literature review or methodology first

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

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

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

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

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

There are five key steps to writing a literature review:

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

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

Instantly correct all language mistakes in your text

Upload your document to correct all your mistakes in minutes

Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

Don't submit your assignments before you do this

The academic proofreading tool has been trained on 1000s of academic texts. Making it the most accurate and reliable proofreading tool for students. Free citation check included.

Try for free

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

Open Google Slides Download PowerPoint

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved June 11, 2024, from https://www.scribbr.com/dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, what is a theoretical framework | guide to organizing, what is a research methodology | steps & tips, how to write a research proposal | examples & templates, get unlimited documents corrected.

✔ Free APA citation check included ✔ Unlimited document corrections ✔ Specialized in correcting academic texts

Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

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.

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

• Knowledge Base
• Dissertation
• 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.

Instantly correct all language mistakes in your text

Be assured that you'll submit flawless writing. Upload your document to correct all your mistakes.

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.

The only proofreading tool specialized in correcting academic writing

The academic proofreading tool has been trained on 1000s of academic texts and by native English editors. Making it the most accurate and reliable proofreading tool for students.

Correct my document today

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

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

For each publication, ask yourself:

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

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

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2022, June 07). What is a Literature Review? | Guide, Template, & Examples. Scribbr. Retrieved 11 June 2024, from https://www.scribbr.co.uk/thesis-dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, how to write a dissertation proposal | a step-by-step guide, what is a theoretical framework | a step-by-step guide, what is a research methodology | steps & tips.

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

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

Harvey Cushing/John Hay Whitney Medical Library

• Collections
• Research Help

YSN Doctoral Programs: Steps in Conducting a Literature Review

• Biomedical Databases
• Global (Public Health) Databases
• Soc. Sci., History, and Law Databases
• Grey Literature
• Trials Registers
• Data and Statistics
• Public Policy
• Google Tips
• Recommended Books
• Steps in Conducting a Literature Review

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.
• << Previous: Recommended Books
• Last Updated: Jan 4, 2024 10:52 AM
• URL: https://guides.library.yale.edu/YSNDoctoral

• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

• 5. The Literature Review
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Applying Critical Thinking
• Choosing a Title
• Making an Outline
• Paragraph Development
• Research Process Video Series
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
• USC Libraries Tutorials and Other Guides
• Bibliography

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.

• << Previous: Theoretical Framework
• Next: Citation Tracking >>
• Last Updated: May 30, 2024 9:38 AM
• URL: https://libguides.usc.edu/writingguide

• University of Texas Libraries

Literature Reviews

Steps in the literature review process.

• What is a literature review?
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
• Librarian Support
• You may need to some exploratory searching of the literature to get a sense of scope, to determine whether you need to narrow or broaden your focus
• Identify databases that provide the most relevant sources, and identify relevant terms (controlled vocabularies) to add to your search strategy
• Finalize your research question
• Think about relevant dates, geographies (and languages), methods, and conflicting points of view
• Conduct searches in the published literature via the identified databases
• Check to see if this topic has been covered in other discipline's databases
• Examine the citations of on-point articles for keywords, authors, and previous research (via references) and cited reference searching.
• Save your search results in a citation management tool (such as Zotero, Mendeley or EndNote)
• De-duplicate your search results
• Make sure that you've found the seminal pieces -- they have been cited many times, and their work is considered foundational 
• Check with your professor or a librarian to make sure your search has been comprehensive
• Evaluate the strengths and weaknesses of individual sources and evaluate for bias, methodologies, and thoroughness
• Group your results in to an organizational structure that will support why your research needs to be done, or that provides the answer to your research question  
• Develop your conclusions
• Are there gaps in the literature?
• Where has significant research taken place, and who has done it?
• Is there consensus or debate on this topic?
• Which methodological approaches work best?
• For example: Background, Current Practices, Critics and Proponents, Where/How this study will fit in 
• Organize your citations and focus on your research question and pertinent studies
• Compile your bibliography

Note: The first four steps are the best points at which to contact a librarian. Your librarian can help you determine the best databases to use for your topic, assess scope, and formulate a search strategy.

Videos Tutorials about Literature Reviews

This 4.5 minute video from Academic Education Materials has a Creative Commons License and a British narrator.

Recommended Reading

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

Literature Reviews

• First Online: 07 June 2024

Cite this chapter

• George P. Moschis 2  

A literature review is a critical component of a scientific study and holds significant importance, as literature reviews serve several important functions within the research process:

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Durable hardcover edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Anthony, D. R., Gucciardi, D. F., & Gordon, S. (2016). A meta-study of qualitative research on mental toughness development. International Review of Sport and Exercise Psychology, 9 (1), 160–190.

Article   Google Scholar  

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8 (1), 19–32.

Arnold, R., & Fletcher, D. (2012). A research synthesis and taxonomic classification of the organizational stressors encountered by sport performers. Journal of Sport and Exercise Psychology, 34 (3), 397–429.

Banning, J. H. (2005). Ecological triangulation: An approach for qualitative meta-synthesis. What works for youth with disabilities project . US Department of Education, School of Education, Colorado: Colorado State University.

Google Scholar  

Barnett-Page, E., & Thomas, J. (2009). Methods for the synthesis of qualitative research: A critical review. BMC Medical Research Methodology, 9 , 59. https://doi.org/10.1186/1471-2288-9-59

Breretona, P., Kitchenhama, B. A., Budgenb, D., Turnera, M., & Khalilc, M. (2007). Lessons from applying the systematic literature review process within the software engineering domain. Journal of Systems and Software, 80 (4), 571–583.

Britten, N., Campbell, R., Pope, C., Donovan, J., Morgan, M., & Pill, R. (2002). Using meta ethnography to synthesise qualitative research: A worked example. Journal of Health Services Research & Policy, 7 (4), 209–215.

Brunton, G., Oliver, S., Oliver, K., & Lorenc, T. (2006). A synthesis of research addressing children’s, young people’s and parents’ views of walking and cycling for transport . EPPI-Centre, Social Science. Research Unit, Institute of Education, University of London.

Cheung, M. W. L., & Vijayakumar, R. (2016). A guide to conducting a meta-analysis. Neuropsychology Review, 26 , 121–128. https://doi.org/10.1007/s11065-016-9319-z

Dhollande, S., Taylor, A., Meyer, S., & Scott, M. (2021). Conducting integrative reviews: A guide for novice nursing researchers. Journal of Research in Nursing, 26 (5), 427–438. https://doi.org/10.1177/1744987121997907

Dieckmann, N. F., Malle, B. F., & Bodner, T. E. (2009). An Empirical Assessment of Meta-Analytic Practice. Review of General Psychology 13 (2), 101–15.

Dixon-Woods, M., Cavers, D., Agarwal, S., Annandale, E., Arthur, A., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., & Smith, L. (2006). Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6 (1), 1.

Donthu, N., Kumar, S., Mukherjee, D., Pandey, N., & Lim, W. M. (2001). How to conduct a bibliometric analysis: An overview and guidelines. Journal of Business Research, 133 , 285–296.

Drew, K., Morris, R., Tod, D., & Eubank, M. (2019). A meta-study of qualitative research on the junior-to-senior transition in sport. Psychology of Sport and Exercise, 45 , 101556.

Evans, D., & Fitzgerald, M. (2002). Reasons for physically restraining patients and residents: A systematic review and content analysis. International Journal of Nursing Studies, 39 , 739–743. https://doi.org/10.1016/S0020-7489(02)00015-9

Ewing, R., & Cervero, R. (2010). Travel and the built environment: A meta-analysis. Journal of the American Planning Association, 76 (3), 265–294.

Fisher, C. L., Maloney, E., Glogowski, E., Hurley, K., Edgerson, S., Lichtenthal, W. G., Kissane, D., & Bylund, C. (2014). Talking about familial breast cancer risk topics and strategies to enhance mother–daughter interactions. Qualitative Health Research, 24 (4), 517–535.

Flemming, K. (2010). Synthesis of quantitative and qualitative research: An example using critical interpretive synthesis. Journal of Advanced Nursing, 66 (1), 201–217.

Glaser, B., & Strauss, A. (1967). The discovery of grounded theory . Aldine.

Glass, G. V. (1976). Primary, secondary, and meta-analysis of research. Educational Researcher, 5 (10), 3–8.

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26 (2), 91–108.

Green, B. N., Johnson, C. D., & Adams, A. (2001). Writing narrative literature reviews for peer-reviewed journals: Secrets of the trade. Journal of Sports Chiropractic & Rehabilitation, 15 (1), 5–19.

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82 (4), 581–629.

Hackenberger, B. K. (2020). Bayesian meta-analysis now—Let’s do it. Croatian Medical Journal, 61 (6), 564–568. https://doi.org/10.3325/cmj.2020.61.564

Hansen, C., Steinmetz, H., & Block, J. (2022). How to conduct a meta-analysis in eight steps: A practical guide. Management Review Quarterly, 72 , 1–19. https://doi.org/10.1007/s11301-021-00247-4

Harden, A., Garcia, J., Oliver, S., Rees, R., Shepherd, J., Brunton, G., & Oakley, A. (2004). Applying systematic review methods to studies of people’s views: An example from public health research. Journal of Epidemiology and Community Health, 58 , 794–800. https://doi.org/10.1136/jech.2003.014829

Harden, S. M., McEwan, D., Sylvester, B. D., Kaulius, M., Ruissen, G., Burke, S. M., Estabrooks, P. A., & Beauchamp, M. R. (2015). Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: A realist review. BMC Public Health, 15 (1), 1.

Herber, O. R., Bücker, B., Metzendorf, M.-I., & Barroso, J. (2017). A qualitative meta-summary using Sandelowski and Barroso’s method for synthesizing qualitative research to explore barriers and facilitators to self-care in heart failure patients. European Journal of Cardiovascular Nursing, 16 , 662–677. https://doi.org/10.1177/1474515117711007

Herber, O. R., Kastaun, S., Wilm, S., & Barroso, J. (2019). From qualitative meta-summary to qualitative meta-synthesis: Introducing a new situation-specific theory of barriers and facilitators for self-Care in Patients with Heart Failure. Qualitative Health Research, 29 (1), 96–106.

Hoffman, D. L., & Holbrook, M. B. (1993). The intellectual structure of consumer research. Journal of Consumer Research, 19 (4), 505–517.

Kitchenham, B., & Charters, S. (2007). Guidelines for performing systematic literature reviews in software engineering . In EBSE technical report. Software Engineering Group, School of Computer Science and Mathematics, Keele University, Department of Computer Science, University of Durham.

Kuhn, T. S. (1970). The structure of scientific revolutions (International encyclopedia of unified science) (Vol. 2(2)). University of Chicago Press.

Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5 (1), 69. https://doi.org/10.1186/1748-5908-5-69

Lim, W. M., & Kumar, S. (2024). Guidelines for interpreting the results of bibliometric analysis: A sensemaking approach. Global Business and Organizational Excellence, 43 (2), 17–26. https://doi.org/10.1002/joe.22229

Limkakeng, A. T., Jr., Herling de Oliveira, L. L., Moreira, T., Phadtare, A., Garcia Rodrigues, C., Hocker, M. B., McKinney, R., Voils, C. I., & Pietrobon, R. (2014). Systematic review and metasummary of attitudes toward research in emergency medical conditions. Journal of Medical Ethics, 40 (6), 401–408.

Lindell, M. K., & Perry, R. W. (2000). Household adjustment to earthquake hazard: A review of research. Environment and Behavior, 32 (4), 461–501.

Lucas, P. J., Baird, J., Arai, L., Law, C., & Roberts, H. M. (2007). Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Medical Research Methodology, 7 (1), 4.

Mak, S., & Thomas, A. (2022). Steps for conducting a scoping review. Journal of Graduate Medical Education, 14 (5), 565–567.

Malekpour, S., Brown, R. R., & de Haan, F. J. (2015). Strategic planning of urban infrastructure for environmental sustainability: Understanding the past to intervene for the future. Cities, 46 , 67–75.

Mikkonen, K., & Kääriäinen, M. (2020). Content analysis in systematic reviews. In H. Kyngäs, K. Mikkonen, & M. Kääriäinen (Eds.), The application of content analysis in nursing science research . Springer. https://doi.org/10.1007/978-3-030-30199-6_10

Chapter   Google Scholar  

Moschis, G. P. (1990). Approaches to the study of consumer behavior in late life. Advances in Consumer Research, XVIII , 517–520.

Moschis, G. P. (1994). Consumer behavior in later life: Multidisciplinary contributions and implication for research. Journal of the Academy of Marketing Science, 22 (3), 195–204.

Neely, E., Walton, M., & Stephens, C. (2014). Young people’s food practices and social relationships. A thematic synthesis. Appetite, 82 , 50–60.

Noblit, G. W., & Hare, R. D. (1988). Meta-ethnography: Synthesizing qualitative studies . Sage.

Book   Google Scholar  

Paré, G., Trudel, M.-C., Jaana, M., & Kitsiou, S. (2015). Synthesizing information systems knowledge: A typology of literature reviews. Information & Management, 52 , 183–199.

Paterson, B. L., Thorne, S. E., Canam, C., & Jillings, C. (2001). Meta-study of qualitative health research. A practical guide to meta-analysis and meta-synthesis . Sage Publications.

Paul, J., Khatri, P., & Duggal, H. K. (2023). Frameworks for developing impactful systematic literature reviews and theory building: What, why and how? Journal of Decision Systems . https://doi.org/10.1080/12460125.2023.2197700

Paul, J., Martinez, L. F., Singh, R. K., & Koklic, M. K. (2024). Systematic literature reviews in consumer studies. International Journal of Consumer Studies , Call for Papers—Annual Special Issue: Submission period: February 15–May 31, 2024 https://onlinelibrary.wiley.com/page/journal/14706431/homepage/callforpapers . Downloaded on January 5, 2024.

Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005). Realist review: A new method of systematic review designed for complex policy interventions. Journal of Health Services Research and Policy, 70 (1), 21–34.

Pollock, D., Davies, E. L., Peters, M. D., et al. (2021). Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. Journal of Advanced Nursing, 77 , 2102–2113.

Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., Britten, N., Roen, K., & Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews . A product from the ESRC methods programme Version 1:b92.

Reis, D. J., Kaizer, A. M., Kinney, A. R., Bahraini, N. H., Holliday, R., Forster, J. E., & Brenner, L. A. (2023). A practical guide to random-effects Bayesian meta-analyses with application to the psychological trauma and suicide literature. Psychological Trauma: Theory, Research, Practice, and Policy, 15 (1), 121–130. https://doi.org/10.1037/tra0001316

Ridgway, N. M., Kukar-Kinney, M., & Monroe, K. B. (2008). An expanded conceptualization and a new measure of compulsive buying. Journal of Consumer Research, 35 (4), 622–639.

Rigolon, A. (2016). A complex landscape of inequity in access to urban parks: A literature review. Landscape and Urban Planning, 153 , 160–169.

Ritzer, G. (1991). Metatheorizing in Sociology . Lexington Books.

Roberts, K. A., Dixon-Woods, M., Fitzpatrick, R., Abrams, K. R., & Jones, D. R. (2002). Factors affecting uptake of childhood immunization: A Bayesian synthesis of qualitative and quantitative evidence. The Lancet, 360 (9345), 1596–1599.

Rycroft-Malone, J., McCormack, B., Hutchinson, A. M., et al. (2012). Realist synthesis: Illustrating the method for implementation research. Implementation Science, 7 , 33. https://doi.org/10.1186/1748-5908-7-33

Sandelowski, M., & Barroso, J. (2007). Handbook for synthesizing qualitative research . Springer Publishing Company.

Sandelowski, M., & Leeman, J. (2012). Writing usable qualitative health research findings. Qualitative Health Research, 22 (10), 1404–1413.

Schutz, A. (1962). Collected papers. Vol. 1. Martinus Nijhoff. 1964. Collected papers 2.

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104 , 333–339.

Spiegelhalter, D., Myles, J. P., Jones, D. R., & Abrams, K. R. (1999). An introduction to Bayesian methods in health technology assessment. British Medical Journal, 319 (7208), 508.

Stemler, S. (2001). An overview of content analysis. Practical Assessment, Research, and Evaluation, 7 , Article 17.

Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory . Sage.

Stremersch, S., Verniers, I., & Verhoef, P. C. (2007). The quest for citations: Drivers of article impact. Journal of Marketing, 71 (3), 171–193. https://doi.org/10.1509/jmkg.71.3.171

Suikkala, A., & Leino-Kilpi, H. (2000). Nursing student-patient relationships: A review of the literature from 1984–1998. Journal of Advanced Nursing., 2000 (33), 42–50. https://doi.org/10.1046/j.1365-2648.2001.01636.x

Sutton, A. J., & Abrams, K. R. (2001). Bayesian methods in meta-analysis and evidence synthesis. Statistical Methods in Medical Research, 10 (4), 277–303.

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8 (1), 1.

Weed, M. (2005). Meta interpretation: A method for the interpretive synthesis of qualitative research. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 6 (1).

Wong, G., MacPhee, M., Merrett, K., Miller, K., Taylor, S., & Pawliuk, C. (2020). The realist review process workshop [presentation]. https://doi.org/10.14288/1.0390457 .

Xiao, Y., & Watson, M. (2019). Guidance on conducting a systematic literature review. Journal of Planning Education and Research, 39 (1), 93–112. https://doi.org/10.1177/0739456X17723971

Zhao, S. (1991). Metatheory, metamethod, meta-data-analysis: What, why and how? Sociological Perspectives, 34 , 377–390.

Download references

Author information

Authors and affiliations.

College of Management, Mahidol University, Bangkok, Thailand

George P. Moschis

You can also search for this author in PubMed   Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Moschis, G.P. (2024). Literature Reviews. In: Academic Research in Business and the Social Sciences. Springer, Cham. https://doi.org/10.1007/978-3-031-56548-9_8

Download citation

DOI : https://doi.org/10.1007/978-3-031-56548-9_8

Published : 07 June 2024

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-56547-2

Online ISBN : 978-3-031-56548-9

eBook Packages : Business and Management Business and Management (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

Psst… there’s more!

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

You Might Also Like:

27 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

• Reviews / Why join our community?
• For companies
• Frequently asked questions

The 5 Stages in the Design Thinking Process

Design thinking is a methodology which provides a solution-based approach to solving problems. It’s extremely useful when used to tackle complex problems that are ill-defined or unknown—because it serves to understand the human needs involved, reframe the problem in human-centric ways, create numerous ideas in brainstorming sessions and adopt a hands-on approach to prototyping and testing. When you know how to apply the five stages of design thinking you will be impowered because you can apply the methodology to solve complex problems that occur in our companies, our countries, and across the world.

Design thinking is a non-linear, iterative process that can have anywhere from three to seven phases, depending on whom you talk to. We focus on the five-stage design thinking model proposed by the Hasso Plattner Institute of Design at Stanford (the d.school) because they are world-renowned for the way they teach and apply design thinking.

What are the 5 Stages of the Design Thinking Process

The five stages of design thinking, according to the d.school, are:

Empathize : research your users' needs .

Define : state your users' needs and problems.

Ideate : challenge assumptions and create ideas.

Prototype : start to create solutions.

Test : try your solutions out.

Let’s dive into each stage of the design thinking process.

• Transcript loading…

Hasso-Platner Institute Panorama

Ludwig Wilhelm Wall, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

Stage 1: Empathize—Research Your Users' Needs

Empathize: the first phase of design thinking, where you gain real insight into users and their needs.

© Teo Yu Siang and the Interaction Design Foundation, CC BY-NC-SA 3.0.

The first stage of the design thinking process focuses on user-centric research . You want to gain an empathic understanding of the problem you are trying to solve. Consult experts to find out more about the area of concern and conduct observations to engage and empathize with your users. You may also want to immerse yourself in your users’ physical environment to gain a deeper, personal understanding of the issues involved—as well as their experiences and motivations . Empathy is crucial to problem solving and a human-centered design process as it allows design thinkers to set aside their own assumptions about the world and gain real insight into users and their needs.

Depending on time constraints, you will gather a substantial amount of information to use during the next stage. The main aim of the Empathize stage is to develop the best possible understanding of your users, their needs and the problems that underlie the development of the product or service you want to create.

Stage 2: Define—State Your Users' Needs and Problems

Define: the second phase of design thinking, where you define the problem statement in a human-centered manner.

In the Define stage, you will organize the information you have gathered during the Empathize stage. You’ll analyze your observations to define the core problems you and your team have identified up to this point. Defining the problem and problem statement must be done in a human-centered manner .

For example, you should not define the problem as your own wish or need of the company: “We need to increase our food-product market share among young teenage girls by 5%.”

You should pitch the problem statement from your perception of the users’ needs: “Teenage girls need to eat nutritious food in order to thrive, be healthy and grow.”

The Define stage will help the design team collect great ideas to establish features, functions and other elements to solve the problem at hand—or, at the very least, allow real users to resolve issues themselves with minimal difficulty. In this stage, you will start to progress to the third stage, the ideation phase, where you ask questions to help you look for solutions: “How might we encourage teenage girls to perform an action that benefits them and also involves your company’s food-related product or service?” for instance.

Stage 3: Ideate—Challenge Assumptions and Create Ideas

Ideate: the third phase of design thinking, where you identify innovative solutions to the problem statement you’ve created.

During the third stage of the design thinking process, designers are ready to generate ideas. You’ve grown to understand your users and their needs in the Empathize stage, and you’ve analyzed your observations in the Define stage to create a user centric problem statement. With this solid background, you and your team members can start to look at the problem from different perspectives and ideate innovative solutions to your problem statement .

There are hundreds of ideation techniques you can use—such as Brainstorm, Brainwrite , Worst Possible Idea and SCAMPER . Brainstorm and Worst Possible Idea techniques are typically used at the start of the ideation stage to stimulate free thinking and expand the problem space. This allows you to generate as many ideas as possible at the start of ideation. You should pick other ideation techniques towards the end of this stage to help you investigate and test your ideas, and choose the best ones to move forward with—either because they seem to solve the problem or provide the elements required to circumvent it.

Stage 4: Prototype—Start to Create Solutions

Prototype: the fourth phase of design thinking, where you identify the best possible solution.

The design team will now produce a number of inexpensive, scaled down versions of the product (or specific features found within the product) to investigate the key solutions generated in the ideation phase. These prototypes can be shared and tested within the team itself, in other departments or on a small group of people outside the design team.

This is an experimental phase, and the aim is to identify the best possible solution for each of the problems identified during the first three stages . The solutions are implemented within the prototypes and, one by one, they are investigated and then accepted, improved or rejected based on the users’ experiences.

By the end of the Prototype stage, the design team will have a better idea of the product’s limitations and the problems it faces. They’ll also have a clearer view of how real users would behave, think and feel when they interact with the end product.

Stage 5: Test—Try Your Solutions Out

Test: the fifth and final phase of the design thinking process, where you test solutions to derive a deep understanding of the product and its users.

Designers or evaluators rigorously test the complete product using the best solutions identified in the Prototype stage. This is the final stage of the five-stage model; however, in an iterative process such as design thinking, the results generated are often used to redefine one or more further problems. This increased level of understanding may help you investigate the conditions of use and how people think, behave and feel towards the product, and even lead you to loop back to a previous stage in the design thinking process. You can then proceed with further iterations and make alterations and refinements to rule out alternative solutions. The ultimate goal is to get as deep an understanding of the product and its users as possible.

Did You Know Design Thinking is a Non-Linear Process?

We’ve outlined a direct and linear design thinking process here, in which one stage seemingly leads to the next with a logical conclusion at user testing . However, in practice, the process is carried out in a more flexible and non-linear fashion . For example, different groups within the design team may conduct more than one stage concurrently, or designers may collect information and prototype throughout each stage of the project to bring their ideas to life and visualize the problem solutions as they go. What’s more, results from the Test stage may reveal new insights about users which lead to another brainstorming session (Ideate) or the development of new prototypes (Prototype).

It is important to note the five stages of design thinking are not always sequential. They do not have to follow a specific order, and they can often occur in parallel or be repeated iteratively. The stages should be understood as different modes which contribute to the entire design project, rather than sequential steps.

The design thinking process should not be seen as a concrete and inflexible approach to design; the component stages identified should serve as a guide to the activities you carry out. The stages might be switched, conducted concurrently or repeated several times to gain the most informative insights about your users, expand the solution space and hone in on innovative solutions.

This is one of the main benefits of the five-stage model. Knowledge acquired in the latter stages of the process can inform repeats of earlier stages . Information is continually used to inform the understanding of the problem and solution spaces, and to redefine the problem itself. This creates a perpetual loop, in which the designers continue to gain new insights, develop new ways to view the product (or service) and its possible uses and develop a far more profound understanding of their real users and the problems they face.

