralised care for as long as possible, even under adverse circumstances, home care providers and their staff need to be organisationally prepared and ready for action at all times [ 9 , 13 ]. Indeed, they must be able to work closely with other health care providers as well as with emergency services and disaster response teams in the event of an incident, and they must be prepared to initiate any necessary evacuation. In the United States (henceforth, USA), a regulation was established in 2016 that includes national disaster requirements for Medicare- and Medicaid-participating providers in order to ensure adequate planning for disasters and to coordinate with emergency preparedness agencies [ 14 ]. However, it remains largely unclear what organisational arrangements home care providers have made or will make to prepare for disasters.

Aside from a few anecdotal reports in the literature (primarily from the USA) suggesting that home care providers are currently insufficiently prepared for disasters [ 13 , 15 , 16 , 17 , 18 ], as well as the availability of a literature review of best practises for disaster planning by home care providers (also from the USA) [ 19 ], it is unknown whether preparedness requirements are systematically implemented by home care providers or how these requirements impact the providers’ disaster preparedness. Thus, there is a lack of knowledge not only about the organisational precautions that home care providers consider or implement in preparation for disasters but also about how effective the activities that have already been initiated are as well as what evidence they are based on. The present research was designed to address this knowledge gap. Therefore, the aim of the present study was to provide information from the international literature about (i) organisational precautions that home care providers consider in preparation for disasters, (ii) whether these measures are systematically implemented, and (iii) what is known about the effectiveness of the measures. Based on this information, the goal was to form recommendations for disaster preparedness in this field, if possible.

The work is part of a multiphase empirical research project on the “Maintenance of home care infrastructures in crisis and disasters” (AUPIK), which runs from February 2020 to June 2023 and is funded by the German Federal Ministry of Research (BMBF) in the context of the civil security research programme (SOFI). AUPIK aims to gain knowledge about how to increase the disaster resilience of home care infrastructure in Germany. In addition to conducting empirical surveys and developing specific tools in support of disaster preparation among home care providers, the objectives of the project also include examining the international state of research and the evidence base on this topic.

An integrative literature review was carried out in order to identify (i) original research on organisational disaster planning activities that are carried out by home care providers and (ii) the documented effects of these activities. This approach enabled different designs to be combined in order to uncover international evidence of innovative activities [ 20 , 21 ].

A systematic literature search was conducted in PubMed (including Medline), CINAHL, and Cochrane. Reference lists of eligible articles were also screened for suitable articles. The SPICE model [ 22 ] served as the starting point for defining search components and identifying search terms. The model was used in a simplified form with two components due to the research question: The component of “setting” comprised terms regarding home care providers, while the combined component of “intervention and evaluation” was related to measures for disaster preparedness and (if applicable) the evaluation of these measures. Table 1 lists the search commands for identifying relevant studies, including medical subject heading terms (MeSH) and title and/or abstract screening terms (TIAB).

Search components and terms used in PubMed.

* stands for truncation.

Articles were included in the review if they represented original primary research studies. Measures of disaster preparedness had to be taken at the organisational level. There were no restrictions placed on the type of disaster. A data limitation was set for up to the year 2001 because the attacks on the World Trade Centre as well as the anthrax incidents in the USA—both of which occurred in 2001—increased the awareness of and efforts to improve disaster preparedness in many countries [ 23 , 24 ]. Studies that focused on other health care providers or settings, on educational aspects at the individual level only, or exclusively on the COVID-19 pandemic were excluded, as were articles without research value.

Thematic analysis of the included articles was carried out as a systematic procedure—following Whittemore & Knafl [ 21 ] —along the five steps of data reduction, data display, data comparison, conclusion, and verification. During data reduction, two researchers (SL, SG) extracted data independently, and discrepancies were discussed with a third member (MK) of the research team. Subsequently, the data from the studies were clustered and presented as tables using an inductive categorisation system.

The Mixed Methods Appraisal Tool (MMAT) [ 25 ] was used to critically appraise the included papers. The MMAT is a well-evaluated checklist [ 26 ] and is suitable for appraising qualitative, quantitative, and mixed-methods studies alike.

