literature review shows a research gap

The Research Gap (Literature Gap)

Everything you need to know to find a quality research gap

By: Ethar Al-Saraf (PhD) | Expert Reviewed By: Eunice Rautenbach (DTech) | November 2022

If you’re just starting out in research, chances are you’ve heard about the elusive research gap (also called a literature gap). In this post, we’ll explore the tricky topic of research gaps. We’ll explain what a research gap is, look at the four most common types of research gaps, and unpack how you can go about finding a suitable research gap for your dissertation, thesis or research project.

Overview: Research Gap 101

• What is a research gap
• Four common types of research gaps
• Practical examples
• How to find research gaps
• Recap & key takeaways

What (exactly) is a research gap?

Well, at the simplest level, a research gap is essentially an unanswered question or unresolved problem in a field, which reflects a lack of existing research in that space. Alternatively, a research gap can also exist when there’s already a fair deal of existing research, but where the findings of the studies pull in different directions , making it difficult to draw firm conclusions.

For example, let’s say your research aims to identify the cause (or causes) of a particular disease. Upon reviewing the literature, you may find that there’s a body of research that points toward cigarette smoking as a key factor – but at the same time, a large body of research that finds no link between smoking and the disease. In that case, you may have something of a research gap that warrants further investigation.

Now that we’ve defined what a research gap is – an unanswered question or unresolved problem – let’s look at a few different types of research gaps.

Types of research gaps

While there are many different types of research gaps, the four most common ones we encounter when helping students at Grad Coach are as follows:

• The classic literature gap
• The disagreement gap
• The contextual gap, and
• The methodological gap

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1. The Classic Literature Gap

First up is the classic literature gap. This type of research gap emerges when there’s a new concept or phenomenon that hasn’t been studied much, or at all. For example, when a social media platform is launched, there’s an opportunity to explore its impacts on users, how it could be leveraged for marketing, its impact on society, and so on. The same applies for new technologies, new modes of communication, transportation, etc.

Classic literature gaps can present exciting research opportunities , but a drawback you need to be aware of is that with this type of research gap, you’ll be exploring completely new territory . This means you’ll have to draw on adjacent literature (that is, research in adjacent fields) to build your literature review, as there naturally won’t be very many existing studies that directly relate to the topic. While this is manageable, it can be challenging for first-time researchers, so be careful not to bite off more than you can chew.

2. The Disagreement Gap

As the name suggests, the disagreement gap emerges when there are contrasting or contradictory findings in the existing research regarding a specific research question (or set of questions). The hypothetical example we looked at earlier regarding the causes of a disease reflects a disagreement gap.

Importantly, for this type of research gap, there needs to be a relatively balanced set of opposing findings . In other words, a situation where 95% of studies find one result and 5% find the opposite result wouldn’t quite constitute a disagreement in the literature. Of course, it’s hard to quantify exactly how much weight to give to each study, but you’ll need to at least show that the opposing findings aren’t simply a corner-case anomaly .

3. The Contextual Gap

The third type of research gap is the contextual gap. Simply put, a contextual gap exists when there’s already a decent body of existing research on a particular topic, but an absence of research in specific contexts .

For example, there could be a lack of research on:

• A specific population – perhaps a certain age group, gender or ethnicity
• A geographic area – for example, a city, country or region
• A certain time period – perhaps the bulk of the studies took place many years or even decades ago and the landscape has changed.

The contextual gap is a popular option for dissertations and theses, especially for first-time researchers, as it allows you to develop your research on a solid foundation of existing literature and potentially even use existing survey measures.

Importantly, if you’re gonna go this route, you need to ensure that there’s a plausible reason why you’d expect potential differences in the specific context you choose. If there’s no reason to expect different results between existing and new contexts, the research gap wouldn’t be well justified. So, make sure that you can clearly articulate why your chosen context is “different” from existing studies and why that might reasonably result in different findings.

4. The Methodological Gap

Last but not least, we have the methodological gap. As the name suggests, this type of research gap emerges as a result of the research methodology or design of existing studies. With this approach, you’d argue that the methodology of existing studies is lacking in some way , or that they’re missing a certain perspective.

For example, you might argue that the bulk of the existing research has taken a quantitative approach, and therefore there is a lack of rich insight and texture that a qualitative study could provide. Similarly, you might argue that existing studies have primarily taken a cross-sectional approach , and as a result, have only provided a snapshot view of the situation – whereas a longitudinal approach could help uncover how constructs or variables have evolved over time.

Practical Examples

Let’s take a look at some practical examples so that you can see how research gaps are typically expressed in written form. Keep in mind that these are just examples – not actual current gaps (we’ll show you how to find these a little later!).

Context: Healthcare

Despite extensive research on diabetes management, there’s a research gap in terms of understanding the effectiveness of digital health interventions in rural populations (compared to urban ones) within Eastern Europe.

Context: Environmental Science

While a wealth of research exists regarding plastic pollution in oceans, there is significantly less understanding of microplastic accumulation in freshwater ecosystems like rivers and lakes, particularly within Southern Africa.

Context: Education

While empirical research surrounding online learning has grown over the past five years, there remains a lack of comprehensive studies regarding the effectiveness of online learning for students with special educational needs.

As you can see in each of these examples, the author begins by clearly acknowledging the existing research and then proceeds to explain where the current area of lack (i.e., the research gap) exists.

How To Find A Research Gap

Now that you’ve got a clearer picture of the different types of research gaps, the next question is of course, “how do you find these research gaps?” .

Well, we cover the process of how to find original, high-value research gaps in a separate post . But, for now, I’ll share a basic two-step strategy here to help you find potential research gaps.

As a starting point, you should find as many literature reviews, systematic reviews and meta-analyses as you can, covering your area of interest. Additionally, you should dig into the most recent journal articles to wrap your head around the current state of knowledge. It’s also a good idea to look at recent dissertations and theses (especially doctoral-level ones). Dissertation databases such as ProQuest, EBSCO and Open Access are a goldmine for this sort of thing. Importantly, make sure that you’re looking at recent resources (ideally those published in the last year or two), or the gaps you find might have already been plugged by other researchers.

Once you’ve gathered a meaty collection of resources, the section that you really want to focus on is the one titled “ further research opportunities ” or “further research is needed”. In this section, the researchers will explicitly state where more studies are required – in other words, where potential research gaps may exist. You can also look at the “ limitations ” section of the studies, as this will often spur ideas for methodology-based research gaps.

By following this process, you’ll orient yourself with the current state of research , which will lay the foundation for you to identify potential research gaps. You can then start drawing up a shortlist of ideas and evaluating them as candidate topics . But remember, make sure you’re looking at recent articles – there’s no use going down a rabbit hole only to find that someone’s already filled the gap 🙂

Let’s Recap

We’ve covered a lot of ground in this post. Here are the key takeaways:

• A research gap is an unanswered question or unresolved problem in a field, which reflects a lack of existing research in that space.
• The four most common types of research gaps are the classic literature gap, the disagreement gap, the contextual gap and the methodological gap. 
• To find potential research gaps, start by reviewing recent journal articles in your area of interest, paying particular attention to the FRIN section .

If you’re keen to learn more about research gaps and research topic ideation in general, be sure to check out the rest of the Grad Coach Blog . Alternatively, if you’re looking for 1-on-1 support with your dissertation, thesis or research project, be sure to check out our private coaching service .

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

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38 Comments

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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.

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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Home » Research Gap – Types, Examples and How to Identify

Research Gap – Types, Examples and How to Identify

Table of Contents

Research Gap

Definition:

Research gap refers to an area or topic within a field of study that has not yet been extensively researched or is yet to be explored. It is a question, problem or issue that has not been addressed or resolved by previous research.

How to Identify Research Gap

Identifying a research gap is an essential step in conducting research that adds value and contributes to the existing body of knowledge. Research gap requires critical thinking, creativity, and a thorough understanding of the existing literature . It is an iterative process that may require revisiting and refining your research questions and ideas multiple times.

Here are some steps that can help you identify a research gap:

• Review existing literature: Conduct a thorough review of the existing literature in your research area. This will help you identify what has already been studied and what gaps still exist.
• Identify a research problem: Identify a specific research problem or question that you want to address.
• Analyze existing research: Analyze the existing research related to your research problem. This will help you identify areas that have not been studied, inconsistencies in the findings, or limitations of the previous research.
• Brainstorm potential research ideas : Based on your analysis, brainstorm potential research ideas that address the identified gaps.
• Consult with experts: Consult with experts in your research area to get their opinions on potential research ideas and to identify any additional gaps that you may have missed.
• Refine research questions: Refine your research questions and hypotheses based on the identified gaps and potential research ideas.
• Develop a research proposal: Develop a research proposal that outlines your research questions, objectives, and methods to address the identified research gap.

Types of Research Gap

There are different types of research gaps that can be identified, and each type is associated with a specific situation or problem. Here are the main types of research gaps and their explanations:

Theoretical Gap

This type of research gap refers to a lack of theoretical understanding or knowledge in a particular area. It can occur when there is a discrepancy between existing theories and empirical evidence or when there is no theory that can explain a particular phenomenon. Identifying theoretical gaps can lead to the development of new theories or the refinement of existing ones.

Empirical Gap

An empirical gap occurs when there is a lack of empirical evidence or data in a particular area. It can happen when there is a lack of research on a specific topic or when existing research is inadequate or inconclusive. Identifying empirical gaps can lead to the development of new research studies to collect data or the refinement of existing research methods to improve the quality of data collected.

Methodological Gap

This type of research gap refers to a lack of appropriate research methods or techniques to answer a research question. It can occur when existing methods are inadequate, outdated, or inappropriate for the research question. Identifying methodological gaps can lead to the development of new research methods or the modification of existing ones to better address the research question.

Practical Gap

A practical gap occurs when there is a lack of practical applications or implementation of research findings. It can occur when research findings are not implemented due to financial, political, or social constraints. Identifying practical gaps can lead to the development of strategies for the effective implementation of research findings in practice.

Knowledge Gap

This type of research gap occurs when there is a lack of knowledge or information on a particular topic. It can happen when a new area of research is emerging, or when research is conducted in a different context or population. Identifying knowledge gaps can lead to the development of new research studies or the extension of existing research to fill the gap.

Examples of Research Gap

Here are some examples of research gaps that researchers might identify:

• Theoretical Gap Example : In the field of psychology, there might be a theoretical gap related to the lack of understanding of the relationship between social media use and mental health. Although there is existing research on the topic, there might be a lack of consensus on the mechanisms that link social media use to mental health outcomes.
• Empirical Gap Example : In the field of environmental science, there might be an empirical gap related to the lack of data on the long-term effects of climate change on biodiversity in specific regions. Although there might be some studies on the topic, there might be a lack of data on the long-term effects of climate change on specific species or ecosystems.
• Methodological Gap Example : In the field of education, there might be a methodological gap related to the lack of appropriate research methods to assess the impact of online learning on student outcomes. Although there might be some studies on the topic, existing research methods might not be appropriate to assess the complex relationships between online learning and student outcomes.
• Practical Gap Example: In the field of healthcare, there might be a practical gap related to the lack of effective strategies to implement evidence-based practices in clinical settings. Although there might be existing research on the effectiveness of certain practices, they might not be implemented in practice due to various barriers, such as financial constraints or lack of resources.
• Knowledge Gap Example: In the field of anthropology, there might be a knowledge gap related to the lack of understanding of the cultural practices of indigenous communities in certain regions. Although there might be some research on the topic, there might be a lack of knowledge about specific cultural practices or beliefs that are unique to those communities.

Examples of Research Gap In Literature Review, Thesis, and Research Paper might be:

• Literature review : A literature review on the topic of machine learning and healthcare might identify a research gap in the lack of studies that investigate the use of machine learning for early detection of rare diseases.
• Thesis : A thesis on the topic of cybersecurity might identify a research gap in the lack of studies that investigate the effectiveness of artificial intelligence in detecting and preventing cyber attacks.
• Research paper : A research paper on the topic of natural language processing might identify a research gap in the lack of studies that investigate the use of natural language processing techniques for sentiment analysis in non-English languages.

How to Write Research Gap

By following these steps, you can effectively write about research gaps in your paper and clearly articulate the contribution that your study will make to the existing body of knowledge.

Here are some steps to follow when writing about research gaps in your paper:

• Identify the research question : Before writing about research gaps, you need to identify your research question or problem. This will help you to understand the scope of your research and identify areas where additional research is needed.
• Review the literature: Conduct a thorough review of the literature related to your research question. This will help you to identify the current state of knowledge in the field and the gaps that exist.
• Identify the research gap: Based on your review of the literature, identify the specific research gap that your study will address. This could be a theoretical, empirical, methodological, practical, or knowledge gap.
• Provide evidence: Provide evidence to support your claim that the research gap exists. This could include a summary of the existing literature, a discussion of the limitations of previous studies, or an analysis of the current state of knowledge in the field.
• Explain the importance: Explain why it is important to fill the research gap. This could include a discussion of the potential implications of filling the gap, the significance of the research for the field, or the potential benefits to society.
• State your research objectives: State your research objectives, which should be aligned with the research gap you have identified. This will help you to clearly articulate the purpose of your study and how it will address the research gap.