The Take Away

Design thinking is an iterative, non-linear process which focuses on a collaboration between designers and users. It brings innovative solutions to life based on how real users think, feel and behave.

This human-centered design process consists of five core stages Empathize, Define, Ideate, Prototype and Test.

It’s important to note that these stages are a guide. The iterative, non-linear nature of design thinking means you and your design team can carry these stages out simultaneously, repeat them and even circle back to previous stages at any point in the design thinking process.

References & Where to Learn More

Take our Design Thinking course which is the ultimate guide when you want to learn how to you can apply design thinking methods throughout a design thinking process. Herbert Simon, The Sciences of the Artificial (3rd Edition), 1996.

d.school, An Introduction to Design Thinking PROCESS GUIDE , 2010.

Gerd Waloszek, Introduction to Design Thinking , 2012.

Hero Image: © the Interaction Design Foundation, CC BY-NC-SA 3.0.

Design Thinking: The Ultimate Guide

Get Weekly Design Tips

Topics in this article, what you should read next, what is design thinking and why is it so popular.

• 1.6k shares

Personas – A Simple Introduction

• 1.5k shares

Stage 2 in the Design Thinking Process: Define the Problem and Interpret the Results

• 1.3k shares

What is Ideation – and How to Prepare for Ideation Sessions

• 1.2k shares

Affinity Diagrams: How to Cluster Your Ideas and Reveal Insights

• 2 years ago

Stage 1 in the Design Thinking Process: Empathise with Your Users

• 3 years ago

Empathy Map – Why and How to Use It

• 2 weeks ago

What Is Empathy and Why Is It So Important in Design Thinking?

10 Insightful Design Thinking Frameworks: A Quick Overview

• 4 years ago

Define and Frame Your Design Challenge by Creating Your Point Of View and Ask “How Might We”

Open Access—Link to us!

We believe in Open Access and the  democratization of knowledge . Unfortunately, world-class educational materials such as this page are normally hidden behind paywalls or in expensive textbooks.

If you want this to change , cite this article , link to us, or join us to help us democratize design knowledge !

Privacy Settings

Our digital services use necessary tracking technologies, including third-party cookies, for security, functionality, and to uphold user rights. Optional cookies offer enhanced features, and analytics.

Experience the full potential of our site that remembers your preferences and supports secure sign-in.

Governs the storage of data necessary for maintaining website security, user authentication, and fraud prevention mechanisms.

Enhanced Functionality

Saves your settings and preferences, like your location, for a more personalized experience.

Referral Program

We use cookies to enable our referral program, giving you and your friends discounts.

Error Reporting

We share user ID with Bugsnag and NewRelic to help us track errors and fix issues.

Optimize your experience by allowing us to monitor site usage. You’ll enjoy a smoother, more personalized journey without compromising your privacy.

Analytics Storage

Collects anonymous data on how you navigate and interact, helping us make informed improvements.

Differentiates real visitors from automated bots, ensuring accurate usage data and improving your website experience.

Lets us tailor your digital ads to match your interests, making them more relevant and useful to you.

Advertising Storage

Stores information for better-targeted advertising, enhancing your online ad experience.

Personalization Storage

Permits storing data to personalize content and ads across Google services based on user behavior, enhancing overall user experience.

Advertising Personalization

Allows for content and ad personalization across Google services based on user behavior. This consent enhances user experiences.

Enables personalizing ads based on user data and interactions, allowing for more relevant advertising experiences across Google services.

Receive more relevant advertisements by sharing your interests and behavior with our trusted advertising partners.

Enables better ad targeting and measurement on Meta platforms, making ads you see more relevant.

Allows for improved ad effectiveness and measurement through Meta’s Conversions API, ensuring privacy-compliant data sharing.

LinkedIn Insights

Tracks conversions, retargeting, and web analytics for LinkedIn ad campaigns, enhancing ad relevance and performance.

LinkedIn CAPI

Enhances LinkedIn advertising through server-side event tracking, offering more accurate measurement and personalization.

Google Ads Tag

Tracks ad performance and user engagement, helping deliver ads that are most useful to you.

Share Knowledge, Get Respect!

or copy link

Cite according to academic standards

Simply copy and paste the text below into your bibliographic reference list, onto your blog, or anywhere else. You can also just hyperlink to this article.

New to UX Design? We’re giving you a free ebook!

Download our free ebook The Basics of User Experience Design to learn about core concepts of UX design.

In 9 chapters, we’ll cover: conducting user interviews, design thinking, interaction design, mobile UX design, usability, UX research, and many more!

New to UX Design? We’re Giving You a Free ebook!

• Open access
• Published: 29 September 2021

Defining ethical challenge(s) in healthcare research: a rapid review

• Guy Schofield   ORCID: orcid.org/0000-0002-9055-292X 1 , 3 ,
• Mariana Dittborn   ORCID: orcid.org/0000-0003-2903-6480 2 ,
• Lucy Ellen Selman   ORCID: orcid.org/0000-0001-5747-2699 3 &
• Richard Huxtable   ORCID: orcid.org/0000-0002-5802-1870 1  

BMC Medical Ethics volume  22 , Article number:  135 ( 2021 ) Cite this article

21k Accesses

15 Citations

11 Altmetric

Metrics details

Despite its ubiquity in academic research, the phrase ‘ethical challenge(s)’ appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of ‘ethical challenge(s)’ and closely related terms as used in current healthcare research literature.

Rapid review to identify peer-reviewed reports examining ‘ethical challenge(s)’ in any context, extracting data on definitions of ‘ethical challenge(s)’ in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher’s Index, EMBASE, CINAHL) were searched from April 2016 to April 2021.

393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of ‘ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to ‘ethical challenge(s)’ within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study.

Conclusions

Only 12/72 studies contained an explicit definition of ‘ethical challenge(s)’, with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research.

Peer Review reports

Methodological rigour within research is a cornerstone in the production of high-quality findings and recommendations. Across the range of empirical methodologies, a broad collection of protocol development tools, methodology guidelines, and reporting guidelines have been developed and evidence of their use is increasingly required by journals [ 1 , 2 , 3 , 4 , 5 , 6 ]. Within both empirical bioethics and descriptive ethics, there has been an accompanying increase in the acknowledgment of the importance of methodological rigour in the empirical elements, including within the recent consensus statement on quality standards in empirical bioethics research by Ives et al. [ 7 , 8 , 9 ]. Aligned with this aim for rigour, definitional clarity of key terms used within a research project is a component of research quality [ 10 , 11 ]. Improving the quality of empirical bioethics is also itself an ethical imperative [ 9 ].

We recently conducted a systematic review examining ‘ethical challenges’ as reported by specialist palliative care practitioners [ 12 ]. Our review, alongside our initial scoping search findings and reading of the literature, suggested that, although many authors use the term ‘ethical challenge(s)’ in empirical ethics research, there appeared to be no commonly described or accepted definition. Furthermore, papers retrieved rarely defined ‘ethical challenge(s)’ explicitly , which has also been noted by other researchers examining other topic areas [ 13 , 14 , 15 ]. Our review further suggested that authors frequently use terms closely related to ‘ethical challenge(s)’—such as ‘moral dilemmas’ or ‘ethical issues’—interchangeably with ‘ethical challenge(s)’ throughout manuscripts, rather than staying with the original term. Research shows that non-philosophers may understand these related terms in heterogeneous ways which may additionally affect understanding of texts across different readerships [ 16 , 17 ].

Without a clear definition of an ethical challenge, each researcher must use individual judgement to ascertain whether they have identified an instance of one within their dataset. This potentially generates an unnecessary source of bias, particularly if multiple researchers are involved in data collection, extraction, or analysis. This risks generating misleading ethical analyses, evaluations, or recommendations. Additionally, and more broadly, if primary studies do not define the term, then work based on these—such as systematic reviews of individual studies or those undertaking secondary data analysis—may unknowingly compare different phenomena without a mechanism for mitigating the effects this introduces.

In the hope of prompting a debate on this topic, we therefore undertook a rapid review, which aimed to explore existing definitions of “ethical challenge(s)” and the use of other closely related terms within recent empirical healthcare ethics literature.

We conducted a rapid review examining the usage of the term ‘ethical challenge(s)’ over the last 5 years in published research articles, in order to identify and summarise if, and how, the term was defined. As a secondary aim, we examined authors’ uses of closely related alternative terms within the included article texts separate to their use within any explicit definitions that may be present.

Rapid reviews use abridged systematic review methodology to understand the evidence base on a particular topic in a time and resource efficient manner [ 18 , 19 , 20 , 21 , 22 ]. Comparative reviews of topics in which both a rapid review and a systematic review had been undertaken demonstrated that the overall conclusions were similar, although rapid reviews were less likely to contain social and economic data, and systematic reviews contained more detailed recommendations [ 18 , 19 , 20 , 23 , 24 ]. The Cochrane Rapid Review Methods Group has recently released interim methodological guidelines for undertaking rapid reviews [ 6 ], advising authors to describe where their protocol deviates from a systematic review and detail any biases that these deviations may introduce [ 18 , 19 , 21 ]. We have followed the Cochrane recommended methodology [ 6 ]. A rapid review reporting guideline is currently under development [ 25 ] and this review is therefore reported based on the PRISMA 2020 statement for systematic reviews, with justifications provided where our approach deviated [ 26 ].

Prospective review protocol registration on the PROSPERO database is the current gold standard, but, at the time of writing, PROSPERO does not accept records for rapid reviews [ 27 ]. The protocol was therefore not published in advance.

Eligibility criteria

The inclusion and exclusion criteria are summarised in Table 1 . We used Strech et al.’s Methodology, Issues, Participants (MIP) structure for our eligibility criteria, which is recommended for systematic reviews in ‘empirical bioethics’ [ 28 ]. The criteria reflect three assumptions. First, that the inclusion of ‘ethical challenge(s)’ in the title would increase the likelihood that this was the authors’ preferred term for the concept under investigation, and therefore increase the probability of a definition being provided. Second, that studies aiming to describe empirical data and identify ethical challenges in real-world contexts are most likely to contain a definition to guide researchers in identifying these challenges as they collect and analyse data. Third, that structured reviews of studies of ethical challenges are likely to include a definition to allow researchers to reliably recognise an ethical challenge in retrieved records. We used a 5-year timeframe as a date restriction. This reflected a balance between adequately covering recent use of the term and time and resource restrictions of the rapid review.

Information sources

The search strategy was as follows:

‘ethical challenge’.ti OR ‘ethical challenges’.ti.

We searched Medline (Ovid interface), Philosopher’s Index (OVID interface), EMBASE (OVID interface), and CINAHL (Cumulative Index to Nursing and Allied Health Literature, EBSCO interface) for studies indexed over a five-year period between April 2016 and April 2021. These resources cover the breadth of healthcare research. Including Philosopher’s Index increased coverage of the bioethics literature. We did not search the grey literature [ 6 ]. The search strategy was tested by successfully retrieving three sentinel studies known to the research team.

Study selection

Retrieved studies were imported into Endnote X9.2 [ 29 ]. Records unavailable through institutional subscriptions were requested from corresponding authors. If unavailable 14 days after the request, the record was excluded. A random sample of 20% of records were dual screened at the title/abstract level by GS/MD. After discussion, the remainder were screened by GS. At full-text screening, a further 20% were dual screened by GS/MD and, again after discussion, the remaining studies were screened by GS.

Data extraction and analysis

Data extraction was undertaken using a pre-piloted form, with the first 5 records dually extracted by GS and MD. Data from the remaining included studies was then extracted by GS, with correctness and completeness checked by MD. We collected data on date of publication, authors, journal, country (for primary studies), methodology, definition of ‘ethical challenge(s)’ (present (yes/no)) and (where offered) the definition provided, and any closely related terms used, with counts of all terms used in each article. For closely related terms, data was extracted from the authors’ text, but not from direct quotations from qualitative research. Where definitions of ‘ethical challenge(s)’ were offered and/or related terms were identified, these were categorised and counted following the principles of summative content analysis [ 30 ]. Summative content analysis combines both the quantitative counting of specific content or words/terms with latent content analysis to identify and categorise their meanings. We identified keywords (‘ethical challenge(s)’ and closely related terms) deployed by the authors of the included papers, both prior to and during data analysis, and analysed the retrieved definitions. This approach allowed for exploration of both the content of definitions and development of insights into the use of related terms.

Risk of bias assessment

The focus of the rapid review was the definition of the term ‘ethical challenge(s)’ within retrieved records. We therefore did not undertake quality assessment for the included studies and reviews.

831 records were retrieved, reduced to 393 after de-duplication. 238 records were excluded after reviewing the title and/or abstract. 157 records were identified for full text screening, with 3 unavailable [ 31 , 32 , 33 ]. 82 records were excluded at full text stage and 72 records were included for analysis. See Fig.  1 for the PRISMA flowchart.

PRISMA flow diagram of record identification

Record characteristics

Of the 72 included records, 53 were empirical studies [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], 10 non-systematic reviews [ 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ], 7 systematic reviews [ 12 , 13 , 14 , 97 , 98 , 99 , 100 ], 1 systematic review protocol [ 101 ], and 1 non-systematic review protocol [ 102 ]. Of the 53 empirical studies, 42 (79%) were qualitative studies [ 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 48 , 50 , 51 , 52 , 54 , 55 , 56 , 57 , 58 , 60 , 62 , 63 , 64 , 65 , 66 , 67 , 69 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 79 , 80 , 81 , 83 , 84 , 85 , 86 ], 6 (12%) used a mixed methods approach [ 45 , 46 , 53 , 59 , 61 , 68 ], and 5 (10%) were quantitative [ 37 , 49 , 70 , 78 , 82 ]. 7/56 empirical studies, all qualitative interview studies, recruited participants internationally with no specific location stated [ 40 , 54 , 55 , 58 , 60 , 63 , 73 ]. Of the remaining studies, all but one were single-country studies: Botswana [ 75 ], Canada [ 41 , 65 ], China [ 57 ], Denmark [ 39 , 43 ], Dominican Republic [ 44 ], Germany [ 51 , 84 ], India [ 61 ], Iran [ 38 , 46 , 49 , 68 , 70 , 71 , 72 , 78 , 82 , 98 ], Italy [ 45 ], Mexico [ 87 ], the Netherlands [ 76 ], New Zealand [ 47 ], Norway [ 42 , 52 , 56 , 64 , 80 , 81 , 83 ], Saudi Arabia [ 34 , 35 , 36 , 37 ], Tanzania [ 69 , 74 ], Uganda [ 67 ], UK [ 86 ], and USA [ 50 , 53 , 59 , 62 , 66 , 77 , 79 , 85 , 85 ]. The remaining study was undertaken in both Sierra Leone and the UK [ 48 ]. See Table 2 for a summary.

12/72 (17%) of retrieved studies offered an explicit definition for ‘ethical challenge(s)’ [ 12 , 13 , 14 , 48 , 50 , 56 , 57 , 66 , 69 , 81 , 98 , 101 ]. Definitions were more likely to be found in more recent publications, with 4/12 included studies published in 2016–2018 [ 14 , 48 , 56 , 81 ], and 8/12 published in 2019–2021 [ 12 , 13 , 50 , 57 , 66 , 69 , 98 , 101 ]. The included study locations were evenly distributed, matching the overall pattern of retrieved studies, with studies from high- [ 48 , 50 , 56 , 66 , 81 ], middle- [ 57 , 98 ], and low-income settings [ 48 , 69 ]. The identified studies included eight qualitative studies [ 48 , 50 , 56 , 57 , 66 , 69 , 81 , 98 ], 3 systematic reviews [ 12 , 13 , 14 ], and 1 systematic review protocol [ 101 ]. Two of these records were the systematic review protocol and the report from our group, which accordingly contained the same definition [ 12 , 101 ], leaving 11 unique definitions. Definitions of ‘ethical challenge(s)’ identified in included studies are provided in Table 3 . Additionally, 68/72 (94%) reports used closely related terms synonymously in place of ‘ethical challenge(s)’ throughout their manuscript text, with between 1 and 8 different terms used within each report, and 32 different terms were identified. This occurred in both those reports that contained a definition and those that did not. See Table 4 for terms and frequencies.

Those records that offered explicit definitions used four approaches: (1) definition through concepts [ 12 , 57 , 66 ]; (2) reference to moral conflict, moral uncertainty or difficult choices [ 13 , 14 , 48 , 57 , 69 , 98 ]; (3) definition by study participants [ 12 , 48 , 50 , 56 ]; or (4) challenges as linked to their ability to generate emotional or moral distress within healthcare practitioners [ 14 , 14 , 66 , 81 ]. Each definition was associated with one or more of the identified elements, although none covered all four approaches. We describe these approaches below.

Approach 1: definition through concepts

This approach involves primarily defining ‘ethical challenge(s)’ in terms of related concepts. All three definitions using this approach defined ‘ethical challenge(s)’ as a summative collection of related concepts, including ‘ethical dilemmas’, ‘moral dilemmas’, ‘moral challenges’, ‘ethical issues’, and ‘ethical conflicts’ [ 12 , 57 , 66 ], for example:

‘The expression “ethical challenges” mainly refers to ethical dilemmas and ethical conflicts as well as other scenarios where difficult choices have to be made’ [ 57 ] p34

Only one went on to define the other concepts they utilised, ‘ethical dilemmas’ and ‘ethical conflicts’:

‘Ethical dilemmas are described as situations that cannot be solved; decisions made between two options may be morally plausible but are equally problematic due to the circumstances. Ethical conflicts, on the contrary, arise when one is aware of the necessity of proper actions but he or she may have trouble exercising these actions because of certain internal or external factors.’ [ 57 ] p34

Approach 2: moral conflict, moral uncertainty or difficult choices

This approach anchors an ethical challenge to the requirement for an agent to make a (difficult) choice in a situation where moral principles conflict, or there is moral uncertainty as to the ‘right’ way forward.

‘In this context, ethical challenge refers to the situation whereby every alternative is morally wrong and still one has to make a choice’ [ 69 ] p676 ‘An ethical challenge occurs when one does not know how to behave and act in the best way…’ [ 14 ] p93

Approach 3: definition by study participants

Four of the definitions involved research participants themselves defining something as an ‘ethical challenge’ [ 12 , 48 , 50 , 56 ], with three studies explicitly stating that participants would lead this definitional work [ 48 , 50 , 56 ]. Draper & Jenkins offer a starting definition, adopted from Schwartz et al. [ 103 ] with which to prime participants, while Forbes and Phillips [ 50 ] and Jakobsen and Sørlie [ 56 ] left the definition fully with their participants (Table 3 ). Finally, Schofield et al. proposed a very broad definition (Table 3 ), alongside the specific statement that either participants or researchers could nominate something as an ‘ethical challenge’ [ 12 ].

Approach 4: emotional or moral distress

This final approach was to tie ethical challenges to situations where participants feel ‘discomfort’, emotional distress or more specifically moral distress or moral residue [ 14 , 66 , 81 ]. Larkin et al. are clear that this distress must be tied to moral causes, but Hem et al. and Storaker et al. also refer more broadly to ‘discomfort’ [ 14 ] and ‘emotional stress’ [ 81 ] respectively. For example:

‘In this article, ethical challenges refer to values that entail emotional and moral stress in healthcare personnel.’ [ 81 ] p557

To the authors’ knowledge, this is the first rapid review to examine the use of the term ‘ethical challenge(s)’ in empirical healthcare research literature. Notably, only 12/72 (17%) of included studies published in the last 5 years contained a definition for ‘ethical challenge(s)’, despite this being the focus of the research being reported. The definitions identified were found in qualitative studies and systematic reviews and were evenly distributed geographically across high-, middle- and low-income settings. Definitions contained one or more of the identified approaches, although none contained elements from all four. Taken together, these findings suggest that a clear definition of ‘ethical challenge(s)’, and consistent use thereof, is currently lacking.

The four approaches indicate the diverse approaches to understanding ‘ethical challenge(s)’. Approaches 1 and 2 explore the concept from opposite viewpoints, with approach 1 looking from the conceptual perspective, through terms such as ‘dilemmas’ and ‘conflict’, and approach 2 from a participant perspective, specifically in those situations in which someone is trying to make a decision in circumstances where the preferred option is not possible or when they perceive there to be clash in values they feel are important. Within the concept-led definitions (approach 1), the use of a plurality of terms highlights a potential risk of bias, as different readers may interpret these differently. For example, some terms, such as ‘moral dilemma’, have relatively well understood specific meanings for some readers, particularly those with philosophical training [ 104 , 105 , 106 ]. The presence in the literature of specific and multiple meanings for some related terms highlights the importance of empirical studies providing a definition of these additional terms alongside their primary definition for ‘ethical challenge(s)’. This is more likely to be relevant where an a priori definition is used, but may be relevant to any prompting text for studies using a participant-led process, as in the study by Draper and Jenkins [ 48 ]. This clarity is important for both readers and future researchers who may undertake a secondary analysis of the data.

Approach 3 involves facilitating participants to nominate something as an ethical challenge [ 12 , 48 , 50 , 56 ]. This speaks to an important question about who, in a research context, is permitted to define or describe the object of interest, in this case ‘ethical challenge(s)’. Restricting the identification of ‘ethical challenge(s)’ to researchers alone may introduce bias by excluding input from those without bioethical ‘expertise’, but with important lived experience of the context under investigation. There is evidence that although clinicians can be sensitive to major ethical dilemmas, they can be less sensitive to small everyday ethical elements in clinical practice, and that ethical awareness varies between individuals [ 107 , 108 ]. Additionally, there is evidence in healthcare ethics research that patients and carers identify ethical challenges in situations that healthcare workers do not [ 109 ]. Therefore, relying entirely on a particular stakeholders’ perspectives (such as clinicians’) may risk missing important ethical challenges present in a scenario (assuming, of course, that we can settle what counts as an ‘ethical challenge(s)’).

In Approach 4, ethical challenges were linked to situations in which participants felt discomfort [ 14 ], emotional stress [ 81 ], moral distress or moral residue [ 66 ]. These concepts are themselves defined in quite varied ways (see, for example, definitions of ‘moral distress’ in a systematic review by Morley et al. [ 110 ]), potentially leading to additional conceptual confusion. Identifying triggers for moral distress is important, as high levels of moral distress are known to have negative impacts on work environments and lead to increased levels of compassion fatigue, increased staff turnover rates and poorer patient outcomes [ 110 , 111 , 112 ]. However, it is also possible that the requirement that, to be identified as an ethical challenge, the situation must invoke stress or distress might result in the under-identification of ethical challenges. We anticipate that many practitioners will daily manage multiple low-level ethical challenges, many of which will not generate moral distress or leave a moral residue. As such, the presence of moral distress may not be sufficient or even necessary in order to label a moral event an ‘ethical challenge’. However, the relationship between ‘ethical challenge(s)’ and moral distress is complex, and some might argue that the latter has an important relationship to the former. For example, moral distress, as conceived by Jameton and others [ 110 , 113 , 114 ], is linked to the after-effects of having to handle ethical challenge(s), so some researchers might view the generation of moral distress as relevant to identifying ethical challenges.

Although our review revealed these four approaches, the wider literature indicates there may be alternative approaches available. For example, other potential approaches would define ethical challenges as events that interact with moral principles, such as autonomy, beneficence, non-maleficence or justice, as proposed by Beauchamp and Childress [ 115 ], or as events in which those principles clash, for example as used by Klingler et al. in their research focusing on ethical issues in health surveillance [ 116 ]. However, these approaches were not seen amongst our included papers.

Returning to our included papers, the high rates of use of closely related terms within included manuscript texts may add to difficulties in understanding the exact object of interest if these terms are being used as synonyms for ‘ethical challenge(s)’. This may be particularly the case if terms used include those such as ‘moral dilemma’, which (as shown above) will have specific meanings for some readers. Interchangeable, undefined usage of these terms by study authors within study texts risks further exacerbating the problems caused by a lack of definitional clarity.

Strengths and limitations

This rapid review is the first systematic attempt to describe the definitions of ‘ethical challenge(s)’ available within the recent published literature.

There are, however, five limitations to note. First, the review only includes results from the past 5 years, which inevitably means that older publications, which may have contained further definitions of ‘ethical challenge(s)’, were excluded. The focus on the previous 5 years does, however, allow for an assessment of the term’s use(s) within a reasonable period of time and was felt to be appropriate given the aims and resources available to this project.

Second, our three assumptions listed in the methodology section may have excluded some records that contained a relevant definition. However, these assumptions, and the resulting focus on two search terms, allowed for a balance between retrieved record numbers and team resources.

Third, the four databases searched were chosen for their focus on the healthcare ethics literature; we may therefore may have missed relevant usage in other fields or disciplines. Similarly, we did not search the grey literature, which might have excluded relevant research.

