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Why is it important to do a literature review in research?

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 “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research”. Boote and Baile 2005

Authors of manuscripts treat writing a literature review as a routine work or a mere formality. But a seasoned one knows the purpose and importance of a well-written literature review.  Since it is one of the basic needs for researches at any level, they have to be done vigilantly. Only then the reader will know that the basics of research have not been neglected.

The aim of any literature review is to summarize and synthesize the arguments and ideas of existing knowledge in a particular field without adding any new contributions.   Being built on existing knowledge they help the researcher to even turn the wheels of the topic of research.  It is possible only with profound knowledge of what is wrong in the existing findings in detail to overpower them.  For other researches, the literature review gives the direction to be headed for its success. 

The common perception of literature review and reality:

As per the common belief, literature reviews are only a summary of the sources related to the research. And many authors of scientific manuscripts believe that they are only surveys of what are the researches are done on the chosen topic.  But on the contrary, it uses published information from pertinent and relevant sources like

• Scholarly books
• Scientific papers
• Latest studies in the field
• Established school of thoughts
• Relevant articles from renowned scientific journals

and many more for a field of study or theory or a particular problem to do the following:

• Summarize into a brief account of all information
• Synthesize the information by restructuring and reorganizing
• Critical evaluation of a concept or a school of thought or ideas
• Familiarize the authors to the extent of knowledge in the particular field
• Encapsulate
• Compare & contrast

By doing the above on the relevant information, it provides the reader of the scientific manuscript with the following for a better understanding of it:

• It establishes the authors’  in-depth understanding and knowledge of their field subject
• It gives the background of the research
• Portrays the scientific manuscript plan of examining the research result
• Illuminates on how the knowledge has changed within the field
• Highlights what has already been done in a particular field
• Information of the generally accepted facts, emerging and current state of the topic of research
• Identifies the research gap that is still unexplored or under-researched fields
• Demonstrates how the research fits within a larger field of study
• Provides an overview of the sources explored during the research of a particular topic

Importance of literature review in research:

The importance of literature review in scientific manuscripts can be condensed into an analytical feature to enable the multifold reach of its significance.  It adds value to the legitimacy of the research in many ways:

• Provides the interpretation of existing literature in light of updated developments in the field to help in establishing the consistency in knowledge and relevancy of existing materials
• It helps in calculating the impact of the latest information in the field by mapping their progress of knowledge.
• It brings out the dialects of contradictions between various thoughts within the field to establish facts
• The research gaps scrutinized initially are further explored to establish the latest facts of theories to add value to the field
• Indicates the current research place in the schema of a particular field
• Provides information for relevancy and coherency to check the research
• Apart from elucidating the continuance of knowledge, it also points out areas that require further investigation and thus aid as a starting point of any future research
• Justifies the research and sets up the research question
• Sets up a theoretical framework comprising the concepts and theories of the research upon which its success can be judged
• Helps to adopt a more appropriate methodology for the research by examining the strengths and weaknesses of existing research in the same field
• Increases the significance of the results by comparing it with the existing literature
• Provides a point of reference by writing the findings in the scientific manuscript
• Helps to get the due credit from the audience for having done the fact-finding and fact-checking mission in the scientific manuscripts
• The more the reference of relevant sources of it could increase more of its trustworthiness with the readers
• Helps to prevent plagiarism by tailoring and uniquely tweaking the scientific manuscript not to repeat other’s original idea
• By preventing plagiarism , it saves the scientific manuscript from rejection and thus also saves a lot of time and money
• Helps to evaluate, condense and synthesize gist in the author’s own words to sharpen the research focus
• Helps to compare and contrast to  show the originality and uniqueness of the research than that of the existing other researches
• Rationalizes the need for conducting the particular research in a specified field
• Helps to collect data accurately for allowing any new methodology of research than the existing ones
• Enables the readers of the manuscript to answer the following questions of its readers for its better chances for publication
• What do the researchers know?
• What do they not know?
• Is the scientific manuscript reliable and trustworthy?
• What are the knowledge gaps of the researcher?

22. It helps the readers to identify the following for further reading of the scientific manuscript:

• What has been already established, discredited and accepted in the particular field of research
• Areas of controversy and conflicts among different schools of thought
• Unsolved problems and issues in the connected field of research
• The emerging trends and approaches
• How the research extends, builds upon and leaves behind from the previous research

A profound literature review with many relevant sources of reference will enhance the chances of the scientific manuscript publication in renowned and reputed scientific journals .

References:

http://www.math.montana.edu/jobo/phdprep/phd6.pdf

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

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

For each publication, ask yourself:

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

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

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

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Conducting a literature review: why do a literature review, why do a literature review.

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

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

You identify:

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

It Also Helps You:

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

Great brief overview, from NCSU

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• Last Updated: Apr 25, 2024 1:10 PM
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Literature reviews, what is a literature review, learning more about how to do a literature review.

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

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

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

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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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Hannah Chapman Tripp : Biology, Neuroscience

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

Larayne Dallas : Engineering

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

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

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

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

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

• 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
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A literature review is not only a summary of key sources, but  has an organizational pattern which 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.

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].
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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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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Research outcomes informing the selection of public health interventions and strategies to implement them: A cross-sectional survey of Australian policy-maker and practitioner preferences

• Luke Wolfenden 1 , 2 , 3 ,
• Alix Hall 1 , 2 , 3 ,
• Adrian Bauman 1 , 4 , 5 ,
• Andrew Milat 6 , 7 ,
• Rebecca Hodder 1 , 2 , 3 ,
• Emily Webb 1 ,
• Kaitlin Mooney 1 ,
• Serene Yoong 1 , 2 , 3 , 8 , 9 ,
• Rachel Sutherland 1 , 2 , 3 &
• Sam McCrabb 1 , 2 , 3  

Health Research Policy and Systems volume  22 , Article number:  58 ( 2024 ) Cite this article

Metrics details

A key role of public health policy-makers and practitioners is to ensure beneficial interventions are implemented effectively enough to yield improvements in public health. The use of evidence to guide public health decision-making to achieve this is recommended. However, few studies have examined the relative value, as reported by policy-makers and practitioners, of different broad research outcomes (that is, measures of cost, acceptability, and effectiveness). To guide the conduct of research and better inform public health policy and practice, this study aimed at describing the research outcomes that Australian policy-makers and practitioners consider important for their decision-making when selecting: (a) public health interventions; (b) strategies to support their implementation; and (c) to assess the differences in research outcome preferences between policy-makers and practitioners.

An online value-weighting survey was conducted with Australian public health policy-makers and practitioners working in the field of non-communicable disease prevention. Participants were presented with a list of research outcomes and were asked to select up to five they considered most critical to their decision-making. They then allocated 100 points across these – allocating more points to outcomes perceived as more important. Outcome lists were derived from a review and consolidation of evaluation and outcome frameworks in the fields of public health knowledge translation and implementation. We used descriptive statistics to report relative preferences overall and for policy-makers and practitioners separately.

Of the 186 participants; 90 primarily identified as policy-makers and 96 as public health prevention practitioners. Overall, research outcomes of effectiveness, equity, feasibility, and sustainability were identified as the four most important outcomes when considering either interventions or strategies to implement them. Scores were similar for most outcomes between policy-makers and practitioners.

For Australian policy-makers and practitioners working in the field of non-communicable disease prevention, outcomes related to effectiveness, equity, feasibility, and sustainability appear particularly important to their decisions about the interventions they select and the strategies they employ to implement them. The findings suggest researchers should seek to meet these information needs and prioritize the inclusion of such outcomes in their research and dissemination activities. The extent to which these outcomes are critical to informing the decision of policy-makers and practitioners working in other jurisdictions or contexts warrants further investigation.

Peer Review reports

Research evidence has a key role in public health policy-making [ 1 ]. Consideration of research is important to maximize the potential impact of investments in health policies and services. Public health policy-makers and practitioners frequently seek out research to inform their professional decision-making [ 2 ]. However, they report that published research is not well aligned with their evidence needs [ 3 , 4 ]. Public health decision-making is a complex and dynamic process where evidence is used in a variety of ways, and for different purposes [ 3 , 5 , 6 ]. Ensuring research meets the evidence needs of public health policy-makers and practitioners is, therefore, an important strategy to improve its use in decision-making [ 7 , 8 , 9 , 10 ].