Importance of Research Gap

The importance of research gaps can be summarized as follows:

• Advancing knowledge: Identifying research gaps is crucial for advancing knowledge in a particular field. By identifying areas where additional research is needed, researchers can fill gaps in the existing body of knowledge and contribute to the development of new theories and practices.
• Guiding research: Research gaps can guide researchers in designing studies that fill those gaps. By identifying research gaps, researchers can develop research questions and objectives that are aligned with the needs of the field and contribute to the development of new knowledge.
• Enhancing research quality: By identifying research gaps, researchers can avoid duplicating previous research and instead focus on developing innovative research that fills gaps in the existing body of knowledge. This can lead to more impactful research and higher-quality research outputs.
• Informing policy and practice: Research gaps can inform policy and practice by highlighting areas where additional research is needed to inform decision-making. By filling research gaps, researchers can provide evidence-based recommendations that have the potential to improve policy and practice in a particular field.

Applications of Research Gap

Here are some potential applications of research gap:

• Informing research priorities: Research gaps can help guide research funding agencies and researchers to prioritize research areas that require more attention and resources.
• Identifying practical implications: Identifying gaps in knowledge can help identify practical applications of research that are still unexplored or underdeveloped.
• Stimulating innovation: Research gaps can encourage innovation and the development of new approaches or methodologies to address unexplored areas.
• Improving policy-making: Research gaps can inform policy-making decisions by highlighting areas where more research is needed to make informed policy decisions.
• Enhancing academic discourse: Research gaps can lead to new and constructive debates and discussions within academic communities, leading to more robust and comprehensive research.

Advantages of Research Gap

Here are some of the advantages of research gap:

• Identifies new research opportunities: Identifying research gaps can help researchers identify areas that require further exploration, which can lead to new research opportunities.
• Improves the quality of research: By identifying gaps in current research, researchers can focus their efforts on addressing unanswered questions, which can improve the overall quality of research.
• Enhances the relevance of research: Research that addresses existing gaps can have significant implications for the development of theories, policies, and practices, and can therefore increase the relevance and impact of research.
• Helps avoid duplication of effort: Identifying existing research can help researchers avoid duplicating efforts, saving time and resources.
• Helps to refine research questions: Research gaps can help researchers refine their research questions, making them more focused and relevant to the needs of the field.
• Promotes collaboration: By identifying areas of research that require further investigation, researchers can collaborate with others to conduct research that addresses these gaps, which can lead to more comprehensive and impactful research outcomes.

Disadvantages of Research Gap

While research gaps can be advantageous, there are also some potential disadvantages that should be considered:

• Difficulty in identifying gaps: Identifying gaps in existing research can be challenging, particularly in fields where there is a large volume of research or where research findings are scattered across different disciplines.
• Lack of funding: Addressing research gaps may require significant resources, and researchers may struggle to secure funding for their work if it is perceived as too risky or uncertain.
• Time-consuming: Conducting research to address gaps can be time-consuming, particularly if the research involves collecting new data or developing new methods.
• Risk of oversimplification: Addressing research gaps may require researchers to simplify complex problems, which can lead to oversimplification and a failure to capture the complexity of the issues.
• Bias : Identifying research gaps can be influenced by researchers’ personal biases or perspectives, which can lead to a skewed understanding of the field.
• Potential for disagreement: Identifying research gaps can be subjective, and different researchers may have different views on what constitutes a gap in the field, leading to disagreements and debate.

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Q: How do I identify a research gap during the literature review?

When writing the literature review of a particular research topic, how do I know what the previous literature is missing and what needs to be addressed?

Asked on 29 Jan, 2021

Specifically in the context of doing and writing the literature review, you can identify a gap in any/all of the following ways:

• Look up papers that build on previous papers, be it by the same author/s or others. Find out what gaps the later papers have addressed, and if there are still any.
• On the same lines, you may also wish to go through papers cited by the present paper.
• Go through the Discussion/Conclusion section of the paper, where the author(s) talk(s) of the shortcomings of their research and suggest ways in which they think their research could be improved in the future. Also go through the implications and recommendations mentioned (if any) in case there are any ideas there.
• Finally, it also comes down to your knowledge of the topic you are studying and your research acumen, your astuteness in being able to identify a gap that could lead to a potential study of considerable significance/impact. This, as you can gauge, will come with time.

For now, here are some resources for further help with your question.

• How does a problem statement lend itself to further inquiry on confirming a gap in research?
• How can I describe the gap in literature when no previous research has been done on the problem?
• Would my work be considered addressing a research gap or making a contribution?

And here are some resources for help with writing a literature review .

• What a journal editor expects to see in a literature review
• How to write the literature review of your research paper

And in case you’re presently writing a review paper, all the best!

Answered by Editage Insights on 02 Feb, 2021

• Upvote this Answer

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Literature Review

• What is a Literature Review?
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Literature Review  is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.

Also, we can define a literature review as the collected body of scholarly works related to a topic:

• Summarizes and analyzes previous research relevant to a topic
• Includes scholarly books and articles published in academic journals
• Can be an specific scholarly paper or a section in a research paper

The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic

• Help gather ideas or information
• Keep up to date in current trends and findings
• Help develop new questions

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.
• Helps focus your own research questions or problems
• Discovers relationships between research studies/ideas.
• Suggests unexplored ideas or populations
• Identifies major themes, concepts, and researchers on a topic.
• Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
• Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
• Indicates potential directions for future research.

All content in this section is from Literature Review Research from Old Dominion University 

Keep in mind the following, a literature review is NOT:

Not an essay 

Not an annotated bibliography  in which you summarize each article that you have reviewed.  A literature review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.

Not a research paper   where you select resources to support one side of an issue versus another.  A lit review should explain and consider all sides of an argument in order to avoid bias, and areas of agreement and disagreement should be highlighted.

A literature review serves several purposes. For example, it

• provides thorough knowledge of previous studies; introduces seminal works.
• helps focus one’s own research topic.
• identifies a conceptual framework for one’s own research questions or problems; indicates potential directions for future research.
• suggests previously unused or underused methodologies, designs, quantitative and qualitative strategies.
• identifies gaps in previous studies; identifies flawed methodologies and/or theoretical approaches; avoids replication of mistakes.
• helps the researcher avoid repetition of earlier research.
• suggests unexplored populations.
• determines whether past studies agree or disagree; identifies controversy in the literature.
• tests assumptions; may help counter preconceived ideas and remove unconscious bias.

As Kennedy (2007) notes*, it is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the original studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally that become part of the lore of field. In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews.

Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are several approaches to how they can be done, depending upon the type of analysis underpinning your study. Listed below are definitions of types of literature reviews:

Argumentative Review      This form examines literature selectively in order to support or refute an argument, deeply imbedded 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 to make summary claims of the sort found in systematic reviews.

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

Historical Review      Few things rest in isolation from historical precedent. Historical reviews are focused on examining research throughout a period of time, often starting with the first time an issue, concept, theory, 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 [content], but how they said it [method of analysis]. This approach provides a framework of understanding at different levels (i.e. those of theory, substantive fields, research approaches and data collection and analysis techniques), enables researchers to draw on a wide variety of knowledge ranging from the conceptual level to practical documents for use in fieldwork in the areas of ontological and epistemological consideration, quantitative and qualitative integration, sampling, interviewing, data collection and data analysis, and helps highlight many ethical issues which we should be aware of and consider as we go through our study.

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

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

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

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

Robinson, P. and Lowe, J. (2015),  Literature reviews vs systematic reviews.  Australian and New Zealand Journal of Public Health, 39: 103-103. doi: 10.1111/1753-6405.12393

What's in the name? The difference between a Systematic Review and a Literature Review, and why it matters . By Lynn Kysh from University of Southern California

Systematic review or meta-analysis?

A  systematic review  answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.

A  meta-analysis  is the use of statistical methods to summarize the results of these studies.

Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:

• clearly stated objectives with pre-defined eligibility criteria for studies
• explicit, reproducible methodology
• a systematic search that attempts to identify all studies
• assessment of the validity of the findings of the included studies (e.g. risk of bias)
• systematic presentation, and synthesis, of the characteristics and findings of the included studies

Not all systematic reviews contain meta-analysis. 

Meta-analysis is the use of statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review.  More information on meta-analyses can be found in  Cochrane Handbook, Chapter 9 .

A meta-analysis goes beyond critique and integration and conducts secondary statistical analysis on the outcomes of similar studies.  It is a systematic review that uses quantitative methods to synthesize and summarize the results.

An advantage of a meta-analysis is the ability to be completely objective in evaluating research findings.  Not all topics, however, have sufficient research evidence to allow a meta-analysis to be conducted.  In that case, an integrative review is an appropriate strategy. 

Some of the content in this section is from Systematic reviews and meta-analyses: step by step guide created by Kate McAllister.

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Robinson KA, Akinyede O, Dutta T, et al. Framework for Determining Research Gaps During Systematic Review: Evaluation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Feb.

Framework for Determining Research Gaps During Systematic Review: Evaluation [Internet].

Introduction.

The identification of gaps from systematic reviews is essential to the practice of “evidence-based research.” Health care research should begin and end with a systematic review. 1 - 3 A comprehensive and explicit consideration of the existing evidence is necessary for the identification and development of an unanswered and answerable question, for the design of a study most likely to answer that question, and for the interpretation of the results of the study. 4

In a systematic review, the consideration of existing evidence often highlights important areas where deficiencies in information limit our ability to make decisions. We define a research gap as a topic or area for which missing or inadequate information limits the ability of reviewers to reach a conclusion for a given question. A research gap may be further developed, such as through stakeholder engagement in prioritization, into research needs. Research needs are those areas where the gaps in the evidence limit decision making by patients, clinicians, and policy makers. A research gap may not be a research need if filling the gap would not be of use to stakeholders that make decisions in health care. The clear and explicit identification of research gaps is a necessary step in developing a research agenda. Evidence reports produced by Evidence-based Practice Centers (EPCs) have always included a future research section. However, in contrast to the explicit and transparent steps taken in the completion of a systematic review, there has not been a systematic process for the identification of research gaps.

In a prior methods project, our EPC set out to identify and pilot test a framework for the identification of research gaps. 5 , 6 We searched the literature, conducted an audit of EPC evidence reports, and sought information from other organizations which conduct evidence synthesis. Despite these efforts, we identified little detail or consistency in the frameworks used to determine research gaps within systematic reviews. In general, we found no widespread use or endorsement of a specific formal process or framework for identifying research gaps using systematic reviews.

We developed a framework to systematically identify research gaps from systematic reviews. This framework facilitates the classification of where the current evidence falls short and why the evidence falls short. The framework included two elements: (1) the characterization the gaps and (2) the identification and classification of the reason(s) for the research gap.

The PICOS structure (Population, Intervention, Comparison, Outcome and Setting) was used in this framework to describe questions or parts of questions inadequately addressed by the evidence synthesized in the systematic review. The issue of timing, sometimes included as PICOTS, was considered separately for Intervention, Comparison, and Outcome. The PICOS elements were the only sort of framework we had identified in an audit of existing methods for the identification of gaps used by EPCs and other related organizations (i.e., health technology assessment organizations). We chose to use this structure as it is one familiar to EPCs, and others, in developing questions.

It is not only important to identify research gaps but also to determine how the evidence falls short, in order to maximally inform researchers, policy makers, and funders on the types of questions that need to be addressed and the types of studies needed to address these questions. Thus, the second element of the framework was the classification of the reasons for the existence of a research gap. For each research gap, the reason(s) that most preclude conclusions from being made in the systematic review is chosen by the review team completing the framework. To leverage work already being completed by review teams, we mapped the reasons for research gaps to concepts from commonly used evidence grading systems. Briefly, these categories of reasons, explained in detail in the prior JHU EPC report 5 , are:

• Insufficient or imprecise information
• Biased information
• Inconsistent or unknown consistency results
• Not the right information

The framework facilitates a systematic approach to identifying research gaps and the reasons for those gaps. The identification of where the evidence falls short and how the evidence falls short is essential to the development of important research questions and in providing guidance in how to address these questions.

As part of the previous methods product, we developed a worksheet and instructions to facilitate the use of the framework when completing a systematic review (See Appendix A ). Preliminary evaluation of the framework and worksheet was completed by applying the framework to two completed EPC evidence reports. The framework was further refined through peer review. In this current project, we extend our work on this research gaps framework.

Our objective in this project was to complete two types of further evaluation: (1) application of the framework across a larger sample of existing systematic reviews in different topic areas, and (2) implementation of the framework by EPCs. These two objectives were used to evaluate the framework and instructions for usability and to evaluate the application of the framework by others, outside of our EPC, including as part of the process of completing an EPC report. Our overall goal was to produce a revised framework with guidance that could be used by EPCs to explicitly identify research gaps from systematic reviews.