3.1. Results of the Literature Search

The search initially yielded 286 articles. After screening, 25 articles were identified for closer inspection. These articles were independently reviewed by two researchers (SL, SG) via a full reading. A third member of the research team (MK) was consulted for making the decision as to whether to include an article in cases of doubt. Finally, 12 articles remained that met the inclusion criteria. The results of the electronic search were entered into the literature management programme EndNote (Version X9.2 for Windows). Figure 1 presents the search results as a flow chart based on the PRISMA statement [ 27 ].

Flow chart with an overview of hits in specialised databases and other sources based on the 2020 PRISMA statement [ 27 ].

3.2. Characteristics of the Included Studies

All 12 considered articles originated from the USA and were published between 2003 and 2020 ( Table 2 ). One follow-up study was documented in three different articles [ 28 , 29 , 30 ]. Another empirical study was published in two articles [ 31 , 32 ]. As a result, nine different original research studies were included in this analysis.

Overview of the included articles.

3.3. Thematic Analysis

The thematic analysis inductively identified three overarching areas of organisational disaster planning by home care providers: (1) internal operational arrangements, (2) information and networking activities, and (3) measures for safeguarding patient care. These three areas are presented here in condensed form.

3.3.1. Internal Operational Arrangements

Based on the studies considered here, home care providers’ internal operational arrangements for disaster planning were assigned to three subcategories, as shown in Table 3 .

Internal operational arrangements.

• Organisational disaster plan

Disaster plans were mentioned relatively often as an organisational measure that home care providers use to prepare for disasters [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 ]. These plans covered, for example, an incident command system as well as other communication plans, a hazard vulnerability analysis, employee protection, an integrated business continuity plan, processes for safeguarding client records, material resources, agreements with partners, and other procedures for patient tracking. Information on whether these plans were regularly reviewed, tested in exercises, or even adapted after specific disasters was rare. The plans presented differed between the included articles and the agencies interviewed in them. For example, some of the agencies reported that their plans essentially consisted of maintaining a list of all patients and their caregivers with emergency contact information [ 35 ]. Another article presented a toolkit for creating a plan that takes an all-hazards approach and addresses the factors that home care providers need to be prepared for [ 37 ].

• Staff disaster arrangements

Less frequently, home care providers mentioned measures for supporting the willingness and readiness of employees to work even under adverse circumstances and in times of disaster [ 28 , 29 , 30 , 36 ]. Such measures included, for example, the provision of individual disaster plans for staff members, securing child or adult care arrangements, keeping emergency supplies or emergency “go-kits” in employees’ homes, and having a pre-arranged meeting point for employees in the event of an emergency (e.g., a blackout or communication failure). In one study, a respondent reported that personal back up emergency plans are in place for staff relatives to ensure continuity of services for all patients [ 28 , 29 , 30 ].

• In-house disaster training

Internal disaster training for the staff of home care providers ranged from no or minimal training to routine and comprehensive training that was offered either as initial training upon hire, as annual refresher courses, or as targeted training for different staff depending on their role in the agency or in the disaster plan [ 28 , 29 , 30 , 33 , 34 , 35 , 37 ]. Themes and didactic approaches were diverse and comprised, for example, online systems or platforms for delivering learning modules, staff meetings, “lunch and learns”, local disaster planning meetings for discussing certain topics, simulations, tabletop drills, and annual mock drills with home care staff for testing policy protocols. One agency surveyed found that conducting mock drills regularly each year resulted in a more orderly response (e.g., staff were more prepared, patients were better able to adapt) [ 35 ].

3.3.2. Information and Networking Activities

This category included any activities that the home care providers in the included studies mentioned for communicating disaster-related information in preparation for—as well as for communication during and after—a disaster affecting their staff (internal), the users of their home care services, and other providers (external), as well as for networking with other organisations or providers in their region (see Table 4 ).

Information and networking activities.