“Research outcomes” are broad domains or constructs measured to evaluate the impacts of health policies, practices or interventions, such as their effectiveness or acceptability. They are distinct from “outcome measures”, which are the measures selected to assess an outcome. Outcome measures require detailed specification of measurement parameters, including the measurement techniques and instrument, and consideration of the suitability of its properties (for example, validity) given the research question. The inclusion of research outcomes considered most relevant to public health policy-makers and practitioners is one way in which researchers can support evidence-informed decision-making.

Policy-makers are primarily responsible for developing public health policy and selecting and resourcing health programs. Practitioners are primarily responsible for supporting their implementation. As such, public health policy-makers and practitioners require research to: (i) help identify “what works” to guide the selection of interventions that will be beneficial for their community, for example, those that are effective in improving health, and acceptable to the target population and/or (ii) to help identify “how to implement” effective intervention, for example, strategies that are capable of achieving implementation at a level sufficient to accrue benefit, are affordable and reach the targeted population [ 6 , 11 ]. Research that includes outcomes relevant to these responsibilities facilitates evidence-informed decision-making by public health policy-makers and practitioners.

Initiatives such as the World Health Organization INTEGRATe Evidence (WHO INTEGRATE) framework [ 12 ], and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework [ 13 ] have been designed to support the selection of public health interventions. Application of these frameworks required the collation and synthesis of a range of scientific evidence including studies employing qualitative and quantitative research designs. Collectively, the frameworks suggest public health policy-makers and practitioners should consider, alongside research outcomes reporting the effectiveness of a public health intervention, other research outcomes such as cost–effectiveness, potential harms and acceptability of an intervention to patients or community.

Several authors have also sought to guide outcomes researchers should include in implementation studies [ 11 ]. Proctor and colleagues defined a range of implementation research outcomes [distinct from service or clinical (intervention) effectiveness outcomes] – including intervention adoption, appropriateness, feasibility, fidelity, cost, penetration and sustainability [ 14 ]. This work helped standardize how the field of implementation science defined, measured and reported implementation outcomes. More recently McKay and colleagues put forward measures of implementation “determinants” and “outcomes” and proposed a “minimum set” of such outcomes to include in implementation and scale-up studies. The implementation research outcomes proposed by both Proctor and McKay and colleagues were developed primarily from the input of researchers to improving the quality and consistency of reporting in implementation science. However, the relative value of these outcomes to the decision-making of public health policy-makers, and in particular practitioners, has largely been unexplored.

While several studies have explored policy-maker and practitioner research evidence preferences, these have focused on a small number of potential outcomes [ 15 , 16 , 17 ]. An appraisal of the potential value, and importance of a comprehensive range of research outcomes to public health policy-maker and practitioner decision-making, therefore, is warranted. In this study, we sought to quantify the relative importance of research outcomes from the perspective of Australian public health policy-makers and practitioners working in the field of non-communicable disease prevention (hereafter referred to as “prevention” policy-makers or practitioners). Specifically, using a value-weighting methodology to elicit relative preferences, the study aimed to describe: (a) research the outcomes prevention policy-makers and practitioners regard as important to their decision-making when selecting a public health intervention to address an identified health issue, (b), research the outcomes prevention policy-makers and practitioners regard as important to their decision-making when selecting a strategy to support the implementation of a public health intervention in the community and (c) assess the differences between prevention policy-makers and practitioners regarding their research outcome preferences.

Design and setting

An online cross-sectional value-weighting survey was conducted with Australian public health prevention policy-makers and practitioners. This study was undertaken as one step of a broader program of work to establish a core outcome set that has been prospectively registered on the Core Outcome Measures in Effectiveness Trials (COMET database; https://www.comet-initiative.org/Studies/Details/1791 ).

Participant eligibility

To be eligible, participants had to self-identify as having worked as a public health prevention policy-maker or practitioner at a government or non-government health organization within the past 5 years. While the term “policy-maker” has been used to describe legislators in US studies, in Australian research it has broadly been used to describe employees of government departments (or non-government agencies) involved in the development of public health policy [ 18 , 19 , 20 , 21 , 22 ]. Policy-makers are not typically involved in the direct implementation of policy or the delivery of health services. We defined a “policy-maker” as a professional who makes decisions, plans and actions that are undertaken to achieve specific public health prevention goals on behalf of a government or non-government organization [ 23 ]. Practitioners are typically employed by government or non-government organizations responsible for prevention service provision, and are directly involved in the implementation or supporting the implementation of public health policies or programs. Specifically, we defined a “practitioner” as a professional engaged in the delivery of public health prevention programs, implementing services or models of care in health and community settings (definition developed by research team). Research and evaluation are a core competency of the public health prevention workforce in Australia [ 24 ], as it is in other countries [ 25 ]. As such, participants may be engaged in research and have published research studies. Researchers, such as those employed by academic institutions only and without an explicit public health policy or practice role in a policy or practice organization, were excluded.

Recruitment

Comprehensive methods were used to recruit individuals through several agencies. First, email invitations were distributed to Australian government health agencies at local (for example, New South Wales Local Health District Population Health units), state (for example, departments or ministries of health) and national levels, as well as to non-government organizations (for example, Cancer Council) and professional societies (for example, Public Health Association Australia). Registered practitioners with the International Union for Health Promotion and Education (IUHPE) from Australia were contacted by public domain emails or on LinkedIn (where identified) with the study invitation. Authors who had published articles of relevant topics from 2018 to 2021 within three Australian public health journals [ Australian and New Zealand Journal of Public Health ( ANZJPH ), Health Promotion Journal of Australia ( HPJA ) and Public Health Research and Practice ( PHRP )] were invited to participate in the study. Invitation emails included links to the information statement for participants and the online survey. The online survey was also promoted on the social media account of a partnering organization [National Centre of Implementation Science (NCOIS)] as well as on Twitter and LinkedIn. From these social media accounts individuals could self-select to participate in the online survey. Reminder emails were sent to non-responders at approximately 2 and 4 weeks following the initial email invitation.

Data collection and measures

The online survey was kept on servers at the Hunter Medical Research Institute, New South Wales, Australia, and deployed using the REDCap software [ 26 ], a secured web-based application for building and managing online surveys and databases. The length of the survey was approximately 20–30 min in duration.

Professional characteristics

Participants completed brief items assessing their professional role (that is, practitioner or policy-maker), the number of years’ experience as policy-makers or practitioners, their professional qualifications and the prevention risk factors (for example, smoking, nutrition, physical activity, injury, sexual health, etc.) for which they had expertise.

Valued intervention and implementation outcomes

We sought to identify outcomes that may be valued by public health policy-makers and practitioners when making decisions about what policies and/or programs of interventions to implement and how implementation could best occur. We separated outcomes on this basis, consistent with recommendations of the evidence policy and practice [ 27 ], the effectiveness–implementation research typology [ 28 , 29 ] and trial conduct and reporting guidelines [ 30 ]. This is illustrated in a broad study logic model (Fig.  1 ).

Both effective interventions and effective implementation are required to improve health outcomes

The authors undertook a review of intervention- and implementation-relevant outcome frameworks to determine program and intervention outcomes that may be of interest to policy-makers and practitioners, including the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework [ 31 , 32 ], the Intervention Scalability Assessment Tool (ISAT) [ 18 ] and Proctor and colleagues’ implementation outcome definitions [ 14 ] as well as a series of publications on the topic [ 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. This was used to generate a comprehensive inventory of all possible outcomes (and outcome definitions) that may be of interest to public health policy-makers and practitioners. The outcome list was then reduced following grouping of outcomes addressing similar constructs or concepts. A panel of 16 public health policy-makers provided feedback on their perceived importance of each outcome for evidence-informed policy and practice decision-making, as well as the proposed outcome definition. This process occurred over two rounds until no further suggested improvements or clarifications were provided or requested, yielding a final list of 17 outcomes to inform the selection of public health intervention and 16 outcomes for the selection of implementation strategies (Additional file 1 : Table S1). Panel participants also pre-tested the survey instrument; however, they were not invited to participate in the value-weighting study.