• Cite this Page Robinson KA, Akinyede O, Dutta T, et al. Framework for Determining Research Gaps During Systematic Review: Evaluation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Feb. Introduction.
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Research Process

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Research Articles

These examples below illustrate how researchers from different disciplines identified gaps in existing literature. For additional examples, try a NavigatorSearch using this search string: ("Literature review") AND (gap*)

• Addressing the Recent Developments and Potential Gaps in the Literature of Corporate Sustainability
• Applications of Psychological Science to Teaching and Learning: Gaps in the Literature
• Attitudes, Risk Factors, and Behaviours of Gambling Among Adolescents and Young People: A Literature Review and Gap Analysis
• Do Psychological Diversity Climate, HRM Practices, and Personality Traits (Big Five) Influence Multicultural Workforce Job Satisfaction and Performance? Current Scenario, Literature Gap, and Future Research Directions
• Entrepreneurship Education: A Systematic Literature Review and Identification of an Existing Gap in the Field
• Evidence and Gaps in the Literature on HIV/STI Prevention Interventions Targeting Migrants in Receiving Countries: A Scoping Review
• Homeless Indigenous Veterans and the Current Gaps in Knowledge: The State of the Literature
• A Literature Review and Gap Analysis of Emerging Technologies and New Trends in Gambling
• A Review of Higher Education Image and Reputation Literature: Knowledge Gaps and a Research Agenda
• Trends and Gaps in Empirical Research on Open Educational Resources (OER): A Systematic Mapping of the Literature from 2015 to 2019
• Where Should We Go From Here? Identified Gaps in the Literature in Psychosocial Interventions for Youth With Autism Spectrum Disorder and Comorbid Anxiety

What is a ‘gap in the literature’?

The gap, also considered the missing piece or pieces in the research literature, is the area that has not yet been explored or is under-explored. This could be a population or sample (size, type, location, etc.), research method, data collection and/or analysis, or other research variables or conditions.

It is important to keep in mind, however, that just because you identify a gap in the research, it doesn't necessarily mean that your research question is worthy of exploration. You will want to make sure that your research will have valuable practical and/or theoretical implications. In other words, answering the research question could either improve existing practice and/or inform professional decision-making (Applied Degree), or it could revise, build upon, or create theoretical frameworks informing research design and practice (Ph.D Degree). See the Dissertation Center  for additional information about dissertation criteria at NU.

For a additional information on gap statements, see the following:

• How to Find a Gap in the Literature
• Write Like a Scientist: Gap Statements

How do you identify the gaps?

Conducting an exhaustive literature review is your first step. As you search for journal articles, you will need to read critically across the breadth of the literature to identify these gaps. You goal should be to find a ‘space’ or opening for contributing new research. The first step is gathering a broad range of research articles on your topic. You may want to look for research that approaches the topic from a variety of methods – qualitative, quantitative, or mixed methods. 

See the videos below for further instruction on identifying a gap in the literature.

Identifying a Gap in the Literature - Dr. Laurie Bedford

How Do You Identify Gaps in Literature? - SAGE Research Methods

Literature Gap & Future Research - Library Workshop

This workshop presents effective search techniques for identifying a gap in the literature and recommendations for future research.

Where can you locate research gaps?

As you begin to gather the literature, you will want to critically read for what has, and has not, been learned from the research. Use the Discussion and Future Research sections of the articles to understand what the researchers have found and where they point out future or additional research areas. This is similar to identifying a gap in the literature, however, future research statements come from a single study rather than an exhaustive search. You will want to check the literature to see if those research questions have already been answered.

Roadrunner Search

Identifying the gap in the research relies on an exhaustive review of the literature. Remember, researchers may not explicitly state that a gap in the literature exists; you may need to thoroughly review and assess the research to make that determination yourself.

However, there are techniques that you can use when searching in NavigatorSearch to help identify gaps in the literature. You may use search terms such as "literature gap " or "future research" "along with your subject keywords to pinpoint articles that include these types of statements.

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Framing challenges

Gap analysis for literature reviews and advancing useful knowledge

By Steve Wallis and Bernadette Wright 02/06/2020

The basics of research are seemingly clear. Read a lot of articles, see what’s missing, and conduct research to fill the gap in the literature. Wait a minute. What is that? ‘See what’s missing?’ How can we see something that is not there?

Imagine you are videoconferencing a colleague who is showing you the results of their project. Suddenly, the screen and sound cut out for a minute. After pressing some keys, you manage to restore the link; only to have your colleague ask, ‘What do you think?’. Of course, you know that you missed something from the presentation because of the disconnection. You can see that something is missing, and you know what to ask for to get your desired results, ‘Sorry, could you repeat that last minute of your presentation, please’. It’s not so easy when we’re looking at research results, proposals, or literature reviews.

While all research is, to some extent, useful, we’ve seen a lot of research that does not have the expected impact. That means wasted time, wasted money, under-served clients, and frustration on multiple levels. A big part of that problem is that directions for research are often chosen intuitively; in a sort of ad-hoc process. While we deeply respect the intuition of experts, that kind of process is not very rigorous.

In this post, we will show you how to ‘see the invisible’: How to identify the missing pieces in any study, literature review, or program analysis. With these straight-forward techniques, you will be able to better target your research in a more cost-effective way to fill those knowledge gaps to develop more effective theories, plans, and evaluations.

The first step is to choose your source material. That can be one or more articles, reports, or other study results. Of course, you want to be sure that the material you use is of high quality . Next, you want to create a causal map of your source material.

We’re going to go a bit abstract on you here because people sometimes get lost in the ‘content’ when what we are looking at here is more about the ‘structure’. Think of it like choosing how to buy a house based on how well it is built, rather than what color it is painted. So, instead of using actual concepts, we’ll refer to them as concepts A, B, C… and so on.

So, the text might say something like: ‘Our research shows that A causes B, B causes C, and D causes less C. Oh yes, and E is also important (although we’re not sure how it’s causally connected to A, B, C, or D)’.

When we draw causal maps from the source material we’ve found, we like to have key concepts in circles, with causal connections represented by arrows.

Figure 1. Abstract example of a causal map of a theory

There are really three basic kinds of gaps for you to find: relevance/meaning, logic/structure, and data/evidence. Starting with structure, there is a gap any place where there are two circles NOT connected by a causal arrow. It is important to have at least two arrows pointing at each concept/circle for the same reason we like to have multiple independent variables for each dependent variable (although, with more complex maps, we’re learning to see these as interdependent variables).

For example, there is no arrow between A and D. Also, there is no arrow between E and any of the other concepts. Each of those is a structural gap – an opening for additional research.

You might also notice that there are two arrows pointing directly at C. Like having two independent variables and one dependent variable, it is structurally better to have at least two arrows pointing at each concept.

So, structurally , C is in good shape. This part of the map has the least need for additional research. A larger gap exists around B, because it has only one arrow pointing at it (the arrow from A to B). Larger still is the gap around A, D, and E; because they have no arrows pointing at them.

To get the greatest leverage for your research dollar, it is generally best to search for that second arrow. In short, one research question would be: What (aside from A) has a causal influence on B? Other good research questions would be (a) Is there a causal relationship between A and D? (b) Is there a causal relationship between E and any of the other concepts? (c) What else besides A helps cause B? (d) What are the causes of A, D, and E?

Now, let’s take a look at gaps in the data, evidence, or information upon which each causal arrow is established.

From structure to data

Here, we add to the drawing by making a note showing (very briefly) the kind of data supporting each causal arrow. We like to have that in a box – with a loopy line ‘typing’ the evidence to the connection. You can also use different colors to more easily differentiate between the concepts and the evidence on your map. You can also write the note along the length of the arrow.

Figure 2. Tying the data to the structure

From data to stakeholder relevance

Finally, the gap in meaning (relevance) asks if those studies were done with the ‘right’ people. By this, we mean people related to the situation or topic you are studying. Managers, line workers, clients, suppliers, those providing related services; all of those and more should be included. Similarly, you might look to a variety of academic disciplines, drawing expertise from psychology, sociology, business, economics, policy, and others.

Which participants or stakeholders are actually part of your research depends on the project. However, in general, having a broader selection of stakeholder groups results in a better map. This applies to both choosing what concepts go on the map and also who to contact for interviews and surveys.

Visualizing the gaps

All of these three gaps – gaps in structure, data, and stakeholder perspectives – can (and should) be addressed to help you choose more focused directions for your research – to generate research results that will have more impact. As a final note, remember that many gaps may be filled with secondary research; a new literature review that fills the gaps in the logic/structure, data/information, and meaning/relevance of your map so that your organisation can have a greater impact.

Figure 3. Visualizing the gaps (shown in green)

Some deeper reading on literature reviews may be found here:

• Practical Mapping for Applied Research and Program Evaluation (SAGE) provides a ‘jargon free’ explanation for every phase of research:

https://us.sagepub.com/en-us/nam/practical-mapping-for-applied-research-and-program-evaluation/book261152   (especially Chapter 3)

• This paper uses theories for addressing poverty from a range of academic disciplines and from policy centers from across the political spectrum as an example of interdisciplinary knowledge mapping and synthesis:

https://www.emerald.com/insight/content/doi/10.1108/K-03-2018-0136/full/html

• Restructuring evaluation findings into useful knowledge:

http://journals.sfu.ca/jmde/index.php/jmde_1/article/download/481/436/

This approach helps you to avoid fuzzy understandings and the dangerous ‘pretence of knowledge’ that occasionally crops up in some reports and recommendations. Everyone can see that a piece is missing and so more easily agree where more research is needed to advance our knowledge to better serve our organisational and community constituents.

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

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

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

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

What is the purpose of literature review?

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

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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• 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.

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Library Guide to Capstone Literature Reviews: Find a Research Gap

Find a research gap: tips to get started.

Finding a research gap is not an easy process and there is no one linear path. These tips and suggestions are just examples of possible ways to begin. 

In Ph.D. dissertations, students identify a gap in research. In other programs, students identify a gap in practice. The literature review for a gap in practice will show the context of the problem and the current state of the research. 

Research gap definition

A research gap exists when:

• a question or problem has not been answered by existing studies/research in the field 
• a concept or new idea has not been studied at all
• all the existing literature on a topic is outdated 
• a specific population/location/age group etc has not been studied 

A research gap should be:

• grounded in the literature
• amenable to scientific study
• Litmus Test for a Doctoral-Level Research Problem (Word) This tool helps students determine if they have identified a doctoral level research problem.

Identify a research gap

To find a gap you must become very familiar with a particular field of study. This will involve a lot of research and reading, because a gap is defined by what does (and does not) surround it.

• Search the research literature and dissertations (search all university dissertations, not just Walden!).
• Understand your topic! Review background information in books and encyclopedias . 
• Look for literature reviews, systematic reviews, and meta-analyses.
• Take notes on concepts, themes, and subject terms . 
• Look closely at each article's limitations, conclusions, and recommendations for future research. 
• Organize, analyze, and repeat! 

• Quick Answer: How do I find dissertations on a topic?

Start with broad searches

Use the Library Search (formerly Thoreau)  to do a broad search with just one concept at a time . Broad searches give you an idea of the academic conversation surrounding your topic.

• Try the terms you know (keywords) first.
• Look at the Subject Terms (controlled language) to brainstorm terms. 
• Subject terms help you understand what terms are most used, and what other terms to try.
• No matter what your topic is, not every researcher will be using the same terms. Keep an eye open for additional ways to describe your topic.
• Guide: Subject Terms & Index Searches: Index Overview

Keep a list of terms

• Create a list of terms
• Example list of terms

This list will be a record of what terms are: 

• related to or represent your topic
• synonyms or antonyms
• more or less commonly used
• keywords (natural language) or subject terms (controlled language)
• Synonyms & antonyms (database search skills)
• Turn keywords into subject terms

Term I started with:

culturally aware 

Subject terms I discovered:

cultural awareness (SU) 

cultural sensitivity (SU) 

cultural competence (SU) 

Search with different combinations of terms

• Combine search terms list
• Combine search terms table
• Video: Search by Themes

Since a research gap is defined by the absence of research on a topic, you will search for articles on everything that relates to your topic. 

• List out all the themes related to your gap.
• Search different combinations of the themes as you discover them 

For example, suppose your research gap is on the work-life balance of tenured and tenure-track women in engineering professions. In that case, you might try searching different combinations of concepts, such as: 

• women and STEM 
• STEM or science or technology or engineering or mathematics
• female engineering professors 
• tenure-track women in STEM
• work-life balance and women in STEM
• work-life balance and women professors
• work-life balance and tenure 

Topic adapted from one of the award winning Walden dissertations. 

• Walden University Award Winning Dissertations
• Gossage, Lily Giang-Tien, "Work-Life Balance of Tenured and Tenure-Track Women Engineering Professors" (2019). Walden Dissertations and Doctoral Studies. 6435.

Break your topic into themes and try combining the terms from different themes in different ways. For example: 

Theme 1 and Theme 4

Theme 2 and Theme 1

Theme 3 and Theme 4

Video: Search by Themes (YouTube)

(2 min 40 sec) Recorded April 2014 Transcript

Track where more research is needed

Most research articles will identify where more research is needed. To identify research trends, use the literature review matrix to track where further research is needed. 

• Download or create your own Literature Review Matrix (examples in links below).
• Do some general database searches on broad topics.
• Find an article that looks interesting.
• When you read the article, pay attention to the conclusions and limitations sections.
• Use the Literature Review Matrix to track where  'more research is needed' or 'further research needed'. NOTE:  you might need to add a column to the template.
• As you fill in the matrix you should see trends where more research is needed.

There is no consistent section in research articles where the authors identify where more research is needed. Pay attention to these sections: 

• limitations
• conclusions
• recommendations for future research 
• Literature Review Matrix Templates: learn how to keep a record of what you have read
• Literature Review Matrix (Excel) with color coding Sample template for organizing and synthesizing your research
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Gaps in the literature.

Gaps in the literature are missing pieces or insufficient information in the published research on a topic. These are areas that have opportunities for further research because they are unexplored, under-explored, or outdated. 