Fourth, for resource reasons, the assessment as to whether a related term was being used interchangeably in the text was undertaken by a single researcher (GS). This subjective assessment risks miscalculating both the number of interchangeable terms identified and the frequency counts.

Finally, we did not review the theoretical literature for conceptual definitions of ‘ethical challenge(s)’, hence the definitions we identified might not match completely conceptual understandings of the term. However, our review shows how the term is currently being used in the research literature. Indeed, if there are strong conceptual definitions within the theoretical literature, then it is clear that they are currently not reaching the researchers whose work was identified by our review.

This review is the first, to our knowledge, to identify and describe definitions (and uses) of the widely-utilised concept of ‘ethical challenge(s)’ within healthcare research. Only 17% (12/72) of retrieved papers presented an explicit definition of ‘ethical challenge(s)’ before beginning to investigate this concept in context. The definitions found contained one or more of four identified approaches, with significant cross-reference to related terms and concepts which themselves have variation in their accepted meanings. We recommend that researchers define the phenomenon of interest—in this case, ‘ethical challenge(s)’—to help ensure clarity. This should either be a priori, or, if using an approach that includes participant participation in the generation of the definition, reporting their final working definition a posteriori. The choice of definition should be justified, including the decision as to whether to include participants in this process. Additionally, if a definition references other conceptual terms, then consideration should be given to defining these as well.

The results of this rapid review suggest that a common conceptual understanding of the term ‘ethical challenge(s)’ is lacking within empirical bioethical research and that there is a need for researchers in this area to consider what conceptual formulations might be most useful. Again, failure to use definitions of crucial research concepts within empirical bioethics research potentially generates confusion and avoidable bias within research outputs, risking misleading ethical analyses, evaluations, and resulting recommendations. We therefore hope this review will help stimulate debate amongst empirical bioethics researchers on possible definitional content for such a commonly used term and prompt further discussion and research. Additionally, given the central role of patient and public partnership and involvement in research, further thought should be given to who should be involved in nominating something as a challenge worthy of study.

Following on from this work, there would be value in conducting an empirical bioethical project combining a full systematic review of definitions of ‘ethical challenge(s)’ (and related terms) integrated with an exploration of the conceptual literature to generate recommendations for approaches towards the content of potential definitions, perhaps related to the identified approaches above. Such a project could also ask authors who currently use the term ‘ethical challenge(s)’ in their research how they conceptualise this. Furthermore, work to better understand the benefits of including study participants in the definition process is also important. Finally, whilst researchers should justify whatever approach they choose to take, there may be merit in examining whether anything is lost if studies lack a robust or agreed definition, or whether doing so affords a flexibility and openness that allows for a broader range of ethical challenges to be identified.

Availability of data and materials

All data is presented in this manuscript.

Critical Appraisal Skills Programme. CASP Qualitative Checklist. 2018. https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist.pdf . Accessed 16 Aug 2018.

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups | The EQUATOR Network. https://www.equator-network.org/reporting-guidelines/coreq/ . Accessed 2 Apr 2020.

Standards for reporting qualitative research: a synthesis of recommendations | The EQUATOR Network. https://www.equator-network.org/reporting-guidelines/srqr/ . Accessed 2 Apr 2020.

Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci. 2018;13:2.

Article   Google Scholar  

The EQUATOR Network | Enhancing the QUAlity and Transparency of Health Research. https://www.equator-network.org/ . Accessed 2 Apr 2020.

Garritty C, Gartlehner G, Nussbaumer-Streit B, King VJ, Hamel C, Kamel C, et al. Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. J Clin Epidemiol. 2021;130:13–22.

Singh I. Evidence, epistemology and empirical bioethics. In: Cribb A, Ives J, Dunn M, editors. Empirical bioethics: theoretical and practical perspectives. Cambridge: Cambridge University Press; 2016. p. 67–83. https://doi.org/10.1017/9781139939829.006 .

Chapter   Google Scholar  

Ives J, Dunn M, Molewijk B, Schildmann J, Bærøe K, Frith L, et al. Standards of practice in empirical bioethics research: towards a consensus. BMC Med Ethics. 2018;19:68.

Mertz M, Inthorn J, Renz G, Rothenberger LG, Salloch S, Schildmann J, et al. Research across the disciplines: a road map for quality criteria in empirical ethics research. BMC Med Ethics. 2014;15:17.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

Cronin P, Ryan F, Coughlan M. Concept analysis in healthcare research. Int J Ther Rehabil. 2010;17:62–8.

Schofield G, Dittborn M, Huxtable R, Brangan E, Selman LE. Real-world ethics in palliative care: a systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. Palliat Med. 2021;35:315–34.

Heggestad AKT, Magelssen M, Pedersen R, Gjerberg E. Ethical challenges in home-based care: a systematic literature review. Nurs Ethics. 2020;28:628–44.

Hem MH, Gjerberg E, Husum TL, Pedersen R. Ethical challenges when using coercion in mental healthcare: a systematic literature review. Nurs Ethics. 2018;25:92–110.

Lillemoen L, Pedersen R. Ethical challenges and how to develop ethics support in primary health care. Nurs Ethics. 2013;20:96–108.

Saarni SI, Halila R, Palmu P, Vänskä J. Ethically problematic treatment decisions in different medical specialties. J Med Ethics. 2008;34:262–7.

Self D, Skeel J, Jecker N. A comparison of the moral reasoning of physicians and clinical medical ethicists. Acad Med. 1993;68:852–5.

Ganann R, Ciliska D, Thomas H. Expediting systematic reviews: methods and implications of rapid reviews. Implement Sci IS. 2010;5:56.

Cameron A. Rapid versus full systematic reviews: an inventory of current mathods and practice in health technology assessment. Stepney: Royal Australasian College of Dental Surgeons; 2007.

Google Scholar  

Tricco AC, Antony J, Zarin W, Strifler L, Ghassemi M, Ivory J, et al. A scoping review of rapid review methods. BMC Med. 2015;13:224.

Haby MM, Chapman E, Clark R, Barreto J, Reveiz L, Lavis JN. What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review. Health Res Policy Syst. 2016;14:83.

Gough D, Thomas J, Oliver S. Clarifying differences between review designs and methods. Syst Rev. 2012;1:28.

Watt A, Cameron A, Sturm L, Lathlean T, Babidge W, Blamey S, et al. Rapid reviews versus full systematic reviews: an inventory of current methods and practice in health technology assessment. Int J Technol Assess Health Care. 2008;24:133–9.

Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Syst Rev. 2012;1:10.

Stevens A, Garritty C, Hersi M, Moher D. Developing PRISMA-RR, a reporting guideline for rapid reviews of primary studies (Protocol). 2018. https://www.equator-network.org/wp-content/uploads/2018/02/PRISMA-RRprotocol.pdf . Accessed 6 Oct 2019.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

PROSPERO: International prospective register of systematic reviews. https://www.crd.york.ac.uk/prospero/ . Accessed 10 June 2021.

Strech D, Synofzik M, Marckmann G. Systematic reviews of empirical bioethics. J Med Ethics. 2008;34:472–7.

The Endnote Team. Endnote X9.2. Philadelphia, PA: Clarivate Analysis; 2013.

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.

Khalili M. Iranian nurses’ ethical challenges in controlling children’s fever. Int J Pharm Res. 2018;10:337–40.

Rezaee N. Ethical challenges in cancer care: a qualitative analysis of nurses’ perceptions. Res Theory Nurs Pract. 2019;33:169–82.

Bartnik E. Ethical challenges in genetics. J Med Liban. 2019;67:138–40.

Alahmad G, Aljohani S, Najjar MF. Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC Med Ethics. 2020;21:1–7.

Alahmad G, Al-Kamli H, Alzahrani H. Ethical challenges of pediatric cancer care: interviews with nurses in Saudi Arabia. Cancer Control. 2020;27:1073274820917210.

Alahmad G, Richi H, BaniMustafa A, Almutairi AF. Ethical challenges related to the novel coronavirus (COVID-19) outbreak: interviews with professionals from Saudi Arabia. Front Med. 2021. https://doi.org/10.3389/fmed.2021.620444 .

Alahmad G, AlSaqabi M, Alkamli H, Aleidan M. Ethical challenges in consent procedures involving pediatric cancer patients in Saudi Arabia: an exploratory survey. Dev World Bioeth. 2021. https://doi.org/10.1111/dewb.12308 .

Bijani M, Mohammadi F. Ethical challenges of caring for burn patients: a qualitative study. BMC Med Ethics. 2021;22:1–10.

Bladt T, Vorup-Jensen T, Sædder E, Ebbesen M. Empirical investigation of ethical challenges related to the use of biological therapies. J Law Med Ethics. 2020;48:567–78.

Boulanger RF, Komparic A, Dawson A, Upshur REG, Silva DS. Developing and implementing new TB technologies: key informants’ perspectives on the ethical challenges. J Bioeth Inq. 2020;17:65–73.

Bourbonnais A, Rousseau J, Lalonde M-H, Meunier J, Lapierre N, Gagnon M-P. Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: a qualitative study. Int J Older People Nurs. 2019;14:e12266.

Brodtkorb K, Skisland AV-S, Slettebø Å, Skaar R. Preserving dignity in end-of-life nursing home care: some ethical challenges. Nord J Nurs Res. 2017;37:78–84.

Bruun H, Lystbaek SG, Stenager E, Huniche L, Pedersen R. Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010–2015: a qualitative content analyses. BMC Med Ethics. 2018;19:62.

Canario Guzmán JA, Espinal R, Báez J, Melgen RE, Rosario PAP, Mendoza ER. Ethical challenges for international collaborative research partnerships in the context of the Zika outbreak in the Dominican Republic: a qualitative case study. Health Res Policy Syst. 2017;15:82.

Carnevale F, Delogu B, Bagnasco A, Sasso L. Correctional nursing in Liguria, Italy: examining the ethical challenges. J Prev Med Hyg. 2018;59:E315.

Delpasand K, Nazari Tavakkoli S, Kiani M, Abbasi M, Afshar L. Ethical challenges in the relationship between the pharmacist and patient in Iran. Int J Hum Rights Healthc. 2020;13:317–23.

Donnelly S, Walker S. Enabling first and second year doctors to negotiate ethical challenges in end-of-life care: a qualitative study. BMJ Support Palliat Care. 2021. https://doi.org/10.1136/bmjspcare-2020-002672 .

Draper H, Jenkins S. Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014–2015 Ebola outbreak: a qualitative study. BMC Med Ethics. 2017;18:77.

Ebrahimi A, Ebrahimi S. Pediatric residents’ and attending physicians’ perspectives on the ethical challenges of end of life care in children. J Med Ethics Hist Med. 2018;11:16.

Forbes S, Phillips C. Ethical challenges encountered by clinical trials nurses: a grounded theory study. Oncol Nurs Forum. 2020;47:428–35.

Gágyor I, Heßling A, Heim S, Frewer A, Nauck F, Himmel W. Ethical challenges in primary care: a focus group study with general practitioners, nurses and informal caregivers. Fam Pract. 2019;36:225–30.

Haugom W, Ruud E, Hynnekleiv T. Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals. BMC Health Serv Res. 2019;19:879.

Hawking M, Kim J, Jih M, Hu C, Yoon JD. “Can virtue be taught?”: a content analysis of medical students’ opinions of the professional and ethical challenges to their professional identity formation. BMC Med Educ. 2020;20:380.

Hyder A, Krubiner C. Ethical challenges in designing and implementing health systems research: experiences from the field. AJOB Empir Bioeth. 2016;7:209–17.

Jackson C, Gardy JL, Shadiloo HC, Silva DS. Trust and the ethical challenges in the use of whole genome sequencing for tuberculosis surveillance: a qualitative study of stakeholder perspectives. BMC Med Ethics. 2019;20:43.

Jakobsen R, Sørlie V. Ethical challenges: trust and leadership in dementia care. Nurs Ethics. 2016;23:636–45.

Jia Y, Chen O, Xiao Z, Xiao J, Bian J, Jia H. Nurses’ ethical challenges caring for people with COVID-19: a qualitative study. Nurs Ethics. 2021;28:33–45.

Kalkman S, van Thiel GJMW, Grobbee DE, Meinecke A-K, Zuidgeest MGP, van Delden JJM, et al. Stakeholders’ views on the ethical challenges of pragmatic trials investigating pharmaceutical drugs. Trials. 2016;17:419.

Kasper J, Mulye A, Doobay-Persaud A, Seymour B, Nelson BD. Perspectives and solutions from clinical trainees and mentors regarding ethical challenges during global health experiences. Ann Glob Health. 2020;86:34.

Kelley MC, Brazg T, Wilfond BS, Lengua LJ, Rivin BE, Martin-Herz SP, et al. Ethical challenges in research with orphans and vulnerable children: a qualitative study of researcher experiences. Int Health. 2016;8:187–96.

Kemparaj VM, Panchmal GS, Kadalur UG. The top 10 ethical challenges in dental practice in indian scenario: dentist perspective. Contemp Clin Dent. 2018;9:97.

Klitzman R. Unconventional combinations of prospective parents: ethical challenges faced by IVF providers. BMC Med Ethics. 2017;18:18.

Komparic A, Dawson A, Boulanger RF, Upshur REG, Silva DS. A failure in solidarity: ethical challenges in the development and implementation of new tuberculosis technologies. Bioethics. 2019;33:557–67.

Laholt H, McLeod K, Guillemin M, Beddari E, Lorem G. Ethical challenges experienced by public health nurses related to adolescents’ use of visual technologies. Nurs Ethics. 2019;26:1822–33.

Laliberté M, Williams-Jones B, Feldman DE, Hunt M. Ethical challenges for patient access to physical therapy: views of staff members from three publicly-funded outpatient physical therapy departments. Narrat Inq Bioeth. 2017;7:157–69.

Larkin ME, Beardslee B, Cagliero E, Griffith CA, Milaszewski K, Mugford MT, et al. Ethical challenges experienced by clinical research nurses: a qualitative study. Nurs Ethics. 2019;26:172–84.

Mbalinda SN, Bakeera-Kitaka S, Amooti DL, Magongo EN, Musoke P, Kaye DK. Ethical challenges of the healthcare transition to adult antiretroviral therapy (ART) clinics for adolescents and young people with HIV in Uganda. BMC Med Ethics. 2021;22:1–14.

Mehdipour Rabori R, Dehghan M, Nematollahi M. Nursing students’ ethical challenges in the clinical settings: a mixed-methods study. Nurs Ethics. 2019;26:1983–91.

Mlughu TS, Anaeli A, Joseph R, Sirili N. Voluntary HIV counseling and testing among commercial motorcyclist youths: an exploration of ethical challenges and coping mechanisms in Dar es Salaam. HIVAIDS - Res Palliat Care. 2020;12:675–85.

Moeini S, Shahriari M, Shamali M. Ethical challenges of obtaining informed consent from surgical patients. Nurs Ethics. 2020;27:527–36.

Naseri-Salahshour V, Sajadi M. Ethical challenges of novice nurses in clinical practice: Iranian perspective. Int Nurs Rev. 2020;67:76–83.

Naseri-Salahshour V, Sajadi M. From suffering to indifference: reaction of novice nurses to ethical challenges in first year of clinical practice. Iran J Nurs Midwifery Res. 2019;24:251.

Nicholls SG, Carroll K, Zwarenstein M, Brehaut JC, Weijer C, Hey SP, et al. The ethical challenges raised in the design and conduct of pragmatic trials: an interview study with key stakeholders. Trials. 2019;20:765.

Pancras G, Shayo J, Anaeli A. Non-medical facilitators and barriers towards accessing haemodialysis services: an exploration of ethical challenges. BMC Nephrol. 2018;19:342.

Sabone M, Mazonde P, Cainelli F, Maitshoko M, Joseph R, Shayo J, et al. Everyday ethical challenges of nurse-physician collaboration. Nurs Ethics. 2020;27:206–20.

Seekles W, Widdershoven G, Robben P, van Dalfsen G, Molewijk B. Inspectors’ ethical challenges in health care regulation: a pilot study. Med Health Care Philos. 2017;20:311–20.

Segal AG, Frasso R, Sisti DA. County jail or psychiatric hospital? Ethical challenges in correctional mental health care. Qual Health Res. 2018;28:963–76.

Shayestefar S, Hamooleh MM, Kouhnavard M, Kadivar M. Ethical challenges in pediatrics from the viewpoints of Iranian pediatric residents. J Compr Pediatr. 2018. https://doi.org/10.5812/compreped.62747 .

Sinow C, Burgart A, Char DS. How anesthesiologists experience and negotiate ethical challenges from drug shortages. AJOB Empir Bioeth. 2020;12:84–91.

Slettebø Å, Skaar R, Brodtkorb K, Skisland A. Conflicting rationales: leader’s experienced ethical challenges in community health care for older people. Scand J Caring Sci. 2018;32:645–53.

Storaker A, Nåden D, Sæteren B. From painful busyness to emotional immunization: nurses’ experiences of ethical challenges. Nurs Ethics. 2017;24:556–68.

Taebi M, Bahrami R, Bagheri-Lankarani N, Shahriari M. Ethical challenges of embryo donation in embryo donors and recipients. Iran J Nurs Midwifery Res. 2018;23:36.

Tønnessen S, Solvoll B-A, Brinchmann BS. Ethical challenges related to next of kin - nursing staffs’ perspective. Nurs Ethics. 2016;23:804–14.

Ullrich A, Theochari M, Bergelt C, Marx G, Woellert K, Bokemeyer C, et al. Ethical challenges in family caregivers of patients with advanced cancer—a qualitative study. BMC Palliat Care. 2020;19:1–13.

Verma A, Smith AK, Harrison KL, Chodos AH. Ethical challenges in caring for unrepresented adults: a qualitative study of key stakeholders. J Am Geriatr Soc. 2019;67:1724–9.

Morley G, Ives J, Bradbury-Jones C. Moral distress and austerity: an avoidable ethical challenge in healthcare. Health Care Anal. 2019;27:185–201.

Ayala-Yáñez R, Ruíz-López R, McCullough LB, Chervenak FA. Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine. J Perinat Med. 2020;48:728–32.

Binns C, Lee M, Kagawa M. Ethical challenges in infant feeding research. Nutrients. 2017;9:59.

Čartolovni A, Habek D. Guidelines for the management of the social and ethical challenges in brain death during pregnancy. Int J Gynecol Obstet. 2019;146:149–56.

Hofmann B. Informing about mammographic screening: ethical challenges and suggested solutions. Bioethics. 2020;34:483–92.

Hunt M, Pal NE, Schwartz L, O’Mathúna D. Ethical challenges in the provision of mental health services for children and families during disasters. Curr Psychiatry Rep. 2018;20:60.

Johnson S, Parker M. Ethical challenges in pathogen sequencing: a systematic scoping review. Wellcome Open Res. 2020;5:119.

MacDonald S, Shemie S. Ethical challenges and the donation physician specialist: a scoping review. Transplantation. 2017. https://doi.org/10.1097/TP.0000000000001697 .

Saigle V, Racine E. Ethical challenges faced by healthcare professionals who care for suicidal patients: a scoping review. Monash Bioeth Rev. 2018;35:50–79.

Saigle V, Séguin M, Racine E. Identifying gaps in suicide research: a scoping review of ethical challenges and proposed recommendations. IRB Ethics Hum Res. 2017;39:1–9.

Wilson E, Kenny A, Dickson-Swift V. Ethical challenges in community-based participatory research: a scoping review. Qual Health Res. 2018;28:189–99.

Martins Pereira S, Hernández-Marrero P. Ethical challenges of outcome measurement in palliative care clinical practice: a systematic review of systematic reviews. Ann Palliat Med. 2018;7:S207–18.

Saghafi A, Bahramnezhad F, Poormollamirza A, Dadgari A, Navab E. Examining the ethical challenges in managing elder abuse: a systematic review. J Med Ethics Hist Med. 2019. https://doi.org/10.18502/jmehm.v12i7.1115 .

West E, Stuckelberger A, Pautex S, Staaks J, Gysels M. Operationalising ethical challenges in dementia research—a systematic review of current evidence. Age Ageing. 2017;46:678–87.

Ewuoso C, Hall S, Dierickx K. How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies. Glob Bioeth. 2021;32:67–84.

Schofield G, Brangan E, Dittborn M, Huxtable R, Selman L. Real-world ethics in palliative care: protocol for a systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. BMJ Open. 2019;9:e028480.

Sun W, Wilson MG, Schreiber D, Wang RH. Ethical challenges related to assistive product access for older adults and adults living with a disability: a scoping review protocol. Syst Rev. 2017;6:24.

Schwartz L, Sinding C, Hunt M, Elit L, Redwood-Campbell L, Adelson N, et al. Ethics in humanitarian aid work: learning from the narratives of humanitarian health workers. AJOB Prim Res. 2010;1:45–54.

McConnell T. Moral Dilemmas. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. Fall 2018. Metaphysics Research Lab, Stanford University; 2018. https://plato.stanford.edu/archives/fall2018/entries/moral-dilemmas/ . Accessed 30 Oct 2019.

Tessman L. Moral failure: on the impossible demands of morality. New York, NY: Oxford University Press; 2014. http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=859724 . Accessed 5 Nov 2019.

Ejder Apay S, Gürol A, Gür EY, Church S. Midwifery students’ reactions to ethical dilemmas encountered in outpatient clinics. Nurs Ethics. 2020;27:1542–55.

Milliken A, Ludlow L, DeSanto-Madeya S, Grace P. The development and psychometric validation of the Ethical Awareness Scale. J Adv Nurs. 2018;74:2005–16.

Truog RD, Brown SD, Browning D, Hundert EM, Rider EA, Bell SK, et al. Microethics: the ethics of everyday clinical practice. Hastings Cent Rep. 2015;45:11–7.

Woods S, Beaver K, Luker K. User’s views of palliative care services: ethical implications. Nurs Ethics Int J Health Care Prof. 2000;7:314–26.

Morley G, Ives J, Bradbury-Jones C, Irvine F. What is ‘moral distress’? A narrative synthesis of the literature. Nurs Ethics. 2017;26:646–62.

Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2009;20:330–42.

Mason VM, Leslie G, Clark K, Lyons P, Walke E, Butler C, et al. Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study. Dimens Crit Care Nurs DCCN. 2014;33:215–25.

Jameton A. Nursing practice: the ethical issues. Englewood Cliffs: Prentice-Hall; 1984.

Tigard DW. The positive value of moral distress. Bioethics. 2019;33:601–8.

Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University Press; 1979.

Klingler C, Silva DS, Schuermann C, Reis AA, Saxena A, Strech D. Ethical issues in public health surveillance: a systematic qualitative review. BMC Public Health. 2017;17:295.

Solvoll B-A, Hall EO, Brinchmann BS. Ethical challenges in everyday work with adults with learning disabilities. Nurs Ethics. 2015;22:417–27.

Download references

Acknowledgements

Not applicable.

GS is supported by a Wellcome Trust Research Award for Health Professionals (208129/Z/17/Z). LES is funded by a Career Development Fellowship from the National Institute for Health Research. RH is part-funded by the Wellcome Trust (209841/Z/17/Z) and the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. He serves on various local, regional, and national ethics committees and related groups. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health, or any of the other organisations with and for whom the authors work.

Author information

Authors and affiliations.

Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK

Guy Schofield & Richard Huxtable

Paediatric Bioethics Centre, Great Ormond Street Hospital, London, WC1N 3JH, UK

Mariana Dittborn

Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK

Guy Schofield & Lucy Ellen Selman

You can also search for this author in PubMed   Google Scholar

Contributions

GS, MD and RH conceived of the idea for the review; LES, GS, MD and RH designed the review protocol; GS and MD conducted the literature searching, screening, data extraction and led on data interpretation but all authors were involved; GS led on drafting the manuscript; all authors critically revised the manuscript for content and approved the version to be published. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Guy Schofield .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that there are no conflicts of interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Schofield, G., Dittborn, M., Selman, L.E. et al. Defining ethical challenge(s) in healthcare research: a rapid review. BMC Med Ethics 22 , 135 (2021). https://doi.org/10.1186/s12910-021-00700-9

Download citation

Received : 10 June 2021

Accepted : 03 September 2021

Published : 29 September 2021

DOI : https://doi.org/10.1186/s12910-021-00700-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Ethical challenges
• Rapid review
• Empirical bioethics
• Moral dilemmas

BMC Medical Ethics

ISSN: 1472-6939

• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• CBE Life Sci Educ
• v.21(3); Fall 2022

Literature Reviews, Theoretical Frameworks, and Conceptual Frameworks: An Introduction for New Biology Education Researchers

Julie a. luft.