• Disseminating information to staff (internally)

Electronic communication tools such as the telephone, text messaging, and email were often mentioned as a means of spreading disaster-related information. Some providers used secure text messaging systems, software, or mobile apps, while others relied on manual telephone chains or call trees. Sometimes, backup strategies for employee accessibility during communication outages were mentioned, such as an 800-Hz-radio battery-operated walkie-talkie system, web-based scheduling, two-way digital radio communication devices, or a contract with local ham radio operators [ 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 ].

• Disseminating information to home care users

Identifying emergency contact information and informing patients and caregivers about disaster preparedness can be part of the patient admission process and may be reviewed regularly. Some providers communicated with patients via telephone after an incident in order to ensure the patients’ safety, to see if the patients needed anything, or to check whether a family member was available to help them [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 ]. An alternative mode of communication was “knocking on doors” to assess patients’ status in case of a communication disruption [ 28 , 29 , 30 ].

• Disseminating information to others (externally)

Emergency notifications from a local or state emergency management or public safety agency, as well as health alerts from a local or state health department, were mentioned by some home care providers as important sources of external information. Other providers faxed or forwarded patient lists containing information such as medical risk, supply reserves, transportation needs, contact information, and special needs to local emergency responder agencies [ 28 , 29 , 30 , 33 , 35 , 38 , 39 ]. A study reports on the New York State Health Provider Network (HPN), a web-based system for exchanging information quickly and efficiently. It includes a communications directory with contact information and a health alert network. The HPN coordinator is an individual who has a designated role in each agency and serves as the primary point of contact [ 28 , 29 , 30 ].

Networking initiatives by home care providers can be directed to the local government, law enforcement, public health departments, emergency management agencies, the Red Cross, the EMS, the local fire department, the transportation industry, nursing homes, or hospitals. Informal agreements that specify roles or provide support with emergency responders, supply companies, or other home care providers were also mentioned, as was informal advice from local authorities, for example, on disseminating literature on preparedness, setting up a website, or organising awareness-raising events [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. One article noted that agency cooperation and collaboration with local, regional, or state preparedness partners varied (from active participation to the inability to find partners). However, many agencies interviewed indicated that this collaboration is challenging [ 33 ].

3.3.3. Measures for Safeguarding Patient Care

This category summarises the organisational disaster planning measures of home care providers that were designed to ensure patient care in the event of a disaster (see Table 5 ).

Measures for safeguarding patient care.

• Personal patient disaster plan

In order to develop individual disaster plans [ 31 , 32 , 33 , 36 , 38 ] with which patients could ensure their own care, one measure that was mentioned in some of the studies considered here involved reviewing these plans regularly and adjusting them after a disaster [ 31 , 32 , 33 ].

• Disaster education

Disaster education for patients and relatives was also mentioned as a preparatory measure that was mostly conducted during patient admission. However, wide variation was found in terms of the scope of the training and the covered topics (e.g., discussions of the emergency plan, emergency contact information, emergency shelter information, evacuation procedures, patient responsibilities, emergency kits, medical equipment, and patient safety) [ 31 , 32 , 33 , 34 , 35 , 36 , 38 ]. Occasionally, leaflets and written instructions were simply handed out [ 35 , 36 ]. A study presented and evaluated a checklist-like assessment tool to help providers assess and train their patients’ disaster preparedness [ 37 ].

• Triage/patient classification

Classifying patients into risk-category groups in order to prioritise care during disasters was another way that home care providers prepared for an incident. Two-, three-, four-, or five-level categorisation systems were applied based on selected characteristics, which included the time frame in which each patient needed to be seen, the patient’s medical needs, and the support available to the patient [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 38 , 39 ]. In some cases, providers reported continually updating their rankings, especially in preparation for predicted events [ 33 , 39 ]. Based on the experiences of the interviewed agencies with their systems, the authors of one selected article developed a standardised classification system [ 39 ].

• Evacuation preparedness

Some home care providers prepared an evacuation plan upon patient admission, assisted their patients in registering for emergency transport and shelter, and educated them about the evacuation procedure [ 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 ]. Other providers relied on Emergency Medical Service (EMS) for patient evacuation but were willing to provide medical and nursing care at the evacuation site or in special-needs shelters [ 34 ]. In some cases, home care providers tracked their patients after evacuation [ 31 , 32 , 33 ]. In one study, agencies had different degrees of involvement with special-need shelters (e.g., some were actively involved, others hardly at all) [ 35 ].