Participating public health policy-makers and practitioners completed the value-weighting survey. Value-weighting surveys offer advantages over other methods to identify preferences (such as ranks or mean scores on a rating scale), as they provide an opportunity to quantify the relative preference or value of different dissemination strategies from the perspective of public health policy-makers or practitioners. Specifically, they were only presented with the list of outcomes and their definition, and were asked to select up to 5 of the 17 interventions “that they considered are critical to their decision-making when selecting a public health intervention to address an identified health issue” and 16 implementation outcomes “that they consider to be critical to their decision-making when selecting a strategy to support the implementation of a public health intervention in the community” in a decision-making context. Participants were then asked to value weight, allocating 100 points across their five (or less) intervention and implementation outcomes. A higher allocation of points represented a greater level of perceived importance. In this way, participants weight the allocation of points to outcomes based on preference. No statistical weights are applied in the analysis. Participants were asked to select up to five outcomes as this restriction forced a prioritization of the outcomes among participants. The identification of a small number of critical outcomes, rather than all relevant outcomes, is also recommended to facilitate research outcome harmonization [ 44 , 45 ].

Statistical analysis

All statistical analyses and data management were undertaken in SAS version 9.3. Descriptive statistics were used to describe the study sample. Similar to other value-weighting studies, we used descriptive analyses to identify the intervention and implementation outcomes ranked from highest to lowest importance [ 46 , 47 ]. Items not selected or allocated any points were assumed a score of 0, to reflect that they were not perceived as a high-priority outcome by the participant. Specifically, the mean points allocated to each of the individual outcomes were calculated and ranked in descending order. This was calculated overall for the entire participant sample, as well as separately by policy-makers and practitioners. As points were assigned in free-text fields, in instances where participants allocated more or less than 100 points across the individual items, the points they allocated were standardized to 100. Differences in the points allocated to each individual outcome by policy-maker/practitioner role were explored using Mann–Whitney U test. To examine any differences in the outcome preferences by participant risk factor expertise, we also examined and described outcome preferences among risk factor subgroups (with a combined sample of > 30 participants). These findings are discussed.

A total of 186 eligible participants completed the survey in part or in full.

Of the 186 participants, 90 primarily identified as policy-makers and 96 as public health prevention practitioners (Table  1 ). In all, 37% of participants (47% policy-makers, 27% practitioners) had over 15 years’ experience, and approximately one third (32% policy-makers, 36% practitioners) had a PhD. The most common areas of experience were nutrition and dietetics (38% policy-maker, 53% practitioner), physical activity or sedentary behaviour (46% policy-maker, 44% practitioner), obesity (49% policy-maker, 48% practitioner) and tobacco, alcohol or other drugs (51% policy-maker, 34% practitioner).

Valued outcomes

Intervention outcomes.

A total of 169 participants (83 policy-makers and 86 practitioners, with 7 and 10 missing, respectively) responded to the value-weighting questions for the 17 listed intervention outcomes. Table 2 (Fig.  2 ) reports the mean and standard deviation of points allocated by policy-makers and practitioners for each outcome, ranked in descending order to represent the most to least important. For policy-makers and practitioners combined, the effectiveness of an intervention, and its impact on equity, were clearly identified by participants as the leading two outcomes, with a mean allocation of 24.47 [standard deviation (SD) = 17.43] and 13.44(SD = 12.80), respectively. The mean scores for outcomes of feasibility (9.78) and sustainability (9.04) that ranked third and fourth, respectively, were similar; then scores dropped noticeably to 7.24 for acceptability and 5.81 for economic outcomes.

Line graph representing mean points allocated for the 17 intervention outcomes overall and by role

For most outcomes, average scores were similar for policy-makers and practitioners. However, practitioner scores for the outcome of acceptability (mean = 8.95, SD = 9.11), which ranked third most important for practitioners was significantly different than for policy-makers (mean = 5.48, SD = 9.62), where it was ranked seventh ( p  = 0.005). Economics/cost outcomes were ranked fifth by policy-makers (mean = 8.28, SD = 10.63), which significantly differed from practitioners (mean = 3.43, SD = 6.56), where it was ranked ninth ( p  = 0.002). For co-benefits, ranked eighth by policy-makers (mean = 4.37, SD = 7.78), scores were significantly different than for practitioners (mean = 2.27, SD = 6.49), where it was ranked thirteenth ( p  = 0.0215). Rankings for the top five outcomes were identical for those with expertise in nutrition and dietetics, physical activity or sedentary behaviour, obesity and tobacco, alcohol or other drugs (Additional file 1 : Table S2).

Implementation outcomes

A total of 153 participants (75 policy-makers and 78 practitioners, with 15 and 18 missing, respectively) responded to the value-weighting questions for the 16 listed implementation outcomes (Table  3 , Fig.  3 ). The effectiveness of an implementation strategy was clearly identified by participants as the most important intervention outcome, with a mean allocation of 19.82 (SD = 16.85) overall. The mean scores for the next three ranked outcomes namely equity (mean = 10.42, SD = 12.7), feasibility (mean = 10.2, SD = 12.91) and sustainability (mean = 10.08, SD = 10.58) were similar, and thereafter, scores noticeably dropped for measures of adoption (mean = 8.55, SD = 10.90), the fifth-ranked outcome.

Line graph representing mean points allocated for the 16 implementation outcomes overall and by role

For most implementation outcomes (Fig.  3 ) policy-makers and practitioners scores were similar. However, economics outcomes were ranked seventh for policy-makers with a mean = 5.58 (SD = 9.25), compared with practitioners who had a ranking of eleventh for this outcome (mean = 2.88, SD = 6.67). The difference in the points allocated were statistically significant between the two groups ( p  = 0.0439). Timeliness was ranked tenth most important for policy-makers, with a mean allocation of 4.03 (SD = 7.72), compared with practitioners who had a ranking of fourteenth for this outcome and a mean allocation of 2.05 (SD = 5.78). The difference in mean scores between policy-makers and practitioners on this outcome was not significant. Rankings and scores were similar for those with expertise in nutrition and dietetics, physical activity or sedentary behaviour, obesity and tobacco, alcohol or other drugs (Additional file 1 : Table S3).

Broadly, this study sought to better understand the information valued by public health policy-makers and practitioners to support their decisions regarding what and how interventions should be implemented in the community. The most valued research outcomes were the same regardless of whether policy-makers or practitioners were selecting interventions or implementation strategies. Namely outcomes regarding the effectiveness of interventions and implementation strategies. Following this, outcomes about equity, feasibility and sustainability also appeared to represent priorities. The study also found broad convergence among the most valued research outcomes, between policy-makers and practitioners, and across participants with expertise across different non-communicable disease (NCD) risk factors (for example, nutrition, obesity and tobacco). Such findings underscore the importance of research reporting these outcomes to support the translation of public health research into policy and practice.

For outcomes about decisions regarding intervention selection, the findings are broadly consistent with factors recommended by evidence-to-decision frameworks. For example, the top six ranked outcomes (effectiveness, equity, feasibility, sustainability, acceptability and economic), are also represented in both the WHO INTEGRATE framework [ 12 ] and the GRADE Evidence to Decision framework [ 13 ]. However, research outcomes about harms (adverse effects), which are included in both the WHO INTEGRATE and GRADE frameworks were ranked 13th by participants in this study. Such a finding was surprising given that potential benefits and harms of an intervention must be considered to appraise its net impact on patient or public health. Health professionals, however, do not have accurate expectations of the harms and benefits of therapeutic interventions. This appears particularly to be the case for public health professionals who acknowledge the potential for unintended consequences of policies [ 48 ] but consider these risks to be minimal [ 49 ]. The findings, therefore, may reflect the tendency of health professionals to overestimate the benefits of therapeutic interventions, and to a larger extent, underestimate harms [ 50 , 51 ]. In doing so, participants may have elevated their reported value of outcomes regarding the beneficial effectiveness of an intervention and discounted their value of outcomes reporting potential harms. Further research is warranted to substantiate this hypothesis, or explore whether other factors such as participant comprehension or misinterpretation of the outcome description may explain the finding. Nonetheless, the inclusion of measures of adverse effects (or harms) as trial outcomes is prudent to support evidence-informed public health decision-making, as is the use of strategies to facilitate risk communication to ensure the likelihood of such outcomes is understood by policy-makers and practitioners [ 52 , 53 , 54 ].