† Department of Mathematics, Social Studies, and Science Education, Mary Frances Early College of Education, University of Georgia, Athens, GA 30602-7124

Sophia Jeong

‡ Department of Teaching & Learning, College of Education & Human Ecology, Ohio State University, Columbus, OH 43210

Robert Idsardi

§ Department of Biology, Eastern Washington University, Cheney, WA 99004

Grant Gardner

∥ Department of Biology, Middle Tennessee State University, Murfreesboro, TN 37132

Associated Data

To frame their work, biology education researchers need to consider the role of literature reviews, theoretical frameworks, and conceptual frameworks as critical elements of the research and writing process. However, these elements can be confusing for scholars new to education research. This Research Methods article is designed to provide an overview of each of these elements and delineate the purpose of each in the educational research process. We describe what biology education researchers should consider as they conduct literature reviews, identify theoretical frameworks, and construct conceptual frameworks. Clarifying these different components of educational research studies can be helpful to new biology education researchers and the biology education research community at large in situating their work in the broader scholarly literature.

INTRODUCTION

Discipline-based education research (DBER) involves the purposeful and situated study of teaching and learning in specific disciplinary areas ( Singer et al. , 2012 ). Studies in DBER are guided by research questions that reflect disciplines’ priorities and worldviews. Researchers can use quantitative data, qualitative data, or both to answer these research questions through a variety of methodological traditions. Across all methodologies, there are different methods associated with planning and conducting educational research studies that include the use of surveys, interviews, observations, artifacts, or instruments. Ensuring the coherence of these elements to the discipline’s perspective also involves situating the work in the broader scholarly literature. The tools for doing this include literature reviews, theoretical frameworks, and conceptual frameworks. However, the purpose and function of each of these elements is often confusing to new education researchers. The goal of this article is to introduce new biology education researchers to these three important elements important in DBER scholarship and the broader educational literature.

The first element we discuss is a review of research (literature reviews), which highlights the need for a specific research question, study problem, or topic of investigation. Literature reviews situate the relevance of the study within a topic and a field. The process may seem familiar to science researchers entering DBER fields, but new researchers may still struggle in conducting the review. Booth et al. (2016b) highlight some of the challenges novice education researchers face when conducting a review of literature. They point out that novice researchers struggle in deciding how to focus the review, determining the scope of articles needed in the review, and knowing how to be critical of the articles in the review. Overcoming these challenges (and others) can help novice researchers construct a sound literature review that can inform the design of the study and help ensure the work makes a contribution to the field.

The second and third highlighted elements are theoretical and conceptual frameworks. These guide biology education research (BER) studies, and may be less familiar to science researchers. These elements are important in shaping the construction of new knowledge. Theoretical frameworks offer a way to explain and interpret the studied phenomenon, while conceptual frameworks clarify assumptions about the studied phenomenon. Despite the importance of these constructs in educational research, biology educational researchers have noted the limited use of theoretical or conceptual frameworks in published work ( DeHaan, 2011 ; Dirks, 2011 ; Lo et al. , 2019 ). In reviewing articles published in CBE—Life Sciences Education ( LSE ) between 2015 and 2019, we found that fewer than 25% of the research articles had a theoretical or conceptual framework (see the Supplemental Information), and at times there was an inconsistent use of theoretical and conceptual frameworks. Clearly, these frameworks are challenging for published biology education researchers, which suggests the importance of providing some initial guidance to new biology education researchers.

Fortunately, educational researchers have increased their explicit use of these frameworks over time, and this is influencing educational research in science, technology, engineering, and mathematics (STEM) fields. For instance, a quick search for theoretical or conceptual frameworks in the abstracts of articles in Educational Research Complete (a common database for educational research) in STEM fields demonstrates a dramatic change over the last 20 years: from only 778 articles published between 2000 and 2010 to 5703 articles published between 2010 and 2020, a more than sevenfold increase. Greater recognition of the importance of these frameworks is contributing to DBER authors being more explicit about such frameworks in their studies.

Collectively, literature reviews, theoretical frameworks, and conceptual frameworks work to guide methodological decisions and the elucidation of important findings. Each offers a different perspective on the problem of study and is an essential element in all forms of educational research. As new researchers seek to learn about these elements, they will find different resources, a variety of perspectives, and many suggestions about the construction and use of these elements. The wide range of available information can overwhelm the new researcher who just wants to learn the distinction between these elements or how to craft them adequately.

Our goal in writing this paper is not to offer specific advice about how to write these sections in scholarly work. Instead, we wanted to introduce these elements to those who are new to BER and who are interested in better distinguishing one from the other. In this paper, we share the purpose of each element in BER scholarship, along with important points on its construction. We also provide references for additional resources that may be beneficial to better understanding each element. Table 1 summarizes the key distinctions among these elements.

Comparison of literature reviews, theoretical frameworks, and conceptual reviews

This article is written for the new biology education researcher who is just learning about these different elements or for scientists looking to become more involved in BER. It is a result of our own work as science education and biology education researchers, whether as graduate students and postdoctoral scholars or newly hired and established faculty members. This is the article we wish had been available as we started to learn about these elements or discussed them with new educational researchers in biology.

LITERATURE REVIEWS

Purpose of a literature review.

A literature review is foundational to any research study in education or science. In education, a well-conceptualized and well-executed review provides a summary of the research that has already been done on a specific topic and identifies questions that remain to be answered, thus illustrating the current research project’s potential contribution to the field and the reasoning behind the methodological approach selected for the study ( Maxwell, 2012 ). BER is an evolving disciplinary area that is redefining areas of conceptual emphasis as well as orientations toward teaching and learning (e.g., Labov et al. , 2010 ; American Association for the Advancement of Science, 2011 ; Nehm, 2019 ). As a result, building comprehensive, critical, purposeful, and concise literature reviews can be a challenge for new biology education researchers.

Building Literature Reviews

There are different ways to approach and construct a literature review. Booth et al. (2016a) provide an overview that includes, for example, scoping reviews, which are focused only on notable studies and use a basic method of analysis, and integrative reviews, which are the result of exhaustive literature searches across different genres. Underlying each of these different review processes are attention to the s earch process, a ppraisa l of articles, s ynthesis of the literature, and a nalysis: SALSA ( Booth et al. , 2016a ). This useful acronym can help the researcher focus on the process while building a specific type of review.

However, new educational researchers often have questions about literature reviews that are foundational to SALSA or other approaches. Common questions concern determining which literature pertains to the topic of study or the role of the literature review in the design of the study. This section addresses such questions broadly while providing general guidance for writing a narrative literature review that evaluates the most pertinent studies.

The literature review process should begin before the research is conducted. As Boote and Beile (2005 , p. 3) suggested, researchers should be “scholars before researchers.” They point out that having a good working knowledge of the proposed topic helps illuminate avenues of study. Some subject areas have a deep body of work to read and reflect upon, providing a strong foundation for developing the research question(s). For instance, the teaching and learning of evolution is an area of long-standing interest in the BER community, generating many studies (e.g., Perry et al. , 2008 ; Barnes and Brownell, 2016 ) and reviews of research (e.g., Sickel and Friedrichsen, 2013 ; Ziadie and Andrews, 2018 ). Emerging areas of BER include the affective domain, issues of transfer, and metacognition ( Singer et al. , 2012 ). Many studies in these areas are transdisciplinary and not always specific to biology education (e.g., Rodrigo-Peiris et al. , 2018 ; Kolpikova et al. , 2019 ). These newer areas may require reading outside BER; fortunately, summaries of some of these topics can be found in the Current Insights section of the LSE website.

In focusing on a specific problem within a broader research strand, a new researcher will likely need to examine research outside BER. Depending upon the area of study, the expanded reading list might involve a mix of BER, DBER, and educational research studies. Determining the scope of the reading is not always straightforward. A simple way to focus one’s reading is to create a “summary phrase” or “research nugget,” which is a very brief descriptive statement about the study. It should focus on the essence of the study, for example, “first-year nonmajor students’ understanding of evolution,” “metacognitive prompts to enhance learning during biochemistry,” or “instructors’ inquiry-based instructional practices after professional development programming.” This type of phrase should help a new researcher identify two or more areas to review that pertain to the study. Focusing on recent research in the last 5 years is a good first step. Additional studies can be identified by reading relevant works referenced in those articles. It is also important to read seminal studies that are more than 5 years old. Reading a range of studies should give the researcher the necessary command of the subject in order to suggest a research question.

Given that the research question(s) arise from the literature review, the review should also substantiate the selected methodological approach. The review and research question(s) guide the researcher in determining how to collect and analyze data. Often the methodological approach used in a study is selected to contribute knowledge that expands upon what has been published previously about the topic (see Institute of Education Sciences and National Science Foundation, 2013 ). An emerging topic of study may need an exploratory approach that allows for a description of the phenomenon and development of a potential theory. This could, but not necessarily, require a methodological approach that uses interviews, observations, surveys, or other instruments. An extensively studied topic may call for the additional understanding of specific factors or variables; this type of study would be well suited to a verification or a causal research design. These could entail a methodological approach that uses valid and reliable instruments, observations, or interviews to determine an effect in the studied event. In either of these examples, the researcher(s) may use a qualitative, quantitative, or mixed methods methodological approach.

Even with a good research question, there is still more reading to be done. The complexity and focus of the research question dictates the depth and breadth of the literature to be examined. Questions that connect multiple topics can require broad literature reviews. For instance, a study that explores the impact of a biology faculty learning community on the inquiry instruction of faculty could have the following review areas: learning communities among biology faculty, inquiry instruction among biology faculty, and inquiry instruction among biology faculty as a result of professional learning. Biology education researchers need to consider whether their literature review requires studies from different disciplines within or outside DBER. For the example given, it would be fruitful to look at research focused on learning communities with faculty in STEM fields or in general education fields that result in instructional change. It is important not to be too narrow or too broad when reading. When the conclusions of articles start to sound similar or no new insights are gained, the researcher likely has a good foundation for a literature review. This level of reading should allow the researcher to demonstrate a mastery in understanding the researched topic, explain the suitability of the proposed research approach, and point to the need for the refined research question(s).

The literature review should include the researcher’s evaluation and critique of the selected studies. A researcher may have a large collection of studies, but not all of the studies will follow standards important in the reporting of empirical work in the social sciences. The American Educational Research Association ( Duran et al. , 2006 ), for example, offers a general discussion about standards for such work: an adequate review of research informing the study, the existence of sound and appropriate data collection and analysis methods, and appropriate conclusions that do not overstep or underexplore the analyzed data. The Institute of Education Sciences and National Science Foundation (2013) also offer Common Guidelines for Education Research and Development that can be used to evaluate collected studies.

Because not all journals adhere to such standards, it is important that a researcher review each study to determine the quality of published research, per the guidelines suggested earlier. In some instances, the research may be fatally flawed. Examples of such flaws include data that do not pertain to the question, a lack of discussion about the data collection, poorly constructed instruments, or an inadequate analysis. These types of errors result in studies that are incomplete, error-laden, or inaccurate and should be excluded from the review. Most studies have limitations, and the author(s) often make them explicit. For instance, there may be an instructor effect, recognized bias in the analysis, or issues with the sample population. Limitations are usually addressed by the research team in some way to ensure a sound and acceptable research process. Occasionally, the limitations associated with the study can be significant and not addressed adequately, which leaves a consequential decision in the hands of the researcher. Providing critiques of studies in the literature review process gives the reader confidence that the researcher has carefully examined relevant work in preparation for the study and, ultimately, the manuscript.

A solid literature review clearly anchors the proposed study in the field and connects the research question(s), the methodological approach, and the discussion. Reviewing extant research leads to research questions that will contribute to what is known in the field. By summarizing what is known, the literature review points to what needs to be known, which in turn guides decisions about methodology. Finally, notable findings of the new study are discussed in reference to those described in the literature review.

Within published BER studies, literature reviews can be placed in different locations in an article. When included in the introductory section of the study, the first few paragraphs of the manuscript set the stage, with the literature review following the opening paragraphs. Cooper et al. (2019) illustrate this approach in their study of course-based undergraduate research experiences (CUREs). An introduction discussing the potential of CURES is followed by an analysis of the existing literature relevant to the design of CUREs that allows for novel student discoveries. Within this review, the authors point out contradictory findings among research on novel student discoveries. This clarifies the need for their study, which is described and highlighted through specific research aims.

A literature reviews can also make up a separate section in a paper. For example, the introduction to Todd et al. (2019) illustrates the need for their research topic by highlighting the potential of learning progressions (LPs) and suggesting that LPs may help mitigate learning loss in genetics. At the end of the introduction, the authors state their specific research questions. The review of literature following this opening section comprises two subsections. One focuses on learning loss in general and examines a variety of studies and meta-analyses from the disciplines of medical education, mathematics, and reading. The second section focuses specifically on LPs in genetics and highlights student learning in the midst of LPs. These separate reviews provide insights into the stated research question.

Suggestions and Advice

A well-conceptualized, comprehensive, and critical literature review reveals the understanding of the topic that the researcher brings to the study. Literature reviews should not be so big that there is no clear area of focus; nor should they be so narrow that no real research question arises. The task for a researcher is to craft an efficient literature review that offers a critical analysis of published work, articulates the need for the study, guides the methodological approach to the topic of study, and provides an adequate foundation for the discussion of the findings.

In our own writing of literature reviews, there are often many drafts. An early draft may seem well suited to the study because the need for and approach to the study are well described. However, as the results of the study are analyzed and findings begin to emerge, the existing literature review may be inadequate and need revision. The need for an expanded discussion about the research area can result in the inclusion of new studies that support the explanation of a potential finding. The literature review may also prove to be too broad. Refocusing on a specific area allows for more contemplation of a finding.

It should be noted that there are different types of literature reviews, and many books and articles have been written about the different ways to embark on these types of reviews. Among these different resources, the following may be helpful in considering how to refine the review process for scholarly journals:

• Booth, A., Sutton, A., & Papaioannou, D. (2016a). Systemic approaches to a successful literature review (2nd ed.). Los Angeles, CA: Sage. This book addresses different types of literature reviews and offers important suggestions pertaining to defining the scope of the literature review and assessing extant studies.
• Booth, W. C., Colomb, G. G., Williams, J. M., Bizup, J., & Fitzgerald, W. T. (2016b). The craft of research (4th ed.). Chicago: University of Chicago Press. This book can help the novice consider how to make the case for an area of study. While this book is not specifically about literature reviews, it offers suggestions about making the case for your study.
• Galvan, J. L., & Galvan, M. C. (2017). Writing literature reviews: A guide for students of the social and behavioral sciences (7th ed.). Routledge. This book offers guidance on writing different types of literature reviews. For the novice researcher, there are useful suggestions for creating coherent literature reviews.

THEORETICAL FRAMEWORKS

Purpose of theoretical frameworks.

As new education researchers may be less familiar with theoretical frameworks than with literature reviews, this discussion begins with an analogy. Envision a biologist, chemist, and physicist examining together the dramatic effect of a fog tsunami over the ocean. A biologist gazing at this phenomenon may be concerned with the effect of fog on various species. A chemist may be interested in the chemical composition of the fog as water vapor condenses around bits of salt. A physicist may be focused on the refraction of light to make fog appear to be “sitting” above the ocean. While observing the same “objective event,” the scientists are operating under different theoretical frameworks that provide a particular perspective or “lens” for the interpretation of the phenomenon. Each of these scientists brings specialized knowledge, experiences, and values to this phenomenon, and these influence the interpretation of the phenomenon. The scientists’ theoretical frameworks influence how they design and carry out their studies and interpret their data.

Within an educational study, a theoretical framework helps to explain a phenomenon through a particular lens and challenges and extends existing knowledge within the limitations of that lens. Theoretical frameworks are explicitly stated by an educational researcher in the paper’s framework, theory, or relevant literature section. The framework shapes the types of questions asked, guides the method by which data are collected and analyzed, and informs the discussion of the results of the study. It also reveals the researcher’s subjectivities, for example, values, social experience, and viewpoint ( Allen, 2017 ). It is essential that a novice researcher learn to explicitly state a theoretical framework, because all research questions are being asked from the researcher’s implicit or explicit assumptions of a phenomenon of interest ( Schwandt, 2000 ).

Selecting Theoretical Frameworks

Theoretical frameworks are one of the most contemplated elements in our work in educational research. In this section, we share three important considerations for new scholars selecting a theoretical framework.

The first step in identifying a theoretical framework involves reflecting on the phenomenon within the study and the assumptions aligned with the phenomenon. The phenomenon involves the studied event. There are many possibilities, for example, student learning, instructional approach, or group organization. A researcher holds assumptions about how the phenomenon will be effected, influenced, changed, or portrayed. It is ultimately the researcher’s assumption(s) about the phenomenon that aligns with a theoretical framework. An example can help illustrate how a researcher’s reflection on the phenomenon and acknowledgment of assumptions can result in the identification of a theoretical framework.

In our example, a biology education researcher may be interested in exploring how students’ learning of difficult biological concepts can be supported by the interactions of group members. The phenomenon of interest is the interactions among the peers, and the researcher assumes that more knowledgeable students are important in supporting the learning of the group. As a result, the researcher may draw on Vygotsky’s (1978) sociocultural theory of learning and development that is focused on the phenomenon of student learning in a social setting. This theory posits the critical nature of interactions among students and between students and teachers in the process of building knowledge. A researcher drawing upon this framework holds the assumption that learning is a dynamic social process involving questions and explanations among students in the classroom and that more knowledgeable peers play an important part in the process of building conceptual knowledge.

It is important to state at this point that there are many different theoretical frameworks. Some frameworks focus on learning and knowing, while other theoretical frameworks focus on equity, empowerment, or discourse. Some frameworks are well articulated, and others are still being refined. For a new researcher, it can be challenging to find a theoretical framework. Two of the best ways to look for theoretical frameworks is through published works that highlight different frameworks.

When a theoretical framework is selected, it should clearly connect to all parts of the study. The framework should augment the study by adding a perspective that provides greater insights into the phenomenon. It should clearly align with the studies described in the literature review. For instance, a framework focused on learning would correspond to research that reported different learning outcomes for similar studies. The methods for data collection and analysis should also correspond to the framework. For instance, a study about instructional interventions could use a theoretical framework concerned with learning and could collect data about the effect of the intervention on what is learned. When the data are analyzed, the theoretical framework should provide added meaning to the findings, and the findings should align with the theoretical framework.

A study by Jensen and Lawson (2011) provides an example of how a theoretical framework connects different parts of the study. They compared undergraduate biology students in heterogeneous and homogeneous groups over the course of a semester. Jensen and Lawson (2011) assumed that learning involved collaboration and more knowledgeable peers, which made Vygotsky’s (1978) theory a good fit for their study. They predicted that students in heterogeneous groups would experience greater improvement in their reasoning abilities and science achievements with much of the learning guided by the more knowledgeable peers.

In the enactment of the study, they collected data about the instruction in traditional and inquiry-oriented classes, while the students worked in homogeneous or heterogeneous groups. To determine the effect of working in groups, the authors also measured students’ reasoning abilities and achievement. Each data-collection and analysis decision connected to understanding the influence of collaborative work.

Their findings highlighted aspects of Vygotsky’s (1978) theory of learning. One finding, for instance, posited that inquiry instruction, as a whole, resulted in reasoning and achievement gains. This links to Vygotsky (1978) , because inquiry instruction involves interactions among group members. A more nuanced finding was that group composition had a conditional effect. Heterogeneous groups performed better with more traditional and didactic instruction, regardless of the reasoning ability of the group members. Homogeneous groups worked better during interaction-rich activities for students with low reasoning ability. The authors attributed the variation to the different types of helping behaviors of students. High-performing students provided the answers, while students with low reasoning ability had to work collectively through the material. In terms of Vygotsky (1978) , this finding provided new insights into the learning context in which productive interactions can occur for students.

Another consideration in the selection and use of a theoretical framework pertains to its orientation to the study. This can result in the theoretical framework prioritizing individuals, institutions, and/or policies ( Anfara and Mertz, 2014 ). Frameworks that connect to individuals, for instance, could contribute to understanding their actions, learning, or knowledge. Institutional frameworks, on the other hand, offer insights into how institutions, organizations, or groups can influence individuals or materials. Policy theories provide ways to understand how national or local policies can dictate an emphasis on outcomes or instructional design. These different types of frameworks highlight different aspects in an educational setting, which influences the design of the study and the collection of data. In addition, these different frameworks offer a way to make sense of the data. Aligning the data collection and analysis with the framework ensures that a study is coherent and can contribute to the field.

New understandings emerge when different theoretical frameworks are used. For instance, Ebert-May et al. (2015) prioritized the individual level within conceptual change theory (see Posner et al. , 1982 ). In this theory, an individual’s knowledge changes when it no longer fits the phenomenon. Ebert-May et al. (2015) designed a professional development program challenging biology postdoctoral scholars’ existing conceptions of teaching. The authors reported that the biology postdoctoral scholars’ teaching practices became more student-centered as they were challenged to explain their instructional decision making. According to the theory, the biology postdoctoral scholars’ dissatisfaction in their descriptions of teaching and learning initiated change in their knowledge and instruction. These results reveal how conceptual change theory can explain the learning of participants and guide the design of professional development programming.

The communities of practice (CoP) theoretical framework ( Lave, 1988 ; Wenger, 1998 ) prioritizes the institutional level , suggesting that learning occurs when individuals learn from and contribute to the communities in which they reside. Grounded in the assumption of community learning, the literature on CoP suggests that, as individuals interact regularly with the other members of their group, they learn about the rules, roles, and goals of the community ( Allee, 2000 ). A study conducted by Gehrke and Kezar (2017) used the CoP framework to understand organizational change by examining the involvement of individual faculty engaged in a cross-institutional CoP focused on changing the instructional practice of faculty at each institution. In the CoP, faculty members were involved in enhancing instructional materials within their department, which aligned with an overarching goal of instituting instruction that embraced active learning. Not surprisingly, Gehrke and Kezar (2017) revealed that faculty who perceived the community culture as important in their work cultivated institutional change. Furthermore, they found that institutional change was sustained when key leaders served as mentors and provided support for faculty, and as faculty themselves developed into leaders. This study reveals the complexity of individual roles in a COP in order to support institutional instructional change.

It is important to explicitly state the theoretical framework used in a study, but elucidating a theoretical framework can be challenging for a new educational researcher. The literature review can help to identify an applicable theoretical framework. Focal areas of the review or central terms often connect to assumptions and assertions associated with the framework that pertain to the phenomenon of interest. Another way to identify a theoretical framework is self-reflection by the researcher on personal beliefs and understandings about the nature of knowledge the researcher brings to the study ( Lysaght, 2011 ). In stating one’s beliefs and understandings related to the study (e.g., students construct their knowledge, instructional materials support learning), an orientation becomes evident that will suggest a particular theoretical framework. Theoretical frameworks are not arbitrary , but purposefully selected.

With experience, a researcher may find expanded roles for theoretical frameworks. Researchers may revise an existing framework that has limited explanatory power, or they may decide there is a need to develop a new theoretical framework. These frameworks can emerge from a current study or the need to explain a phenomenon in a new way. Researchers may also find that multiple theoretical frameworks are necessary to frame and explore a problem, as different frameworks can provide different insights into a problem.

Finally, it is important to recognize that choosing “x” theoretical framework does not necessarily mean a researcher chooses “y” methodology and so on, nor is there a clear-cut, linear process in selecting a theoretical framework for one’s study. In part, the nonlinear process of identifying a theoretical framework is what makes understanding and using theoretical frameworks challenging. For the novice scholar, contemplating and understanding theoretical frameworks is essential. Fortunately, there are articles and books that can help:

• Creswell, J. W. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Los Angeles, CA: Sage. This book provides an overview of theoretical frameworks in general educational research.
• Ding, L. (2019). Theoretical perspectives of quantitative physics education research. Physical Review Physics Education Research , 15 (2), 020101-1–020101-13. This paper illustrates how a DBER field can use theoretical frameworks.
• Nehm, R. (2019). Biology education research: Building integrative frameworks for teaching and learning about living systems. Disciplinary and Interdisciplinary Science Education Research , 1 , ar15. https://doi.org/10.1186/s43031-019-0017-6 . This paper articulates the need for studies in BER to explicitly state theoretical frameworks and provides examples of potential studies.
• Patton, M. Q. (2015). Qualitative research & evaluation methods: Integrating theory and practice . Sage. This book also provides an overview of theoretical frameworks, but for both research and evaluation.

CONCEPTUAL FRAMEWORKS

Purpose of a conceptual framework.

A conceptual framework is a description of the way a researcher understands the factors and/or variables that are involved in the study and their relationships to one another. The purpose of a conceptual framework is to articulate the concepts under study using relevant literature ( Rocco and Plakhotnik, 2009 ) and to clarify the presumed relationships among those concepts ( Rocco and Plakhotnik, 2009 ; Anfara and Mertz, 2014 ). Conceptual frameworks are different from theoretical frameworks in both their breadth and grounding in established findings. Whereas a theoretical framework articulates the lens through which a researcher views the work, the conceptual framework is often more mechanistic and malleable.