3.4. Quality Appraisal

The studies included in this review referred to various measures related to disaster preparedness and the response of home care providers. All studies had a descriptive, exploratory character, and most (i.e., five studies) used qualitative methods. Moreover, the only quantitative study [ 37 ], as well as the studies with a quantitative research component (mixed methods), remained on a descriptive level. Table 6 presents the methods and samples used in each study, along with the quality appraisal.

Overview of the methods, samples, and quality appraisal of the included articles.

According to the MMAT, four studies fulfilled three or more of the five criteria. The data presented from these studies is easily comprehensible, has internal validity, and allows the research questions of the appraised study to be answered. Nonetheless, the external validity of the data is limited due to convenience sampling and existing selection bias. Four studies were rated, with fewer than three fulfilled MMAT criteria. The sampling and study designs used by these studies appeared to be appropriate to answer the research questions; however, the methodological procedures—such as the measurements and statistical analyses—were not easily comprehensible due to a lack of transparency, and the internal and external validity were thus difficult to assess. Furthermore, in studies with a mixed-method design, any inconsistencies or correlations between the methodological approaches that may have occurred were hardly mentioned. In one study, quality could not be assessed. Even though the three articles appeared to have scientific merit and may have pointed to guiding recommendations for home care providers to promote their disaster preparedness, there was a lack of information about the methodological approaches.

None of the examined studies investigated the effectiveness of the described disaster preparedness activities. Three studies evaluated tools (e.g., a disaster preparedness toolkit, a patient assessment tool, and a patient classification tool), albeit in terms of utility rather than effectiveness [ 37 , 38 , 39 ]. Almost all studies considered here took a primarily explorative and descriptive approach, which has inherently methodological limitations when it comes to measuring effectiveness. The included studies displayed strong heterogeneity with respect to different characteristics (which affects external validity) and indicated multiple initiatives on multiple levels. For example, some studies focused on the overall disaster preparedness of home care agencies (e.g., Ref. [ 33 ]), while other studies concentrated on a specific topic, such as patient classification (e.g., Ref. [ 39 ]). In addition to the fact that all of the studies included here were conducted in the USA, with a few exceptions, their data collection was regionally limited [ 33 , 37 ].

Individuals who reported information about the measures differed across studies in terms of their positions and affiliations with the surveyed home care providers (e.g., administrative staff, programme managers, practitioners, clinical staff, state-level preparedness experts). Similarly, differences existed between the health care settings and the types of providers included in the studies. For instance, while the respondents in some studies worked in home health and hospice agencies (e.g., Refs. [ 33 , 39 ], in other studies they worked in home-based primary care programmes [ 37 , 38 ]. Moreover, in some cases, personal care and home health care agencies were distinguished [ 34 , 35 ]. In addition to the lack of effectiveness evaluations, this high degree of heterogeneity impeded a comparison of measures across studies.

4. Discussion

The aim of this integrative literature review was to obtain information on the implementation and effectiveness of organisational precautions that home care providers already take to prepare for disasters.

Despite the rather limited literature on the topic, it became clear that there are a wide range of organisational precautions that home care providers have already taken or can take to strengthen their resilience to disasters. These precautions range from internal operational arrangements (e.g., the preparation of disaster plans) as well as internal and external information and networking activities (e.g., with patients, staff, or other health care providers in the community) to measures for safeguarding patient care (e.g., triage systems, evacuation precautions). Some of these precautions are innovative and inspiring and may have the potential to ensure decentralised care in times of disaster for as long as possible, thereby providing safety both for those in need of home care and for those who work in the field [ 13 , 15 , 16 , 17 , 18 , 19 ]. However, the literature does not provide any reliable information on whether some or all of these disaster preparedness arrangements are implemented systematically or consistently. Therefore, it remains unclear whether–and to what extent–people in need of home care or those responsible for the health and wellbeing of the population in a country can rely on these arrangements.