Finding Gaps

Gaps can be missing or incomplete:

• Population or sample: size, type, location etc…
• Research methods: qualitative, quantitative, or mixed
• Data collection or analysis
• Research variables or conditions

Conduct a thorough literature search to find a broad range of research articles on your topic. Search research databases ;  you can find recommended databases for your subject area in  research by subject  for your course or program.

Identifying Gaps

If you do not find articles in your literature search, this may indicate a gap.

If you do find articles, the goal is to find a gap for contributing new research. Authors signal that there is a gap using phrases such as:

• Has not been clarified, studied, reported, or elucidated
• Further research is required or needed
• Is not well reported
• Suggestions for further research
• Key question is or remains
• It is important to address
• Poorly understood or known
• Lack of studies
• These findings provide valuable insights into the potential benefits of mindfulness-based interventions for stress management,however, further study is needed to address several limitations and extend our understanding in this area .
• While this study provides preliminary evidence of the potential efficacy of VRET in reducing PTSD symptoms, several aspects related to its implementation and specific treatment outcomes  remain inadequately clarified, highlighting the need for further research .
• Although the studies reviewed provide valuable insights into the potential effects of climate change on species composition and ecosystem functioning.  The question of how climate change will interact with other anthropogenic stressors to influence the resilience and adaptive capacity of tropical rainforest ecosystems remains unanswered, highlighting the need for further research .

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If you have questions on this, or another, topic, contact a librarian for help!

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Types of Research Gaps in Literature Review | How to Find a Research Gap

Posted by Md. Harun Ar Rashid | Nov 30, 2022 | Research Methodology

A research gap ( which indicates a lack of prior research on a topic ) is essentially an unanswered question or unsolved issue in a certain discipline. Alternatively, when there is a good number of studies conducted but the findings reflect in multiple ways, making it difficult to draw solid conclusions, there may be a research gap. Let’s take an example; where the goal of your study is to determine the cause (or causes) of a specific disease. In the literature, there is evidence to suggest that smoking is a major contributing factor, but there is also a substantial body of data that shows no connection between smoking and the disease. In that scenario, you may find a research gap that needs further investigation. In the rest of this article, we are going to know about the different types of research gaps in literature review and how to find a research gap .

Definition of Research Gap:

A research gap is essentially an unanswered question or unresolved problem in a field, reflecting a lack of existing research ( Grad Coach ).

A research gap is a key problem or a question that has not been answered by any of the existing studies within your area of research ( Dr. Sowndarya Somasundaram ).

From the above definitions, we can say that a research gap is a topic or area where there is a lack of information or insufficient data that prevents reviewers to grasp a conclusion regarding a particular question.

Types of Research Gaps in Literature Review:

According to (Robinson, et al., (2011), Muller-Bloch, & Kranz (2015), and Miles (2017); the research gap can be classified into seven categories which are briefly being:

1. Evidence Gap: An evidence gap occurs with a provocative exception arising if a new research finding contradicts widely accepted conclusions. This gap involves contradictions in the findings of the prior research. It occurs if results from studies allow for conclusions in their own right, but are contradictory when examined from a more abstract point of view. The identification of contradictory evidence starts with analyzing each research stream. Subsequently, the results from these analyses need to be synthesized in order to reveal contradictory evidence.

2. Knowledge Gap: The knowledge gap is a common gap in prior research. There are two settings where a knowledge gap (knowledge void) might occur. First, knowledge may not exist in the actual field of theories and literature from related research domains. Second, it might be the case that the results of a study differ from what was expected.

3. Practical-Knowledge Conflict Gap: This kind of gap tends to be a discrepancy that can motivate new research in this direction. A practical–knowledge (action-knowledge) conflict arises when the actual behavior of professionals is different from their advocated behavior. In this case, the research could seek to determine the scope of the conflict and uncover the reasons for its existence.

4. Methodological Gap: A methodological gap is the type of gap that deals with the conflict that occurs due to the influence of methodology on research results. This gap addresses the conflicts with the research methods in the prior studies and offers a new line of research that is divergent from those research methods. It is noted that it might be useful to various research methods, especially if certain research topics have been mainly explored using a singular or common method.

5. Empirical Gap: An empirical gap is the type of gap that deals with gaps in prior research. This conflict deals with the research findings or propositions that need to be evaluated or empirically verified. For example, the empirical gap often addresses conflicts that no study to date has directly attempted to evaluate a subject or topic from an empirical approach.

6. Theoretical Gap: The theoretical gap is the type of gap that deals with the gaps in theory with prior research. For example, if one phenomenon is being explained through various theoretical models, similar to a methodological gap conflict, there might be a theoretical conflict. Researchers and scholars could examine whether one of those theories is superior in terms of the gap in the prior research. Theoretical gaps are a common occurrence in examining prior research on a phenomenon.

7. Population Gap: A population gap is a common gap recognized among researchers. There are always under-served populations that have been under-researched. This gap is the type of research regarding the population that is not adequately represented or under-researched in the evidence base or prior research (e.g., gender, race/ethnicity, age, etc).

How to Find a Research Gap:

Start with a broad topic related to your field of interest: A broad topic allows you more opportunities to find a research gap. Pick a topic that interests you and that you already know something about. As you learn more about your topic, you can narrow it down further to help you find your focus.

Conduct preliminary research to explore your topic: Begin with a simple online search to learn the basics of a topic. Read encyclopedia entries, journal articles, and recent news articles related to your topic. Then, search online databases for peer-reviewed journal articles related to your topic of study.

Compile a wide range of articles about your topic: Search for different types of articles, like informative texts, research texts, and meta-analyses. This will provide you with a broader understanding of your topic so you can more easily find a gap.

Once you’ve gathered a meaty collection of resources, the section that you really want to focus on is the one titled “further research opportunities” or “further research is needed”. In this section, the researchers will explicitly state where more studies are required – in other words, where potential research gaps may exist. You can also look at the “limitations” section of the studies, as this will often spur ideas for methodology-based research gaps.

By following this process, you’ll orient yourself with the current state of research, which will lay the foundation for you to identify potential research gaps. You can then start drawing up a shortlist of ideas and evaluating them as candidate topics. But remember, make sure you’re looking at recent articles – there’s no use going down a rabbit hole only to find that someone’s already filled the gap.

References:

• Miles, D.A. (2017). A Taxonomy of Research Gaps: Identifying and Defining the Seven Research Gaps, Doctoral Student Workshop: Finding Research Gaps – Research Methods and Strategies, Dallas, Texas, 2017.
• Müller-Bloch, C. & Kranz, J., (2014). A Framework for Rigorously Identifying Research Gaps in Qualitative Literature Reviews, The Thirty Sixth International Conference on Information Systems, Fort Worth 2015 , pp. 1–19.
• Robinson, K., Saldanha, I. & McKoy, N.A. (2011). Development of A Framework for to Identify Research Gaps Systematic Reviews, Journal of Epidemiology , 64(1), pp. 1325-1330.

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Md. Harun Ar Rashid

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Gap Analysis for Literature Reviews and Advancing Useful Knowledge

2020, Research to Action: The Global Guide to Research Impact

The basics of research are seemingly clear. Read a lot of articles, see what’s missing, and conduct research to fill the gap in the literature. Wait a minute. What is that? “See what’s missing?” How can we see something that is not there? In this post, we will show you how to “see the invisible;” How to identify the missing pieces in any study, literature review, or program analysis. With these straight-forward techniques, you will be able to better target your research in a more cost-effective way to fill those knowledge gaps to develop more effective theories, plans, and evaluations.

Related Papers

ISSAH BAAKO

Various researchers have established the need for researchers to position their research problem in the research gap of the study area. This does not only indicate the relevance of the study but it demonstrates the significant contribution it would make in the field of study. The purpose of this paper is to conduct a systematic literature review on the concept of research gaps and provoke a discussion on the contemporary literature on types of research gaps. The paper discusses the various approaches for researchers to identify, align and position research problems, research design, and methodology in the research gaps to achieve relevance in their findings and study. A systematic review of the current literature on research gaps might assist beginning researchers in the justification of research problems. Given the acceptable tenet of developing a research agenda, design, and development on a research gap, many early career researchers especially (post)graduate students have difficulties in systematically identifying research gaps as a basis for conducting research work. The significance of this paper is twofold. First, it provides a systematic review of literature on the identification of research gaps to undertake research that would challenge assumptions and underlying existing theories in a significant way. Second, it provides a theoretical discussion on the importance of developing research problems on research gaps to structure their study.

Journal of Research Methods and Strategies

D. Anthony Miles

One of the most prevailing issues in the craft of research is to develop a research agenda and build the research on the development of the research gap. Most research of any endeavor is attributed to the development of the research gap, which is a primary basis in the investigation of any problem, phenomenon or scientific question. Given this accepted tenet of engagement in research, surprising in the research fraternity, we do not train researchers on how to systematically identify research gaps as basis for the investigation. This is has continued to be a common problem with novice researchers. Unfailingly, very little theory and research has been developed on identifying research gaps as a basis for a line in inquiry. The purpose of this research is threefold. First, the proposed theoretical framework builds on the five-point theoretical model of Robinson, Saldanhea, and McKoy (2011) on research gaps. Second, this study builds on the six-point theoretical model of Müller-Bloch and Franz (2014) on research gaps. Lastly, the purpose of this research is to develop and propose a theoretical model that is an amalgamation of the two preceding models and re-conceptualizes the research gap concepts and their characteristics. Thus, this researcher proposes a seven-point theoretical model. This article discusses the characteristics of each research and the situation in which its application is warranted in the literature review The significance of this article is twofold. First, this research provides theoretical significance by developing a theoretical model on research gaps. Second, this research attempts to build a solid taxonomy on the different characteristics of research gaps and establish a foundation. The implication for researchers is that research gaps should be structured and characterized based on their functionality. Thus, this provides researchers with a basic framework for identifying them in the literature investigation.

Kayode Oyediran

Problem in a research as well as human body calls for perfect diagnosis of illness. This is important to avoid treating the symptoms instead of the actual disease. A research problem could be identified through professional or/and academic efforts. This poses a lot of problems to students, both at the undergraduate and postgraduate levels, as this determines the title of their articles or research works. Many of them have to submit many topics to their supervisors before one could be reframed and approved. At times, students appealed to their supervisors to provide them with researchable topics. This to the supervisor(s) almost writing the dissertations/theses for them. The argument of this paper is to let students understand "problem identification" using an analogy from the Holy Bible. The study employed a conversation analysis methodology, which is empirically grounded, exploratory in process and inferential. This involves using every conversation between two or more parties to explore facts/lesson. It was recommended that seasoned lecturers should explain to students how to identify research problems using what are familiar to them to make them understand this important aspect of research.

Omini Akpang

Publications

Cherley C Du Plessis

The ability to conduct an explicit and robust literature review by students, scholars or scientists is critical in producing excellent journal articles, academic theses, academic dissertations or working papers. A literature review is an evaluation of existing research works on a specific academic topic, theme or subject to identify gaps and propose future research agenda. Many postgraduate students in higher education institutions lack the necessary skills and understanding to conduct in-depth literature reviews. This may lead to the presentation of incorrect, false or biased inferences in their theses or dissertations. This study offers scientific knowledge on how literature reviews in different fields of study could be conducted to mitigate against biased inferences such as unscientific analogies and baseless recommendations. The literature review is presented as a process that involves several activities including searching, identifying, reading, summarising, compiling, analysing, interpreting and referencing. We hope this article serves as reference material to improve the academic rigour in the literature review chapters of postgraduate students' theses or dissertations. This article prompts established scholars to explore more innovative ways through which scientific literature reviews can be conducted to identify gaps (empirical, knowledge, theoretical, methodological, application and population gap) and propose a future research agenda.

Management Information Systems Quarterly

Richard Watson

Journal of General Internal Medicine

Susanne Hempel

BACKGROUND: Well-defined, systematic, and transparent processes to identify health research gaps, needs, and priorities are vital to ensuring that available funds target areas with the greatest potential for impact. OBJECTIVE: The purpose of this review is to characterize methods conducted or supported by research funding organizations to identify health research gaps, needs, or priorities. METHOD: We searched MEDLINE, PsycINFO, and the Web of Science up to September 2019. Eligible studies reported on methods to identify health research gaps, needs, and priorities that had been conducted or supported by research funding organizations. Using a published protocol, we extracted data on the method, criteria, involvement of stakeholders, evaluations, and whether the method had been replicated (i.e., used in other studies). RESULTS: Among 10,832 citations, 167 studies were eligible for full data extraction. More than half of the studies employed methods to identify both needs and priorities, whereas about a quarter of studies focused singularly on identifying gaps (7%), needs (6%), or priorities (14%) only. The most frequently used methods were the convening of workshops or meetings (37%), quantitative methods (32%), and the James Lind Alliance approach, a multistakeholder research needs and priority setting process (28%). The most widely applied criteria were importance to stakeholders (72%), potential value (29%), and feasibility (18%). Stakeholder involvement was most prominent among clinicians (69%), researchers (66%), and patients and the public (59%). Stakeholders were identified through stakeholder organizations (51%) and purposive (26%) and convenience sampling (11%). Only 4% of studies evaluated the effectiveness of the methods and 37% employed methods that were reproducible and used in other studies. DISCUSSION: To ensure optimal targeting of funds to meet the greatest areas of need and maximize outcomes, a much more robust evidence base is needed to ascertain the effectiveness of methods used to identify research gaps, needs, and priorities.