Conceptual frameworks are broader, encompassing both established theories (i.e., theoretical frameworks) and the researchers’ own emergent ideas. Emergent ideas, for example, may be rooted in informal and/or unpublished observations from experience. These emergent ideas would not be considered a “theory” if they are not yet tested, supported by systematically collected evidence, and peer reviewed. However, they do still play an important role in the way researchers approach their studies. The conceptual framework allows authors to clearly describe their emergent ideas so that connections among ideas in the study and the significance of the study are apparent to readers.

Constructing Conceptual Frameworks

Including a conceptual framework in a research study is important, but researchers often opt to include either a conceptual or a theoretical framework. Either may be adequate, but both provide greater insight into the research approach. For instance, a research team plans to test a novel component of an existing theory. In their study, they describe the existing theoretical framework that informs their work and then present their own conceptual framework. Within this conceptual framework, specific topics portray emergent ideas that are related to the theory. Describing both frameworks allows readers to better understand the researchers’ assumptions, orientations, and understanding of concepts being investigated. For example, Connolly et al. (2018) included a conceptual framework that described how they applied a theoretical framework of social cognitive career theory (SCCT) to their study on teaching programs for doctoral students. In their conceptual framework, the authors described SCCT, explained how it applied to the investigation, and drew upon results from previous studies to justify the proposed connections between the theory and their emergent ideas.

In some cases, authors may be able to sufficiently describe their conceptualization of the phenomenon under study in an introduction alone, without a separate conceptual framework section. However, incomplete descriptions of how the researchers conceptualize the components of the study may limit the significance of the study by making the research less intelligible to readers. This is especially problematic when studying topics in which researchers use the same terms for different constructs or different terms for similar and overlapping constructs (e.g., inquiry, teacher beliefs, pedagogical content knowledge, or active learning). Authors must describe their conceptualization of a construct if the research is to be understandable and useful.

There are some key areas to consider regarding the inclusion of a conceptual framework in a study. To begin with, it is important to recognize that conceptual frameworks are constructed by the researchers conducting the study ( Rocco and Plakhotnik, 2009 ; Maxwell, 2012 ). This is different from theoretical frameworks that are often taken from established literature. Researchers should bring together ideas from the literature, but they may be influenced by their own experiences as a student and/or instructor, the shared experiences of others, or thought experiments as they construct a description, model, or representation of their understanding of the phenomenon under study. This is an exercise in intellectual organization and clarity that often considers what is learned, known, and experienced. The conceptual framework makes these constructs explicitly visible to readers, who may have different understandings of the phenomenon based on their prior knowledge and experience. There is no single method to go about this intellectual work.

Reeves et al. (2016) is an example of an article that proposed a conceptual framework about graduate teaching assistant professional development evaluation and research. The authors used existing literature to create a novel framework that filled a gap in current research and practice related to the training of graduate teaching assistants. This conceptual framework can guide the systematic collection of data by other researchers because the framework describes the relationships among various factors that influence teaching and learning. The Reeves et al. (2016) conceptual framework may be modified as additional data are collected and analyzed by other researchers. This is not uncommon, as conceptual frameworks can serve as catalysts for concerted research efforts that systematically explore a phenomenon (e.g., Reynolds et al. , 2012 ; Brownell and Kloser, 2015 ).

Sabel et al. (2017) used a conceptual framework in their exploration of how scaffolds, an external factor, interact with internal factors to support student learning. Their conceptual framework integrated principles from two theoretical frameworks, self-regulated learning and metacognition, to illustrate how the research team conceptualized students’ use of scaffolds in their learning ( Figure 1 ). Sabel et al. (2017) created this model using their interpretations of these two frameworks in the context of their teaching.

Conceptual framework from Sabel et al. (2017) .

A conceptual framework should describe the relationship among components of the investigation ( Anfara and Mertz, 2014 ). These relationships should guide the researcher’s methods of approaching the study ( Miles et al. , 2014 ) and inform both the data to be collected and how those data should be analyzed. Explicitly describing the connections among the ideas allows the researcher to justify the importance of the study and the rigor of the research design. Just as importantly, these frameworks help readers understand why certain components of a system were not explored in the study. This is a challenge in education research, which is rooted in complex environments with many variables that are difficult to control.

For example, Sabel et al. (2017) stated: “Scaffolds, such as enhanced answer keys and reflection questions, can help students and instructors bridge the external and internal factors and support learning” (p. 3). They connected the scaffolds in the study to the three dimensions of metacognition and the eventual transformation of existing ideas into new or revised ideas. Their framework provides a rationale for focusing on how students use two different scaffolds, and not on other factors that may influence a student’s success (self-efficacy, use of active learning, exam format, etc.).

In constructing conceptual frameworks, researchers should address needed areas of study and/or contradictions discovered in literature reviews. By attending to these areas, researchers can strengthen their arguments for the importance of a study. For instance, conceptual frameworks can address how the current study will fill gaps in the research, resolve contradictions in existing literature, or suggest a new area of study. While a literature review describes what is known and not known about the phenomenon, the conceptual framework leverages these gaps in describing the current study ( Maxwell, 2012 ). In the example of Sabel et al. (2017) , the authors indicated there was a gap in the literature regarding how scaffolds engage students in metacognition to promote learning in large classes. Their study helps fill that gap by describing how scaffolds can support students in the three dimensions of metacognition: intelligibility, plausibility, and wide applicability. In another example, Lane (2016) integrated research from science identity, the ethic of care, the sense of belonging, and an expertise model of student success to form a conceptual framework that addressed the critiques of other frameworks. In a more recent example, Sbeglia et al. (2021) illustrated how a conceptual framework influences the methodological choices and inferences in studies by educational researchers.

Sometimes researchers draw upon the conceptual frameworks of other researchers. When a researcher’s conceptual framework closely aligns with an existing framework, the discussion may be brief. For example, Ghee et al. (2016) referred to portions of SCCT as their conceptual framework to explain the significance of their work on students’ self-efficacy and career interests. Because the authors’ conceptualization of this phenomenon aligned with a previously described framework, they briefly mentioned the conceptual framework and provided additional citations that provided more detail for the readers.

Within both the BER and the broader DBER communities, conceptual frameworks have been used to describe different constructs. For example, some researchers have used the term “conceptual framework” to describe students’ conceptual understandings of a biological phenomenon. This is distinct from a researcher’s conceptual framework of the educational phenomenon under investigation, which may also need to be explicitly described in the article. Other studies have presented a research logic model or flowchart of the research design as a conceptual framework. These constructions can be quite valuable in helping readers understand the data-collection and analysis process. However, a model depicting the study design does not serve the same role as a conceptual framework. Researchers need to avoid conflating these constructs by differentiating the researchers’ conceptual framework that guides the study from the research design, when applicable.

Explicitly describing conceptual frameworks is essential in depicting the focus of the study. We have found that being explicit in a conceptual framework means using accepted terminology, referencing prior work, and clearly noting connections between terms. This description can also highlight gaps in the literature or suggest potential contributions to the field of study. A well-elucidated conceptual framework can suggest additional studies that may be warranted. This can also spur other researchers to consider how they would approach the examination of a phenomenon and could result in a revised conceptual framework.

It can be challenging to create conceptual frameworks, but they are important. Below are two resources that could be helpful in constructing and presenting conceptual frameworks in educational research:

• Maxwell, J. A. (2012). Qualitative research design: An interactive approach (3rd ed.). Los Angeles, CA: Sage. Chapter 3 in this book describes how to construct conceptual frameworks.
• Ravitch, S. M., & Riggan, M. (2016). Reason & rigor: How conceptual frameworks guide research . Los Angeles, CA: Sage. This book explains how conceptual frameworks guide the research questions, data collection, data analyses, and interpretation of results.

CONCLUDING THOUGHTS

Literature reviews, theoretical frameworks, and conceptual frameworks are all important in DBER and BER. Robust literature reviews reinforce the importance of a study. Theoretical frameworks connect the study to the base of knowledge in educational theory and specify the researcher’s assumptions. Conceptual frameworks allow researchers to explicitly describe their conceptualization of the relationships among the components of the phenomenon under study. Table 1 provides a general overview of these components in order to assist biology education researchers in thinking about these elements.

It is important to emphasize that these different elements are intertwined. When these elements are aligned and complement one another, the study is coherent, and the study findings contribute to knowledge in the field. When literature reviews, theoretical frameworks, and conceptual frameworks are disconnected from one another, the study suffers. The point of the study is lost, suggested findings are unsupported, or important conclusions are invisible to the researcher. In addition, this misalignment may be costly in terms of time and money.

Conducting a literature review, selecting a theoretical framework, and building a conceptual framework are some of the most difficult elements of a research study. It takes time to understand the relevant research, identify a theoretical framework that provides important insights into the study, and formulate a conceptual framework that organizes the finding. In the research process, there is often a constant back and forth among these elements as the study evolves. With an ongoing refinement of the review of literature, clarification of the theoretical framework, and articulation of a conceptual framework, a sound study can emerge that makes a contribution to the field. This is the goal of BER and education research.

Supplementary Material

• Allee, V. (2000). Knowledge networks and communities of learning . OD Practitioner , 32 ( 4 ), 4–13. [ Google Scholar ]
• Allen, M. (2017). The Sage encyclopedia of communication research methods (Vols. 1–4 ). Los Angeles, CA: Sage. 10.4135/9781483381411 [ CrossRef ] [ Google Scholar ]
• American Association for the Advancement of Science. (2011). Vision and change in undergraduate biology education: A call to action . Washington, DC. [ Google Scholar ]
• Anfara, V. A., Mertz, N. T. (2014). Setting the stage . In Anfara, V. A., Mertz, N. T. (eds.), Theoretical frameworks in qualitative research (pp. 1–22). Sage. [ Google Scholar ]
• Barnes, M. E., Brownell, S. E. (2016). Practices and perspectives of college instructors on addressing religious beliefs when teaching evolution . CBE—Life Sciences Education , 15 ( 2 ), ar18. https://doi.org/10.1187/cbe.15-11-0243 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Boote, D. N., Beile, P. (2005). Scholars before researchers: On the centrality of the dissertation literature review in research preparation . Educational Researcher , 34 ( 6 ), 3–15. 10.3102/0013189x034006003 [ CrossRef ] [ Google Scholar ]
• Booth, A., Sutton, A., Papaioannou, D. (2016a). Systemic approaches to a successful literature review (2nd ed.). Los Angeles, CA: Sage. [ Google Scholar ]
• Booth, W. C., Colomb, G. G., Williams, J. M., Bizup, J., Fitzgerald, W. T. (2016b). The craft of research (4th ed.). Chicago, IL: University of Chicago Press. [ Google Scholar ]
• Brownell, S. E., Kloser, M. J. (2015). Toward a conceptual framework for measuring the effectiveness of course-based undergraduate research experiences in undergraduate biology . Studies in Higher Education , 40 ( 3 ), 525–544. https://doi.org/10.1080/03075079.2015.1004234 [ Google Scholar ]
• Connolly, M. R., Lee, Y. G., Savoy, J. N. (2018). The effects of doctoral teaching development on early-career STEM scholars’ college teaching self-efficacy . CBE—Life Sciences Education , 17 ( 1 ), ar14. https://doi.org/10.1187/cbe.17-02-0039 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cooper, K. M., Blattman, J. N., Hendrix, T., Brownell, S. E. (2019). The impact of broadly relevant novel discoveries on student project ownership in a traditional lab course turned CURE . CBE—Life Sciences Education , 18 ( 4 ), ar57. https://doi.org/10.1187/cbe.19-06-0113 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Creswell, J. W. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Los Angeles, CA: Sage. [ Google Scholar ]
• DeHaan, R. L. (2011). Education research in the biological sciences: A nine decade review (Paper commissioned by the NAS/NRC Committee on the Status, Contributions, and Future Directions of Discipline Based Education Research) . Washington, DC: National Academies Press. Retrieved May 20, 2022, from www7.nationalacademies.org/bose/DBER_Mee ting2_commissioned_papers_page.html [ Google Scholar ]
• Ding, L. (2019). Theoretical perspectives of quantitative physics education research . Physical Review Physics Education Research , 15 ( 2 ), 020101. [ Google Scholar ]
• Dirks, C. (2011). The current status and future direction of biology education research . Paper presented at: Second Committee Meeting on the Status, Contributions, and Future Directions of Discipline-Based Education Research, 18–19 October (Washington, DC). Retrieved May 20, 2022, from http://sites.nationalacademies.org/DBASSE/BOSE/DBASSE_071087 [ Google Scholar ]
• Duran, R. P., Eisenhart, M. A., Erickson, F. D., Grant, C. A., Green, J. L., Hedges, L. V., Schneider, B. L. (2006). Standards for reporting on empirical social science research in AERA publications: American Educational Research Association . Educational Researcher , 35 ( 6 ), 33–40. [ Google Scholar ]
• Ebert-May, D., Derting, T. L., Henkel, T. P., Middlemis Maher, J., Momsen, J. L., Arnold, B., Passmore, H. A. (2015). Breaking the cycle: Future faculty begin teaching with learner-centered strategies after professional development . CBE—Life Sciences Education , 14 ( 2 ), ar22. https://doi.org/10.1187/cbe.14-12-0222 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Galvan, J. L., Galvan, M. C. (2017). Writing literature reviews: A guide for students of the social and behavioral sciences (7th ed.). New York, NY: Routledge. https://doi.org/10.4324/9781315229386 [ Google Scholar ]
• Gehrke, S., Kezar, A. (2017). The roles of STEM faculty communities of practice in institutional and departmental reform in higher education . American Educational Research Journal , 54 ( 5 ), 803–833. https://doi.org/10.3102/0002831217706736 [ Google Scholar ]
• Ghee, M., Keels, M., Collins, D., Neal-Spence, C., Baker, E. (2016). Fine-tuning summer research programs to promote underrepresented students’ persistence in the STEM pathway . CBE—Life Sciences Education , 15 ( 3 ), ar28. https://doi.org/10.1187/cbe.16-01-0046 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Institute of Education Sciences & National Science Foundation. (2013). Common guidelines for education research and development . Retrieved May 20, 2022, from www.nsf.gov/pubs/2013/nsf13126/nsf13126.pdf
• Jensen, J. L., Lawson, A. (2011). Effects of collaborative group composition and inquiry instruction on reasoning gains and achievement in undergraduate biology . CBE—Life Sciences Education , 10 ( 1 ), 64–73. https://doi.org/10.1187/cbe.19-05-0098 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kolpikova, E. P., Chen, D. C., Doherty, J. H. (2019). Does the format of preclass reading quizzes matter? An evaluation of traditional and gamified, adaptive preclass reading quizzes . CBE—Life Sciences Education , 18 ( 4 ), ar52. https://doi.org/10.1187/cbe.19-05-0098 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Labov, J. B., Reid, A. H., Yamamoto, K. R. (2010). Integrated biology and undergraduate science education: A new biology education for the twenty-first century? CBE—Life Sciences Education , 9 ( 1 ), 10–16. https://doi.org/10.1187/cbe.09-12-0092 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lane, T. B. (2016). Beyond academic and social integration: Understanding the impact of a STEM enrichment program on the retention and degree attainment of underrepresented students . CBE—Life Sciences Education , 15 ( 3 ), ar39. https://doi.org/10.1187/cbe.16-01-0070 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lave, J. (1988). Cognition in practice: Mind, mathematics and culture in everyday life . New York, NY: Cambridge University Press. [ Google Scholar ]
• Lo, S. M., Gardner, G. E., Reid, J., Napoleon-Fanis, V., Carroll, P., Smith, E., Sato, B. K. (2019). Prevailing questions and methodologies in biology education research: A longitudinal analysis of research in CBE — Life Sciences Education and at the Society for the Advancement of Biology Education Research . CBE—Life Sciences Education , 18 ( 1 ), ar9. https://doi.org/10.1187/cbe.18-08-0164 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lysaght, Z. (2011). Epistemological and paradigmatic ecumenism in “Pasteur’s quadrant:” Tales from doctoral research . In Official Conference Proceedings of the Third Asian Conference on Education in Osaka, Japan . Retrieved May 20, 2022, from http://iafor.org/ace2011_offprint/ACE2011_offprint_0254.pdf
• Maxwell, J. A. (2012). Qualitative research design: An interactive approach (3rd ed.). Los Angeles, CA: Sage. [ Google Scholar ]
• Miles, M. B., Huberman, A. M., Saldaña, J. (2014). Qualitative data analysis (3rd ed.). Los Angeles, CA: Sage. [ Google Scholar ]
• Nehm, R. (2019). Biology education research: Building integrative frameworks for teaching and learning about living systems . Disciplinary and Interdisciplinary Science Education Research , 1 , ar15. https://doi.org/10.1186/s43031-019-0017-6 [ Google Scholar ]
• Patton, M. Q. (2015). Qualitative research & evaluation methods: Integrating theory and practice . Los Angeles, CA: Sage. [ Google Scholar ]
• Perry, J., Meir, E., Herron, J. C., Maruca, S., Stal, D. (2008). Evaluating two approaches to helping college students understand evolutionary trees through diagramming tasks . CBE—Life Sciences Education , 7 ( 2 ), 193–201. https://doi.org/10.1187/cbe.07-01-0007 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Posner, G. J., Strike, K. A., Hewson, P. W., Gertzog, W. A. (1982). Accommodation of a scientific conception: Toward a theory of conceptual change . Science Education , 66 ( 2 ), 211–227. [ Google Scholar ]
• Ravitch, S. M., Riggan, M. (2016). Reason & rigor: How conceptual frameworks guide research . Los Angeles, CA: Sage. [ Google Scholar ]
• Reeves, T. D., Marbach-Ad, G., Miller, K. R., Ridgway, J., Gardner, G. E., Schussler, E. E., Wischusen, E. W. (2016). A conceptual framework for graduate teaching assistant professional development evaluation and research . CBE—Life Sciences Education , 15 ( 2 ), es2. https://doi.org/10.1187/cbe.15-10-0225 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Reynolds, J. A., Thaiss, C., Katkin, W., Thompson, R. J. Jr. (2012). Writing-to-learn in undergraduate science education: A community-based, conceptually driven approach . CBE—Life Sciences Education , 11 ( 1 ), 17–25. https://doi.org/10.1187/cbe.11-08-0064 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rocco, T. S., Plakhotnik, M. S. (2009). Literature reviews, conceptual frameworks, and theoretical frameworks: Terms, functions, and distinctions . Human Resource Development Review , 8 ( 1 ), 120–130. https://doi.org/10.1177/1534484309332617 [ Google Scholar ]
• Rodrigo-Peiris, T., Xiang, L., Cassone, V. M. (2018). A low-intensity, hybrid design between a “traditional” and a “course-based” research experience yields positive outcomes for science undergraduate freshmen and shows potential for large-scale application . CBE—Life Sciences Education , 17 ( 4 ), ar53. https://doi.org/10.1187/cbe.17-11-0248 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sabel, J. L., Dauer, J. T., Forbes, C. T. (2017). Introductory biology students’ use of enhanced answer keys and reflection questions to engage in metacognition and enhance understanding . CBE—Life Sciences Education , 16 ( 3 ), ar40. https://doi.org/10.1187/cbe.16-10-0298 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sbeglia, G. C., Goodridge, J. A., Gordon, L. H., Nehm, R. H. (2021). Are faculty changing? How reform frameworks, sampling intensities, and instrument measures impact inferences about student-centered teaching practices . CBE—Life Sciences Education , 20 ( 3 ), ar39. https://doi.org/10.1187/cbe.20-11-0259 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Schwandt, T. A. (2000). Three epistemological stances for qualitative inquiry: Interpretivism, hermeneutics, and social constructionism . In Denzin, N. K., Lincoln, Y. S. (Eds.), Handbook of qualitative research (2nd ed., pp. 189–213). Los Angeles, CA: Sage. [ Google Scholar ]
• Sickel, A. J., Friedrichsen, P. (2013). Examining the evolution education literature with a focus on teachers: Major findings, goals for teacher preparation, and directions for future research . Evolution: Education and Outreach , 6 ( 1 ), 23. https://doi.org/10.1186/1936-6434-6-23 [ Google Scholar ]
• Singer, S. R., Nielsen, N. R., Schweingruber, H. A. (2012). Discipline-based education research: Understanding and improving learning in undergraduate science and engineering . Washington, DC: National Academies Press. [ Google Scholar ]
• Todd, A., Romine, W. L., Correa-Menendez, J. (2019). Modeling the transition from a phenotypic to genotypic conceptualization of genetics in a university-level introductory biology context . Research in Science Education , 49 ( 2 ), 569–589. https://doi.org/10.1007/s11165-017-9626-2 [ Google Scholar ]
• Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes . Cambridge, MA: Harvard University Press. [ Google Scholar ]
• Wenger, E. (1998). Communities of practice: Learning as a social system . Systems Thinker , 9 ( 5 ), 2–3. [ Google Scholar ]
• Ziadie, M. A., Andrews, T. C. (2018). Moving evolution education forward: A systematic analysis of literature to identify gaps in collective knowledge for teaching . CBE—Life Sciences Education , 17 ( 1 ), ar11. https://doi.org/10.1187/cbe.17-08-0190 [ PMC free article ] [ PubMed ] [ Google Scholar ]

• Open access
• Published: 01 December 2022

The psychological impact, risk factors and coping strategies to COVID-19 pandemic on healthcare workers in the sub-Saharan Africa: a narrative review of existing literature

• Freddy Wathum Drinkwater Oyat 1 ,
• Johnson Nyeko Oloya 1 , 2 ,
• Pamela Atim 1 , 3 ,
• Eric Nzirakaindi Ikoona 4 ,
• Judith Aloyo 1 , 5 &
• David Lagoro Kitara   ORCID: orcid.org/0000-0001-7282-5026 1 , 6 , 7  

BMC Psychology volume  10 , Article number:  284 ( 2022 ) Cite this article

6038 Accesses

9 Citations

1 Altmetric

Metrics details

The ongoing COVID-19 pandemic has significantly impacted the physical and mental health of the general population worldwide, with healthcare workers at particular risk. The pandemic's effect on healthcare workers' mental well-being has been characterized by depression, anxiety, work-related stress, sleep disturbances, and post-traumatic stress disorder. Hence, protecting the mental well-being of healthcare workers (HCWs) is a considerable priority. This review aimed to determine risk factors for adverse mental health outcomes and protective or coping measures to mitigate the harmful effects of the COVID-19 crisis among HCWs in sub-Saharan Africa.

We performed a literature search using PubMed, Google Scholar, Cochrane Library, and Embase for relevant materials. We obtained all articles published between March 2020 and April 2022 relevant to the subject of review and met pre-defined eligibility criteria. We selected 23 articles for initial screening and included 12 in the final review.

A total of 5,323 participants in twelve studies, predominantly from Ethiopia (eight studies), one from Uganda, Cameroon, Mali, and Togo, fulfilled the eligibility criteria. Investigators found 16.3–71.9% of HCWs with depressive symptoms, 21.9–73.5% with anxiety symptoms, 15.5–63.7% experienced work-related stress symptoms, 12.4–77% experienced sleep disturbances, and 51.6–56.8% reported PTSD symptoms. Healthcare workers, working in emergency, intensive care units, pharmacies, and laboratories were at higher risk of adverse mental health impacts. HCWs had deep fear, anxious and stressed with the high transmission rate of the virus, high death rates, and lived in fear of infecting themselves and families. Other sources of fear and work-related stress were the lack of PPEs, availability of treatment and vaccines to protect themselves against the virus. HCWs faced stigma, abuse, financial problems, and lack of support from employers and communities.

The prevalence of depression, anxiety, insomnia, and PTSD in HCWs in sub-Saharan Africa during the COVID-19 pandemic has been high. Several organizational, community, and work-related challenges and interventions were identified, including improvement of workplace infrastructures, adoption of correct and shared infection control measures, provision of PPEs, social support, and implementation of resilience training programs. Setting up permanent multidisciplinary mental health teams at regional and national levels to deal with mental health and providing psychological support to HCWs, supported with long-term surveillance, are recommended.

Peer Review reports

Introduction

When coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020, healthcare workers (HCWs) globally and in sub-Saharan Africa (SSA) were unprepared for the scale of the physical and mental health devastation that was to follow [ 1 ]. The impact of the COVID-19 pandemic on healthcare workers has been profound, characterized by death, disability, and untenable burden on mental health and well-being [ 2 ]. Factors impacting their mental health include high risks of exposure and infection, financial insecurity, separation from loved ones, stigma, difficult triage decisions, stressful work environment, scarcity of supplies including personal protective equipment (PPEs), exhaustion, traumatic experiences due to regular witnessing of deaths among patients and colleagues [ 2 , 3 ]. Greenberg et al. [ 4 ] observed that the COVID-19 pandemic put healthcare professionals worldwide in an unprecedented situation, making difficult decisions to provide care for many severely ill patients with constrained or inadequate resources.

