different approaches to literature review

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Writing a Literature Review

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

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

For each publication, ask yourself:

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

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

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

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

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

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

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

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

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Research 101: The Health Sciences

• Terminology
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• The Literature Review

What Is A Literature (Narrative) Review?

How to write a literature review.

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A literature review, also called a narrative review, is an analysis of published literature used to summarize a body of literature, draw conclusions about a topic, and identify research gaps. 

Reasons to Do a Literature Review

• Summarize a research topic or concept
• Explain the background of research on a topic
• Demonstrate the importance of a topic
• Identify research gaps/suggest new areas of research

A Literature Review is NOT

• Just a summary of sources
• A review of  all  literature on a topic
• A paper that argues for a specific viewpoint - a good literature review should avoid bias and highlight points of disagreement in the literature

1. Choose a topic & create a research question

• Use a narrow research question for more focused search results.
• Use a question framework such as PICO to develop your research question.
• Break down your research question into search concepts.

2. Select the sources for searching & develop a search strategy

• Identify databases to search for articles in.
• Develop a comprehensive search strategy using keywords, controlled vocabularies, and Boolean operators. 
• Reach out to a librarian for help!

3. Conduct the search

• Use a consistent search strategy, keeping it as similar as possible between the different databases you use.
• Use a citation manager to organize your search results.

4. Review the references

• Review each reference and remove articles that are not relevant to your research question.
• Take notes on each reference you keep. Consider using an Excel spreadsheet or other standardized way of summarizing information from each article.

5. Summarize Findings

• Synthesize the findings from the articles you reviewed into a final paper.
• The paper should cover the themes identified in the research, explain any conflicts or disagreements in the research, identify research gaps and potential future research areas, and explain the importance of the research topic.
• The Literature Review: A Few Tips On Conducting It See this article from the University of Toronto for more advice on writing a literature review.
• Ten Simple Rules for Writing a Literature Review In this article, the author shares ten simple rules learned working on about 25 literature reviews as a PhD and post doctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

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• Next: Types of Literature >>
• Last Updated: Apr 30, 2024 6:41 PM
• URL: https://culibraries.creighton.edu/health-sciences-research

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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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Types of Literature Review

There are many types of literature review. The choice of a specific type depends on your research approach and design. The following types of literature review are the most popular in business studies:

Narrative literature review , also referred to as traditional literature review, critiques literature and summarizes the body of a literature. Narrative review also draws conclusions about the topic and identifies gaps or inconsistencies in a body of knowledge. You need to have a sufficiently focused research question to conduct a narrative literature review

Systematic literature review requires more rigorous and well-defined approach compared to most other types of literature review. Systematic literature review is comprehensive and details the timeframe within which the literature was selected. Systematic literature review can be divided into two categories: meta-analysis and meta-synthesis.

When you conduct meta-analysis you take findings from several studies on the same subject and analyze these using standardized statistical procedures. In meta-analysis patterns and relationships are detected and conclusions are drawn. Meta-analysis is associated with deductive research approach.

Meta-synthesis, on the other hand, is based on non-statistical techniques. This technique integrates, evaluates and interprets findings of multiple qualitative research studies. Meta-synthesis literature review is conducted usually when following inductive research approach.

Scoping literature review , as implied by its name is used to identify the scope or coverage of a body of literature on a given topic. It has been noted that “scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review.” [1] The main difference between systematic and scoping types of literature review is that, systematic literature review is conducted to find answer to more specific research questions, whereas scoping literature review is conducted to explore more general research question.

Argumentative literature review , as the name implies, examines literature selectively in order to support or refute an argument, deeply imbedded assumption, or philosophical problem already established in the literature. It should be noted that a potential for bias is a major shortcoming associated with argumentative literature review.

Integrative literature review reviews , critiques, and synthesizes secondary data about research topic in an integrated way such that new frameworks and perspectives on the topic are generated. If your research does not involve primary data collection and data analysis, then using integrative literature review will be your only option.

Theoretical literature review focuses on a pool of theory that has accumulated in regard to an issue, concept, theory, phenomena. Theoretical literature reviews play an instrumental role in establishing what theories already exist, the relationships between them, to what degree existing theories have been investigated, and to develop new hypotheses to be tested.

At the earlier parts of the literature review chapter, you need to specify the type of your literature review your chose and justify your choice. Your choice of a specific type of literature review should be based upon your research area, research problem and research methods.  Also, you can briefly discuss other most popular types of literature review mentioned above, to illustrate your awareness of them.

[1] Munn, A. et. al. (2018) “Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach” BMC Medical Research Methodology

  John Dudovskiy

Literature Review: Types of Literature Reviews

• Literature Review
• Purpose of a Literature Review
• Work in Progress
• Compiling & Writing
• Books, Articles, & Web Pages

Types of Literature Reviews

• Departmental Differences
• Citation Styles & Plagiarism
• Know the Difference! Systematic Review vs. Literature Review

It is important to think of knowledge in a given field as consisting of three layers.

• First, there are the primary studies that researchers conduct and publish.
• Second, are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the original studies.
• Third, there are the perceptions, conclusions, opinions, and interpretations that are shared informally that become part of the lore of 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 several approaches to how they can be done, depending upon the type of analysis underpinning your study. Listed below are definitions of types of literature reviews:

Argumentative Review      This form examines literature selectively in order to support or refute an argument, deeply 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.