UNICAF University - Zambia

Ivan Steenkamp

This section contains the four Thematic Gap Analyses and the Cross-Cutting Gap Analysis. Each of the chapters has a lead author (s) as noted on the front page of the chapter. This follows the way that the team has divided-up the responsibilities for each Thematic Area, with a disciplinary specialist (s) taking the lead on each area. The chapters have, however, been reviewed and commented by others in the project team so the analysis and suggested actions and conclusions have the general support of the full project team.

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• Published: 04 July 2024

Adherence to single inhaler triple therapy and digital inhalers in Chronic Obstructive Pulmonary Disease: a literature review and protocol for a randomized controlled trial (TRICOLON study)

• Liz J. A. Cuperus 1 , 2 , 3 ,
• Job van der Palen 4 ,
• Arnoud Aldenkamp 5 ,
• Astrid van Huisstede 6 ,
• Erik W. M. A. Bischoff 7 ,
• Job F. M. van Boven 8 ,
• Folkert Brijker 9 ,
• Stephan Dik 10 ,
• Jeroen A. J. M. van Excel 11 ,
• Martijn Goosens 12 ,
• Peter Th. W. van Hal 13 ,
• Jolanda C. Kuijvenhoven 14 ,
• Lisette I. Z. Kunz 15 ,
• Erwin C. Vasbinder 16 ,
• Huib A. M. Kerstjens 2 ,
• Johannes C. C. M. in ’t Veen 1 , 3 &

the TRICOLON study group

BMC Pulmonary Medicine volume  24 , Article number:  317 ( 2024 ) Cite this article

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Metrics details

Medication non-adherence is a significant problem in patients with Chronic Obstructive Pulmonary Disease (COPD). Efforts to address this issue are receiving increased attention. Simplifying treatment by prescribing single-inhaler triple therapy (SITT) as an alternative to multi-inhaler triple therapy (MITT) or with smart inhalers are often considered potential solutions. However, the actual impact of these innovations on adherence and clinical outcomes is unclear.

To address this knowledge gap we first conducted a literature review focusing on two research questions: 1) the difference in adherence between SITT and MITT users in COPD, and 2) the effect of smart inhalers on adherence in COPD. Separate searches were conducted in PubMed and two authors independently assessed the articles. In addition, we present a protocol for a study to acquire knowledge for the gaps identified.

To address the first research question, 8 trials were selected for further review. All trials were observational, i.e. randomized controlled trials were lacking. Seven of these trials showed higher adherence and/or persistence in patients on SITT compared with patients on MITT. In addition, four studies showed a positive effect of SITT on various clinical outcomes. For the second research question, 11 trials were selected for review. While most of the studies showed a positive effect of smart inhalers on adherence, there was considerable variation in the results regarding their effect on other clinical outcomes.

The TRICOLON (TRIple therapy COnvenience by the use of one or multipLe Inhalers and digital support in ChrONic Obstructive Pulmonary Disease) trial aims to improve understanding regarding the effectiveness of SITT and smart inhalers in enhancing adherence. This open-label, randomized, multi-center study will enroll COPD patients requiring triple therapy at ten participating hospitals. In total, 300 patients will be randomized into three groups: 1) MITT; 2) SITT; 3) SITT with digital support through a smart inhaler and an e-health platform. The follow-up period will be one year, during which three methods of measuring adherence will be used: smart inhaler data, self-reported data using the Test of Adherence to Inhalers (TAI) questionnaire, and drug analysis in scalp hair samples. Finally, differences in clinical outcomes between the study groups will be compared.

Our review suggests promising results concerning the effect of SITT, as opposed to MITT, and smart inhalers on adherence. However, the quality of evidence is limited due to the absence of randomized controlled trials and/or the short duration of follow-up in many studies. Moreover, its impact on clinical outcomes shows considerable variation. The TRICOLON trial aims to provide solid data on these frequently mentioned solutions to non-adherence in COPD. Collecting data in a well-designed randomized controlled trial is challenging, but the design of this trial addresses both the usefulness of SITT and smart inhalers while ensuring minimal interference in participants' daily lives.

Trial registration

NCT05495698 (Clinicaltrials.gov), registered at 08–08-2022. Protocol version: version 5, date 27–02-2023.

Peer Review reports

Introduction

Chronic obstructive pulmonary disease (COPD) is characterized by chronic respiratory symptoms due to abnormalities in the airways and/or alveoli, resulting in persistent and often progressive airflow obstruction. Inhalation medication is the primary medical treatment, with three types of inhalation medication available as maintenance therapy: 1) long-acting β2-agonist (LABA), 2) long-acting muscarinic antagonist (LAMA), and 3) inhaled corticosteroids (ICS). Triple therapy is defined as treatment with LABA, LAMA and ICS [ 1 ]. Large randomized controlled trials have shown that triple therapy provides clinical benefits compared to dual therapy in patients with moderate-to-severe COPD and a history of exacerbations, particularly when eosinophilia is present [ 2 , 3 , 4 , 5 , 6 ]. Furthermore, two trials suggest that triple therapy reduces mortality in this specific population [ 7 , 8 ]. Triple therapy can be administered through multiple devices, known as multi-inhaler-triple therapy (MITT), or combined in one inhaler, known as single-inhaler-triple therapy (SITT). Assessment of adherence to inhalation therapy is a crucial element in managing COPD patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [ 1 ]. Previous studies have shown that medication adherence is poor in patients with COPD. A systematic review showed that non-adherence rates ranged from 22 to 93%, depending on the study population and method of measurement [ 9 ]. Non-adherence is associated with poor clinical and economic outcomes [ 10 , 11 ]. Simplifying treatment with smart-inhalers and prescribing single-inhaler triple therapy (SITT) as an alternative to multi-inhaler triple therapy (MITT) can be considered as potential solutions. Nowadays, the GOLD report (version 2024) acknowledges that a single inhaler may be more convenient compared to multi-inhaler therapy. [ 1 ]. The actual impact of these innovations on adherence is unclear. Therefore, we conducted a literature review to examine the current evidence on these two potential solutions. Should the evidence prove to be insufficient, we wanted to present a protocol for a study to fill this gap.

Methods for measuring adherence

Adherence is defined as the process by which patients take their medication as prescribed, while persistence refers to the duration from initiation to discontinuation of the treatment. Adherence and persistence are complex constructs, as previously described by Vrijens et al. [ 12 , 13 ]. Various methods can be used to assess medication adherence. Healthcare professionals commonly inquire directly about their patients' adherence. While this approach is straightforward, research has demonstrated its unreliability in comparison to more objective measurement methods. Unstructured self-reports often lead to an overestimation of adherence [ 14 ]. Patients can structurally self-report their adherence using questionnaires, such as the Test of Adherence to Inhalers (TAI). The TAI is developed specifically to measure adherence to inhalation medication in patients with COPD or asthma [ 15 ]. Furthermore, pharmacy data are often used to determine patient’s access to medication over time by calculating the Proportion of Days Covered (PDC). This method may be less reliable due to missing or inaccessible data (e.g. when multiple pharmacies are used) and the uncertainty about whether the patient actually used the medication [ 16 , 17 ]. Smart inhalers offer a more objective method for measuring adherence. These electronic sensors (e-devices) are attached to or integrated into inhalers. Devices range from simple dose counters to advanced devices that provide reminders, feedback, and/or analyse inhalation technique [ 18 ]. Smart inhalers are often integrated with other e-health interventions, such as telemonitoring, personalised feedback with apps, counselling, and training [ 19 , 20 , 21 ]. Finally, hair analysis can provide a bioanalytical assessment of average long-term drug exposure in the human body. This method could potentially provide an objective measure of adherence over the last few months. However, external factors can impact measurement, and only small part of medication that has been present in the systemic blood circulation is built into hair [ 22 ].

First, we present a review of the literature on two strategies to improve adherence. Second, we describe the study protocol of the TRICOLON trial (TRIple therapy COnvenience by the use of one or multipLe Inhalers and digital support in ChrONic Obstructive Pulmonary Disease).

Search strategy literature review

Separate searches were conducted in PubMed based on two research questions: 1) What is the difference in adherence between SITT and MITT users in COPD?, and 2) What is the effect of smart inhalers on adherence in COPD? The selection of articles from the second PubMed search was supplemented by four papers known to the authors or found by snowballing. Two authors independently assessed these articles to determine whether they should be included in this review (LC and JiV). In cases of disagreement, the opinion of a third author was sought (HK). Only original English-language studies were included. Details of the PubMed search and selection process can be found in the Appendix, Suppl.1.

Assessment of the evidence

The primary outcome was the adherence and/or persistence to triple therapy. Secondary outcomes were clinical outcomes, such as exacerbations, COPD Assessment Test (CAT) score, and FEV 1 . Each study underwent an evaluation across multiple criteria to assess the evidence supporting the research question. The strength of the study design was rated with stars: one star for retrospective studies, two stars for prospective observational studies or intervention studies without randomization (e.g. before-and-after designs), and three stars for randomised controlled trials. A green smiley indicates statistically significant superior results in the intervention group (either SITT or smart-inhaler group, depending on the research question) compared to the control group; a yellow neutral smiley signifies no difference between the groups, while a red sad smiley denotes statistically significant inferior results in the intervention group compared to the control group. Additionally, a thumbs-up signifies that other clinical outcomes were measured in that study, whereas a thumbs-down indicates the absence of measurements for other clinical outcomes, Tables  1 and  2 .

Literature review

Adherence to single versus multi inhaler triple therapy.

The first search yielded eighteen articles, Suppl. Figure 1. After the selection process, eight articles were included for further evaluation, Table  1 . None had a randomized controlled design. Four studies compared SITT with MITT in a prospective setting [ 23 , 27 , 28 , 30 ] and four in a retrospective analysis [ 24 , 25 , 26 , 29 ]. The retrospective studies used either anonymized data from electronic health records of patients in primary or secondary care [ 24 , 26 ], or databases of health insurance claims [ 25 , 29 ]. Seven of these studies showed that adherence and/or persistence to SITT was significantly higher compared to MITT in COPD patients [ 23 , 24 , 25 , 27 , 28 , 29 , 30 ]. Deslee et al. presented contrasting findings, showing that while persistence was higher in the SITT group (median 181 versus 135 days), adherence levels were similar in SITT and MITT (85.7% versus 86.1%) [ 26 ]. The seven trials that showed a positive effect of SITT on adherence were heterogeneous in terms of study design, and methods of measurement, type of inhaler, and molecules. Although most studies directly compared SITT with MITT, two of the prospective studies assessed adherence to SITT after switching from either dual therapy or MITT [ 27 , 28 ]. Brusselle et al. reported separate results for former MITT users: 71.9% at baseline, 74.7% three months after switching to SITT, and 83.8% at six months [ 28 ]. In contrast, Gessner et al. did not report separate results for the different treatments at baseline. Therefore, this difference between SITT and the control group should be interpreted with caution [ 27 ].

Clinical outcomes in single vs multi inhaler triple therapy

Five trials investigated the effect of SITT compared to MITT on clinical outcomes. Four of these trials showed a beneficial effect of SITT on clinical outcomes, Table  1 . SITT users had a lower risk of exacerbations compared to MITT users in two studies [ 23 , 28 ]; three studies showed lower CAT-scores and higher FEV 1 in SITT users [ 27 , 28 , 30 ]; and one study showed a reduced all-cause mortality risk in SITT users [HR: 0.475 (0.237–0.952), p  = 0.036] [ 23 ]. In contrast to these studies with positive effects of SITT, Bogart et al. showed different results in two different groups of patients. In patients enrolled in Medicare Advantage with Part D (MAPD) insurance, a significant reduction in exacerbations and healthcare utilisation was seen in the SITT group. However, these differences were not statistically significant in the commercially insured patients [ 29 ].

The effect of smart inhalers on adherence

The second part of our literature review investigated the effect of smart inhalers on adherence in patients with COPD and resulted in 78 articles, from which 11 studies were selected, Table  2 . These studies were heterogenetic in terms of number of patients, study design, and type of intervention and/or smart inhaler. Additionally, length of follow-up ranged from 1 to 12 months, with the vast majority (90.9%) having a follow-up period of ≤ 6 months. Seven studies prospectively compared COPD patients who used a smart-inhalers with a control group; four of those had a randomized controlled open-label design. Six of these seven studies showed a statistically better adherence in the intervention group [ 19 , 31 , 32 , 37 , 38 , 40 ]; one prospective study showed no difference in adherence between smart inhaler users and controls [ 33 ]. Four other observational studies showed variable average adherence rates in smart-inhaler users from 44–77%; however, it should be noted that these trials did not include a control group without smart-inhaler [ 34 , 35 , 36 , 39 ].

The effect of smart inhalers on clinical outcomes

Nine studies also investigated the effect of smart inhalers on clinical outcomes [ 19 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 ]. These studies showed mixed results, Table  2 . A significant better inhalation technique was seen in two studies [ 31 , 33 ]. The impact of smart inhalers on other clinical outcomes, including exacerbations, disease burden, quality of life assessments, rescue medication usage, hospitalizations, and healthcare utilization, varied across different studies [ 19 , 32 , 33 , 35 , 36 , 37 , 38 , 39 ].