In almost all WHO regions, data indicates that infection rates among healthcare workers are higher than in the general population [ 5 ]. Scholars suggest that the end of the COVID-19 pandemic is not yet in sight. Neither are they sure about the virulence of the following variant when it appears as caseloads are still rising, with more than 621 million infections and 6.5 million deaths reported worldwide by 19th October 2022 [ 6 ]; mainly driven by the newer omicron variants. However, recently in October 2022, we received with gratitude a reassuring message from US President Biden declaring the end of the COVID-19 pandemic in the United States of America.

Meanwhile, previous studies found high levels of depression, anxiety, and PTSD in survivors among the general population and healthcare workers (HCWs) one-to-three years after the control of the SARS epidemic [ 7 ] and the 2014–2016 Ebola epidemic in West Africa [ 8 ]. In addition, recent surveys [ 9 , 10 , 11 , 12 , 13 , 14 ], reviews, and meta-analyses [ 15 , 16 , 17 , 18 ] are pointing to early evidence that a considerable proportion of healthcare workers have experienced stress, anxiety, depression, and sleep disturbances during the COVID-19 pandemic, raising concerns about risks to their long-term mental health.

Studies from the global north countries [ 19 , 20 ], UK [ 21 ], USA [ 22 ], and in India [ 23 ], and China [ 24 , 25 ] have shed light on the vulnerability that characterizes frontline healthcare workers during this pandemic, especially regarding their mental health and well-being. However, evidence in sub-Saharan Africa is scanty, and the pattern and prevalence of psychological disorders are not well understood.

Evidence from a systematic review by Pappa S et al. on 33,062 Chinese HCWs in April 2020 found a pooled prevalence rate of mental health problems among respondents; anxiety 23.2%, depression 22.8%, and insomnia 38.9% [ 26 ]. Similarly, Singapore study, Tan et al . [ 27 ], Li et al . [ 28 ], BMA [ 29 ] and in China [ 31 ] found high levels of psychological disorders among health workers.

Since the beginning of the pandemic, we found one systematic review involving 919 frontline HCWs, 3928 general HCWs, and 2979 medical students conducted in Africa from December 2019 to April 2020 [ 31 ]. The study by Chen J et al . reported a high prevalence of depression, anxiety, and insomnia among frontline HCWs in sub-Saharan Africa (SSA) at 45%, 51%, and 28%, respectively. In comparison, the prevalence of depression, anxiety, and insomnia among the general population was much lower at 30%, 31%, and 24%, respectively [ 31 ]. Furthermore, we found that only a few studies investigated protective and coping measures, given the many uncertainties surrounding the evolution of the COVID-19 pandemic [ 32 ]. Adequate data are needed to equip frontline HCWs and healthcare managers in sub-Saharan Africa to mitigate the medium and long-term adverse effects of the COVID-19 pandemic [ 33 ].

This review aimed to answer three questions (1) What is the psychological impact of the COVID-19 pandemic on HCWs in Sub-Saharan Africa?

(2) What are the associated risk factors during the COVID-19 pandemic?

(3) What interventions (mitigating and coping strategies) protect and support the mental health and well-being of HCWs during the ongoing crises and after the pandemic?

Methodology

Search methodology and article selection.

This current article is a mixed-method narrative review of existing literature on mental health disorders, risk factors, and interventions relevant to the COVID-19 pandemic on HCWs in sub-Saharan. A search on the PubMed electronic database was undertaken using the search terms "novel coronavirus", "COVID-19", "nCoV", "mental health", "psychiatry", "psychology", "anxiety", "depression" and "stress" in various permutations and combinations.

Search processes

We conducted a comprehensive literature search on original articles published from March 2020 to 30 April 2022 in electronic databases of Embase, PubMed, Google Scholar, and the daily updated WHO COVID-19 database. Our search terms included but were not limited to ('COVID-19'/exp OR COVID-19 OR 'coronavirus'/exp OR coronavirus) AND ('psychological'/exp OR psychological OR 'mental'/exp OR mental OR 'stress'/exp OR stress OR 'anxiety' OR anxiety OR 'depression' OR depression OR 'post-traumatic' OR 'post-traumatic'/exp OR 'trauma' OR 'trauma'/exp) OR Health care workers, medical workers of health care professionals, sub-Saharan Africa, for Embase. ("COVID-19" [All Fields] OR "coronavirus" [All Fields]) AND ("Stress, Psychological" [Mesh] OR "mental" OR "anxiety" OR "depression" OR "stress" OR "post-traumatic" OR "trauma") for PubMed, for the WHO COVID-19 database, and ("COVID-19" OR "coronavirus") AND ("Psychological" OR "mental" OR "anxiety" OR "depression" OR "stress" OR "post-traumatic" OR "trauma") for Google Scholar. On reviewing the above citations, twelve articles met the inclusion criteria relevant for this review and are in Table 1 . All twelve articles were cross-sectional, with one qualitative and the others quantitative observational studies.

Eligibility criteria

We included original qualitative and quantitative studies examining the risk factors, psychological impact of COVID-19 and coping strategies of healthcare workers (HCWs) in sub-Saharan Africa during the COVID-19 pandemic. We excluded studies if they were.

1. Not reported in the English language 2. Studies which were not primary research 3. Studies that had not been published in a peer-reviewed journal 4. Studies that did not include data on HCWs’ mental health or psychological well-being 5. Duplicate studies 6. not using validated instruments to measure the risks and psychological impact.

FWDO performed the search of articles. DLK reviewed the articles involving screening of titles, followed by examination of abstracts. The potential articles identified were further reviewed in full text to examine their eligibility. In addition, four of the authors independently reviewed the full articles to abstract the relevant data required for the review. Thereafter, a meeting to harmonise findings were done and presented in a report.

Data extraction and appraisal of the study

We extracted information from each study, including author, study population, year of publication, country, socio-demographic characteristics, sample size, response rate, gender proportion, age, and study time, areas assessed, the validated instrument used and the prevalence. The appraisal involved assessing the research design, recruitment of respondents, inclusion and exclusion criteria, reliability of outcome determination, statistical analyses, ethical compliance, strengths, limitations, and clinical implications of the articles.

Our review protocol was not registered on PROSPERO because of the significant variation in the methodologies of the articles used in the review. The results precluded using a meta-analytic approach and made a narrative review the most suitable for this work. In addition, we did not use the Cochrane Collaboration GRADE method to assess the quality of evidence of outcomes included in this narrative review. Instead, we used the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) 22 items checklist to gauge the quality of the twelve articles included in this review. We qualitatively validated the articles based on additional considerations namely study design, sample sizes, sampling procedures, response rates, statistical methods used, measures taken by the authors to deal with bias and confounding factors and ethical consideration.

Definition of healthcare worker (HCW)

For this narrative review, we adhered to the Centres for Disease Control and Prevention (CDC) definition of HCWs, which includes physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, and administrative staff [ 34 ].

Search results

The search found twenty-three studies of interest. Full texts of potentially relevant studies underwent eligibility assessment, and twelve articles met the inclusion criteria for this narrative review.

Study characteristics

The twelve articles comprised eleven quantitative and one qualitative study. The common mental health conditions assessed were depression, anxiety, perceived stress, and post-traumatic stress disorder (PTSD). The coping strategy, perceived health status, health distress (including burnout), insomnia, and perceived stigma were also assessed [ 35 , 36 ]. The total number of respondents in these studies was 5,323. The qualitative study had fifty respondents [ 35 ], while the most significant number of participants, 420 was recorded in one of the quantitative studies from Ethiopia [ 37 ]. The questionnaire response rates varied between 90%-100%, with most studies dominated by male respondents at 51.9%-69.2% [ 38 ]. Nurses were the commonest study population, followed by doctors, pharmacists, and laboratory technicians, and no study involved non-HCWs of facilities. Most papers utilized probability sampling procedures, and four quantitative studies used non-random sampling procedures limiting generalizability of their findings and increasing the risk of selection bias. Eight studies were from Ethiopia, and one was from Cameroon, Uganda, Mali, and Togo, respectively (Table 1 ). Most studies were conducted in urban tertiary public hospitals, university teaching hospitals, and rural and urban general hospitals, including primary care facilities operated by Non-Governmental Organizations (NGOs) for example in Mali [ 39 ]. Several validated tools assessed depression, anxiety, insomnia, stress, and PTSD (Table 1 ).

Table 1 provides an overview of the studies selected and validated instruments used to measure psychological disorders.

Table 2 provides comparisons with studies conducted outside of sub-Saharan Africa.

Table 3 provides information on studies showing the classification of psychological outcomes.

Table 4 are studies showing risk factors associated with psychological disorders.

Table 5 are studies that identified protective factors for psychological disorders.

Risks of bias and confounding factors

Most articles selected were cross-sectional studies that employed probability sampling procedures (Table 1 ). Cross-sectional study design minimized selection biases, but many used structured questionnaires, including online self-administered questionnaires, which increased bias due to social desirability. It was not clear how confounding variables were controlled in five papers reviewed [ 38 , 39 , 40 , 43 , 45 ] leading to excessive and perhaps inappropriate determination of associations.

Socio-demographic factors

In this review, the mean age of the respondents ranged between 23 and 35 years, and predominantly males. Age was associated with anxiety, and stress symptoms in 6(50%) of all the studies reviewed [ 35 , 37 , 40 , 41 , 42 , 44 ]. An age of over 40 years was associated with moderate to severe symptoms of PTSD. Two studies concluded that respondents aged over 40 years were more likely to develop PTSD symptoms than their younger counterparts [ 37 , 41 ].

Female gender was significantly associated with depression, anxiety, and stress symptoms among HCWs in seven studies reviewed [ 36 , 37 , 38 , 41 , 42 , 43 ]. Many studies found that being female, married, and a nurse were independent predictors of stress symptoms. Moreover, sex, age, marital status, type of profession, and working environment were significant factors for PTSD symptoms [ 37 , 41 ]. However, one study in Ethiopia found that the odds of depression were twice higher among male healthcare providers than among female healthcare providers [ 35 ].

Psychological impact on healthcare workers

Most studies reviewed directly assessed the prevalence of depression, anxiety, stress, insomnia, and PTSD in HCWs. Common causes of anxiety, fear, or psychological distress that health professionals reported were: lack of access to PPEs and other equipment, being exposed to COVID-19 at work and taking the infection home to their families, uncertainties that their organization will support/take care of their personal and family needs if they got infection, long working hours, death of colleagues, lack of social support, stigmatization, high rates of transmission and poor income [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. However, the prevalence of mental health symptoms exhibited great variations for example depressive symptoms were examined in nine studies [ 35 , 36 , 37 , 39 , 43 , 44 , 45 , 46 ], and varied between 16.3% and 71.9% among HCWs [ 38 , 39 ].

In addition, nine other studies reported high prevalence of anxiety symptoms among HCWs [ 35 , 36 , 37 , 40 , 43 , 44 , 45 , 46 , 47 ] which varied between 21.9% and 73.5% [ 36 , 39 ]. Five studies investigated HCWs' perceived stress during the pandemic; 15.5%-63.7% of HCWs reported high levels of work-related stress [ 35 , 36 , 37 , 43 , 45 ]. Three studies reported 12.4–77% of HCWs experienced sleep disturbances during the COVID-19 pandemic [ 37 , 39 , 40 ].

Post-traumatic stress disorder (PTSD) was in three studies [ 38 , 41 , 42 ], and the prevalence of PTSD-like symptoms varied between 51.6 and 56.8% in HCWs [ 38 , 41 ]. A qualitative study from Uganda reported high symptoms of depression, anxiety, and PTSD among HCWs [ 35 ]. Additionally, factors that increased the risk of PTSD symptoms were for example, working in emergency units and being frontline workers. Furthermore, many studies found that frontline HCWs had increased symptoms of mental disorders and being a frontline worker was an independent risk factor for depression, anxiety, and PTSD [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].

Risk factors associated with adverse mental health outcomes

The qualitative study from Uganda reported the factors associated with mental disorder symptoms among HCWs. These were long working hours, lack of equipment (PPEs, testing kits), lack of sleep, exhaustion, high death rates, death of colleagues, and a high COVID-19 transmission rate among HCWs [ 35 ]. Lack of equipment (PPEs, ventilators, and testing kits), overworking, and lack of logistic support were in Ethiopian studies [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 45 ]. Most studies identified several risk factors for adverse mental health outcomes among respondents for example those with medical and mental illnesses, contacts with confirmed COVID-19 patients, and poor social support which were significantly associated with depression [ 42 , 43 ]. Other factors were females, nurses, married, frontline workers, ICU, emergency units, living alone, and lack of social support [ 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Too, participants’ families with chronic illnesses, had contacts with confirmed COVID-19 cases, and poor social support were significantly associated with anxiety. Other risk factors associated with anxiety include exhaustion, long working hours, frontline workers, emergencies, nurses, pharmacists, laboratory technicians, married, older, younger, living alone, being female, working at general and referral hospitals, and perceived stigma. In addition, participants’ families with chronic illnesses, those who had contacts with confirmed COVID-19 cases, and those with poor social support were predictors of stress during the COVID-19 pandemic [ 37 , 38 , 40 , 41 , 42 , 43 , 45 ]. Other stress symptoms include having a medical illness, a mental illness, being a frontline worker, married, nurse, female, pharmacist, laboratory technician, physician, older age, lack of standardized PPE supply, low incomes, and living with a family [ 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 ]. Healthcare providers with low monthly incomes were significantly more likely to develop stress than those with high monthly incomes [ 38 ]. In addition, participants living alone, living with a family, and being married were associated with symptoms of psychological disorders among HCWs [ 36 , 37 , 38 , 45 ]. Overall, the risk factors for adverse psychological impacts are categorized in three thematic areas (i) occupational, (ii) psychosocial, and (iii) environmental aspects.

Occupational factors

Most studies showed that frontline HCWs, nurses, doctors, pharmacists, and laboratory technicians had significantly higher levels of mental health risks compared to non-frontline HCWs [ 35 , 36 , 37 , 38 , 40 , 42 , 43 , 45 ]. They experienced higher frequency of insomnia, anxiety, depression, and somatization than non-frontline medical HCWs. In contrast, Mali [ 39 ] and Cameroon [ 46 ] studies found a higher prevalence of depression, anxiety, and PTSD in non-frontline HCWs [ 39 , 46 ]. However, among HCWs, physicians were 20% less likely to develop mental health disorders than nurses, pharmacists, and laboratory technicians [ 39 ]. In addition, healthcare workers with low monthly incomes had higher symptoms of depression, anxiety, stress, and insomnia [ 37 ].

Healthcare groups

Five studies found that being a nurse was associated with worse mental disorders than doctors [ 36 , 37 , 40 , 44 , 45 ].

Frontline staff with direct contact with COVID-19

Most papers in the review found that being in a “frontline” position or having direct contact with COVID-19 patients was associated with higher level of psychological distress [ 35 , 36 , 37 , 38 , 40 , 42 , 43 , 45 ]. In addition, studies found that contact with COVID-19 patients was independently associated with an increased risk of sleep disturbances [ 40 , 46 ]. Moreover, HCWs who had contact with confirmed COVID-19 cases were more likely to develop depression, anxiety, and stress symptoms than those who had no contact with COVID-19 patients [ 36 , 37 , 38 , 43 , 45 ].

Lack of personal protective equipment (PPEs)

Most studies reported that the lack of PPEs was associated with higher symptoms of depression, anxiety, stress, and insomnia, while its availability was associated with fewer mental disorder symptoms [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. In Mali, workers from centres that provided facemasks were 51% less likely to suffer from depression, 62% less likely to develop anxiety, and 45% less likely to develop insomnia [ 39 ]. In Ethiopia, the odds of developing post-traumatic stress disorder were much higher among HCWs who did not receive standardized PPEs supplies than those who had [ 38 , 41 , 42 ]. In Uganda, the lack of PPEs was associated with depression, anxiety, and PTSD [ 35 ].

Heavy workload

Longer working hours, increased work intensity, increased patient load, and exhaustion were risk factors in Ugandan [ 35 ] and Ethiopian studies [ 36 ].

Psychosocial factors: perceived stigma and fear of infection

The fear of infection was in the qualitative study from Uganda [ 35 ], one quantitative study from Cameroon [ 47 ] and seven cross-sectional studies from Ethiopia [ 36 , 37 , 38 , 41 , 42 , 43 , 44 ]. Poor social support was associated with PTSD symptoms, depression, anxiety, and stress [ 35 , 36 , 37 , 38 , 42 , 43 ]. Two studies reported that HCWs with perceived stigmatization were more likely to suffer from depression, anxiety, stress, and PTSD [ 37 , 42 ].

family concerns

This came up as one of the main risk factors of stress in almost all studies, especially among those HCWs in direct contact with confirmed COVID-19 cases [ 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 ]. A family member suffering from COVID-19 was associated with poor mental health outcomes in HCWs [ 36 , 37 ].

Protective psychosocial factors

Two studies suggest a reduction of perceived stigma can be achieved by sensitization of communities about COVID-19 [ 37 , 42 ], and four studies recommend solid social support [ 36 , 37 , 42 , 43 ].

Safety of family

Family safety had the most significant impact in reducing stress. Safety from COVID-19 infection and financial protection of families were essential coping strategies for HCWs [ 35 , 36 ].

Underlying illnesses

We found three studies that reported an underlying medical and mental illness as an independent risk factor for poor psychological outcomes [ 42 , 43 , 45 ].

Protective factors against adverse mental health outcomes

The review identified protective factors to adverse mental health outcomes during COVID-19. The qualitative study from Uganda and four quantitative cross-sectional studies from Ethiopia identified some protective factors [ 35 , 38 , 41 , 42 , 45 ]. The protective factors are grouped under three thematic areas (i) occupational, (ii) psychosocial, and (iii) environmental aspects.

The qualitative study identified many social coping strategies among respondents, including family networks, community networks, help from family, responsibility to society, assistance from community members, availability of assistance from strangers, and the symbiotic nature of assistance in the community [ 35 ].

Protective occupational factors

Studies suggest that physicians suffered fewer mental health disorders partly because of their experience with previous epidemics [ 37 , 42 , 45 ].

Some necessary coping measures include good hospital guidance and ongoing training of frontline HCWs [ 37 , 42 , 45 ].

Adequate supply of PPEs

As mentioned above, PPE was a protective factor when adequate and a risk factor for poor mental health outcomes when deemed inadequate [ 35 , 36 , 37 , 42 , 43 ].

The COVID-19 pandemic has been an ongoing global public health emergency that has burdened healthcare workers' physical and mental well-being (HCWs) [ 1 , 5 ]. Our review confirms the enormous magnitude of mental health impact of COVID-19 on healthcare workers in sub-Saharan Africa, and it is widespread, with significant levels of depression, anxiety, distress, and insomnia; especially those working directly with COVID-19 patients at particular risk [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Out of the twelve articles reviewed, eight studies (66%) came from Ethiopia, and this has implications on the results (Table 1 ). This finding indicates few research published to date on the psychological impact of the pandemic on the mental health of HCWs in sub-Saharan Africa; a subregion that the COVID-19 pandemic has severely impacted.

Overview of the study sites

Studies in this review were conducted predominantly in hospital settings. We found only one study relating to primary healthcare workers or facilities [ 38 ]. This finding is of concern, as there is increasing evidence that many non-frontline HCWs continue to suffer psychological symptoms long after the conclusion of infectious disease epidemics [ 7 , 8 ]. In addition, a significant mortality due to COVID-19 was due to excess morbidity, some of which were from primary care facilities. Given that this study is the first narrative review in sub-Saharan Africa, it would be helpful to briefly compare our findings with some published reviews and surveys from other regions (Table 2 ).

High prevalence of psychological disorders among participants

Investigators in this review found 16.3–71.9% HCWs with depressive symptoms, 21.9–73.5% had anxiety symptoms, 15.5–63.7% experienced work-related stress symptoms, 12.4–77% experienced sleep disturbances, and 51.6–56.8% PTSD symptoms [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. This high prevalence of mental health symptoms among HCWs in our review is consistent with previous reviews conducted early in the pandemic in sub-Saharan Africa [ 31 ], Asia [ 17 , 18 , 26 , 28 ], USA & Europe [ 15 , 16 ], and supported by a batch of cross-sectional studies globally [ 11 , 12 , 13 , 14 , 19 , 27 , 30 ]. We found mixed results with significant variations within and among regions and countries, as depicted in Tables 1 and 2 .

Risk factors of psychological disorders among participants

Studies established that HCWs responding to the COVID-19 pandemic in sub-Saharan Africa were exposed to long working hours, overworking, exhaustion, high risk of infection, and shortage of personal protective equipment (Tables 3 and 4 ). In addition, HCWs had deep fear, were anxious and stressed with the high transmission rate of the virus among themselves, high death rates among themselves and their patients, and lived under constant fear of infecting themselves and their families with obvious consequences [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Some HCWs were deeply worried about the lack of standardized PPEs, known treatments and vaccines to protect against the virus. Many health workers had financial problems, lacked support from families and employers if they contracted the virus [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 44 ]. An additional source of fear and anxiety was the perceived stigma attached to being infected with COVID-19 by the public [ 36 , 41 ]. Studies found that HCWs, especially those working in emergency, intensive care units, infectious disease wards, pharmacies, and laboratories, were at higher risk of developing adverse mental health impacts compared to others [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 ]. This is supported by previous reviews [ 15 , 16 , 17 , 18 , 26 , 28 ] and cross-sectional studies [ 10 , 11 , 12 , 13 , 14 , 20 , 21 , 23 , 25 , 30 ]. However, findings were inconsistent on the impact of COVID-19 on frontline health workers, with ten studies [ 35 , 36 , 37 , 39 , 40 , 41 , 42 , 44 , 45 ] suggesting they are at higher risk than peers and two studies showing no significant difference in psychological disorders relating to the departments [ 38 , 43 ].

The Mali’s study was conducted exclusively in primary care facilities among HCWs not involved in treating COVID-19 cases but still registered a very high prevalence of depression 71.9%, anxiety 73.6%, and insomnia 77.0% [ 39 ]. In contrast, two studies conducted among HCWs at COVID-19 treatment facilities in Ethiopia [ 36 , 38 ] registered much lower prevalence of depression 20.2%, anxiety 21.0%, and insomnia12.4% [ 36 ], and 16.3%, 30.7% and 15.9% respectively, in the second study [ 38 ]. These findings show that not only frontline HCWs experienced mental health disorders during this pandemic but highlight the need for direct interventions for all HCWs regardless of occupation or workstation during this and future pandemics. The significant disparity in the studies could be due to structural, occupational, and environmental issues for example challenges faced by Mali's healthcare systems, characterized by acute equipment shortages, lack of PPEs, human resources, lack of trained and experienced HCWs, ongoing nationwide insecurity, and terrorism compared to Ethiopia. Therefore, local context needs to be considered as contributing factor to mental health disorders among HCWs.

Regional variations of psychological disorders

Tan et al . found a higher prevalence of anxiety among non-medical HCWs in Singapore [ 27 ]. As previously noted, the prevalence of poor psychological outcomes varied between countries. Compared to sub-Saharan Africa and China, data from India [ 23 ] and Singapore [ 27 ] revealed an overall lower prevalence of anxiety and depression than similar cross-sectional data from sub-Saharan Africa [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] and China [ 9 , 25 , 30 ]. This finding suggests that different contexts and cultures may reveal different psychological findings and that, it is possible that being at different countries’ outbreak curve may play a part, as there is evidence that it is influential.

Tan et al . suggests that medical HCWs in Singapore had experienced a SARS outbreak and thus were well prepared for COVID-19 psychologically and infection control measures [ 27 ]. What can be deduced is that context and cultural factors play a role, not just the cadre or role of healthcare workers [ 16 ]. It also highlights the importance of reviewing evidence regularly as more data emerge from other countries.

One hospital in Ethiopia found that the thought of resignation was associated with higher chances of mental health disorders and that pharmacists and laboratory technicians who did not receive prior training exhibited higher symptoms of mental health disorders compared to others [ 36 ]. Work shift arrangement, considering a dangerous atmosphere presented by working in COVID-19 wards, was one which exacerbated or relieved mental health symptoms among HCWs, with shorter exposure periods being most beneficial [ 36 ]. Meanwhile, studies found that financial worries caused by severe lockdowns and erratic payment of salaries and allowances were also major stressors [ 35 ]. This finding is like studies in Pakistan [ 13 ] and China [ 30 , 32 ].