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

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

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

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

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

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

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

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How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

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

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

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

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

Types of Literature Reviews

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

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

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

Examples of Literature Reviews

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

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

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

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

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

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

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

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

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• Volume 19, Issue 1
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• Joanna Smith 1 ,
• Helen Noble 2
• 1 School of Healthcare, University of Leeds , Leeds , UK
• 2 School of Nursing and Midwifery, Queens's University Belfast , Belfast , UK
• Correspondence to Dr Joanna Smith , School of Healthcare, University of Leeds, Leeds LS2 9JT, UK; j.e.smith1{at}leeds.ac.uk

https://doi.org/10.1136/eb-2015-102252

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Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review.

Are there different approaches to undertaking a literature review?

What stages are required to undertake a literature review.

The rationale for the review should be established; consider why the review is important and relevant to patient care/safety or service delivery. For example, Noble et al 's 4 review sought to understand and make recommendations for practice and research in relation to dialysis refusal and withdrawal in patients with end-stage renal disease, an area of care previously poorly described. If appropriate, highlight relevant policies and theoretical perspectives that might guide the review. Once the key issues related to the topic, including the challenges encountered in clinical practice, have been identified formulate a clear question, and/or develop an aim and specific objectives. The type of review undertaken is influenced by the purpose of the review and resources available. However, the stages or methods used to undertake a review are similar across approaches and include:

Formulating clear inclusion and exclusion criteria, for example, patient groups, ages, conditions/treatments, sources of evidence/research designs;

Justifying data bases and years searched, and whether strategies including hand searching of journals, conference proceedings and research not indexed in data bases (grey literature) will be undertaken;

Developing search terms, the PICU (P: patient, problem or population; I: intervention; C: comparison; O: outcome) framework is a useful guide when developing search terms;

Developing search skills (eg, understanding Boolean Operators, in particular the use of AND/OR) and knowledge of how data bases index topics (eg, MeSH headings). Working with a librarian experienced in undertaking health searches is invaluable when developing a search.

Once studies are selected, the quality of the research/evidence requires evaluation. Using a quality appraisal tool, such as the Critical Appraisal Skills Programme (CASP) tools, 5 results in a structured approach to assessing the rigour of studies being reviewed. 3 Approaches to data synthesis for quantitative studies may include a meta-analysis (statistical analysis of data from multiple studies of similar designs that have addressed the same question), or findings can be reported descriptively. 6 Methods applicable for synthesising qualitative studies include meta-ethnography (themes and concepts from different studies are explored and brought together using approaches similar to qualitative data analysis methods), narrative summary, thematic analysis and content analysis. 7 Table 1 outlines the stages undertaken for a published review that summarised research about parents’ experiences of living with a child with a long-term condition. 8

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An example of rapid evidence assessment review

In summary, the type of literature review depends on the review purpose. For the novice reviewer undertaking a review can be a daunting and complex process; by following the stages outlined and being systematic a robust review is achievable. The importance of literature reviews should not be underestimated—they help summarise and make sense of an increasingly vast body of research promoting best evidence-based practice.

• ↵ Centre for Reviews and Dissemination . Guidance for undertaking reviews in health care . 3rd edn . York : CRD, York University , 2009 .
• ↵ Canadian Best Practices Portal. http://cbpp-pcpe.phac-aspc.gc.ca/interventions/selected-systematic-review-sites / ( accessed 7.8.2015 ).
• Bridges J , et al
• ↵ Critical Appraisal Skills Programme (CASP). http://www.casp-uk.net / ( accessed 7.8.2015 ).
• Dixon-Woods M ,
• Shaw R , et al
• Agarwal S ,
• Jones D , et al
• Cheater F ,

Twitter Follow Joanna Smith at @josmith175

Competing interests None declared.

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How To Write A Literature Review In 9 Simple Steps

Need help on how to write a literature review? Follow these 9 simple steps to create a well-structured and comprehensive literature review.

Table of Contents

What Are The Parts Of A Literature Review

The body: summarizing, synthesizing, analyzing, and evaluating, the conclusion: summarizing and connecting, related reading, different styles of literature reviews, summarization of prior work vs. critical evaluation, chronological vs. categorical and other types of organization, unriddle: read faster and write better, defining the research scope, identifying the literature, reading and evaluating articles, analyzing the literature, organizing selected papers, critically analyzing the literature, developing a thesis or purpose statement, writing the paper, reviewing your work, complete step-by-step guide on how to use unriddle's ai research tool, interact with documents, automatic relations, citing your sources, writing with ai, chat settings, literature review strategies, read faster & write better with unriddle for free today, efficient literature review, seamless citation management, enhanced writing with unriddle's ai autocomplete suggestions, collaborative workspace: unriddle's platform for teamwork, streamlining literature reviews.

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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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Literature Review Guide: How to organise the review

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• How to start?
• Search strategies and Databases
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• How to organise the review
• Library summary
• Emerald Infographic

How to structure your literature review (ignore the monotone voice as advice is good)

How to structure and write your literature review

• Chronological, ie. by date of publication or trend
• Methodological
• Use Cooper's taxonomy to explore and determine what elements and categories to incorporate into your review
• Revise and proofread your review to ensure your arguments, supporting evidence and writing is clear and precise

Cronin, P., Ryan, F. & Coughlan, M. (2008). Undertaking a literature review: A step-by-step approach . British Journal of Nursing, 17 (1), pp.38-43.

Different ways to organise a Literature Review

CHRONOLOGICAL (by date): This is one of the most common ways, especially for topics that have been talked about for a long time and have changed over their history. Organise it in stages of how the topic has changed: the first definitions of it, then major time periods of change as researchers talked about it, then how it is thought about today.

BROAD-TO-SPECIFIC : Another approach is to start with a section on the general type of issue you're reviewing, then narrow down to increasingly specific issues in the literature until you reach the articles that are most specifically similar to your research question, thesis statement, hypothesis, or proposal. This can be a good way to introduce a lot of background and related facets of your topic when there is not much directly on your topic but you are tying together many related, broader articles.