Conclusion of literature review

This review suggests promising results concerning the effect of SITT, as opposed to MITT, and smart inhalers on adherence. However, the quality of evidence is limited due to the absence of randomized controlled trials and/or the short duration of follow-up in many studies. Moreover, there is considerable variation in the findings of these studies regarding diverse clinical outcomes. Consequently, there is a clear need for comprehensive randomised controlled trials to evaluate the benefits of SITT versus MITT in COPD, as well as the individual and combined effects of smart inhalers, both on adherence and clinical outcomes.

Study protocol for an RCT: the TRICOLON study

The TRICOLON study was initiated to provide evidence on two previously mentioned potential solutions for the non-adherence issue in COPD patients. The primary objective is to investigate whether the adherence to SITT is superior to the adherence to MITT over 12 months of treatment and to investigate whether the adherence of SITT users with a smart inhaler and digital support is superior to the adherence of MITT and SITT users without the smart inhaler and digital support. As a secondary objective, three methods of measuring adherence will be compared: smart inhaler data, self-reported data using the Test of Adherence to Inhalers (TAI) questionnaire [ 15 ], and drug analysis of formoterol in scalp hair samples [ 41 ]. Finally, differences in clinical outcomes between the study groups will be examined.

Study design

The TRICOLON study is an investigator-initiated, prospective, open-label, randomised, real-world, multicentre study. The study will be conducted at ten hospitals in the Netherlands, Supplement 2. Patients will be recruited from the pulmonary wards or outpatient clinics of the participating hospitals. Informed consent will be obtained by a member of the research team. Participants are randomly assigned in a 1:1:1 ratio to one of three groups: 1) multi-inhaler triple therapy (Bevespi® and Qvar®), 2) single-inhaler triple therapy (Trimbow®), 3) single-inhaler triple therapy (Trimbow®) with digital support, Fig.  1 . The follow-up period will be one year, during which we aim to minimise disruption to their usual care, thus creating a (close to) real-world situation. The study outline is presented in Fig.  2 . Ethical approval for this study was granted by the United Medical Research Ethics Committees (NL79938.100.22). The trial is registered on clinicaltrials.gov (NCT05495698).

Study design. Patients are randomly assigned in a 1:1:1 ratio to one of three groups: 1) multi-inhaler triple therapy (Bevespi® and Qvar®), 2) single-inhaler triple therapy (Trimbow®), 3) single-inhaler triple therapy (Trimbow®) with e-health. The follow-up period is one year

Study program

*time in months

Study participants

A total of 300 patients will be enrolled. Patients with a diagnosis of COPD and an indication for triple therapy according to their physician following the GOLD report are eligible to participate. Patients are excluded if asthma is the dominant diagnosis (asthma in the past or as a comorbidity is allowed), if patients use nebulizers or if they already use an e-health application for their COPD. The inclusion and exclusion criteria are displayed in Table  3 .

Interventions

The study groups have uniform doses, identical molecules and doses (beclomethasone 100µg, formoterol 6µg, and glycopyrronium 10µg), and the same device type (pressurised metered dose inhaler). Therefore, the only differentiating factors are the number of devices used and the use of digital support. Digital support comprises the Findair® smart-inhaler, an electronic device that is attached to the inhaler and measures the frequency and time of the actuations, and the Curavista® platform (Gezondheidsmeter PGO), a digital platform that promotes patient self-management by displaying their medication use and providing medication intake reminders [ 31 , 32 ]. Each patient is provided with smart inhalers that are attached to all their inhalers, including the potential rescue medication. This enables the measurement of actuation frequency and timing. The smart-inhalers are linked to the digital platform for data collection. However, it is important to note that only group 3 has access to an overview of the actuations with feedback in the app and reminders, along with full access to the digital platform. Groups 1 and 2 will not receive any reminders and cannot access the digital platform. Their e-health applications are solely used for data collection purposes, ensuring "silent monitoring" that should not influence their adherence.

We aim for all participants to complete the study using the original study medication. However, given the real-world nature of the study, it is possible that patients require a change in medication due to clinical reasons such as side effects or lack of effectiveness. To prevent the loss of these patients from the study, changes in medication are permitted only when absolutely necessary. Data collection will persist via the electronic devices and with the same settings of the app (silent monitoring or full access). Patients who no longer use a pressurized metered dose inhaler will be excluded, as the electronic devices are specifically tailored for this type of inhaler.

The primary outcome is the average adherence to ICS therapy (measured as the number of actuations registered by the smart-inhaler divided by the total number of doses prescribed, in %) over 12 months of treatment. As a secondary outcome, the average adherence to LABA/LAMA in study group 1 will be compared with adherence to ICS in group 1, and with adherence to LABA/LAMA/ICS in groups 2 and 3. Additional secondary outcomes include the percentage of patients with good adherence, defined as an average ICS adherence of more than 80% and less than 110% actuations measured by the smart inhaler; the Test of Adherence to Inhalers (TAI) scores; and drug levels of formoterol in scalp hair. The hair samples will be collected, stored, and prepared according to the guidelines of the Society of Hair Testing [ 42 ]. Additionally, the study will measure changes in Patient Reported Outcome Measures (PROMs), use of rescue medication, number of exacerbations and hospitalizations, healthcare consumption, and spirometry (FEV 1 ). The PROMs are displayed in Supplement 3.

Statistical analysis

The statistical software G*Power version 3.1.9.6 was used to calculate the sample size. The study aims to compare three groups: group 1 vs group 2, group 2 vs group 3, and group 1 vs group 3. The sample size calculation is based on the comparison of the average adherence in group 1 vs group 2 (so MITT vs SITT without e-health). Based on a previous study [ 19 ], we expect a 15% difference between the groups, with a standard deviation of 30%. The significance level of the test was set at (alpha) 0.0167 using the Holm-Bonferroni method to adjust for multiple testing, as we are comparing three groups (alpha 0.05/3 = 0.0167), with a power of 80%. We calculated n = 84 for each group using a two-sided T-test, and plan to include 100 patients in each group of the study, considering a potential drop-out rate of 15%. The patients will be randomized using the program Castor EDC. To prevent inequality in the study groups, at randomization patients will be stratified for their treatment before the study (dual therapy, MITT or SITT) and for inclusion during an exacerbation or during stable disease. The data will be analyzed using both the intention-to-treat (primary analysis) and per-protocol methods. The Kruskal–Wallis test or ANOVA, as appropriate, will be used to compare the average adherence between the three study groups. Post-hoc comparisons will be performed using Mann–Whitney U tests or Tukey’s HSD, as appropriate. The average baseline scores of the PROMs and baseline clinical status (FEV 1 , number of exacerbations, hospitalizations and rescue medication use) will be presented descriptively. These scores and outcomes are all continuous, unpaired data and will be compared between more than two groups. Therefore, we will use the Kruskal–Wallis or ANOVA, as appropriate, to investigate the differences between the three groups. The Net Promoter score is a binary variable, so we will use the Chi-square test. Questionnaire data will be analysed by both the difference in mean scores between groups and the percentage of patients achieving the minimally clinical important difference (MCID) when available. Furthermore, a mixed model repeated measurement analysis will be performed to assess the differences in the previously mentioned outcomes over time. The analysis will be conducted on normally distributed data, with or without transformations. The main parameter of interest is the group * time interaction. Between-group comparisons will be adjusted using the method of Sidak. If the data cannot be normalized, difference scores will be calculated (follow-up – baseline). These differences will be analysed using either the Kruskal–Wallis test or ANOVA, where appropriate. Post-hoc comparisons will be conducted using Mann–Whitney U tests or Tukey’s HSD, where appropriate.

Serious adverse events (SAEs) will be monitored and reported in accordance with the legal requirements and deadlines. The Ethics committee has granted permission for hospital admissions resulting from a COPD exacerbation not to be reported as SAE. This exemption is due to their frequent occurrence in this specific population. Instead, to monitor this fragile population, a Data and Safety Monitoring Board (DSMB) has been established. The DSMB will periodically review mortality rates, serious adverse events, and premature withdrawals from the study every six months. The application and e-health platform in use have a substantial history, spanning many years. Over the past two decades, 26 peer-reviewed scientific publications have been published. Notably, there have been no reported safety concerns, and assessments of usability, feasibility, and efficacy consistently yield positive results [ 43 ].

Non-adherence is a significant challenge in COPD patients, and addressing this issue is receiving increased attention. The first solution we investigated was simplifying the treatment by prescribing single-inhaler triple therapy (SITT) as an alternative to multi-inhaler triple therapy (MITT). The GOLD report 2023 suggested, for the first time, that single inhaler therapy may be more convenient than multi inhaler therapy [ 1 ]. However, although our literature review reveals some promising results regarding the effect of SITT on adherence, the quality of evidence is limited due to the absence of randomized controlled trials that specifically examined the difference in adherence between SITT and MITT. Due to the observational setting and design of all studies in the first part of this review, the SITT and MITT groups showed differences in their baseline characteristics, including the number of exacerbations prior to enrolment, disease severity, and FEV-1. Moreover, the quality of the observational data was occasionally limited. For example, two studies relied on administrative databases using health insurance claims [ 25 , 29 ]. Consequently, from these trials we are unable to draw conclusions on the cause-effect relationship between improved adherence and clinical outcomes. In contrast to the four studies included in our review, which all demonstrated slightly better clinical outcomes in SITT users, other literature, not incorporated into our review due to a lack of adherence as an outcome, presented contrasting results regarding the effect of SITT on clinical outcomes. Specifically, a retrospective study in Spain and an RCT showed improved clinical outcomes in SITT users [ 44 , 45 ]. However, three randomized controlled trials indicated that both SITT and MITT users exhibited similar results in terms of lung function, health status, exacerbation rate, and rescue medication usage [ 2 , 46 , 47 ].

The use of smart inhalers was the second potential solution to non-adherence that we investigated. Our review showed that while the effect on adherence was mostly positive, no consistent differences in clinical outcomes were observed. The strength of studies showing improved adherence in the absence of improved clinical outcomes is limited. These findings are consistent with other recent reviews in both COPD and asthma [ 18 , 20 , 21 ]. Demonstrating the connection between adherence and clinical outcomes has proven to be challenging. Given that COPD entails irreversible lung damage and the medication aims to stabilize rather than cure the disease, an extensive follow-up period is essential to demonstrate its impact on clinical outcomes. However, the current studies have limitations regarding the duration of follow-up. The smart inhalers used, as well as the supplementary interventions, and the extent of monitoring and/or interference varied significantly among the studies. The majority of smart inhalers used in current literature can only record the time and location of actuation. They are unable to measure whether inhalation is performed correctly. Other techniques, such as smart inhalers capable of measuring airflow or hair analysis of inhaled drugs, can assist in addressing this limitation. Further research is needed to gain a deeper understanding of the contributions of the different electronic modalities, the underlying mechanisms, clinical outcomes, and optimal implementation of these devices in clinical practice. Several challenges must be addressed before integrating smart inhalers into daily practice, including technical complexities, limited evidence concerning clinical outcomes, uncertainties about cost-effectiveness, and the issue of funding for the devices [ 18 ]. The TRICOLON study aims to offer additional evidence, potentially bringing us closer to their use in daily practice.

To the best of our knowledge, the TRICOLON trial is the first that aims to investigate whether single inhaler usage in COPD patients receiving triple therapy can improve adherence in a large-scale, randomized, controlled, real-world setting. Moreover, unlike the majority of existing studies focusing on the impact of smart inhalers, the TRICOLON trial distinguishes itself with a prolonged follow-up period of one year. We acknowledge that patients’ adherence may be influenced by their awareness of participating in a study. To minimize this interference, we have limited the number of study visits to closely resemble real-world settings. Additionally, patients are informed that the focus of this study is on the convenience of various treatment options, and adherence is not specifically mentioned in the information provided by the researchers or in the patient information letter. This has been approved by the Medical Ethical Review Board. The Tricolon study not only investigates the impacts of a single inhaler and the use of a smart inhaler on adherence but also evaluates various clinical outcomes, including exacerbation rates, hospitalizations, and disease burden. Nevertheless, the study is powered on the primary outcome adherence to inhalation therapy. Therefore, although not powered for the clinical outcomes or for the correlation between adherence and clinical outcomes, valuable information on these outcomes will be collected to inform possible follow-up studies.

The implementation of an e-health application may present challenges, whether due to technical issues or the potential unfamiliarity among patients and healthcare professionals [ 48 ]. To proactively address these concerns, we dedicated time to thoroughly test the application before the start of the study. This involved multiple stakeholders, including the researchers, the app producer, and patients. Moreover, the application's design is intentionally kept simple and clear, ensuring that individuals of all ages, educational backgrounds, and health literacy levels can easily comprehend and use it. This was confirmed in a previous study where an older, and thus more digitally challenged, population of patients with Idiopathic Pulmonary Fibrosis (IPF) used this app for daily spirometry. The study found that 80% of the participants found the app easy to use, and 90% did not perceive it as burdensome [ 49 ].

Beyond addressing the primary research questions, this TRICOLON study creates an opportunity for a direct comparison between three methods to measure adherence: digital data from the smart inhaler, self-reported data collected through the TAI questionnaire, and drug deposition data in hair. The use of this final technique is relatively uncommon in studies concerning inhalation medication, although it has been used in previous research related to cortisol and in forensic studies [ 22 , 50 ]. In a specific study involving asthma and COPD patients, the measurement of inhalation medication demonstrated a clear dose–response relationship among those using formoterol [ 41 ].