To our knowledge, this is the first study to examine the research evidence needs of public health policy-makers and practitioners when deciding on what strategies may be used to support policy or program implementation. Most of the eight implementation outcomes recommended by Proctor and colleagues [ 14 ] were ranked within the top eight by participants of this study. However, equity outcomes, ranked second by these participants, were not an outcome included in the list of outcomes defined by Proctor and colleagues. The findings may reflect public health values, which, as a discipline, has equity at its core [ 55 ]. It may also reflect the increasing attention to issues of health equity in implementation science [ 56 ].

Further, one of the eight Proctor outcomes, penetration – defined by Proctor and colleagues as the integration or saturation of an intervention within a service setting and its subsystems – was not ranked highly. Successful penetration implies a level of organization institutionalization of an intervention, which once achieved may continue to provide ongoing benefit to patients or populations. It may also suggest the capacity within the organization to expand implementation or adopt new interventions. Penetration outcomes, therefore, have been suggested to be particularly important to model and understand the potential impact of investment of scarce health resources in the implementation of public health policies and interventions [ 57 ].

At face value, such findings may suggest, at least from the perspective of public health policy-makers and practitioners, that penetration outcomes may not be particularly valued in terms of decision-making. However, it may also reflect a lack of familiarity with this term among public health policy-makers and practitioners, where related outcomes such as “reach” are more commonly used in the literature [ 14 , 58 ]. Alternatively it may be due to the conceptual similarity of this and other outcomes such as adoption, maintenance or sustainability. In other studies, for example, penetration has been operationalized to include the product of “reach”, “adoption” and “organizational maintenance” [ 58 ]. A lack of clear conceptual distinction may have led some participants to allocate points to related outcomes such as “adoption” rather than “penetration”.

The use of concept mapping techniques, consolidation of definitions of existing outcomes, and articulation of specific measures aligned to these outcomes may reduce some of these conceptual challenges. Indeed, best practice processes to develop core outcome sets for clinical trials suggest processes of engagement with end-users [ 45 ], stakeholders and researchers to articulate both broad outcomes and specific measures of these to support a shared understanding of important outcomes (and measures) to be included in such research. For example, there are many measures and economic methods to derive related to a broad outcome of “cost” (for example, absolute costs, cost–effectiveness, cost–benefit, cost–utility, and budget impact analysis) [ 59 ]. However, public health policy-makers’ preference or perceived value of these different measures to their decision-making will likely vary. While work in the field to map or align specific measures to broad outcomes is ongoing [ 57 , 58 , 60 ], extending this to empirically investigate end-user preferences for measures would be an important contribution to the field.

Broadly speaking, there was little variation in the outcomes valued between policy-makers and practitioners. However, economic evaluations were ranked as more important by policy-makers. The findings may reflect differences in the roles of Australian public health policy-makers and practitioners. That is, government policy-makers are often responsible for setting and financing the provision of public health programs, whereas health practitioners are responsible for directly supporting or undertaking their delivery. Economic considerations, therefore, may have greater primacy among policy-makers, who may be more likely to incur program costs [ 19 ]. Further research to explore and better understand these areas of divergence is warranted.

The study intended to provide information about outcomes that were generally of most use in public health policy and practice decision-making. However, such decisions are often highly contextual, and preferences may vary depending on the policy-maker or practitioner, the health issue to be addressed, the target population or broader decision-making circumstances [ 2 , 61 ]. As such, the extent to which the findings reported in this study generalize to other contexts, such as those working in different fields of public health, on different health issues or from countries or jurisdictions outside Australia is unknown. Future research examining the outcome preferences of public health policy-makers and practitioners in different contexts, therefore, is warranted.

The contextual nature of evidence needs of policy-makers and practitioners may explain, in part, the variability in outcome preferences. In many cases, for example, the mean of the outcome preference was less than its standard deviation. The interpretation of the study findings should consider this variability. That is, there is little distinguishing the mean preference ranks of many outcomes. However, the study findings at the extremes are unambiguous, suggesting clear preferences for the highest over the lowest ranking outcomes that did not differ markedly across policy-makers, practitioners or those with expertise in addressing different non-communicable disease risks such as nutrition, physical activity or tobacco or alcohol use.

Several study limitations are worth considering when interpreting the research findings. The initial inventory of outcomes was compiled from outcome frameworks, many of which were generic health or medical research outcomes that are uncommon in public health prevention research. There was considerable overlap in the outcomes included across frameworks, though how these were defined at times varied. Variability in outcome terminology has previously been identified as a problem for the field [ 62 ]. Despite being provided definitions for each, some participants may have responded to survey items based on their pre-existing understanding of these terms. Furthermore, following completion of the study, a programming error was identified whereby the definition of “Acceptability of the implementation strategy” was incorrectly assigned as “A measure of the uptake or reach of an implementation strategy”. The extent to which this may have influenced participant preferences is unclear, so sensitivity analysis was conducted by removing all participants who selected acceptability as a measure of interest. We conducted two analyses, one where the people who chose acceptability were removed but their other rankings remained and another where all their data were deleted. Results indicated that the top five outcomes did not differ after conducting the analysis, with only sustainability moving from fourth to second place in the second sensitivity analysis (Additional file 1 : Tables S4 and S5).

The pathway from research production to research in health policy or practice is complex. While a range of effective public health policies and interventions exist across a range of community settings [ 63 , 64 , 65 , 66 ], their implementation at a level capable of achieving population-level risk reductions remains elusive [ 67 , 68 , 69 , 70 ]. Nonetheless, undertaking research with end-use in mind, including reporting of outcomes valued by decision-makers, will likely facilitate the knowledge translation process [ 7 ]. In this study we found that outcomes related to effectiveness, equity, feasibility and sustainability appear important to decisions policy-makers and practitioners make about the interventions they select and the strategies they employ to implement public health prevention initiatives. Researchers interested in supporting evidence-informed decision-making should seek to provide for these information needs and prioritize such outcomes in dissemination activities to policy-makers and practitioners.

Contribution to the literature

It is essential to the research needs of policy-makers and practitioners to determine core outcomes to facilitate research use and knowledge translation.

Here we quantify the relative values of a variety of research outcomes commonly used in health research.

Findings suggest the primary outcomes of interest to public health prevention policy-makers and practitioners when making decisions about the selection of interventions and strategies to implement them are related to effectiveness, equity, feasibility and sustainability and that these do not differ markedly between public health prevention policy-makers and practitioners.

Availability of data and materials

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

Abbreviations

Australian and New Zealand Journal of Public Health

Health Promotion Journal of Australia

Intervention scalability assessment tool

Non-communicable disease

National Centre of Implementation Science

Public Health Research and Practice

World Health Organization

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This study was funded in part by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence – National Centre of Implementation Science (NCOIS) Grant (APP1153479) and a New South Wales (NSW) Cancer Council Program Grant (G1500708). LW is supported by an NHMRC Investigator Grant (G1901360).

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LW and SMc led the conception and design of the study, were closely involved in data analysis and interpretation and wrote the manuscript. AH, AB, AM and RH comprised the study advisory committee, reviewed the study’s methods and assisted with survey development. AH was responsible for data analysis. KM and EW assisted with survey development, data collection and preliminary analysis. AH, AB, AM, RH, SY and RS were involved in interpretation and revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

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Additional file 1:.