One of the main challenges of the present analysis stems from the fact that the included studies pointed to numerous initiatives at different levels—and as reported by various people—and that they used different survey methods. Due to their strong heterogeneity, the measures mentioned in the individual studies were hardly comparable either within or between studies. The predominantly regionally limited data collections as well as the methodological limitations of the primarily exploratory studies did not allow conclusions to be drawn about the systematic implementation of preparedness measures by home care providers. This finding was also shown in the literature review conducted by Wyte-Lake et al. [ 19 ] in 2012 and was confirmed ten years later in the present study. Consequently, no conclusions could be drawn about the actual dissemination or standardised use of measures beyond what the surveyed home care providers reported in each study, even for the USA, where these studies were undertaken. Even less can be said about the disaster preparedness arrangements of home care providers in other countries due to the lack of relevant research on the topic.

However, it should be considered whether the heterogeneity of the different measures described above is a characteristic of disaster preparedness among home care providers. In this case, they could be seen as an expression of the individual adaptation of the disaster preparedness measures to the very specific conditions on the site or in the respective service. This aspect should be adequately taken into account when comparing disaster planning measures and evaluating their effectiveness.

Although some of the included studies were methodologically well conducted, most were exploratory, descriptive, or comparative. There were hardly any evaluation or impact studies; thus, no statements can be made about which of the measures are effective and evidence-based. A few studies mentioned that home care providers reviewed their measures at regular intervals in the form of internal evaluation processes; however, scientifically evaluated data were not available. Thus, there appears to be a dearth of research on disaster preparedness measures for home care providers. This is perhaps not surprising given the paucity of robust empirical research in the field of home care overall, particularly when compared with inpatient and acute care [ 40 , 41 ]. This fact can be attributed to numerous problems, such as a lack of research expertise, capacities, and research funding in the field. Another reason for the lack of research that assesses the effectiveness of disaster preparedness measures in home care, in particular, might be that previous experience with disasters is highly important when it comes to disaster response [ 42 ]. The strength of qualitative research should be emphasised both because it can be used to answer questions about the experiences that home care providers have with disasters and because most of the included studies did so. In some studies, new measures were even implemented, or existing measures were adapted after lessons learned from disasters (e.g., [ 35 ]). However, the extent to which these experience-based measures result in better preparing home care providers for the next disaster remains unclear. This finding can pose significant challenges to policymakers, agencies, and providers alike when it comes to enacting or implementing effective disaster risk reduction measures. If the resilience of home care services as an infrastructure is to be strengthened, evidence-based planning and implementation are needed.

5. Limitations

The present review aimed to provide evidence of the effectiveness of primary studies that examined measures at the organisational level. Of the nine studies included in the review, only three received a 100% rating using the MMAT. Nevertheless, even if the desired findings on the evidence basis and the effectiveness of disaster preparedness measures were largely not achieved, the results of the present review provide a comprehensive overview of existing research activities on home care provider interventions and demonstrate the need for further evaluation studies. Such research is important in order to be able to target scarce resources in the future and direct these resources towards maintaining home care provision both during and after disasters.

Furthermore, we excluded articles that dealt only with educational aspects of disaster preparedness at the individual level. In this study, internal disaster training was considered as an outcome at the organisational level. In future research, external disaster preparedness teaching and training programs for health and care workers could also be included in the consideration.

Although no criterion was defined regarding the country in which the measures had to be implemented, all identified studies were from the USA, possibly because disasters occur more frequently in the USA than in other geographical regions (e.g., Europe). This fact may have painted a biased, less international picture of home care agencies´ disaster preparedness measures. Studies were also found from the Asia-Pacific region and Australia, both of which are particularly frequently affected by natural disasters [ 43 , 44 , 45 , 46 ], but these studies did not meet the inclusion criteria and were excluded due to their lack of focus on home care agencies or to their lack of a description of explicit measures at the organisational level. Additionally, only English-language articles were included, which may have excluded possible studies, for example, from the Asia-Pacific region. Furthermore, home care structures may exist in other (world) regions that make it difficult to implement concrete disaster-risk reduction measures where concrete measures for disaster preparedness are not explicitly located or have not yet been researched.