Our identification of a lack of high-quality data on the improvement of adherence of SITT over MITT therapy in COPD and limited data for smart inhalers highlights the need for further research. The multi-centre, randomized controlled, three-arm, real-world TRICOLON trial aims to increase insight in the value of SITT and the added value of electronic adherence monitoring.

Availability of data and materials

All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We appreciate the assistance of Carmen van der Heijden, librarian at the Medical Library in the Franciscus Gasthuis & Vlietland hospital, in conducting the PubMed searches. We would like to thank the members of the investigational teams across all participating hospitals for their dedicated time and effort in conducting this study.

TRICOLON study group

The TRICOLON Study Group consortium consists of the individuals listed below:

Liz J.A. Cuperus MD 1,2,3 , Job van der Palen PhD 4 , Arnoud Aldenkamp MD 5 , Astrid van Huisstede MD PhD 6 , Erik W.M.A. Bischoff MD PhD 7 , Job F.M. van Boven PharmD PhD 8 , Folkert Brijker MD 9 , Stephan Dik MD 10 , Jeroen A.J.M. van Excel MD 11 , Martijn Goosens MD 12 , Peter Th.W. van Hal MD PhD 13 , Jolanda C. Kuijvenhoven MD PhD 14 , Lisette I.Z. Kunz MD PhD 15 , Erwin C. Vasbinder PhD 16 , Huib A.M. Kerstjens MD PhD 2 , Johannes C.C.M. in ’t Veen MD PhD 1,3 , Marjo van der Poel 17 , Marijke Amelink 9 , Anke Rol 18 , Jennifer de Graaf 18 , Petra Hirmann 19 , Fleur van Tour 20 , Elly Jordens 13 , Lydia Alfing 13 , Gerda Lenderink 21 , Thecla Rupert 21 , Truus Rietveld 21 , Jasmijn van Campen 15 , Jantine de Bruijn 15 , Janice van ter Burg 15 , Walter van Litsenburg 5 , Len Knoops 22 , Margot Eggermont-Schilt 23 , Manon de Waard-Heijligers 23 , Ilonka Paalvast-Schouten 23 , Sarah van Oord 11

1 Pulmonology Department, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands

2 Pulmonology Department, University of Groningen, University Medical Center Groningen, and Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands

3 Pulmonology Department, Erasmus Medical Centre, Rotterdam, the Netherlands

4 Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands

5 Department of Pulmonary Medicine, Catharina Hospital, Eindhoven, The Netherlands

6 Department of Pulmonology, Northwest Clinics, Alkmaar, the Netherlands

7 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands

8 Department of Clinical Pharmacy & Pharmacology Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

9 Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands

10 Department of Pulmonary Medicine, Albert Schweitzer ziekenhuis, Dordrecht, The Netherlands

11 Department of Pulmonary Medicine, HagaZiekenhuis, The Hague, The Netherlands

12 Department of Pulmonary Medicine, Gelre Ziekenhuizen, Zutphen, The Netherlands

13 Department of Respiratory Medicine, Van Weel-Bethesda Hospital, Dirksland, the Netherlands

14 Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands

15 Department of Pulmonology, Haaglanden Medical Centre, The Hague, the Netherlands

16 Department of Clinical Pharmacy, Franciscus Gasthuis, Rotterdam, the Netherlands

17 Spaarne Gasthuis, Haarlem, The Netherlands

18 Northwest Clinics, Alkmaar, the Netherlands

19 Medical Centre Leeuwarden, Leeuwarden, the Netherlands

20 Albert Schweitzer ziekenhuis, Dordrecht, The Netherlands

21 Gelre Ziekenhuizen, Zutphen, The Netherlands

22 Catharina Hospital, Eindhoven, The Netherlands

23 HagaZiekenhuis, The Hague, The Netherlands

The faculty received an unrestricted grant from Chiesi Pharmaceuticals B.V. Furthermore, the funding includes contributions from the research group in the Franciscus Gasthuis & Vlietland hospital and transformation funds from health insurance companies.

Author information

Authors and affiliations.

Pulmonology Department, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands

Liz J. A. Cuperus & Johannes C. C. M. in ’t Veen

Pulmonology Department, University of Groningen, University Medical Center Groningen, and Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands

Liz J. A. Cuperus & Huib A. M. Kerstjens

Pulmonology Department, Erasmus Medical Centre, Rotterdam, the Netherlands

Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands

Job van der Palen

Department of Pulmonary Medicine, Catharina Hospital, Eindhoven, The Netherlands

Arnoud Aldenkamp

Department of Pulmonology, Northwest Clinics, Alkmaar, the Netherlands

Astrid van Huisstede

Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands

Erik W. M. A. Bischoff

Department of Clinical Pharmacy & Pharmacology Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Job F. M. van Boven

Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands

Folkert Brijker

Department of Pulmonary Medicine, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands

Stephan Dik

Department of Pulmonary Medicine, HagaZiekenhuis, The Hague, The Netherlands

Jeroen A. J. M. van Excel

Department of Pulmonary Medicine, Gelre Ziekenhuizen, Zutphen, The Netherlands

Martijn Goosens

Department of Respiratory Medicine, Van Weel-Bethesda Hospital, Dirksland, The Netherlands

Peter Th. W. van Hal

Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands

Jolanda C. Kuijvenhoven

Department of Pulmonology, Haaglanden Medical Centre, The Hague, The Netherlands

Lisette I. Z. Kunz

Department of Clinical Pharmacy, Franciscus Gasthuis, Rotterdam, The Netherlands

Erwin C. Vasbinder

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• Liz J. A. Cuperus
• , Job van der Palen
• , Arnoud Aldenkamp
• , Astrid van Huisstede
• , Erik W. M. A. Bischoff
• , Job F. M. van Boven
• , Folkert Brijker
• , Stephan Dik
• , Jeroen A. J. M. van Excel
• , Martijn Goosens
• , Peter Th. W. van Hal
• , Jolanda C. Kuijvenhoven
• , Lisette I. Z. Kunz
• , Erwin C. Vasbinder
• , Huib A. M. Kerstjens
• , Johannes C. C. M. in ’t Veen
• , Marjo van der Poel
• , Marijke Amelink
• , Jennifer de Graaf
• , Petra Hirmann
• , Fleur van Tour
• , Elly Jordens
• , Lydia Alfing
• , Gerda Lenderink
• , Thecla Rupert
• , Truus Rietveld
• , Jasmijn van Campen
• , Jantine de Bruijn
• , Janice ter Burg
• , Walter van Litsenburg
• , Len Knoops
• , Margot Eggermont-Schilt
• , Manon de Waard-Heijligers
• , Ilonka Paalvast-Schouten
•  & Sarah van Oord

Contributions

LC and JV conducted the assessment and selection of articles from the PubMed searches, HK was consulted in case of author disagreements. JV initiated the Tricolon trial and acquired the funding. LC, JV, HK, JvdP, EB, JvB were involved in the study design and protocol. LC is the coordinating investigator, JV is the principal investigator. LC, JV and HK wrote the main manuscript text. All authors have thoroughly read, critically revised, and approved the submitted version of the final manuscript.

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Correspondence to Liz J. A. Cuperus .

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Ethics approval and consent to participate.

Ethics approval for the Tricolon study was waived by the Medical research Ethics Committees United (NL79938.100.22). This study is performed after approval by the Institutional Research Board and Board of Directors of the participating hospitals. The study is registered at clinicaltrials.gov (NCT05495698). Informed consent was obtained from all subjects.

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Not Applicable.

Competing interests

JvdP: none.

EB: unrestricted grants and speaking fees received from Chiesi Pharmaceuticals B.V., Boehringer Ingelheim bv, GlaxoSmithKline.

JvB: received unrestricted research grants from Aardex, AstraZeneca, Chiesi, European Commission COST Action 19132 (ENABLE), European Respiratory Society CRC “CONNECT”, Novartis, Pfizer, Pill Connect, Trudell Medical and consultancy/speaker fees from AstraZeneca, Chiesi, GSK, Novartis, Teva and Vertex. All payments were unrelated to this manuscript and all paid to his institution (UMCG).

LK: received speaker fees from AZ.

EV: received unrestricted research grants from AstraZeneca and Pfizer.

HK: reports grants and consultancy/advisory board participation from/for AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, and Novartis, all outside the submitted work. All were paid to his institution.

JiV: received unrestricted faculty research grants from GSK, Teva, AZ, Chiesi, Sanofi, and speaker fees from AZ, GSK, Sanofi, Chiesi, Stichting RoLeX and Health Investment.

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Cuperus, L.J.A., van der Palen, J., Aldenkamp, A. et al. Adherence to single inhaler triple therapy and digital inhalers in Chronic Obstructive Pulmonary Disease: a literature review and protocol for a randomized controlled trial (TRICOLON study). BMC Pulm Med 24 , 317 (2024). https://doi.org/10.1186/s12890-024-03044-3

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Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies

• Samantha Spanos   ORCID: orcid.org/0000-0003-3734-3907 1 ,
• Elle Leask   ORCID: orcid.org/0000-0003-1698-9151 1 ,
• Romika Patel   ORCID: orcid.org/0009-0000-6523-8798 1 ,
• Michael Datyner 1 ,
• Erwin Loh   ORCID: orcid.org/0000-0001-7157-0826 2 &
• Jeffrey Braithwaite   ORCID: orcid.org/0000-0003-0296-4957 1  

BMC Medical Education volume  24 , Article number:  720 ( 2024 ) Cite this article

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Metrics details

As healthcare systems rapidly become more complex, healthcare leaders are navigating expanding role scopes and increasingly varied tasks to ensure the provision of high-quality patient care. Despite a range of leadership theories, models, and training curricula to guide leadership development, the roles and competencies required by leaders in the context of emerging healthcare challenges (e.g., disruptive technologies, ageing populations, and burnt-out workforces) have not been sufficiently well conceptualized. This scoping review aimed to examine these roles and competencies through a deep dive into the contemporary academic and targeted gray literature on future trends in healthcare leadership roles and competencies.

Three electronic databases (Business Source Premier, Medline, and Embase) were searched from January 2018 to February 2023 for peer-reviewed literature on key future trends in leadership roles and competencies. Websites of reputable healthcare- and leadership-focused organizations were also searched. Data were analyzed using descriptive statistics and thematic analysis to explore both the range and depth of literature and the key concepts underlying leadership roles and competencies.

From an initial 348 articles identified in the literature and screened for relevance, 39 articles were included in data synthesis. Future leadership roles and competencies were related to four key themes: innovation and adaptation (e.g., flexibility and vision setting), collaboration and communication (e.g., relationship and trust building), self-development and self-awareness (e.g., experiential learning and self-examination), and consumer and community focus (e.g., public health messaging). In each of these areas, a broad range of strategies and approaches contributed to effective leadership under conditions of growing complexity, and a diverse array of contexts and situations for which these roles and competencies are applicable.

Conclusions

This research highlights the inherent interdependence of leadership requirements and health system complexity. Rather than as sets of roles and competencies, effective healthcare leadership might be better conceptualized as a set of broad goals to pursue that include fostering collaboration amongst stakeholders, building cultures of capacity, and continuously innovating for improved quality of care.

Peer Review reports

Healthcare leadership has grown in scope and importance in response to the increasing complexity of healthcare delivery [ 1 ]. Healthcare systems have become increasingly multifaceted, delivering a vast array of services across multiple levels, from preventative and primary care to acute, specialized care, and long-term care, to address the care needs of a changing population [ 1 ]. As populations age, chronic diseases rise, and the epidemiology and demographics of disease shift, new models of care rapidly emerge to address the ever-expanding spectrum of patient needs [ 2 ]. Advancements in technologies, tests and treatments and personalized medicine come with regulatory and ethical implications, and a growth in workforce specializations [ 3 , 4 ]. Healthcare leaders are navigating evermore complex webs of actors in the system – doctors, nurses, technicians, administrators, insurers, and patients – striving to balance priorities, foster collaboration, and provide strategic direction toward high-quality and safe patient care [ 5 ]. At the same time as running complex services, healthcare leaders need to continually assess, implement, and govern new technologies and services, adhere to the latest regulations and guidelines, operate within the confines of budgetary allocations, and meet growing consumer expectations for affordable and accessible care [ 6 , 7 ].

Competent healthcare leadership is widely considered to be critical for improving patient safety, system performance, and the effectiveness of healthcare teams [ 8 , 9 , 10 ]. Leadership has been identified as a key shaping influence on organizational culture [ 11 ], including workplace commitment to safety [ 12 ], and on preventing workforce burnout [ 13 , 14 ]. The increased need for multidisciplinary and integrated care models has shed growing light on the leadership roles of clinicians, including physicians, nurses, and allied health practitioners [ 15 , 16 , 17 ]. Individuals with both clinical and leadership expertise have been considered vital in complex healthcare landscapes because of their ability to balance administrative needs while prioritizing safety and high-quality care provision [ 18 , 19 , 20 , 21 , 22 ]. For example, physician leaders, through their deep understanding of clinical care and their credibility and influence, have been considered best able to devise strategies that improve patient care amidst stringent financial conditions [ 23 , 24 , 25 , 26 ]. Clinical leaders, particularly physician leaders, might also be of key importance for facilitating the success of collaborative care and care integration [ 27 ].