Table S1. Mean point allocations for each of the 17 intervention outcomes overall and by area of expertise (where field of expertise n ≥ 30). Table S2. Mean point allocations for each of the 16 implementation outcomes overall and by area of expertise (where field of expertise n ≥ 30). Table S3. Mean points for implementation outcomes overall and by area of expertise (field of expertise n ≥ 30). Table S4. Sensitivity analysis, participants who selected ‘acceptability’ removed from the analysis, their other rankings remained. Table S5. Sensitivity analysis, participants who selected ‘acceptability’ whole data set removed from the analysis.

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Wolfenden, L., Hall, A., Bauman, A. et al. Research outcomes informing the selection of public health interventions and strategies to implement them: A cross-sectional survey of Australian policy-maker and practitioner preferences. Health Res Policy Sys 22 , 58 (2024). https://doi.org/10.1186/s12961-024-01144-4

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Differences and common ground in the frameworks of health-related quality of life in traditional Chinese medicine and modern medicine: a systematic review

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• Yifan Ding   ORCID: orcid.org/0009-0006-8112-628X 1 ,
• Zhuxin Mao 2 ,
• Nan Luo 3 ,
• Zhihao Yang 4 &
• Jan Busschbach 1  

This systematic review aims to explore the conceptualization of health-related quality of life (HRQoL) in China. With HRQoL influenced by both modern medicine (MM) and traditional Chinese medicine (TCM), the study seeks to identify differences and common ground between the frameworks of MM and TCM as defined in the literature.

A systematic literature search was conducted across three Chinese databases and four English databases. The data was extracted including title, author(s), publication year, region, aim, method, category, and result. When sorting data, we broke down the HRQoL frameworks into concepts, domains and facets, with a focus on overlapped facets between the frameworks of MM and TCM.

A total of 31 studies were included. In the perspective of TCM, HRQoL is centered around three key 'concepts': (1) 'xingshentongyi' (unity of body and spirit), (2) 'tianrenheyi' (harmony between man and nature), and (3) 'qiqing' (seven emotional forms). In contrast, the MM framework comprises 'physical,' 'mental,' 'social,' and 'environment' domains. Out of the 59 unique facets identified, 28 are common to both TCM and MM, 9 specific to TCM, and 22 specific to MM. 'Appetite,' 'sleep,' and 'energy' are the most frequently mentioned facets in both frameworks.

The concept of HRQoL in China encompasses frameworks rooted in both TCM and MM. While TCM and MM have distinct healthcare approaches, they share overlapping domains when measuring HRQoL through questionnaires. Furthermore, TCM and MM demonstrate considerable convergence in terms of HRQoL facets, showing the potential for utilizing HRQoL instruments across different cultural settings.

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Plain English summary

Health-related quality of life (HRQoL) is about how people perceive their own health. The instruments used to measure it, even in China, are mostly devised in the West. However, it is increasingly understood that cultural distinctions might impact how we understand HRQoL, causing doubts about whether Western tools accurately represent this concept. This suggests that instruments created in the West might not fully grasp the health experiences of people in China, considering their unique cultural background. This systematic review study tries to understand from the literature how Chinese people think about HRQoL. It found two different ways of thinking about it: one based on modern medicine and the other on traditional Chinese medicine. Surprisingly, these ways of thinking lead to similar ideas about HRQoL. This study demonstrates the adaptability of HRQoL instruments across cultural settings with minimal adjustments. This challenging the notion that diverse cultures yield entirely distinct perspectives on HRQoL.

Introduction

Health-related quality of life (HRQoL) is a multi-dimensional concept. Despite the challenge of defining HRQoL, there is a broad consensus that HRQoL focuses on revealing people’s subjective evaluation of health [ 1 , 2 , 3 , 4 ]. Obtaining HRQoL information is crucial for comprehending patient health, making informed medical decisions [ 5 , 6 ], evaluating healthcare interventions, guiding public health policies, and ultimately contributing to evidence-based medicine [ 7 , 8 , 9 ]. Some HRQoL outcomes are preference-based, informing decisions on health products, technologies, and policies through QALY calculations [ 7 ]. Note that in this paper, we focus on HRQoL, rather than quality of life (QoL) in general.

The way we conceptualize HRQoL determines the specific health facets that we include in HRQoL measurements. To ensure valid and reliable HRQoL observations, standardized instruments are utilized. However, the recognition of cultural influences on HRQoL conceptualization has led to discussions about the suitability of Western-developed HRQoL measures in China [ 10 , 11 ]. Specifically, when Western instruments, grounded in a distinct cultural context, are applied to measure HRQoL in China, dimensions important to the Chinese population's understanding of health might be overlooked or not accurately captured. This misalignment can lead to an incomplete representation of the true HRQoL experienced by Chinese individuals [ 12 ].

For example, Prior et al. found that participants from Cantonese-speaking communities in England described HRQoL using facets related to traditional Chinese medicine (TCM), such as ‘demons’, ‘food’, and ‘weather’, alongside common Western facets [ 13 ]. Similarly, a Q-methodological study emphasized the importance of 'spirits' and 'body constitution' in describing HRQoL among Chinese living in China, which were often absent in commonly used instruments [ 11 ]. Additionally, Mao et al. compared Western and Chinese-developed HRQoL instruments and identified exclusive HRQoL domains in China, including ‘emotion control’, ‘weather adaption’, ‘social adaption’, ‘spirit’, and ‘complexion’ [ 8 ]. These new aspects of Chinese HRQoL appear to be linked to TCM, indicating that TCM could influence how people perceive and describe HRQoL. Alternatively, it's possible that the Chinese perspective on HRQoL shapes practices within TCM. Thus, it can be argued that Western-developed instruments may inadequately capture the health experiences of Chinese populations within their cultural context, for instance in neglecting the influence of TCM [ 8 , 10 , 14 ]. Consequently, using Western-developed HRQoL instruments to assess HRQoL in Chinese populations may not yield optimal results if there are conceptual differences between Western and Chinese perspectives [ 10 , 12 ].

Despite debates regarding the applicability of Western HRQoL instruments, the influence of culture on HRQoL conceptualization and instrument development remains unclear [ 15 ]. In China, efforts have been made by the scientific community to define HRQoL within a Chinese cultural context and use it to guide instrument development. However, there has been no systematic assessment, comparison, or synthesis of these Chinese-specific definitions or instruments. Consequently, it is still unclear how HRQoL is defined in China, and how these ‘Chinese definitions’ differ from those used in imported HRQoL instruments. This study aims to systematically review published studies that describe the theoretical and operationalised conceptualization of HRQoL. The objective is to explore and synthesize perceptions of HRQoL within a Chinese cultural setting.

This systematic review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 16 ], including the following four parts: search strategy, identification and selection, data extraction and quality assessment.

Search strategy and inclusion criteria

A comprehensive search was conducted across three Chinese databases (CNKI, Weipu, and Wanfang) and four English databases (EMBASE, MEDLINE, Web of Science, and Cochrane), in addition to a restricted search on Google Scholar. We applied specific inclusion criteria: (a) reporting HRQoL measures developed in a Chinese cultural setting; (b) discussing the definition of HRQoL in Chinese cultural setting or constructing a conceptual framework of HRQoL specifically to Chinese culture; (c) qualitative interviews exploring Chinese people's understandings of HRQoL. We excluded articles focusing on Western-based perspectives of HRQoL.

Both of detailed Chinese and English search strategies were presented in the Appendix 1 . The Chinese search strategy was developed through an internal discussion between the four Chinese researchers in team. When formulating the English strategy, we sought professional assistance from the librarians at Erasmus MC, followed by a discussion within the entire research team. To ensure a comprehensive search, we took into account potential spelling errors and synonyms when formulating the search strategies, as can be seen in the search strategies presented in the Appendix 1 .

Identification, selection and exclusion criteria

The research team reviewed all types of publications including original research, reviews, commentaries and dissertations. However, conference reports were excluded due to their potential lack of rigor and incomplete data. There were no constraints based on publication date other than the specified end date (March 3rd, 2022).