MAJOR MODELS or MAJOR THEORIES : When there are multiple models or prominent theories, it is a good idea to outline the theories or models that are applied the most in your articles. That way you can group the articles you read by the theoretical framework that each prefers, to get a good overview of the prominent approaches to your concept.

PROMINENT AUTHORS : If a certain researcher started a field, and there are several famous people who developed it more, a good approach can be grouping the famous author/researchers and what each is known to have said about the topic. You can then organise other authors into groups by which famous authors' ideas they are following. With this organisation it can help to look at the citations your articles list in them, to see if there is one author that appears over and over.

CONTRASTING SCHOOLS OF THOUGHT : If you find a dominant argument comes up in your research, with researchers taking two sides and talking about how the other is wrong, you may want to group your literature review by those schools of thought and contrast the differences in their approaches and ideas.

Ways to structure your Literature Review

Different ways to organise your literature review include:

• Topical order (by main topics or issues, showing relationship to the main problem or topic)
• Chronological order (simplest of all, organise by dates of published literature)
• Problem-cause-solution order
• General to specific order
• Known to unknown order
• Comparison and contrast order
• Specific to general order
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The Literature Review: 5. Organizing the Literature Review

• 1. Introduction
• 2. Why Do a Literature Review?
• 3. Methods for Searching the Literature
• 4. Analysing the Literature
• 5. Organizing the Literature Review
• 6. Writing the Review

1. Organizing Principles

A literature review is a piece of discursive prose, not a list describing or summarizing one piece of literature after another. It should have a single organizing principle:

• Thematic - organize around a topic or issue
• Chronological - sections for each vital time period
• Methodological - focus on the methods used by the researchers/writers

4. Selected Online Resources

• Literature Review in Education & Behavioral Sciences This is an interactive tutorial from Adelphi University Libraries on how to conduct a literature review in education and the behavioural sciences using library databases
• Writing Literature Reviews This tutorial is from the Writing section of Monash University's Language and Learning Online site
• The Literature Review: A Few Tips on Conducting It This guide is from the Health Services Writing Centre at the University of Toronto
• Learn How to Write a Review of the Literature This guide is part of the Writer's Handbook provided by the Writing Center at the University of Wisconsin-Madison

2. Structure of the Literature Review

Although your literature review will rely heavily on the sources you read for its information, you should dictate the structure of the review. It is important that the concepts are presented in an order that makes sense of the context of your research project.

There may be clear divisions on the sets of ideas you want to discuss, in which case your structure may be fairly clear. This is an ideal situation. In most cases, there will be several different possible structures for your review.

Similarly to the structure of the research report itself, the literature review consists of:

• Introduction

Introduction - profile of the study

• Define or identify the general topic to provide the context for reviewing the literature
• Outline why the topic is important
• Identify overall trends in what has been published about the topic
• Identify conflicts in theory, methodology, evidence, and conclusions
• Identify gaps in research and scholarlship
• Explain the criteria to be used in analysing and comparing the literature
• Describe the organization of the review (the sequence)
• If necessary, state why certain literature is or is not included (scope)

Body - summative, comparative, and evaluative discussion of literature reviewed

For a thematic review:

• organize the review into paragraphs that present themes and identify trends relevant to your topic
• each paragraph should deal with a different theme - you need to synthesize several of your readings into each paragraph in such a way that there is a clear connection between the sources
• don't try to list all the materials you have identified in your literature search

From each of the section summaries:

• summarize the main agreements and disagreements in the literature
• summarize the general conclusions that have been drawn
• establish where your own research fits in the context of the existing literature

5. A Final Checklist

• Have you indicated the purpose of the review?
• Have you emphasized recent developments?
• Is there a logic to the way you organized the material?
• Does the amount of detail included on an issue relate to its importance?
• Have you been sufficiently critical of design and methodological issues?
• Have you indicated when results were conflicting or inconclusive and discussed possible reasons?
• Has your summary of the current literature contributed to the reader's understanding of the problems?

3. Tips on Structure

A common error in literature reviews is for writers to present material from one author, followed by information from another, then another.... The way in which you group authors and link ideas will help avoid this problem. To group authors who draw similar conclusions, you can use linking words such as:

• additionally

When authors disagree, linking words that indicate contrast will show how you have analysed their work. Words such as:

• on the other hand
• nonetheless

will indicate to your reader how you have analysed the material. At other times, you may want to qualify an author's work (using such words as specifically, usually, or generally ) or use an example ( thus, namely, to illustrate ). In this way you ensure that you are synthesizing the material, not just describing the work already carried out in your field.

Another major problem is that literature reviews are often written as if they stand alone, without links to the rest of the paper. There needs to be a clear relationship between the literature review and the methodology to follow.

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Development of a standardised framework with universal core indicators for flood resilience assessment

• Original Paper
• Published: 30 April 2024

Cite this article

• Shiying Xu 1 , 2 ,
• Hao Chen 1 ,
• Adrian Wing-Keung Law 1 , 2 ,
• Feng Zhu   ORCID: orcid.org/0000-0002-9814-6053 1 , 2 ,
• Daniel Martini 1 , 3 &
• Martin Lim 1 , 3  

Understanding the flood resilience of an area is an important task for decision-makers, practitioners, and community members. However, despite the wide acceptance of the need for resilience assessment in recent years, there has been no clear agreement on what flood resilience exactly constitutes and thus no consensus on the way in which it should be quantified. As such, this study aims to identify the most pivotal indicators to establish a standardised sustainable flood resilience framework (SFRF) for an overall measure of resilience before a flood event. The framework uses the United Nations Sustainable Development Goals (UN SDG) indicators as a benchmark to establish a measurement structure that can be consistently implemented globally, using publicly sourced data. Users of the SFRF will be able to assess whether their target area has successfully achieved the conditions required for flood resilience and as a result, the associated UN SDG targets. A detailed review of 55 journal articles related to flood resilience assessment was first conducted to identify the most frequently used indicators globally across the different frameworks in the literature. A hybrid method using the decision-making trial and evaluation laboratory (DEMATEL) approach combined with the analytic network process (ANP) was then adopted to rank the top indicators in terms of their importance in evaluating the flood resilience. Finally, two examples are provided to show how the SFRF established in this study can enable users to make a universally standardised assessment of the level of flood resilience for a specific area.