In this review, HCWs who had contact with confirmed COVID-19 patients were more affected by depression, anxiety, and stress than their counterparts who had not [ 35 , 36 , 37 , 40 , 41 , 43 , 45 ]. This finding is like previous reviews [ 15 , 16 , 17 , 18 , 26 , 28 , 31 ] and cross-sectional studies [ 9 , 10 , 11 , 12 , 13 , 14 , 21 , 23 , 24 , 25 , 27 , 30 ], which reported higher depression, anxiety, and psychological symptoms of distress in HCWs who were in direct contact with confirmed or suspected COVID-19 patients.

A study in Pakistan showed that 80% of participants expected the provision of PPE from authority [ 13 ], and 86% were anxious. Some respondents alluded to forced deployment, while in Mali, 73.3% were anxious, with the majority worrying about the shortage of nurses [ 39 ]. Therefore, prospects of being deployed at a workstation where one had not been trained or oriented contributed to fear among health workers. In the sub-Saharan African context, this scenario can best be represented in HCWs involved in internship who must endure hard work during their training. Tan et al . found that junior doctors were more stressed than nurses in Singapore [ 27 ].

Socio-demographic characteristics

Nearly all studies in our review suggest that socio-demographic variables for example age, gender, marital status, and living alone or with families contribute to the high mental disorder symptoms [ 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 ]. We, the authors suggest that these observations are handled cautiously as several investigators of these reviewed articles did not entirely control the influence of confounding variables. An alternative explanation for this study's findings may be the more significant risks of frontline exposure amongst women and junior HCWs, predominantly employed in lower-status roles, many of whom lacked experience and appropriate training within healthcare system globally. It is also important to note that respondents to all studies, when disaggregated by gender, and age, were predominantly younger or female, which may have impacted the outcomes of these findings [ 16 ]. In addition, the consistently higher mortality rates, and risk of severe COVID-19 disease amongst men would suggest that the complete picture regarding gender and mental health during this pandemic is still incomplete [ 16 ]. Moreover, in several studies, both younger and older age groups were equally affected by mental health symptoms but for different reasons. Cai et al . [ 32 ] in a Chinese study on HCWs for example observed that irrespective of age, colleagues' safety, self and families' safety, the lack of treatment for COVID-19 was a factor that induced stress in HCWs. Similarly, in our review, the lack of PPEs, high infection transmission rates, high death rates among HCWs, and the fear of infecting their families were the factors that induced stress in all HCWs [ 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].

We, the authors propose that paying close attention to concerns of HCWs by employers would greatly relieve some stressors and contribute to increased mental well-being of participants. Compared with physicians, our review showed that nurses were more likely to suffer from depression, anxiety, insomnia, PTSD, and stress [ 35 , 37 , 39 , 40 , 41 , 44 , 45 ]. Workloads and night shifts in healthcare facilities, as well as contacts with risky patients, enhanced nurses' mental distress risks [ 15 , 16 , 17 , 18 , 26 , 27 , 28 ]. In addition, nursing staff have more extended physical contacts and closer interactions with patients than other professionals, providing round-the-clock care required by patients with COVID-19 and thus the increased risk [ 15 ]. On the one hand, we posit that most senior physicians are experienced and always keep well-informed with emerging medical emergencies. The majority become aware of emerging epidemic early and actively protect themselves from infections through regular scientific literature updates compared to their junior counterparts. Senior physicians also spend less time in emergency wards unless there is a need to conduct specific procedures which cannot be undertaken by senior housemen or general medical officers. Cai et al . [ 32 ] concluded that it is essential to have a high level of training and professional experience for healthcare workers engaging in public health emergencies, especially for the new staff. As a result, these findings highlight the importance of focusing on all the frontline HCWs sacrificing to contain the COVID-19 pandemic.

Regular monitoring of high-risk groups

There is a need to continue monitoring the high-at-risk groups, including nursing staff, interns, support staff, and all deployed in emergency wards. These high-at-risk groups should be encouraged to undertake screening, treatment, and vaccination to avoid the medium and long-term consequences of such epidemics [ 15 , 16 , 35 , 37 , 40 , 44 ].

Social support and coping mechanisms

The effect of social support and coping measures is in the qualitative study [ 34 ] and three other quantitative studies [ 36 , 41 , 42 ] which concluded that respondents with good social support were less likely to suffer from severe depression, anxiety, work-related stress, and PTSD. The qualitative study identified several coping measures, including community and organizational support, family, and community networks, help from family, responsibility to society, and assistance from community members and strangers, including the symbiotic nature of assistance in the community [ 35 ]. Other measures include providing accommodation and food to employees [ 35 ].

Interestingly, no study examined the association of resilience and self-efficacy with sleep quality, degrees of anxiety, depression, PTSD, and stress. However, a Chinese study by Cai et al. [ 32 ] suggests that the social support given to HCWs causes a reduction in anxiety and stress levels and increases their self-efficacy. In divergence, Xiao et al . [ 46 ] found no relationship between social support and sleep quality.

Only two studies in our review examined the effects of stigma on the mental health of HCWs [ 36 , 41 ] and found that HCWs with perceived stigma were more likely to be depressed, anxious, stressed, and prone to poor sleep quality [ 36 , 41 ]. We, the authors suggest that better community sensitization by creating public awareness involving appropriate local community structures and networks are essential. The broader community in sub-Saharan Africa may have suffered severely from infodemics with severe consequences on their mental health, especially during the difficult lockdowns. In addition, removing discrimination/inequalities at the workplace based on race and other social standings have a powerful influence on the mental health outcomes of HCWs. Also, because emotional exhaustion is long associated with depression, anxiety, and sleep disturbances, none of the studies in our review examined burnout as an essential component of mental health disorders in HCWs in sub-Saharan Africa.

Protective and coping measures

In this review we have provided evidence about personal, occupational, and environmental factors that were important protective and coping measures against psychological disorders. Based on these factors we suggest some protective and coping measures which can help to reduce the negative effects of the pandemic on mental health of HCWs in sub-Saharan Africa. Organizations and healthcare managers need to be aware that primary prevention is key to any successful interventions to contain and control any epidemic. This should take the form of planned regular training, orientation and continuing medical education grounded on proven infection control measures. These measures need to be backed up by timely provision of protective equipment, drugs, testing facilities, vaccines, isolation facilities, clinical and mental health support, and personal welfare of HCWs [ 35 , 36 , 37 , 42 , 45 ]. The effect of community and organizational support and coping measures was shown by the qualitative study [ 35 ] and five other quantitative studies [ 36 , 37 , 41 , 42 , 43 ] indicating that respondents who had good social and organizational support were less likely to suffer from severe depression, anxiety, work related stress and PTSD. Prior experience with comparable pandemics and training are suggested as beneficial coping strategies for healthcare workers during this pandemic but also local social structural and geopolitical conditions appear to determine the pattern and evolution of mental health symptoms among HCWs [ 14 , 15 , 31 , 32 , 47 ]. In our case the high prevalence of all mental health symptoms in non-frontline primary health care facilities in Mali [ 39 ] which was already plagued with instability and weak healthcare systems prior to the pandemic is a case in point. Results are particularly consistent in showing that provision of PPEs, testing kits, orientation training of workers, work shift arrangements, provision of online counselling, provision of food and accommodation and prompt payment of allowances by employers were important protective measures [ 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. The feeling of being protected is associated with higher work motivation with implication for staff turnover [ 35 , 38 , 43 , 45 ]. Hence, physical protective materials [ 14 ], together with frequent provision of information, should be the cornerstone of any interventions to prevent deterioration in mental health of HCWs (Table 5 ). Finally, provision of rest rooms, online consultation with psychologists/psychiatrists, protection from financial hardships, access to social amenities and religious activities are some important coping measures [ 35 , 36 , 38 , 42 , 45 ]. In this era of digital health care with plentiful internet and smartphones, organization can conduct online trainings, online mental health education, online psychological counselling services, and online psychological self-help intervention tailored to the needs of their HCWs [ 35 , 37 , 42 ]. In addition, it is essential to understand and address the sources of anxiety among healthcare professionals during this COVID-19 pandemic, as this has been one of the most experienced mental health symptoms [ 48 ]. Adequate protective equipment provided by health facilities is one of the most important motivational factors for encouraging continuation of work in future outbreaks. Furthermore, availability of strict infection control guidelines, specialized equipment, recognition of their efforts by facility management, government, and reduction in reported cases of COVID-19 provide psychological benefits [ 15 , 32 ]. Finally, we call upon Governments (the largest employers of HCWs) in sub-Saharan Africa to do what it takes to improve investments in the mental health of HCWs and plan proactively in anticipation of managing infectious disease epidemics, including other expected and unexpected disasters.

Future research direction

There was no study that examined the association of resilience and self-efficacy with sleep quality, degrees of anxiety, depression, PTSD, and stress. Although emotional exhaustion has long been associated with depression, anxiety, and sleep disturbances, no study in our review examined burnout as an important component of mental health disorders in HCWs in sub-Saharan Africa. The impacts of infodemics, stringent lockdown measures, discrimination/inequalities at workplaces based on race, and other social standings on mental health outcomes of HCWs need to be investigated.

Future studies are needed on the above including other critical areas like suicidality, suicidal ideations, and substance abuse during the COVID-19 pandemic. In addition, there is a significant variation of related literature calling for more rigorous research in future. More systematic studies will be required to clarify the full impact of the pandemic so that meaningful interventions can be planned and executed at institutional and national levels in the Sub-Saharan Africa.

Limitations of this study

There are some limitations to this study. First, most of the studies are from one country, limiting the generalizability of the results to the whole African continent. Second, all the studies were cross-sectional and only looked at associations and correlations. There is a need for prospective or retrospective cohort or case–control studies on this subject matter. Longitudinal research studies on the prevalence of mental disorders in the COVID-19 pandemic in the sub-Saharan Africa are urgently required. Third, most studies reviewed did not adequately examine protective factors or coping measures of the health workers in their settings. In addition, most studies did not pay strict attention to confounding variables which could have led to inappropriate results and conclusions. Fourth, most sample sizes were small and unlikely representative of the population and yet larger sample sizes would better identify the extent of mental health problems among health workers in the region. Fifth, depression, anxiety, and stress were assessed solely through self-administered questionnaires rather than face-to-face psychiatric interviews. Sixth, these studies employed various instruments and different cut-off thresholds to assess severity. Notably, the magnitude and severity of reported mental health outcomes may vary based on the validity and sensitivity of the measurement tools. Seventh, there was no mention of mental baseline information among the studied population and therefore it was unknown if the studied population had pre-existing mental health illnesses that decompensated during the pandemic crisis. Eight, investigators did not give much attention to stigma, burnout, resilience, and self-efficacy among study participants.

Furthermore, our review did not employ systematic reviews or meta-analyses methods for the information generated. This narrative review paper precluded deeper insight into the quality of reviewed articles for this paper. Still, our observation was that investigators did not consider the strict lockdown measures, quarantine, and isolation imposed by many countries in sub-Saharan Africa as possible risk factors for mental health disorders among HCWs.

Based on the articles reviewed, the prevalence of depression, anxiety, insomnia, and PTSD in HCWs in the sub-Saharan Africa during the COVID-19 pandemic is high. We implore health authorities to consider setting up permanent multidisciplinary mental health teams at regional and national levels to deal with mental health issues and provide psychological support to patients and HCWs, always supported with sufficient budgetary allocations.

Long-term surveillance is essential to keep track of insidiously rising mental health crises among community members. There is a significant variation of related literature thus calling for more rigorous research in the future. More systematic studies will be needed to clarify the full impact of the pandemic so that meaningful interventions can be planned better and executed at institutional and national levels in sub-Saharan Africa.

Availability of data and materials

Datasets analysed in the current study are available from the corresponding author at a reasonable request.

Abbreviations

Coronavirus disease 2019

Healthcare workers.

Mental health

Public health emergency

Personal protective equipment

World Health Organisation

World Health Organization. Coronavirus disease (COVID-19) outbreak. 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (Accessed 1 March 2020).

Veenema TG, Closser S, Thrul J. Mental Health, and Social Support for Healthcare and Hospital Workers During the COVID-19 Pandemic. Baltimore, MD: Johns Hopkins Center for Health Security; 2021.

Chersich MF, Gray G, Fairlie L. COVID-19 in Africa: care and protection for frontline healthcare workers. Global Health. 2020;16:46. https://doi.org/10.1186/s12992-020-00574-3Interventions .

Article   PubMed   PubMed Central   Google Scholar  

Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during a COVID-19 pandemic. BMJ. 2020;368: m1211. https://doi.org/10.1136/bmj.m1211 .

Article   PubMed   Google Scholar  

WHO. Keep health workers safe to keep patients safe: WHO. 2020. https:// www.who.int/news/item/17-09-2020-keep-health-workers-safe-to-keep - patients-safe-who. Accessed 21 October 2020.

WHO. Weekly epidemiological update on COVID-19- 19 th October 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---19-october-2022 .

Maunder R, Lancee W, Balderson K, Bennett J, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerging Infect Dis. 2006;12(12):1924–32. https://doi.org/10.3201/eid1212.060584 .

Article   Google Scholar  

Jalloh MF, Li W, Bunnell RE. Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015. BMJ Glob Health. 2018;3: e000471. https://doi.org/10.1136/bmjgh-2017-000471 .

Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3): e14.

Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi. Chinese J Indus Hygiene Occup Dis. 2020;38:E001.

Google Scholar  

Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of coronavirus disease. Asian J Psychiatr. 2020. https://doi.org/10.1016/j.ajp.2020.102111 .

Elhadi M, Msherghi A, Elgzairi M, Alhashimi A, Bouhuwaish A, Biala M, Abuelmeda S, et al. Psychological status of healthcare workers during the civil war and COVID-19 pandemic: a cross-sectional study. J Psychosom Res. 2020;137: 110221.

Urooj U, Ansari A, Siraj A, Khan S, Tariq H. Expectations, fears, and perceptions of doctors during COVID-19 pandemic. Pak J Med Sci. 2020;36:S37–42. https://doi.org/10.12669/pjms.36.COVID19-S4.2643 .

Khanal P, Devkota N, Dahal M, Paudel K, Joshi D. Mental health impacts among health workers during COVID-19 in a low resource setting: a cross-sectional survey from Nepal. Global Health. 2020;16(1):89. https://doi.org/10.1186/s12992-020-00621-z .

Preti E, Di Mattei V, Perego G. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020;22(8):43. https://doi.org/10.1007/s11920-020-01166-z .

De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz SA, Ellis L, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health. 2021;21(1):104. https://doi.org/10.1186/s12889-020-10070-3 .

Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and the general public. A systematic review and meta-analysis. Psychiatry Res. 2020;291:113190. https://doi.org/10.1016/j.psychres.2020.113190 .

Bareeqa SB, Ahmed SI, Samar SS, Yasin W, Zehra S, Monese GM, et al. Prevalence of depression, anxiety, and stress in china during COVID-19 pandemic: a systematic review with meta-analysis. Int J Psychiatry Med. 2021;56:210–27.

Søvold LE, Naslund JA, Kousoulis AA. Prioritizing the mental health and well-being of healthcare workers: an urgent global public health priority. Front Public Health. 2021;9: 679397. https://doi.org/10.3389/fpubh.2021.679397 .

Consolo U, Bellini P, Bencivenni D, Iani C, Checchi V. Epidemiological aspects, and psychological reactions to COVID-19 of dental practitioners in the Northern Italy districts of Modena and Reggio Emilia. Int J Environ Res Public Health. 2020;17(10):3459. https://doi.org/10.3390/ijerph17103459 .

Gilleen J, Santaolalla A, Valdearenas L, Salice C, Fusté M. Impact of the COVID-19 pandemic on the mental health and well-being of UK healthcare workers. BJPsych Open. 2021;7(3): e88. https://doi.org/10.1192/bjo.2021.42 .

Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. psychological distress, coping behaviours, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1–8. https://doi.org/10.1016/j.genhosppsych.2020.06.007 .

Wilson W, Raj JP, Rao S, Ghiya M, Nedungalaparambil NM, Mundra H, et al. Prevalence and predictors of stress, anxiety, and depression among healthcare workers managing COVID-19 pandemic in India: a nationwide observational study. Indian J Psychol Med. 2020;42(4):353–8. https://doi.org/10.1177/0253717620933992 .

Wang S, Xie L, Xu Y, Yu S, Yao B, Xiang D. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med. 2020. https://doi.org/10.1093/occmed/kqaa074 .

Kang L, Ma S, Chen M, Yang J, Wang Y, Li R. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross-sectional study. Brain Behav Immun. 2020. https://doi.org/10.1016/j.bbi.2020.03.028 .

Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behavi Immun. 2020. https://doi.org/10.1016/j.bbi.2020.05.026 .

Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med. 2020. https://doi.org/10.7326/M20-1083 .

Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression, anxiety, and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: a systematic review and meta-analysis. PLoS One. 2021;16(3): e0246454. https://doi.org/10.1371/journal.pone.0246454 .

British Medical Association. The mental health and well-being of the medical workforce – now and beyond COVID-19. 2020. Available from URL: https://www.bma.org.uk/media/2475/bma-covid-19-and-nhs-staff-mental-healthwellbeing-report-may-2020.pdf .

Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976 .

Chen J, Farah N, Dong RK, Chen RZ, Xu W, Yin J, et al. Mental health during the COVID-19 crisis in Africa: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18:10604. https://doi.org/10.3390/ijerph182010604 .

Gupta S, Sahoo S. Pandemic, and mental health of the frontline healthcare workers: a review and implications in the Indian context amidst COVID-19. Gen Psychiatr. 2020;33(5): e100284. https://doi.org/10.1136/gpsych-2020-100284 .

Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. psychological impact, and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Med Sci Monit. 2020;26:924171. https://doi.org/10.12659/MSM.924171 .

CDC. National Center for Immunization and Respiratory Diseases. CDC (2020) Available online at: https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html .

Muzyamba C, Makova O, Mushibi GS. Exploring health workers’ experiences of mental health challenges during care of patients with COVID-19 in Uganda: a qualitative study. BMC Res Notes. 2021;14(1):286. https://doi.org/10.1186/s13104-021-05707-4 .

GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Levels and predictors of anxiety, depression, and stress during COVID-19 pandemic among frontline healthcare providers in Gurage zonal public hospitals, Southwest Ethiopia, 2020: a multicentre cross-sectional study. PLoS One. 2021;16(11): e0259906. https://doi.org/10.1371/journal.pone.0259906 .

Mulatu HA, Tesfaye M, Woldeyes E. The prevalence of common mental disorders among health care professionals during the COVID-19 pandemic at a tertiary Hospital in East Africa. Med Rxiv. 2020. https://doi.org/10.1101/2020.10.29.20222430 .

Ayalew M, Deribe B, Abraham Y, Reta Y, Tadesse F, Defar S. Post-traumatic stress disorder symptoms and its predictors among healthcare workers following COVID-19 pandemic in Southern Ethiopia: a cross-sectional study. Front Psychiatry. 2021. https://doi.org/10.3389/fpsyt.2021.818910 .

Sagaon-Teyssier L, Kamissoko A, Yattassaye A, Diallo F, Castro DR, Delabre R, et al. Assessment of mental health outcomes and associated factors among workers in community-based HIV care centers in the early stage of the COVID-19 outbreak in Mali. Health Policy Open. 2020. https://doi.org/10.1016/j.hpopen.2020.100017 .

Kemal J. Psychological distress, early behavioral response, and perception toward the COVID-19 pandemic among health care workers in North Shoa Zone, Oromiya region. Front Psychiatry. 2020. https://doi.org/10.3389/fpsyt.2021.628898 .

Chekole YA, Minaye SY, Abate SM, Mekuriaw B. Perceived stress, and its associated factors during COVID-19 among healthcare providers in Ethiopia: a cross-sectional study. Adv Public Heal. 2020. https://doi.org/10.1155/2020/5036861 .

Asnakew S. Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia 2020: a multi-centred cross-sectional study. PLoS One. 2021;16(9):e0255340.

Asnakew S, Amha H, Kassew T. Mental health adverse effects of COVID-19 pandemic on health care workers in Northwest Ethiopia: a multicenter cross-sectional study. Neuropsychiatr Dis Treat. 2021;17:1375–84. https://doi.org/10.2147/NDT.S306300 .

Kounou KB, Guédénon KM, Foli AAD, Gnassounou-Akpa E. Mental health of medical professionals during the COVID-19 pandemic in Togo. Psychiatry Clin Neurosci. 2020;74:559–60.

Ayalew MB. Prevalence and determinant factors of mental health problems among healthcare professionals during COVID-19 pandemic in southern Ethiopia: a multicentre cross-sectional study. BMJ Open. 2021. https://doi.org/10.1136/bmjopen-2021-057708 .

Keubo FRN, Mboua PC, Tadongfack TD, Tchoffo EF, Tatang CT, Zeuna JI, et al. psychological distress among health care professionals of the three COVID-19 most affected Regions in Cameroon: Prevalence and associated factors. In: Annales Médico-Psychologiques, Revue Psychiatrique; Elsevier Masson: Paris, France. 2021;179:141–146.

Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020;26:e923549. https://doi.org/10.12659/MSM.923549 .

Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among healthcare professionals during the COVID-19 pandemic. JAMA. 2020. https://doi.org/10.1001/jama.2020.5893 .

Download references

Acknowledgements

We thank Uganda Medical Association Acholi-branch members for the financial assistance which enabled the team to conduct this study successfully.

Author information

Authors and affiliations.

Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda

Freddy Wathum Drinkwater Oyat, Johnson Nyeko Oloya, Pamela Atim, Judith Aloyo & David Lagoro Kitara

Moroto Regional Referral Hospital, Moroto, Uganda

Johnson Nyeko Oloya

St. Joseph’s Hospital, Kitgum District, Uganda

Pamela Atim

ICAP at Columbia University, Freetown, Sierra Leone

Eric Nzirakaindi Ikoona

Rhites-N, Acholi, Gulu City, Uganda

Judith Aloyo

Faculty of Medicine, Department of Surgery, Gulu University, P.O. Box 166, Gulu City, Uganda

David Lagoro Kitara

Harvard University, Cambridge, USA

You can also search for this author in PubMed   Google Scholar

Contributions

FWDO, JA, JNO, ENI and DLK searched and screened studies and extracted data from selected articles. FWDO wrote the first draft of the manuscript, and all authors reviewed and edited the final draft. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to David Lagoro Kitara .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

All authors declare no conflict of interest.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Oyat, F.W.D., Oloya, J.N., Atim, P. et al. The psychological impact, risk factors and coping strategies to COVID-19 pandemic on healthcare workers in the sub-Saharan Africa: a narrative review of existing literature. BMC Psychol 10 , 284 (2022). https://doi.org/10.1186/s40359-022-00998-z

Download citation

Received : 03 September 2022

Accepted : 22 November 2022

Published : 01 December 2022

DOI : https://doi.org/10.1186/s40359-022-00998-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• COVID-19 pandemic
• Social support
• Occupational health and safety
• Mental health surveillance
• Workplace organization

BMC Psychology

ISSN: 2050-7283

• General enquiries: [email protected]

• Case report
• Open access
• Published: 10 June 2024

Treatment of primary epididymal adenocarcinoma: a case report and review of the literature

• Jianhua Xiao 1 ,
• Yan You 2 ,
• Ziqiang Dong 1 ,
• Qi Wu 3 &
• Honggang Yuan 1  

Journal of Medical Case Reports volume  18 , Article number:  274 ( 2024 ) Cite this article

Metrics details

Epididymal tumors, especially malignant tumors, have low incidence and are rare in our clinical work. However, they may progress quickly and have poor prognosis. For such rare clinical cases with extremely low incidence rates, and as they are prone to misdiagnosis and missed diagnosis and have a very poor prognosis, clinical workers need to pay special attention and consider the possibility of primary epididymal malignant tumors.

A 63-year-old Chinese male patient from Asia was admitted due to scrotal pain. Upon examination, an abnormal lesion was found in the right epididymal region. After thorough evaluation, surgical resection was performed, and the postoperative pathological result confirmed the presence of epididymal adenocarcinoma. After further ruling out secondary lesions, primary epididymal adenocarcinoma was considered. Right retroperitoneal lymph node dissection was performed under laparoscopic for treatment, and 1/11 lymph node metastasis was detected after surgery. The patient is currently under close follow-up.

Conclusions

The number of clinical cases of primary epididymal malignant tumors is very limited, there is currently no standardized diagnosis and treatment process, and there is a lack of systematic evaluation methods regarding the effectiveness of different treatment options such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy. In addition, the outcome is difficult to predict. In this article, we reviewed relevant literature and systematically elaborated on the diagnosis and treatment of epididymal malignant tumors, hoping to provide useful information for relevant experts.