Two bilingual reviewers (YD and ZM) reviewed the titles and abstracts, applying the following exclusion criteria: (a) studies focused on a specific disease; (b) studies focused on a particular population (e.g., elderly or specific region); (c) studies utilizing existing instruments such as SF-36, EQ-5D, etc.; (d) studies focused on other constructs (e.g., happiness, well-being, life satisfaction); (e) studies focused on the target population which is not Chinese. Any disagreements between the reviewers were resolved through internal team discussions (ZM, ZY, and NL). The first author (YD) then conducted independent reviews of the resulting full-text articles. In cases where YD had doubts regarding the eligibility of a paper, the doubts were discussed with the review team. The review team consisted of one member with methodological expertise (ZM) and two individuals well-versed in the topic (ZY and NL). If disagreements persisted, they were resolved through consensus, but in case a consensus was not reached, an external opinion (JB) was sought.

Data extraction and analysis

According to the searching results, the key information of all eligible studies was extracted including the title, author, publish year, region, study aim, methods, and results (see Appendix 2 ). After reviewing, all eligible articles were categorized into two groups based on their content: definition and framework. The definition category focused on providing a general definition of HRQoL, while the framework category presented a detailed hierarchical system organizing specific health facets into health domains, and further grouped into health concepts. The category of each paper is documented in Appendix 2 . In the “ Results ” section, we extracted specific definitions from papers focusing on the general definition. For those paper that focused on the frameworks, we outlined the main hierarchical structure of domains and concepts. The specific facets for each instrument were documented in Appendix 3 .

This review aimed to synthesize the conceptualization of HRQoL, both theoretically (narrative definition) and operationally (HRQoL instrument presentation). In our approach to HRQoL frameworks, we employed a four-level hierarchy, which included concepts (the first level), domains (the second level), facets (the third level), and items (the fourth level). 'Concepts' represent the higher-order theoretical components of the theory, while 'domains' are the second-order aspects defined using 'items.' Given that closely related items may have different wording (e.g., walking, mobility, movement), we grouped similar items under the term 'facets'. In this study, we looked for the overlap in facets between MM and TCM. However, during the analysis process, we observed that some studies presented HRQoL from a TCM perspective, while others did not. These two perspectives resulted in two distinct conceptual frameworks (see “ Results ” section, Figs.  3 and 4 ).

For studies focusing on a general definition of HRQoL, frequently-mentioned health concepts (sometimes also health domains) were extracted. For studies providing detailed descriptive system, all specific facets were extracted. The extracted facets (see Appendix 3 ) were grouped by the reviewers, and the frequency of each facet was recorded (see Appendix 4 ). During the grouping process, we referred to the existing categories of descriptive systems as found in papers because most of them were already grouped by the designers of frameworks or instruments. If facets were classified into different groups in different frameworks or instruments, we made the classification after discussions within the review team. The grouping was independently conducted by two reviewers (YD and ZM), and any inconsistencies were resolved through internal team discussions.

Quality assessment

Normally, quality assessment for eligible studies is essential to a systematic review. However, after internal discussion, we opted not to conduct such an assessment in this review for maximizing the inclusion of studies. We were concerned that performing a quality assessment might inadvertently exclude relevant studies, resulting in the loss of valuable information. Nevertheless, the paper clearly written outside the scientific domain was excluded. These were articles that lacked 'scientific' jargon and failed to provide sufficient literature references to support the claims made in the article. For instance, it was found that a paper titled '20 New Concepts of Healthy Living,' which appeared more like a glossy magazine article than a scholarly contribution. As a result, such articles were considered unsuitable for inclusion in our study.

After removing duplicates, a total of 6437 English articles and 6169 Chinese articles were identified through database searches. Following title and abstract screening, 33 English studies and 87 Chinese studies remained. Full-text selection further reduced the number to 6 English articles and 25 Chinese articles. The detailed information of the included paper was provided in Appendix 2 . The selection process was illustrated in Figs.  1 and 2 of the PRISMA flow charts.

PRISMA flow diagram (English database)

PRISMA flow diagram (Chinese database)

During full-text review, the 31 included papers were primarily divided into two categories: focusing on general definitions of HRQoL and frameworks of HRQoL. Among them, 14 papers focus on providing a general definition of HRQoL, 11 papers delve into HRQoL frameworks, while 6 papers contain information pertaining to both the general definition and the framework. Additionally, a distinction was made between studies based on TCM perspectives and those using the perspective of modern medicine (MM). The categorization of each paper was provided in Appendix 2 .

The perspective of TCM on HRQoL

Based on the included papers focusing on general definition, we found that these papers introduced the foundational theory of TCM, which not only supplied potential corroborative evidence for TCM framework but also laid the foundation upon which TCM framework was developed.

The notion of 'Yin Yang' theory emerged most prominently as the foundational principle of TCM [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Additionally, the notion of 'Ping ren' [ 21 , 22 , 27 , 28 , 29 , 30 , 31 , 32 ] and 'He' [ 33 , 34 ] were also highlighted as the basis principle of TCM. The meanings of these principles are as follows. According to TCM, everything in the universe can be divided into two opposite but interconnected forces: Yin and Yang. For instance, the earth represents Yin, while the sky represents Yang, reflecting a universal concept. Specifically for human, the spirit is considered Yin, while the body is considered Yang. Health is believed to arise from the balance between Yin and Yang, both internally and within the surrounding environment. Additionally, individuals' health is influenced by the balance between different materials and the harmony between their 'Yin essence' and 'Yang spirit' [ 20 ].

Under the guidance of the general 'Yin Yang' theory, the most recognized definition of health is 'Ping ren' [ 21 , 22 , 27 , 28 , 29 , 30 , 31 , 32 ], which refers to a person in a healthy state with harmonious blood circulation, calm breathing, and steady pulse. TCM practitioners commonly view these indicators as signs of good health [ 19 , 22 , 24 ]. The concept of 'Yin Yang' aligns with another related phrase, 'He,' which emphasizes ‘harmony’ as the essence of health. 'He' represents the harmony between ‘Qi’ (energy in the broadest sense possible) and blood (important indicators of physical health in TCM) and the harmony of the spirit (associated with mental and emotional well-being). Both 'Yin Yang' and 'He' reflect characteristic philosophical thoughts in Chinese traditional culture [ 26 , 30 ].

In the identified studies, the three most commonly used concepts under the 'Yin Yang' theory for defining and measuring health were as follows: ‘Xing Shen Tong Yi'(形神统一) [ 17 , 18 , 19 , 20 , 22 , 25 , 26 , 27 , 31 , 33 , 35 , 36 , 37 ], 'Tian Ren He Yi'(天人合一) [ 17 , 19 , 20 , 22 , 25 , 26 , 27 , 28 , 35 , 37 , 38 ] and 'Qi Qing'(七情) [ 17 , 25 , 27 , 36 , 37 ].

Xing Shen Tong Yi

'Xing Shen Tong Yi' means the unity of body and spirit, which can be specifically divided into two domains: 'xing' and 'shen'. The 'xing' domain refers to the body structure, such as the viscera, meridians, essence, blood, muscles, limbs, and bones [ 19 ], focusing on physical health. By summarizing the included studies, the following facets were identified: stamina, sleep, appetite and digestion, complexion, stool, mobility, self-care, discomfort, pain, urination, voice, and constitution. These indicators can be used to confirm whether a person is physically healthy or not.

The 'Shen' domain has a broader meaning, which refers to both the gods of nature (i.e. natural phenomena and laws) and the mental state of the human body (i.e. emotions, will, personality, memory, and perception) [ 22 ]. By summarizing the included studies, the following facets were identified: thinking, verbal expression, consciousness, spirit of the eyes, memory, concentration, fatigue, confidence, and satisfaction. 'Xing Shen Tong Yi' also reflects the basic view of holism in TCM that people are an organic integrity, and that the body and mind are closely interdependent [ 20 ].