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This study is supported under the RIE2020 Industry Alignment Fund – Industry Collaboration Projects (IAF-ICP) Funding Initiative, as well as cash and in-kind contribution from Surbana Jurong Pte Ltd.

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Xu, S., Chen, H., Law, A.WK. et al. Development of a standardised framework with universal core indicators for flood resilience assessment. Nat Hazards (2024). https://doi.org/10.1007/s11069-024-06631-z

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Published on 25.4.2024 in Vol 12 (2024)

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

Authors of this article:

• Sari Palojoki 1, * , PhD ; 
• Lasse Lehtonen 2, * , MD, PhD ; 
• Riikka Vuokko 1, * , PhD

1 Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, , Helsinki, , Finland

2 Diagnostic Center, Helsinki University Hospital District, , Helsinki, , Finland

*all authors contributed equally

Corresponding Author:

Sari Palojoki, PhD

Background: Semantic interoperability facilitates the exchange of and access to health data that are being documented in electronic health records (EHRs) with various semantic features. The main goals of semantic interoperability development entail patient data availability and use in diverse EHRs without a loss of meaning. Internationally, current initiatives aim to enhance semantic development of EHR data and, consequently, the availability of patient data. Interoperability between health information systems is among the core goals of the European Health Data Space regulation proposal and the World Health Organization’s Global Strategy on Digital Health 2020-2025 .

Objective: To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on semantic interoperability development, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development?

Methods: Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits of these choices in the context of EHRs. Therefore, we performed a systematic literature review in PubMed by defining our study framework based on previous research.

Results: Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases (eg, registers).

Conclusions: When heading toward semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual model or multimodel approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes.

Introduction

Over the past 2 decades, there has been growing interest in digital technologies and eHealth integration into national health care systems to promote health [ 1 ]. The World Health Organization (WHO) has launched the Global Strategy on Digital Health 2020-2025 [ 2 ]. To implement digital health strategy objectives, a toolkit was set up to help countries to integrate eHealth into their health care systems [ 3 ]. The objectives of the WHO strategy include standards for interoperability. Another current large-scale international initiative is the European Health Data Space (EHDS) regulation proposal. EHDS is a health-specific ecosystem comprised of rules, common standards and practices, infrastructures, and a governance framework. It supports the use of health data for better health care delivery, research, innovation, and policy making. Moreover, it aims at empowering patients through increased digital access to and control of their personal health data [ 3 - 6 ].

Interoperability ensures health data availability and use. It is the ability of different organizations and professionals to interact and share information according to standards of data transfer and common protocols that support data exchange [ 4 - 8 ]. In clinical context, interoperable electronic health records (EHRs) help health care practitioners gather, store, and communicate essential health information reliably and securely across care settings. This aims to guarantee coordinated and patient-centered care while creating many efficiencies in the delivery of health care [ 9 ]. EHRs use health-related information pertinent to an individual patient, whereas registries are mainly focused on population management and are designed to obtain information on predefined health outcomes data and data for public health surveillance, for example. Although technological possibilities for using various types of data grow, new demands are placed on data quality and usability and, consequently, on interoperability [ 5 , 10 , 11 ].

Moreover, semantic interoperability enhances the unambiguous representation of clinical concepts, supported by the use of international standard reference systems and ontologies. Since there are different types of health information, such as data from EHRs, patient registries, genomics data, and data from health applications, the development of international data standardization, common guidelines, and recommendations are needed [ 4 - 8 ]. Without applying appropriate semantic standards, such as domain-relevant terminologies, interoperability will be limited. This may diminish the availability and potential value of data. The various parties involved have to address the importance of shared digital health standards and especially semantic interoperability features [ 12 - 15 ]. In the clinical context, interoperability is required to enhance the quality, efficiency, and effectiveness of the health care system by providing information in the appropriate format whenever and wherever it is needed by eliminating unnecessary replication [ 16 ].

Therefore, our study aims to provide readers with up-to-date information about the different types of approaches to resolve semantic interoperability in EHRs specifically and to summarize the benefits of these choices. We aimed to research the topic with an emphasis on patient data availability and use. Our research questions were as follows: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development?

Methodological Framework

With our research questions as a starting point, we set out to perform a systematic literature review of semantic interoperability. Regarding different layers of interoperability, legal interoperability ensures overcoming potential barriers for data exchange. Interoperability agreements are made binding via international- or national-level legislation and via bilateral and multilateral agreements. Organizational interoperability defines, for example, business goals and processes. Semantic interoperability ensures that the precise meaning of exchanged information is understandable by any other application. It enables systems to combine received information with other information resources and process it in a meaningful manner. Technical interoperability covers various issues of linking computer systems and services, such as open interfaces, data integration, data presentation and exchange, accessibility, and security services [ 6 , 7 ].