Peer Review reports

Primary malignant tumors of the epididymis are rare clinical diseases, and the incidence rate is less than 7% of overall male genital system tumors. The age range of its onset is wide, but it is more common between the ages of 30 years and 50 years, which is 10 years later than the average age of onset for benign tumors of the epididymis. Among them, the age distribution of patients with different pathological types varies, and embryonic rhabdomyosarcoma occurs earlier. To date, the youngest patient reported in China is only 14 months old. The onset age of adenocarcinoma is relatively older, generally over 40 years [ 1 ]. There is no relevant report on the difference in incidence rate between different regions or races. Primary malignant tumors of the epididymis are mostly unilateral, with more tumors on the left side. Moreover, tumors are mostly located in the tail of the epididymis, and bilateral cases are very rare. Due to their anatomical characteristics, epididymal tumors are theoretically easy to find. However, as the hidden clinical symptoms and the fact that epididymal masses are mostly benign tumors, chronic inflammatory nodules, or sperm stasis, the incidence of malignant tumors is low, leading to low alertness of clinical physicians to them, thus delaying the time of diagnosis and treatment. At the same time, epididymal malignant tumors are highly malignant tumors and prone to metastasis early with poor prognosis. Moreover, most of the domestic and foreign literature consists of case reports rather than systematic research. Therefore, a relatively standardized diagnosis and treatment mode has not yet been determined [ 2 ].

A 63-year-old Chinese male patient from Asia visited our hospital on 1 August 2021, due to “swelling and pain in the right testicle for over a year” who had a history of surgical treatment for left testicular hydrocele and was without other special medical experiences and allergy history regarding food and drugs, no history of exposure to significant carcinogenic factors, and no obvious family history of tumors. Physical examination: normal vital signs, height 178 cm, weight 74 kg, no swelling of superficial lymph nodes throughout the body, intact scrotal skin, no redness, swelling or pain. The size and morphology of the left testicular epididymis were normal, with slightly lower activity. The size of the right testicle was close to normal, and there was a nodule about 4 cm × 4 cm in size in the upper and posterior epididymal area. The texture was hard, with poor mobility and no obvious squeezing pain. Scrotal ultrasound showed an irregular cystic mass in the right epididymis area that was tightly adhered to the right testicle, exhibiting an uneven mixed echo mass with unclear boundaries. The size of the lump was approximately 4 cm × 3 cm × 2 cm. Magnetic resonance imaging (MRI) prompted the following description: right epididymis was full; within it, there was a range of approximately 2.6 cm × 2.8 cm × 2.1 cm mixed signals of cystic and solid nature; boundary was not smooth, especially in the junction area to the upper edge of the right testicle (Fig.  1 ). Retroperitoneal computed tomography (CT) and chest CT did not show important positive results. The levels of alpha fetoprotein (3.6 ng/mL), human chorionic gonadotropin (0.3 mIU/mL), and lactate dehydrogenase (220 IU/L) were all within the normal range.

Preoperative magnetic resonance imaging (August 2021) showing mixed signals of cystic and solid nature in the right epididymis

Preliminary clinical diagnosis

Tumor of the right epididymis.

The nature of the patient’s right epididymis tumor was uncertain, and a malignant tumor could not be ruled out. After sufficient communication with the patient and his family on feasible management measures, the patient chose to undergo radical resection of the right testicular epididymis directly. With sufficient preparation, we performed radical resection of the right testis and epididymis through a right inguinal incision. The postoperative gross specimen was described as follows: the right testicle with the epididymis was completely cut, measuring 5.5 cm × 5 cm × 3 cm in size; the epididymis was 3 cm × 2.5 cm × 2 cm in size; upon incision, gray yellow spongy testicular tissue was observed, and a gray white lump with a size of approximately 3.5 cm × 3 cm × 2 cm was visible in the epididymis; the surface of the lump was gray white and solid in nature; under the microscope, the tumor cells had varying structures, large nuclei, obvious atypia, deeply stained cytoplasm, and glandular-like structures (Fig.  2 ).

Macroscopic and electron microscopic photos of postoperative specimens, Hematoxylin and eosin (HE) ×40

The immunohistochemical results were as follows: PCK(+), EMA(+), CEA(−), WT-1(+), CK5/6(+), CR(calretinin)(+), CD30(−), SALL4(−), Ki-67(20%), OCT-3/4(−), CK7(+), β-catenin(cytoplasm)(+), inhibin-α(−), MC(HBME-1)(−), D2-40(−), pax-8(−), and Cam5.2(+). Microscopic morphology and immunohistochemical results supported epididymal adenocarcinoma with testicular invasion. Perineural invasion was identified, and no tumor thrombus was found in the vessels. Further gastroscopy, colonoscopy, electronic laryngoscopy, neck enhanced MRI, and positron emission tomography (PET)-CT examinations did not indicate the possibility of tumors in other parts of the body. Therefore, we considered the final diagnosis as primary adenocarcinoma of the right epididymis. Considering the high malignancy of primary adenocarcinoma of the epididymis and its susceptibility to retroperitoneal lymph node metastasis, some scholars have pointed out that retroperitoneal lymph node dissection should be performed not only in cases with lymph node enlargement, but also as a preventive treatment for clinical N0 patients [ 3 ]. Therefore, retroperitoneal lymph node dissection was recommended for this patient.

The laparoscopic retroperitoneal lymph node dissection was performed 2 weeks later. During the surgery, we removed the entire right retroperitoneal lymphoid adipose tissue and checked the wound surface to ensure that there was no obvious bleeding point. After repeatedly rinsing the wound with sterile distilled water, we removed the specimen tissues (Fig.  3 ). The overall appearance of the postoperative specimens was described as follows: a piece of gray yellow adipose tissue with a size of 7.5 cm × 4.5 cm × 2.5 cm; several nodules with a diameter of 0.5–3 cm were observed inside, and all nodules were taken; The microscopic examination results were as follows: 11 lymph nodes were found, with one lymph node showing cancer metastasis (1/11).

Screenshots of the right retroperitoneal lymph node dissection under laparoscopy: (1) clearing retroperitoneal fat; (2) opening perirenal fascia (3) exposing the ureter; (4) exposing vena cava (5) the upper edge of the dissection exceeded the level of the renal artery; (6) exposing the aorta and lymph tissues between the abdominal aorta and vena cava; (7) exposing the contralateral renal vein; (8) overall view after dissection. The black arrows indicate the main anatomical structures described in each image

Postoperative diagnoses

Primary malignant tumor of the right epididymis,

Adenocarcinoma,

Secondary malignant tumor in the right retroperitoneal lymph node.

Follow-up situation

After multidisciplinary discussions and evaluations, the surgery completely removed the tumor tissue. Under sufficient communication with the patient and their family on feasible treatment measures, they decided not to accept adjuvant measures such as radiotherapy and chemotherapy, and strict follow-up had been chosen. At 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, and 30 months after surgery, the imaging showed no progression. As of now, no additional adjuvant treatment has been added, and close follow-up is continuing.

Primary malignant tumors of the epididymis are rare clinical diseases, there is currently no standardized diagnosis and treatment process, and there is a lack of systematic evaluation methods of the effectiveness regarding different treatment options such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy. We want to review relevant literature and systematically elaborate on the diagnosis and treatment of epididymal malignant tumors in this paper.

Risk factors of primary malignant tumors

The existing relevant literature has not systematically elucidated the high-risk factors for primary epididymal malignant tumors, but there are currently no relevant reports on whether cryptorchidism or testicular insufficiency is related to the occurrence of epididymal malignant tumors. However, some literature has mentioned the relationship between cryptorchidism or undescended testis and epididymal malignant tumors, but whether there is a relationship between them is still uncertain [ 4 ].

Clinical symptoms

Primary malignant tumors of the epididymis lack specific symptoms and signs, mostly manifesting as painless masses within the scrotum, mostly located in the tail of the epididymis, followed by the head. Some patients have local soreness or pain accompanied by a sense of heaving. The masses often exhibit progressive growth, with a diameter often greater than 3 cm and unclear boundaries with surrounding tissues. They can be accompanied by thickening of the affected spermatic cord or vas deferens, appearing nodular or beaded on palpation. When accompanied by hydrocele of the tunica vaginalis, the testicular volume substantially increases, and the transparency test can be positive. Some patients also have acute epididymitis, and the affected testis and epididymis are also considerably enlarged, with obvious tenderness, redness, and swelling of the scrotal skin and a notable increase in skin temperature. In severe cases, purulent secretions may be present [ 5 ]. When tumors metastasize locally or remotely, corresponding symptoms and signs are observed.

Laboratory examinations

Early clinical laboratory examinations may show no important abnormalities, and in cases of acute inflammation, white blood cell count, neutrophil count, C-reactive protein, procalcitonin, and other indicators in the blood can be considerably higher than the normal range. When the disease progresses to the terminal stage, important abnormalities in various blood indicators may occur, such as electrolyte disorders, severe hypoproteinemia, liver and kidney dysfunction, and elevated alkaline phosphatase. As of now, there are no reports suggesting specific tumor markers for primary epididymal malignant tumors. Common tumor markers related to testicular malignant tumors, such as blood alpha fetoprotein (AFP), lactate dehydrogenase (LDH), human chorionic gonadotropin (HCG), and carcinoembryonic antigen (CEA), are mostly normal. However, secondary malignant tumors in the epididymis may exhibit specific abnormal tumor markers, such as a substantial increase in blood prostate specific antigen (PSA) when prostate malignant tumors metastasize to the epididymis [ 4 ].

Imaging examinations

Malignant tumors of the epididymis have a complex tissue source and thus lack typical imaging manifestations. High-resolution ultrasound is considered the preferred imaging examination method for testicular and epididymal tumors due to its noninvasive and convenient advantages. It can provide some common features: irregular and large (usually larger than 3 cm) cystic, mixed cystic and solid, or solid masses in the epididymal or epididymal spermatic cord area. Tumors are prone to invading surrounding tissues such as the spermatic cord, testicles, or scrotal skin. The morphology of the testes and epididymis is often unclear when the tumor is large. Epididymal malignant tumors often have an abundant blood supply, but the manifestations of tumors from different tissue sources vary. They can be accompanied by testicular hydrocele and considerable thickening of the spermatic cord. At the same time, ultrasound can also be used to carefully explore the bilateral spermatic cord area, pelvic cavity, and retroperitoneal area to determine whether there is lymph node enlargement [ 6 ]. CT can also clearly display abnormal density lesions near the testicles within the scrotum and clarify the relationship between the tumor and the epididymis, and enhanced scanning can assist in determining the blood supply of the tumor. MRI often shows irregular nodules on the lateral side of the testis, closely related to the epididymis. The internal signals of the nodules are uneven, and the enhanced scan can show gradual enhancement, mainly with edge enhancement. Magnetic resonance imaging diffusion weighted imaging (MRI-DWI) is significantly limited in diffusion, and MRI can also be useful in determining local and distant metastasis. Craniocerebral CT or MRI, emission computed tomography (ECT) bone scan, positron emission computed tomography (PET-CT), among others, can all be used as supplementary examinations [ 7 ].

Methods of tumor tissue acquisition for pathological diagnosis

Due to its rarity and lack of specific clinical manifestations, it is difficult to make a clear diagnosis before surgery for primary malignant tumors of the epididymis. Fu et al . [ 8 , 9 ] reported that there were very few cases of epididymal tumors that were clearly diagnosed before surgery, and most of them were misdiagnosed as other epididymal diseases, with a misdiagnosis rate of 63%. Regarding preoperative needle aspiration cytology examination, Smith et al . reported that the examination could lead to approximately 0.006% malignant tumor implantation, while Andersson et al . [ 10 , 11 ] concluded that the possibility of implantation metastasis through fine needle aspiration was basically negligible, confirming the feasibility of this method. However, after careful analysis of the relevant literature, it was found that needle aspiration cytology is not a routine choice for patients with relatively limited lesions. More people choose to undergo direct surgical exploration followed by intraoperative rapid freezing examination, the results of which guide further comprehensive treatment measures.

Pathological types of malignant tumors in the epididymis

Epithelial malignant tumors of the epididymis are relatively rare, and most of them originate from interstitial tissue. Among all pathological types, adenocarcinoma is more common in clinical practice, followed by embryonic rhabdomyosarcoma [ 12 ]. The remaining tissue types are relatively complex, and different pathological types have different clinical characteristics and prognosis outcomes, which are often difficult to determine before surgery and postoperative pathological analysis. The main types of primary epididymal malignant tumors that are commonly reported in domestic and foreign literature are presented in Table  1 .

Differential diagnosis of malignant tumors in the epididymis

Primary epididymal malignant tumors mainly need to be differentiated from diseases such as epididymal cyst, granuloma of the epididymis, chronic epididymitis, epididymal tuberculosis, benign tumors of the epididymis, and secondary malignant tumors of the epididymis according to medical history, physical examinations, preoperative imaging data, laboratory results, needle aspiration cytology or biopsy, and intraoperative and postoperative pathological results.

Metastasis of malignant tumors in the epididymis

Common metastasis pathways of epididymal malignant tumors: the most common metastasis pathways of epididymal malignant tumors are hematogenous metastasis and lymphatic metastasis. The lymphatic circulation of the epididymis is similar to that of the testis, and the lymphatic vessels of the two coincide with each other. Their collecting lymphatic vessels follow the internal arteries and veins of the spermatic cord, passing through the seminal vesicle, spermatic cord, inguinal segment, and abdominal segment from the beginning and injecting into the corresponding lymph nodes through the retroperitoneal space. The most common sites of lymphatic metastasis are the common iliac lymph nodes and retroperitoneal lymph nodes, and regardless of whether there is local metastasis, metastasis to retroperitoneal lymph nodes may have already occurred. Therefore, some scholars advocate for routine retroperitoneal lymph node dissection after radical epididymectomy for malignant tumors of the epididymis [ 27 ]. Other scholars suggest that patients younger than the age of 10 years do not need to undergo retroperitoneal lymph node dissection if preoperative imaging examinations do not indicate enlarged lymph nodes, while patients older than the age of 10 years must undergo retroperitoneal lymph node dissection if preoperative CT suggests possible lymph node metastasis [ 28 ]. The most common sites of hematogenous metastasis are the liver and lungs; metastasis to these sites can occur in the early stages of poorly differentiated squamous cell carcinoma or undifferentiated carcinoma, and the literature suggests that these patients often die within 8 months of diagnosis [ 5 ].

Treatment measures

Treatment principles: at present, when considering the possibility of epididymal malignant tumors, we prioritize preoperative comprehensive evaluation and direct surgical exploration when conditions permit, assist with rapid frozen biopsy during surgery, and then formulate follow-up plans on the basis of the results. If the results indicate a benign tumor, the tumor or epididymis should be removed. If a malignant tumor is considered, radical resection of the epididymis tumor through the inguinal approach is performed, including the tumor, epididymis, testicle, spermatic cord, and tunica vaginalis. When the tumor invades the scrotum, unilateral scrotal resection is needed. If lymph node metastasis in the spermatic cord, pelvic cavity, or retroperitoneal area is considered before surgery, active regional lymph node dissection is recommended [ 6 , 29 , 30 ]. Further comprehensive treatment measures will be determined on the basis of pathological results after surgery. Among them, if the pathological results indicate adenocarcinoma, even if there are no obvious signs of lymph node metastasis temporarily, as it is the main mode of metastasis, active performance of retroperitoneal lymph node dissection supplemented by chemotherapy after surgery is still recommended. Sarcomas are mainly treated with a combination of chemotherapy and radiotherapy, while undifferentiated cancers are mainly treated by radiotherapy with adjuvant chemotherapy if necessary [ 7 ].

As oncologists or surgeons, we should carefully consider the possibility of malignant tumors when facing patients with epididymal tumors. We recommend direct surgical exploration and complete resection of the lesion in one stage, but performing needle aspiration cytology examination before resection to confirm diagnosis is also a feasible option [ 10 , 11 ]. When pathological result indicates primary adenocarcinoma of the epididymis, retroperitoneal lymph node dissection should be actively performed, and systemic treatments such as chemotherapy and immunotherapy may be temporarily avoided under close follow-up [ 14 , 31 ]. For other pathological types of malignant tumors, comprehensive measures such as radiotherapy and chemotherapy should be actively taken, referring to relevant information [ 7 , 12 , 19 , 21 , 32 ].

Availability of data and materials

PubMed was used as a source of information using the search term: epididymal malignant tumor OR epididymis AND malignancy, epididymis AND cancer, epididymis AND tumor.

Abbreviations

Magnetic resonance imaging

Computer tomography

Pan cytokeratin

Epithelial membrane antigen

Carcinoembryonic antigen

Wilms tumor gene

Cluster of differentiation

Spalt-like transcription factor 4

Nuclear protein Ki-67

POU structural transcription factor

Member of mesothelial markers

Cell adhesion molecule

Emission computed tomography

Positron emission tomography

Wang L, Mo HT, Shi M, Wang J, Dai B, et al . Report of 5 cases of primary malignant tumors of the epididymis. Chin J Urol. 2002;23(1):53 ( In Chinese ).

Google Scholar  

Yin B, Song YS, Fei X, Shan LP, Zhang H, et al . Report of 4 cases of primary malignant tumors of the epididymis. Chin Androl. 2006;12(10):944 ( In Chinese ).

Michal S, Jan D, Daniel M, Antonin K, Radek L. Primary adenocarcinoma of the epididymis: the therapeutic role of retroperitoneal lymphadenectomy. Int Urol Nephrol. 2012;44(4):1049–53.

Article   Google Scholar  

Zhou SJ, Ma LM, Cai XQ, Zhang YP. Diagnosis and treatment of primary malignant tumors of the epididymis (with a clinical report of 5 cases). Clin Treatises. 2010;17(4):36–8 ( In Chinese ).

Tan YB, Zhang NX. Surgical diagnostic pathology. 1st ed. Tianjin: Tianjin Science and Technology Press; 2000. p. 639–40 ( In Chinese ).

Jing JG, Li YZ, Peng YL, Luo Y, Zhuang H, et al . Ultrasound diagnosis of 5 cases of primary malignant tumors of the epididymis. Acoust Technol. 2015;34(4):282–6 ( In Chinese ).

Guo YL, Hu LQ. Clinical andrology. Wuhan: Hubei Science and Technology Press; 1996. p. 213 ( In Chinese ).

Fu Q, Wang F, Li S, Lv J, Ding K, et al. Diagnosis and treatment of primary epididymal tumors (report of 27 cases). Clin Oncol China. 2007;(09):519–520 ( In Chinese ).

Lin DH, Lu SJ, Xing B, Du ZJ, Chen MS, et al . Endovascular intervention therapy for acute lower limb arterial occlusion. Hainan Med J. 2007;18(10):3–4.

Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Radiology. 1991;178(1):253.

Article   CAS   PubMed   Google Scholar  

Andersson R, Andren-Sandberg A, Lundstedt C, Tranberg KG. Implantation metastases from gastrointestinal cancer after percutaneous puncture of drainage. Eur J Surg. 1996;162(7):551.

CAS   PubMed   Google Scholar  

Xu ZQ, Xu HY, Qiu XW. Report of two cases of embryonic rhabdomyosarcoma of the epididymis. Chin J Surg. 1990;11(6):366 ( In Chinese ).

Ruan Y, Fan J, Xia SJ, et al . Clinical characteristics of small round cell malignant tumors of the epididymis (one case report and literature review). Chin Clin Oncol. 2006;33(16):952–3 ( In Chinese ).

Jones MA, Young RH, Scully RE. Adenocarcinoma of the epididymis: a report of four cases and review of the literature. Am J Surg Pathol. 1997;21(12):1474–80.

Li DD, Bai TN, Han RF, Lu BX, Wang JZ, et al . Diagnosis and treatment of primary epididymal leiomyosarcoma. Shandong Med J. 2012;52(48):98–9 ( In Chinese ).

Li WP, Zhao Y, Guo XQ, Wang YM, Zhang HF, et al . Report on 3 cases of primary malignant tumors of the epididymis and literature review. Chin J Androl. 2014;20(1):92–4 ( In Chinese ).

CAS   Google Scholar  

Li WM, Song LH, Fei FL. Embryonic rhabdomyosarcoma of the testis (report of two cases and literature review). Henan J Oncol. 1996;4:301–2 ( In Chinese ).

Fan QH, Zhu XZ, Lai RQ. Soft tissue pathology. Nanchang: Jiangxi Science and Technology Press; 2003. p. 78–9 ( In Chinese ).

Wang KY, Shi H, Mao WP, Li WY, Wu ZL, et al . Rare epididymal-derived myoepithelial carcinoma: a case report and review of literature. Ann Clin Lab Sci. 2020;50(3):391–6.

PubMed   Google Scholar  

Li ZW, Xiang J, Yan S, Gao F, Zheng S. Malignant triton tumor of the retroperitoneum: a case report and review of the literature. World J Surg Oncol. 2012;30(10):96.

Gao LJ, Song HL, Mu K, Wang JX, Guo BY, et al . Primary epididymis malignant triton tumor: case report and review of the literature. Eur J Med Res. 2015;20(1):79.

Article   PubMed   PubMed Central   Google Scholar  

Liguori G, Garaffa G, Trombetta C, Bussani R, Bucci R, et al . Inguinal recurrence of malignant mesothelioma of the tunica vaginalis: one case report with delayed recurrence and review of the literature. Asian J Androl. 2007;9(6):859–60.

Article   PubMed   Google Scholar  

Suh JY, Jeong H, Kim YA. Primary malignant B-cell lymphoma of the epididymis. Urol Case Rep. 2015;4:27–9.

Zuo C, Zou L, Zhang XY, Liu CH, Sun B, et al . Wait A case report of primary malignant tumor of the epididymis and literature review. Modern Biomed Progr. 2013;25(13):4905–7 ( In Chinese ).

Sarvis JA, Auge BK. Myeloid (granulocytic) sarcoma of epididymis as rare manifestation of recurrent acute myelogenous leukemia. Urology. 2009;73(5):1163.e1-3.

Li Q, Guan Y, Hu YP, Yang P. One case of primary epididymal adenosquamous cell carcinoma with multiple metastases. J Clin Urol. 2020;35(5):421–2 ( In Chinese ).

Zhang Y, Sun YC, Chen XS, Gao W. Report of 7 cases of primary epididymal tumors. Chin J Androl. 2003;9(3):229–30 ( In Chinese ).

Stewart RJ, Martelli H, Oberlin O, Rey A, Bouvet N, et al . Treatment of children with nonmetastatic paratesti-cular rhabdomyosarcoma: results of the malignant mesenchymal tumors studies(MMT 84 and MMT 89) of the international society of pediatric oncology. J Clin Oncol. 2003;21(5):793–8.

Matsumoto F, Onitake Y, Shimada K. Paratesticular rhabdomyosarcoma presenting with a giant abdominos-crotal hydrocele in a toddler. Urology. 2016;87:200–1.

Kourda N, Atat REI, Derouiche A, Bettaib I, Baltagi S, et al . Paratesticular pleomorphic rhabdomyosarcoma in an adult: diagnosis and management. Cancer Radiother. 2007;11(5):280–3.

Stanik M, Dolezel J, Macik D, Krpenshy A, Lakomy R. Primary adenocarcinoma of the epididymis: the therapeutic role of retroperitoneal lymphadenectomy. Int Urol Nephrol. 2012;44(4):1049–53.

Wang DY, Qian WQ, Sun ZQ, Song JD. Diagnosis and treatment of primary epididymal tumors. J Clin Urol. 2005;20(6):349–51 ( In Chinese ).

Download references

Acknowledgements

Not applicable.

This research received no external funding.

Author information

Authors and affiliations.

Department of Urology, The First Clinical Medical College of China Three Gorges University, Yichang Central People’s Hospital, Yichang, China

Jianhua Xiao, Ziqiang Dong & Honggang Yuan

Department of Pharmacy, The Second Clinical Medical College of China Three Gorges University, Three Gorges University Renhe Hospital, Yichang, China

Department of Pathology, The First Clinical Medical College of China Three Gorges University, Yichang Central People’s Hospital, Yichang, China

You can also search for this author in PubMed   Google Scholar

Contributions

JX and QW conceived the paper’s objective and collected the patient’s data. ZD, YY, and HY analyzed the data and performed reference search. JX, YY, and HY drafted and revised the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Jianhua Xiao .

Ethics declarations

Ethics approval and consent to participate, consent for publication.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Xiao, J., You, Y., Dong, Z. et al. Treatment of primary epididymal adenocarcinoma: a case report and review of the literature. J Med Case Reports 18 , 274 (2024). https://doi.org/10.1186/s13256-024-04590-4

Download citation

Received : 03 December 2023

Accepted : 03 May 2024

Published : 10 June 2024

DOI : https://doi.org/10.1186/s13256-024-04590-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Primary epididymal malignant tumors
• Treatment surgery

Journal of Medical Case Reports

ISSN: 1752-1947

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]