Tian Ren He Yi

TCM emphasizes the unity of the human body and its relationship with the external environment [ 17 , 27 ]. 'Tian Ren He Yi' emphasizes the harmony between humans and environment [ 17 , 20 , 35 ], which can be divided into two domains: natural environment and social environment.

In the 'natural environment' domain, TCM highlights the interconnectedness between humans and nature. Any changes or movements in nature will directly or indirectly affect the human body, such as seasonal climate changes, regional differences, leading to physiological discomfort or pathological changes [ 17 ]. This domain encompasses two facets: climate adaptation and adjustment, as well as dwelling conditions.

In the 'social environment' domain, TCM recognizes that humans are not only part of nature but also part of society. Health is influenced by various social factors, including political, economic, cultural, marriage, and interpersonal aspects. These factors will affect people's emotional changes, which can further impact the health of human. Common facets in this domain include socialization (e.g., communication, sex life, and loneliness), family (including family relationships, support, and conflicts), work (including relationships with colleagues and work performance), and economic conditions [ 39 ].

The concept of 'Tian Ren He Yi' is the direct embodiment of the relationship between human and environment. People's adaptation to the external environment is also the external embodiment of human health. Maintaining harmony between humans and the natural environment is of great importance [ 19 , 20 , 35 ].

In TCM, the concept of 'Qi Qing' refers to the seven basic emotions: joy, anger, worry, pensiveness, grief, fear, and anxiety [ 17 ]. According to TCM, these emotions are closely linked to the five internal organs to our body: heart, liver, spleen, lung, and kidney [ 36 , 37 ]. Each emotion corresponds to a specific organ, and when emotions become intense or unstable, they can disrupt the balance of ‘Qi’ (energy in the broadest sense possible) and blood, leading to physical problems. For example, anger affects the liver, joy affects the heart, pensiveness affects the spleen, worry affects the lung, and fear affects the kidney [ 17 ]. Therefore, maintaining emotional stability is essential for overall health and proper organ functioning.

Additionally, some of the definitions of HRQoL mentioned in the eligible studies may not fall within the purview of 'Yin Yang'. For instance, Confucianism emphasizes positive attitude and family relationships [ 18 , 22 ], as well as the concept of ‘moderation’ to maintain a healthy state [ 22 ]. Taoism highlights conforming to nature and maintaining peace of mind without overthinking [ 22 , 30 , 31 , 40 ]. Buddhism places importance on virtue and the theory of karma, where good behavior leads to positive outcomes, including physical health and mental satisfaction [ 18 , 22 ].

MM framework

From MM's perspective, two definitions were discussed. Firstly, one study adopted the definition from 'Ci Hai,' an authoritative Chinese dictionary [ 35 ]: ‘The state of well-developed organs and systems, normal functions, strong physique, full of energy, and high labor efficiency, which are usually measured through physical examination and various physiological indicators’ [ 41 ]. Secondly, most studies on HRQoL were based on the World Health Organization's (WHO) definition of ‘health’ [ 10 , 18 , 19 ]: ‘health is a complete state of physical, mental, and social well-being, not simply the absence of disease or infirmity’ [ 42 ]. The WHO definition of ‘health’ was not only used in defining HRQoL but also incorporated into the development of HRQoL instruments. Most studies defined HRQoL using the following three concepts: physical health, mental health, and social health, with some suggesting modifications. In the Chinese context, the concept of 'environment' such as dwelling conditions and changes in climate may be added [ 18 , 21 , 22 , 23 , 38 ]. The detailed framework results are shown in Figs.  3 and 4 .

Traditional Chinese medicine framework

Modern medicine framework

Physical health

The concept of 'physical health' can be divided into two domains: 'physical function' and 'physical senses'. In the domain of ‘physical function’, researchers focus on basic functions of body, such as appetite, sleep, mobility, daily activities, self-care, vision, hearing, body constitution, physical exercise, recreational activities, and heavy physical work. In the domain of ‘physical senses’, attention is given to discomfort, pain, and disease, reflected in facets such as pain, fatigue or tiredness, energy or vitality, body weight, dependence on medication, discomfort, complexion, body strength, and family medical history.

Mental health

'Mental health' consists of three domains: emotional experiences, mind-frame, and cognitive functions. In the domain of ‘emotional experiences’, common facets include depression, stress, anxiety, regularity in daily life, sex life, loneliness, worry, anger, fear, happy mood, no worry, and no pressure. The ‘mind-frame’ domain encompasses facets like self-confidence, morality, positive attitude, peace, breadth of mind, and sense of life satisfaction. Lastly, the ‘cognitive function’ domain includes facets such as memory, concentration ability, sharp mind, clear mind, decision-making ability, and thinking ability.

Social health

'Social health' can be divided into three domains: interpersonal relationships, work or school, and economic condition. ‘Interpersonal relationships’ emphasize the ability to communication with others and the adaptability to the environment. It includes the following facets: social interactions, good relationships and communications with others (e.g. friends, family and colleagues), social support, adaptability to social environment and burdens to others. The ‘work or school’ domain concerns task completion and performance in studies or job. Additionally, ‘economic conditions’ are also a crucial component of overall mental health.

Environment

Apart from the three fundamental WHO health concepts, namely physical, mental, and social health, the concept of 'environment' has also been recognized as an important factor in the included studies [ 18 , 21 , 22 , 23 , 38 ]. This domain encompasses the ability to adapt to changes in weather and living conditions.

Overlap between TCM and MM

Both TCM and MM break down their concepts of HRQoL into 'domains', as depicted in Figs.  3 and 4 . These domains demonstrate significant overlap between TCM and MM perspectives. They encompass intrapersonal (such as physical and emotional aspects) and interpersonal domains (such as relationships and work).

When these domains are operationalized into survey questions, the resulting 'facets' further reveal the similarities between TCM and MM. Figure  5 illustrates that many facets share common wording. Among the 59 facets identified, 28 were addressed in both TCM and MM, 9 were specific to TCM, and 22 were specific to MM. Among the shared facets, we found that 'appetite', 'sleep' and 'energy' were the most frequently mentioned facets in both frameworks.

Intersection diagram of the facets of TCM and the MM frameworks

This paper aims to explore and synthesize perceptions of HRQoL within a Chinese cultural setting. Our systematic review of relevant research reveals that two distinct perspectives existed in defining the conceptual frameworks of HRQoL in China: TCM and MM. To provide a comprehensive overview of these perspectives, we summarized the conceptual frameworks of both perspectives.

Firstly, it is challenging to define HRQoL. Mayo et al. proposed distinguishing between QoL and HRQoL [ 43 ]. However, Chinese studies often use the WHO's definition of 'health' instead of Mayo's HRQoL definition. The Chinese studies used the WHO’s definition of 'health' for defining HRQoL and also used the WHO definition of 'health' for the development of HRQoL instruments [ 10 , 18 , 19 ]. Meanwhile, examining HRQoL from TCM perspective reveals a focus on broader QoL aspects. TCM's emphasis on 'a balance between oneself and the environment' relates more to QoL than the narrow 'impact of disease and treatment' in the HRQoL definition from Mayo.

The two frameworks exhibit certain differences. On the level of concepts, TCM takes a holistic view, emphasizing the interconnectedness and interaction between body and mind, while MM does not. TCM framework uses terms like 'unity' and 'harmony' to underscore this holistic perspective and interaction, considering the inseparability of body and spirit [ 34 ]. By contrast, MM seems to be influenced by the theory of 'mind–body dualism,' separating the mind and body. According to the MM framework, individuals consist of two separate substances: body and mind, which can be described independently. As a result of these fundamental differences, the descriptions of HRQoL from these two frameworks consistently differ. Notably, though the HRQoL conceptual framework of TCM emphasizes the unity of health, instruments developed based on this conceptual framework often do not fully capture this unity. For instance, the Chinese Medicine Quality of Life-11 Dimensions (CQ-11D) emphasizes the unity of body and spirit but it still measures ‘body and ‘mind’ as two independent dimensions [ 33 ]. Therefore, we have observed that the idea of 'holistic' is difficult to embody in TCM instruments. This can be seen in Fig.  3 .