For the study design, we first defined our core concepts to refine the literature search strategy. The scope of the review was semantic interoperability, that is, organizational, legal, and technical interoperability were excluded [ 7 ]. Semantic interoperability was apprehended based on the European Interoperability Framework (EIF) that provides a common set of principles and guidance for the design and development of interoperable digital services. In the EIF, semantic interoperability covers both semantic and syntactic aspects. The semantic aspect refers to the meaning of data elements and their relationships, whereas the syntactic aspect refers to the format of the information to be exchanged. With semantic interoperability, it is ensured that data can be shared in such a way that the meaning of data does not change [ 7 , 15 , 17 , 18 ]. There are also other models for analyzing interoperability layers [ 18 ]. For example, in comparison to the European approach [ 7 ], the Healthcare Information and Management Systems Society defines 4 levels of interoperability for health care technology: foundational, structural, semantic, and organizational [ 19 , 20 ]. Since the EIF is a well-established and largely applied framework [ 6 ], we chose the EIF definitions to primarily guide our review framework, as illustrated in Figure 1 . Our review deals with semantic interoperability, which is highlighted in gray in the figure. Thus, we did not analyze, for example, standards that are related to processes or information quality.

As shown in Figure 1 , processing, storing, and exchanging health care data in EHRs and between EHRs or other clinical applications is, for example, governed and regulated at the legal layer. To continue, processes and workflows regarding information exchange are arranged at the organizational interoperability layer and resolved in the technical layer, for example, according to the principles of data protection and information security. To illustrate the point, for example, the EHDS proposal suggests that compliance with essential requirements on interoperability and data security may be demonstrated by the manufacturers of EHR systems through the implementation of common specifications. To that end, implementation can be grounded on common specifications, such as data sets, coding systems, technical specifications, standards, and profiles for data exchange, as well as requirements and principles related to security, confidentiality, integrity, patient safety, and he protection of personal data and so on [ 6 ].

The semantic interoperability layer in Figure 1 covers various approaches to resolve interoperability issues, such as more established international or domain-specific health care classifications, clinical terminologies, and ontologies and applications of international standards for EHRs. In Figure 1 , we provided some examples to illustrate various semantic aspects, but this is not an exhaustive list. Similarly, for other interoperability levels, real-world examples were given. Based on the EIF, semantic interoperability also covers syntactic features, such as data format and, for example, structured data content. We identified these key features of semantic interoperability based on previous research [ 8 , 16 - 19 , 21 ]. In our framework, a data model is a generic concept that describes various applications of data models from a reference information model (RIM) to a clinical information model. Data models define structures and semantics for storing, exchanging, querying, and processing health care data. Clinical information models can be implemented in an EHR, for example, as archetypes and templates, whereas RIMs refer to standards-based approaches to enable health care documentation and messages, such as the Health Level 7 (HL7) RIM or the International Organization for Standards’ EN/ISO 13606 standard for EHR communication [ 19 , 22 ]. When designing EHRs, for semantic interoperability, a dual-level method can be applied to represent both information and knowledge levels of interoperability requirements, properties, and structures for data. This approach is used, for example, for representing the dual levels of knowledge by an archetype model and information structures by the chosen RIM [ 16 , 21 , 22 ].

Study Design

In the design of the review, we applied the Cochrane review protocol [ 23 ] to ensure the scientific reliability and validity of our review ( Checklist 1 ). The search strategy (see Textbox 1 ) was defined based on the framework for semantic interoperability presented in Figure 1 . We performed the search in the PubMed database in December 2022. To conduct a systematic literature review, PubMed is regarded as a comprehensive database [ 24 ]. Therefore, no further data searches were performed. We documented the search so that it can be reproduced (see Textbox 1 ). The search resulted in 131 unique articles. One article was removed because it did not include an abstract, and 1 was removed because it was not in English. In total, the authors screened 129 articles.

• Search terms: (((((EHR) OR (EMR)) OR (“Electronic Health Record”)) OR (“Electronic Medical Record”)) AND (((((“Semantic interoperability”) OR ((“data model”) AND (“Semantic interoperability”))) OR ((((“classification”) OR (ontology)) OR (terminology)) AND (“Semantic interoperability”))) OR (((“data content”) OR (“data format”)) AND (“Semantic interoperability”))) OR ((“Semantic interoperability”) AND (standard)))
• Filters used: abstract, full text, and English

The research team first screened all the remaining articles by title and abstract from January to March 2023. After the first test reading, the researchers discussed the inclusion and exclusion criteria and coherence of the understanding. Researchers were blinded and performed the analysis independently based on the inclusion and exclusion criteria and then compared the results. Selecting the same alternative created a match. Choosing a different alternative or failing to recognize the category at all was considered a nonmatch. In data-model cases, discussion was needed for alignment, but no complex situations developed. During the first screening, after discussion by the research team, 71 articles were excluded from the review for the following four reasons: (1) EHR was not a key factor but a contextual factor in the original research setting; (2) the original research did not focus on semantic interoperability but on another level of interoperability; (3) the original study did not entail practical implementation goals, but the focus was predominantly theoretical or methodological; and (4) the original research was not a research article but, for example, a poster. The remaining 58 articles were sought for retrieval. For 4 articles, the full text was not available. To evaluate eligibility, full texts of the 54 remaining articles were read by the research team. At this point, 17 articles were excluded because the original research was out of scope, that is, semantic interoperability was not developed with practical goals for advancing the availability and use of interoperable patient data. In addition, 15 articles were excluded as the semantic interoperability case did not involve EHR use or development, 3 articles were excluded due to the absence of semantic interoperability altogether, and 5 more were excluded because they were not research articles. After agreeing upon the final exclusion within our research team, 14 articles were analyzed for semantic interoperability in EHRs. Our final inclusion criteria were grounded on our research questions: the research article should explore an EHR use or development case with the focus on semantic interoperability of clinical data. Preferably, the case would document the stage of interoperability development or use, expected or realized clinical benefits, semantic development goals, and aspects of interoperability to be implemented, as well as the method of application.