6. Conclusions

The purpose of the present integrative review was to present current evidence of disaster planning among home care providers. Although the research base on the topic raised here was highly unsatisfactory, the surveyed providers in the included studies appeared to be taking steps towards disaster preparedness. Such steps may serve as inspiration for countries in which this issue has played an even smaller role in home care than it has in the USA (e.g., in Germany or other European countries). However, there is a fundamental lack of evidence on how home care providers can design organisational disaster planning and, thus, how home care can be effectively maintained for vulnerable populations in the event of a disaster. Overall, home care should be moved more into the focus of health services research. Further research on disaster preparedness measures for home care providers is urgently needed, preferably with a systematic approach based on evaluation studies. Based on studies that provide valid data on the effectiveness of different disaster planning measures, systematic or even meta-analytic approaches could be used to identify best practises for home care providers with regard to disaster planning.

Acknowledgments

The authors would also like to acknowledge Sebastian Gröbe for his contributions to the data collection.

Funding Statement

This research was part of the project AUPIK, which was funded by the German Federal Ministry of Research (BMBF) in the context of the civil security research programme (SOFI), grant number 13N15225.

Author Contributions

Conceptualization, S.L., M.K. and M.E.; methodology, S.L., M.K. and M.E.; formal analysis, S.L., M.K. and M.E.; investigation, S.L. and M.K. writing—original draft preparation, S.L., M.K. and M.E.; writing—review and editing S.L., M.K. and M.E.; visualization, S.L. and M.K.; supervision, S.L.; project administration, S.L. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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Book Review: ‘Nothing But the Bones’ is a compelling noir novel at a breakneck pace

This image released by St. Martin’s Publishing Group shows “Nothing But the Bones” by Brian Panowich. (St. Martin’s Publishing Group via AP)

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Nelson “Nails” McKenna isn’t very bright, stumbles over his words and often says what he’s thinking without realizing it.

We first meet him as a boy reading a superhero comic on the banks of a river in his backcountry hometown in the Blue Ridge Mountains of North Georgia. There, a bully picks on him and then does the same to a pretty girl Nails secretly fancies. Enraged, Nails, ignorant of his own strength, gives the bully a fatal beating.

Nails’ friend Clayton Burroughs, who watches it happen, doesn’t call the police. Instead, he calls his brutal father, Gareth, who runs the rackets on Bull Mountain, to cover it up.

So begins “Nothing But the Bones,” a prequel to the first three Southern noir novels in Brian Panowich’s critically acclaimed Bull Mountain series.

After the killing, the story skips forward nine years and finds history repeating itself. Nails, now working as an enforcer for Gareth, is drinking apple juice in a seedy bar when he sees a punk mistreating a young woman. Moments later, the punk lies dead on the barroom floor.

There are too many witnesses for Gareth to fix things this time. Instead, he hands Nails a bag of cash, orders him to head south, and gives him a phone number to call when he gets to Jacksonville, Florida. As Nails speeds away, he discovers the young woman, a fellow outcast who calls herself Dallas, hiding in the backseat. She persuades a reluctant Nails to take her with him, and as they drive on, an unlikely love story emerges. As readers learn Dallas’s backstory, it becomes clear that they need each other.

When Clayton hears what’s happened, he’s knows that his father, who avoids legal entanglements at all costs, hasn’t sent Nails away for a new start. Nails is driving to his death. So, in defiance of his father, Clayton heads for Jacksonville to save his friend. Their friendship may remind readers of George Milton and Lennie Small in John Steinbeck’s 1937 novella, “Of Mice and Men” — although Nails isn’t as limited as Lennie.

The compelling tale, its tone alternately brutal and tender, unfolds at a breakneck pace. The character development is superb, the settings are vivid, and the prose is as tight as a noose. The plot is full of twists. Among them is a startling revelation about Dallas’s identity, introducing a sensitive subject that Panowich handles with understanding and grace.

Bruce DeSilva, winner of the Mystery Writers of America’s Edgar Award, is the author of the Mulligan crime novels including “The Dread Line.”

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