Differences in specific facets describing HRQoL are also evident (Fig.  5 ). The TCM framework incorporates unique diagnostic indicators, many of which are specific to TCM-related 'symptoms' such as 'defecation' and 'spirit of eyes'. In contrast, MM focuses on measurable physical phenomena like 'vision' and 'weight'. Our analysis highlights two main reasons for these differences. Firstly, TCM places emphasis on 'image thinking' [ 44 , 45 ], which involves intuitively grasping the abstract meaning of the world and its universal connections through intuition, metaphor, symbol, association, and analogy [ 45 , 46 , 47 ]. TCM employs various 'images,' such as tongue image, pulse image, and syndrome image [ 47 ]. Based on this idea, TCM generally collects patients' symptoms through ‘making observations, listening to breathing, asking about symptoms and taking the pulse (the four fundamental methods for diagnosis in TCM)’ for analysis and syndrome differentiation. However, MM focuses on analysing pathological mechanisms using objective and measurable examination results [ 48 ]. Secondly, the discrepancy in specific facets is related to a well-accepted concept known as sub-health, which refers to a state between illness and health [ 49 , 50 ]. Sub-health is characterized by experiencing different types of symptoms, both physical (e.g., pain, discomfort, fatigue) and mental (e.g., negative emotions, poor memory, inattention), for more than three months without any clear clinical attribution [ 51 , 52 ]. In MM, there is no specific diagnose for such health status specific diseases when individuals experience prolonged fatigue despite normal clinical indicators. However, TCM theories have significantly contributed to the widespread recognition and acceptance of the sub-health concept.

Despite some differences, these two conceptual frameworks also share similarities. As mentioned before, while each framework has its unique facets, there is a significant overlap between them, as shown in the middle section of Fig.  5 . This overlap may be inherent to TCM and MM, but can also be the result ‘borrowing’ aspect of TCM into MM and vice versa. The integration of these two frameworks can be observed in Fig.  5 . MM also acknowledges the interconnectedness and interaction of body and mind when considering HRQoL. For instance, in the MM framework, there are facets that resemble TCM facets, such as 'complexion', 'energy', and 'constitution'. Similarly, in the TCM framework, facets emphasized by MM seem to be borrowed, like 'self-care' and 'mobility'. Among the shared facets, we found that 'appetite', 'sleep' and 'energy' were the most frequently mentioned facets in both frameworks. These can be considered vital elements in how people in China define HRQoL. The importance of 'appetite' can be attributed to various factors, including China’s historical experiences with varying food supply and the social aspect of eating [ 53 ]. For example, sharing meals serves as a common way for people to establish and express connections with one another in China. Additionally, 'sleep' was also recognized as an essential facet in most HRQoL instruments within the Chinese cultural setting. TCM regards 'sleep' as crucial for well-being and preventing illness [ 54 , 55 , 56 ]. Compared to TCM, MM only recently acknowledges that sleep is vital for cognitive function, emotion, memory, endocrine balance, and immunity [ 57 ]. Furthermore, 'energy' was also frequently mentioned and covered by the two frameworks. In Chinese culture, 'energy' is closely related to the concept of 'Qi' (also spelled chi) in TCM [ 58 , 59 ]. Qi is believed to exist in all things, including air, water, food, and sunlight, and is often translated as 'vital energy'—a fundamental substance that builds and sustains the body [ 60 ]. Furthermore, it is important to recognize that concepts from two types of frameworks are divided into 'domains', and these domains exhibit considerable overlap (Figs.  3 , 4 ). These figures demonstrate that both frameworks describe HRQoL from four aspects: physical, mental, social, and adaptability to the natural environment. Although the theoretical basis and classification of the two frameworks may differ, the content is quite similar.

Although there are many overlapping facets between two frameworks, we still chose to describe HRQoL using two separate frameworks rather than combining them into one in this article. There are three main reasons: firstly, the original intention was to provide a comprehensive understanding of HRQoL in Chinese cultural. After a systematic literature review and content classification, we found that presenting two conceptual frameworks from different perspectives better represents the definition of HRQoL in China. Secondly, both frameworks have unique facets that cannot be merged. TCM includes facets such as 'urinate', 'stool', and 'spirit of eye', whereas the MM-based framework includes 'body weight', 'dependence on medication', and 'burdens to others'. Thirdly, even for overlapping facets, they have different classifications in each framework due to distinct theories. For example, 'emotions' holds different positions in the two frameworks. In TCM, it is considered a 'concept' contributing to overall health, ranked alongside 'the unity of form and spirit' and 'the unity of man and nature'. In MM, 'emotion' is a domain under the concept of 'mental health'. This divergence arises from MM viewing emotions as only a component of mental health, while TCM recognizes that emotions not only affect an individual's mental state but also have specific relationships with different organs in the body. As a result, TCM emphasizes the importance of maintaining emotional stability and avoiding extreme emotions for good health, leading us to list it separately in the TCM framework.

However, it would be beneficial to integrate these frameworks in future research. This integration aligns with the strategy of 'integrating Chinese and modern medicine', which is widely practiced in clinical practice in China. Integrative medicine, with its efficacy and complementary advantages, has emerged as one of the major medical systems alongside MM and TCM [ 61 ]. In Chinese clinical guidelines, it's common to find a combination of conventional disease diagnoses and traditional syndromes. While there are globally recognized standards for diagnosing diseases (such as the International Classification of Diseases, ICD-10), there's also an emphasis on identifying syndromes that reflect traditional Chinese characteristics [ 61 ]. Supported by the government policy, 'integrating Chinese and modern medicine' will continuously be the trend and our results also support this conclusion. It is evident that in the Chinese context, the definition of HRQoL cannot be adequately captured from a single perspective alone. Therefore, future research should aim to integrate the two HRQoL frameworks to provide a more comprehensive understanding.

The conclusion evokes questions whether we need a specific Chinese HRQoL instrument or if existing ones are sufficient. While instruments focused on 'Integrating Chinese and Modern medicine' naturally differ from Western-developed ones, it's important to assess if they truly benefit Chinese researchers internationally. We need to consider if a 'real Chinese HRQoL instrument' would be valuable outside of China, which could potentially devalue research from China and contradict the findings of the present study. Despite China having two well-developed HRQoL concepts, one possibly unique to China, they seem quite similar in terms of their main ideas.

As mentioned in the methods section, a limitation is the absence of a quality evaluation for the included articles. The second limitation is the inherent subjectively in classifying the concepts, domains and facets. In order to address this, we will employ 'concept mapping' in the future to provide a more objective exploration of the overlap in dimensions and facets between MM and TCM. The third limitation is that our research only included the general population and generic questionnaires. Patient-Reported Outcomes (PROs) are often diseases specific, such as cancer [ 62 ], but we were limited in the use of them due to the variance in patient groups, which would in turn impact how HRQoL is defined. However, this does not imply that PROs cannot be investigated. One potential solution could be to categorize specific disease groups. For instance, several authors have examined the applications and characteristics of PRO instruments as primary and secondary outcomes in randomized clinical trials in China [ 63 ], as well as the use of PROs in clinical trials of TCM [ 64 ] to promote and standardize PROs in China.

The present study is the first systematic review summarizing the conception of HRQoL in the Chinese cultural setting. We found two distinct frameworks of HRQoL exist in China, each basing on its own unique theory: MM and TCM, but arriving at some similar concepts, domains and facets.

Data availability

The data supporting the findings of this study are accessible in both the article and its supplementary material.

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Open Access funding enabled and organized by Erasmus Medical Center. This work was funded by EuroQol Foundation, the Netherlands. The study sponsor had no role in the design of the study, data collection, data management, data analysis, data interpretation, and issues regarding the publication of results. Views expressed by the authors in the publication do not necessarily reflect the views of the EuroQol Foundation.

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Ding, Y., Mao, Z., Luo, N. et al. Differences and common ground in the frameworks of health-related quality of life in traditional Chinese medicine and modern medicine: a systematic review. Qual Life Res (2024). https://doi.org/10.1007/s11136-024-03669-1

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