The extraction and documentation of the information from the research articles was informed by our research questions, the review framework ( Figure 1 ), and by previous research literature. At this stage, previous reviews [ 16 - 19 , 21 ] were especially used in compiling our study framework (see Figure 1 ). Based on our framework, the documentation of the review analysis included elements of interoperability already identified in the search strategy. Consequently, it was necessary to investigate which documented elements are typically examined in research and with what methods they are applied in EHRs [ 8 , 16 - 18 ]. Moreover, we deemed it important to document how semantic interoperability is described in the clinical use context, consisting of various EHRs, clinical applications, registers, and other data resources. Lastly, the information documentation had to include not only the semantic implementation, use goals, or intended benefits but also practical goals or benefits in the clinical use context (see Figure 2 ). We defined and agreed upon the information documentation categories within our research team to conduct a well-grounded analysis for the review.

Contextual Results

We identified 14 articles describing semantic interoperability in EHRs, published between 2011 and 2022, as shown in Multimedia Appendix 1 [ 24 - 37 ]. The results revealed predominantly European advances in the study topic. Most (n=11, 79%) of the research cases were affiliated with different types of institutions in the European Union member states or in European Economic Area countries. One of the publications was coproduced by authors from Columbia and Germany, and the authors of another article represented organizations from the United States, South Korea, China, and Egypt. We decided not to limit the included studies to a certain geographical area but to analyze any potential use case for enabling the interoperability of EHRs.

Two of the reported research cases focused on patients with heart failure [ 24 , 30 ], 1 focused on patients with neurosurgical tumors [ 28 ], 2 focused on patients in cancer care [ 33 , 37 ], and 1 focused on patients with type 1 diabetes [ 31 ]. Other clinical use domains described were a prehospital unit at the site of an incident or during transfer to the emergency department and a hospital emergency care unit where prehospital patient documentation must be reassessed. A primary care–related case documented experimental laboratory test results of a population of 230,000 patients. Examples of older adult medication care and multiprofessional health care were part of our sample. Two articles described multipurpose clinical use of physician’s notes and tertiary care data. One article concerned the domain of clinical research using data from different EHR systems, and another described semantic aspects for retrieval of medication, laboratory test, and diagnosis-related data.

Although all studies concerned data from the EHRs, some studies included more detailed descriptions on data sources. Heart failure summaries containing clinical situation data and diagnoses (severity and certainty), as well as heart failure summaries covering clinical situations and symptoms data (a symptom’s presence, absence, and severity), were represented in the sample. One study regarded clinical history, observations, and findings during tumor control. One study focused on histories of patients with diabetes and diabetes care plans (eg, insulin regimen, diet, and exercise plans) and patients’ self-monitoring of vital signs, and 1 study used self-monitoring data on daily activities, side effects, and patient-reported outcomes. One article reported results around diagnosis and laboratory data; 1 article reported on medication, laboratory, and diagnosis data; and another article reported on neurosurgical imaging and laboratory data, although the starting point in the paper was diagnosis and medication data. The remaining 4 studies generally applied prehospital patient case data, emergency care–related EHR data, laboratory data, and diagnosis data.

Interoperability Results

In our sample, data were transferred and shared between different EHRs and clinical applications with no loss of data or changes in their meaning ( Multimedia Appendix 2 [ 24 - 37 ]). Half (7/14, 50%) of the studies were aimed at developing semantic interoperability between different EHRs or within different EHR modules, such as a medication module in 1 EHR system. One case concentrated specifically on an EHR and a clinical application. Two articles reported results about the interoperability between EHRs and personal health records. Interoperability with the laboratory system and the EHR was the focus of study in 2 cases. Two studies reported advances in interoperability development between EHR and clinical research resources or a clinical registry. Regarding the state of development, the largest number of studies were categorized as “in development” (n=5, 36%) and “in use” (n=6, 43%). Two articles reported results regarding the testing phase, and the remaining study was in an implementation stage.

All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories of clinical benefits within the articles: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). The first category describes use cases where patient care would benefit from better availability of data. This was to be achieved by enhancing interoperable data and its transfer from clinical applications (eg, a laboratory system) to a central EHR and between EHRs to increase accessible data for making informed clinical decisions. These advances were in implementation to enhance the quality and effectiveness of care. Moreover, developing better access to health data and providing homogeneous access to heterogeneous data sets may facilitate resource effectiveness; patient management; and overall, the optimization of data for different purposes. The second category included benefits for the quality of care. The category had largely been implemented in EHRs already. Benefits entail better resource effectiveness and optimization of patient care planning and monitoring and better patient management, as well as the continuity of care based on interoperable and accessible health data that facilitates informed decision-making by clinicians. One of these cases documented improved patient safety based on interoperable health data across EHRs. The third category, enhancing clinical data use and reuse, included 2 use cases where data were used across EHRs. One use case described data transfer between an EHR and a national oncology registry, where interoperability enhanced data integration and redesign of the systems in use. The other 2 cases documented the evidence of data use, where better availability of data provided a means for developing new EHR integrated tools, such as clinical alerts, dynamic patient lists, and clinical follow-up dashboards. In summary, semantic development goals emphasized better access to data regardless of underlying standards and data structures or EHRs in use. The underlying assumption is that with better access to data, it is possible to facilitate better communication between professionals and the continuity of care.

In our analysis, semantic development goals were divided in 3 categories. All of these were closely coupled with the need to build usable and available data based on heterogeneous medical information that is accessible through various EHRs and databases, such as registers. Data harmonization and developing semantic interoperability between different EHRs or between EHRs and clinical application was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. Semantic development goals were described as harmonizing data or otherwise processing semantically equivalent data across different medical domains and among different clinical data sources including EHRs and applications, thus facilitating clinicians’ availability of health data. One case included the formalization of data with a semantic converter to increase the interoperability of data. In 2 research cases, the main semantic development goals concentrated on advancing the interoperability of EHR data and patient-generated data or sensor data to monitor the situation of patients who are chronically ill. Regarding data standardization, 1 research case reported increasing data quality as the semantic interoperability development goal. Standardized data content decreased information overload of clinicians. Through data standardization, it was possible to increase conceptualization and, thus, access to data within an EHR regardless of the underlying standards and data structures, by providing a semantic standardized layer to facilitate clinicians’ data use, or by otherwise ensuring complete and coherent information with no errors due to the loss of meaning or context. One of these research cases documented improvements for system-level efficiency for EHR functions and integrated tools based on advances of semantic interoperability.

Features of semantic interoperability were described in all 14 articles. Most (9/14, 64%) of the analyzed cases incorporated 1 or more semantic aspects. In more detail, the aspects of semantic interoperability were described as follows: ontologies were the chosen aspect in 3 research cases, terminologies in 6 cases, classifications in 4 cases, various clinical documentation standards in 8 cases, and different data models in 10 cases. In this categorization, data model refers to various semantic model layers, namely, the use of various types of data models that include, for example, data content specifications, RIMs, and clinical information models depending on the development context. A dual model was discussed in 2 of the cases for the application of data models.

Closely related to the aspects of interoperability, several interoperability standard solutions were named. Named ontology solutions included a top-domain ontology for the life sciences (BioTopLite) in 2 cases, a HL7 Fast Health Interoperability Resources (FHIR) and semantic sensor network–based type 1 diabetes ontology for type 1 diabetes data, and a system of several ontologies to be used for building EHR interoperability. Systematized Nomenclature of Medicine Clinical Terminology was the common terminology application in 7 cases, whereas classification systems were applied in more heterogeneous ways. The following international classifications were named: International Classification of Diseases, Tenth Revision ; International Classification of Diseases, Ninth Revision, Clinical Modification ; The Anatomical Therapeutic Chemical Classification System; and Logical Observation Identifiers Names and Codes. One article documented national classification use. Applied health care–specific standards included the open standard specification in health informatics (openEHR; n=6), Digital Imaging and Communications in Medicine (n=1), HL7 FHIR (n=5), and the HL7 Clinical Document Architecture (n=2). Regarding data models or reference information models, several types were applied for distinct use environments. These included the Observational Medical Outcomes Partnership common data model, an EHR-specific data component model, the i2b2 common data model for data warehouse development, the HL7 FHIR RIM, and the EN/ISO 13606 standard–based model. Moreover, 1 case reported using openEHR as a data model reference.

The method for applying an interoperability framework or approach is related to the overall design of the data use purposes and the needs driving the semantic development. The chosen methodology for semantic development was based on ontology development or the application of an ontology framework in 4 research cases, data model–based development in 5 cases, archetype development in 1 case, and clinical data warehouse development to enhance access and processing of data in 1 case. In data model–based approaches, use cases document a method’s capability in separating different semantic levels of development, that is, system level, application level, clinical user interface level, or patient information level. The reusability of data model–based semantic approaches and related methods were assessed for resource savings in time and cost in development projects and, thus, to justify the choice of the approach. For example, clinical knowledge model–based development may allow recycling archetypes that further promote semantic interoperability.

Principal Findings

Our results are related to the main goals of semantic interoperability development, such as enabling patient data use regardless of which EHR the data originated from and by which terminologies, classifications, or other semantic features they are supported [ 16 - 19 , 21 ]. Regarding key elements of semantic interoperability, of the documented terminologies, Systematized Nomenclature of Medicine Clinical Terminology seemed to prevail as the dominant choice for clinical terminology [ 24 - 30 ]. For international classifications that are typically integrated into EHRs, a selection of well-established classifications was documented [ 25 , 26 , 31 , 32 ]. Likewise, several health care specific standards [ 24 - 26 , 28 , 31 , 33 ], ontologies [ 21 , 24 , 32 , 33 ], and data models [ 25 , 27 , 28 , 30 - 36 ] were presented, albeit in a relatively small sample in this study. One possible factor affecting the selection of interoperability features such as international standards may be open availability and the level of cost of the standard-specific resources and their deployment. Consequently, shared implementation experiences and recommendations from previous projects or from collaboration in international communities may promote and facilitate decision-making concerning future implementations.

Our review illustrates several approaches for building sematic interoperability. For ontologies and data models, based on the review, several layers may be deployed to address semantic interoperability development needs. For ontologies, deploying a system of ontologies seeks to bridge, for example, domain-specific ontologies and application-specific ontologies. In our sample, a case with a data model–based development approach enhanced the communication of clinical information with the application. The application was used by the patients in self-monitoring, and the EHR served as a clinical data repository to avoid the loss of meaningful information. In general, when applying data model–based approaches, a dual model or multimodel approach may be needed to address different semantic interoperability issues during development—from the clinician as an EHR user to the system transaction level.

Our review highlights several clinical benefits of semantic interoperability. Primarily semantic interoperability fulfills the need to support the implementation of applications that enhance the continuity of care and ensure access to safe and high-quality health care. The reported clinical benefits of developing semantic interoperability reflect well common international goals [ 2 , 3 , 5 ]. The results in our sample show that an evident goal driving the development in these studies is the following assumption: through increased access to patient information, better quality and outcomes in care can be achieved [ 24 , 26 , 27 , 33 , 37 ]. Better communication based on easily accessible data across EHRs is facilitated not only between clinicians but also between professionals and patients [ 28 , 34 , 35 ]. Further advances are related to efficiency and subsequent economic factors, for example, reducing the clinicians’ workload for documenting and evaluating extensive patient data, to avoid information overload and support multiprofessional care [ 26 , 31 - 33 , 35 ]. In addition, interoperable patient data provide opportunities for a wide range of EHR-related clinical development, for example, regarding decision-making support, other EHR integrated tools, clinical research, or other types of secondary use [ 25 , 28 - 31 , 33 , 36 ]. Essentially, the interoperability cases in our review demonstrated a well-documented selection of development goals in EHRs, including considerations of patient-generated, self-monitoring data and related interoperability features.

Finally, when reflecting on the goal-related semantic interoperability results, there is evidently not one universal approach available to tackle all interoperability-related needs and challenges. One reason for this is that interoperability is to be achieved in diffuse and disconnected clinical care settings and in registry data use across borders. However, regulations and international recommendations can support the choosing of common tools and standards for building interoperability for patient data generated in various EHRs and clinical applications. This may be the strongest selling point for evolving international frameworks, such as the EHDS regulation proposal. If adopted, unified toolkits of the most crucial means can be achieved for building international eHealth interoperability. Through these mechanisms, common solutions and standards can be agreed upon to remedy existing inconsistencies and avoid possible future imparities that hinder the realization of the common goals. It is noteworthy that all member states have steps to take to meet the international requirements with a country-specific road map to achieve the common goal [ 3 , 5 ]. Moreover, it would require cooperation to align on which level of interoperability should be reached when the operating environment consists of a diverse set of clinical practices and related data needs, such as between public and private care or between primary and specialized care. Additionally, it may be worthwhile to consider whether instead of promoting a single approach, semantic interoperability requirements should be assessed through several levels of semantic requirements, such as standards, data models, classifications, and terminologies. Moreover, developing the necessary skills and increasing capabilities is an essential component of this development.

Specifically, regarding European development, one of the main goals is to support the use of health data for better health care delivery and better research. The comprehensive and timely availability of EHR data is known to improve the quality of care and patient safety [ 26 , 38 ]. Concurrently, the lack of not only technical or organizational but also semantic interoperability has been recognized as one of the barriers for the cross-border exchange of health data [ 2 - 8 ]. Therefore, commonly recognized interoperability approaches and standards for the harmonization of semantic interoperability are needed.

Limitations

Our goal was to ensure that we did not overlook any important studies and to minimize any potential biases by conducting a thorough and comprehensive search of the available literature. However, it is worth noting that our search was limited to a single database, PubMed. Nevertheless, recent literature suggests that PubMed can serve as a primary search tool. It possesses the necessary capabilities for systematic reviews, including the ability to formulate and interpret queries accurately, as well as ensuring search reproducibility. It is important to acknowledge that even a well-performing system such as PubMed might not always yield the desired results in different scenarios [ 23 ]. Our data set was limited by a small sample size of 14 articles. Therefore, findings can only be regarded as descriptive in nature. Relatively large heterogeneity in study environments and selected research approaches limit us from drawing strong conclusions. Despite these limitations, this review demonstrates potentially feasible approaches for promoting semantic interoperability toward harmonized approaches. Additional real-world studies accounting for semantic interoperability are needed to reinforce understanding of the most promising, scalable examples such as international reference models (eg, HL7 RIM). Moreover, it was challenging to determine the “development status” category for certain studies. This was due to varying levels of details in the study reports, where some of the studies provided a wealth of detail, whereas some were more restricted in their scope.

Suggestions for Future Research

Future research directions are 2-fold from the current development perspective. First, evidence-based recommendations on semantic interoperability features, for example, data models and terminologies, are needed. Initially, the applicability of international data models and standards such as HL7 V2 might be evaluated. Second, more experiences of interoperability development should be reported in the peer-reviewed research literature to contribute evidence around successful and not so successful experiences instead of leaning solely on individual expert opinions. Presumably, due to the evolving implementation status of semantic interoperability cases illustrated in the research literature, systematic research–based evaluation of benefits and outcomes is still scarce.

Conclusions

We conclude that based on our review, the research literature highlights valuable aspects in promoting semantic interoperability in terms of the efficiency and feasibility of solutions integrated in EHRs and possibly for enhancing care. However, when heading toward semantic harmonization, more data, pilot experiences, and analyses are needed to assess how applicable the chosen specific solutions are for the standardization and semantic interoperability of patient data. Instead of promoting a single approach, semantic interoperability could be assessed through several levels of semantic approaches. A dual model or multimodel approach is usable to address different semantic interoperability issues during development—from the clinician as an EHR user to the system transaction level. Since interoperability is being implemented in complex and disconnected clinical care environments, choices should be well prepared and justified to meet sustainable and long-term outcomes. From that point of view, it is possible to outline future directions in selecting semantic interoperability approaches for the realization of the international patient data–related goals.

Acknowledgments

The study was supported by Finnish governmental study grant TYH2021319.

Conflicts of Interest

None declared.

Summary of study and sample characteristics.

Summary of results on semantic interoperability in electronic health records.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

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Abbreviations

Edited by Christian Lovis; submitted 10.10.23; peer-reviewed by Hannes Ulrich, Xiaoshuo Huang; final revised version received 21.02.24; accepted 24.02.24; published 25.04.24.

© Sari Palojoki, Lasse Lehtonen, Riikka Vuokko. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 25.4.2024.

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