The formalization of healthcare leadership emerged as the importance of specialized healthcare leadership skills became increasingly needed, recognized and understood [ 1 , 28 , 29 ]. Leadership in healthcare has been conceptualized in several different ways, and a multitude of theories, frameworks, and models have been proposed to explain leadership roles and responsibilities [ 30 , 31 , 32 , 33 ]. For example, the CanMEDS Framework describes the Leader Role of physicians, which is comprised of key and enabling competencies, tasks, and abilities [ 34 , 35 ], and adaptations to this Framework emphasize the varying roles that leadership comprises and the competencies that fulfill them [ 36 ]. Although these frameworks present a good starting point for articulating leadership role scopes and their associated competencies, many fall short in explaining how leaders navigate complex, dynamic, multi-dimensional, and highly variable healthcare systems [ 37 ]. This is becoming increasingly recognized; CanMEDS is due to be updated in 2025 to incorporate competencies related to complexity [ 38 ]. Meanwhile, on the front lines, lack of role clarity and ambiguity about tasks and responsibilities presents a significant barrier for healthcare leaders [ 1 , 15 ]. In complex and unpredictable systems like healthcare, leaders spend substantial time ‘sense-making’, understanding, prioritizing and responding adaptively according to the needs of the situation [ 39 , 40 ]. The latest research on future healthcare trends tells us that increasing complexity associated with digital innovation, healthcare costs, regulatory compliance, sustainability concerns and equitable resource distribution will pose challenges to all actors in health systems [ 41 , 42 , 43 , 44 , 45 ]. In the face of these emerging challenges, it is vital to understand the range and type of roles and competencies that leaders will need to fulfil in the imminent future.

The aim of this scoping review is to examine the literature on the key trends in roles and competencies required for healthcare leaders in the future. We conceptualized ‘competencies’ as the attributes, skills, and abilities that comprise the fulfilment of varying leadership roles, as informed by the CanMEDS Framework [ 34 , 36 ]. Scoping review methodology was utilized to capture a broad range of literature types and identify key themes or groupings of future trends in leadership roles and competencies. Rather than focusing on answering specific questions (as per previous systematic reviews on leadership [ 46 , 47 ]) or developing theory (by utilizing a theoretical review approach to leadership literature [ 48 , 49 ]), we sought to map and identify patterns and trends within the leadership literature [ 50 ]. To investigate trends in leadership roles and competencies, we targeted emerging perspectives from key reputable thought leaders to supplement academic research [ 51 , 52 ].

The conduct and reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [ 53 ].

Search strategy

Comprehensive search strategies were developed, adapting search strategies utilized in a previous systematic review on physician leadership [ 26 ], and receiving input and expertise from two clinical librarians at Macquarie University (see supplementary file 1 for database search strategies). Medline, Embase, and Business Source Premier were searched from January 2018 to February 2023 to enable meaningful inferences to be made about future trends based on current perspectives. To capture key trends, patterns, shifts, and forecast changes to healthcare leadership, the Medline database search was limited to the ‘Trends’ subheading, “ used for the manner in which a subject changes, qualitatively or quantitatively, with time, whether past, present, or future. Includes “forecasting” & “futurology" ” (see supplementary file 1 ) [ 54 ]. For Embase and Business Source Premier, the ‘Trends’ subheading was not available, and instead key search terms were included to capture future trends, including “predict*”, “forecast*”, “shift*” and “transform*”. Efforts were made to locate texts that could not be retrieved, by searching Macquarie University’s digital library records and contacting authors to request the full text.

To complement the database searches, targeted searches of the Faculty of Medical Leadership and Management (FMLM; UK) website and The King’s Fund (UK) website were undertaken to identify emerging perspectives on the future roles and requirements of healthcare leaders. Targeted website searches can aid in uncovering unpublished yet relevant research identified by advocacy organizations or subject specialists, and research potentially missed by database searches [ 52 , 55 ]. Key search terms entered into the websites included ‘future healthcare’, ‘medical leader’, ‘clinical leader’, ‘medical manager’, ‘physician executive’, and ‘education and training’. We included articles that focused on leaders with a clinical background and leaders without a clinical background, to provide a comprehensive overview of leadership roles and requirements of reference to health systems [ 26 ].

Article selection

Database literature search.

References were uploaded into online data management software Rayyan [ 56 ], and duplicate records were identified and removed. Titles and abstracts of results were screened by three team members (SS, EL, RP) according to the inclusion and exclusion criteria (Table  1 ). Articles were included if they focused on future trends in the roles, competencies, attributes, or requirements of healthcare leaders, and if they reported on countries within the Organization for Economic Co-operation and Development (OECD). We limited our search to OECD countries to maximize the generalizability of findings within a developed context and enable meaningful trends to be identified. A subset of the articles was screened by all three team members to ensure that decisions were being made in a standardized manner. After this article subset was screened, the three team members discussed screening decisions, and disagreements were resolved by consensus or through discussion with JB [ 57 ]. During this process, two further exclusion criteria (#4 and #5, Table  1 ) were added to ensure that the screening process adhered to the aim of the current review. We excluded articles that focused on theories and definitions of leadership (e.g., for the purpose of developing educational or professional frameworks) without highlighting trends or changes in roles and competencies for future leadership. We also excluded articles that focused on healthcare interventions in which leaders may have been participants, but their roles or competencies were not the focus. Articles included at title and abstract screening were independently read in full and assessed for eligibility. Disagreements about inclusion were resolved through discussion, with JB available for arbitration if necessary. It was determined at this stage that if articles were conference abstracts in which the full presentation could not be accessed, the article of focus was sought and included in the analysis.

Targeted gray literature search

References were screened according to the inclusion and exclusion criteria (Table  1 ), except that articles only needed to report (rather than focus) on future leadership roles and requirements. This is because we wanted to ensure that our analysis broadly captured the most recent sources of information on healthcare leadership requirements, even if these sources did not focus exclusively on leadership.

Data charting process

Data from all records were appraised and charted simultaneously using a purpose-designed Excel data charting form designed by SS (and subsequently reviewed and endorsed by RP and EL). Multimedia records arising from targeted gray literature searches were listened to and transcribed by RP and checked by SS. Extracted data included article details (authors, year, country, text type), leadership focus (training or educational approaches, styles of leadership), and major and minor themes. Database literature were extracted first to identify and develop themes, and the targeted gray literature were extracted second to extend and embellish those themes.

Synthesis of results

Data from included articles were synthesized according to the Arksey and O’Malley framework for scoping reviews, selected for its detailed guidance on data collation, synthesis, and presentation [ 58 ]. The breadth, range, and type of data were analyzed using descriptive statistics, and underlying groups of leadership roles and competencies were analyzed using thematic analysis. First, the authorship team familiarized themselves with the articles to gain a broad overview of contexts in which leadership was discussed. An inductive approach was used to identify emerging themes of leadership roles and competencies in the database literature, where common concepts were identified, coded, and grouped together to form themes. Team discussion facilitated the final set of themes that were interpreted from the data. During this process, the extracted data were compared to the codes, groups, and resultant themes to examine the degree of consistency between the data and the interpreted findings. Where inconsistencies were identified, suggested changes (e.g., to code labels or groupings) were compared, and the most appropriate changes adopted. Targeted gray literature sources were deductively analyzed according to the identified themes.

Selection of sources of evidence

Figure  1 displays the process of identification and screening of included studies. Database searches yielded 160 records, from which 11 duplicates were removed. The remaining 149 database records were screened by title and abstract, after which a further 114 records were excluded. Of the remaining 35 that were assessed for eligibility, 22 were excluded, and 13 were included in the current review. Targeted gray literature searches yielded an additional 188 records, from which 146 were identified as duplicates and removed. The remaining 42 records were read in full and assessed for eligibility, from which a further 16 were excluded, and 26 were included in the current review. In total, 39 records were retained and synthesized.

PRISMA flowchart displaying the process of identification and selection of included articles

Characteristics of sources of evidence

The characteristics of the included records are displayed in Tables  2 and 3 . Of the database literature, most articles were published in the USA ( n  = 11), and the remaining two articles were published in Canada and Australia. Seven articles were empirical; three studies employed qualitative methods [ 59 , 60 , 61 ], three were quantitative [ 62 , 63 , 64 ], and one mixed methods [ 65 ]. Six articles were non-empirical; three were perspective pieces [ 66 , 67 , 68 ], and three were reports on training or organizational interventions [ 69 , 70 , 71 ]. Of the targeted literature, blog-type articles were most common ( n  = 11) [ 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ], followed by news articles ( n  = 5) [ 83 , 84 , 85 , 86 , 87 ], reports ( n  = 4) [ 88 , 89 , 90 , 91 ], editorials ( n  = 2) [ 92 , 93 ], podcasts ( n  = 2) [ 94 , 95 ], and video and interview transcripts ( n  = 2) [ 96 , 97 ]. As targeted gray sources selected were The King’s Fund website and the FMLM website, the records from these websites were published in the UK.

Leadership roles and competencies

All 13 articles derived from the database searches focused on innovation and adaptation in future leadership. Two empirical articles reported on the ways in which clinical and non-clinical leaders innovated during the COVID-19 pandemic, rapidly designing new models of hospital care [ 61 ] and extending their roles to encompass the implementation of virtual leadership [ 64 ]. Qualitative investigations explored the importance of entrepreneurial leadership for implementing clinical genomics [ 59 ] and key leadership attributes for practice-level innovation and sustainability [ 60 ]. Four articles examined leadership training approaches that build physicians’ capacity to understand, adapt to, and manage change, overcome resistance, and think entrepreneurially [ 62 , 63 , 65 , 70 ]. Two reports described the necessity for healthcare leaders to be able to create a shared vision for an organization; one highlighted the importance of leaders being confident and “self-propelled to intervene” [ 69 ], and one emphasized physician leaders’ credibility as a catalyst for change management among healthcare providers [ 71 ]. The latter report also identified that visible and committed leadership that is sensitive to workplace cultures is critical for the success of change management activities [ 71 ]. Three perspective pieces discussed increasing opportunities for medical and other clinical leaders to create positive change in increasingly complex healthcare landscapes and fulfill the demands of the industry and public [ 66 , 67 , 68 ].

In the targeted gray literature, 19 of 26 records (73%) focused on innovative and adaptive leadership. Records primarily explored adaptive leadership behaviors during COVID-19, such as service redesign, introducing improved flexibility, learning mechanisms, and support platforms [ 73 , 76 , 77 , 97 ], and future innovation to manage climate change impacts [ 81 ], growing inequities [ 89 ], and emerging technologies [ 75 , 83 , 94 , 96 ]. Comfort with change, vision setting, and a desire to innovate were emphasized as key leadership attributes for future healthcare [ 82 , 83 , 88 , 96 ]. Records also explored how to best train and develop leaders for transforming health systems, including the National Health Service (NHS) [ 84 , 90 , 96 ]. New leadership training structures were proposed that foster innovation and adaptability in leaders [ 80 , 90 , 96 ] and encourage flexibility for cross-disciplinary learning.

Collaboration and communication  was a second theme that emerged across all 13 database articles. Three studies explored how collaborative leadership can foster innovation with regards to implementing genomics testing [ 59 ], creating new work models during COVID-19 [ 61 ] and developing new leadership styles via telecommunications [ 64 ]. Six articles focused on the importance of collaborating to build relationships across organisations [ 67 , 68 , 71 ] and within teams [ 65 , 69 , 70 ]. Three articles highlighted that effective communication contributes to organizational success, through fostering psychologically safe cultures [ 60 , 66 ] and generating the trust and rapport necessary for implementing technological innovations [ 71 ]. Two studies examined the impact of leadership training on physicians’ communication competencies [ 62 , 63 ].

In the targeted gray literature, 17 of 26 records (65%) focused on collaboration and communication. Records discussed specific initiatives to improve communication in clinical teams, such as staff surveys, daily huddles, and dedicated days for networking [ 75 , 77 , 80 , 95 ]. Cross-boundary collaboration and collective leadership (e.g., between clinicians and managers) [ 83 ] were advocated as a means to solve challenges [ 81 , 90 ], help build public trust [ 79 , 83 ], and improve quality of care [ 78 , 83 , 85 , 94 ]. Twelve records focused on the importance of team and leadership collaboration to create positive workplace cultures and improve staff wellbeing, through communication strategies such as openness and honesty [ 78 , 80 , 95 ], active listening and empathy [ 73 , 78 , 86 , 88 , 90 ], transparency [ 88 , 94 , 95 ], and inclusivity [ 85 , 94 ]. Three articles emphasized that encouraging staff autonomy, building trust, and demonstrating compassion facilitate better quality care than demanding and punitive leadership actions [ 73 , 74 , 88 ].

Nine of 13 database articles (69%) focused on a third theme, self-development and self-awareness in leadership. Four articles examined approaches to leadership development that incorporated self-development and self-awareness (e.g., personality testing) [ 63 , 65 , 69 , 70 ], with two articles describing these competencies as enablers for the development of other more advanced competencies (e.g., execution) [ 69 , 70 ]. Similar competencies explored included landscape awareness [ 60 ], self-organisation [ 60 ], emotional intelligence [ 64 ], and self-examination, the last of which was described as essential to gain skills beyond clinical roles [ 68 ], facilitate positive perceptions of others [ 66 ], and to remain relevant and effective in a changing healthcare environment [ 67 ]. One article also proposed strategies such as journaling, mindfulness, and feedback to encourage ongoing reflection on leadership decisions and biases [ 67 ].

In the targeted gray literature, seven of 26 records (27%) focused on self-development and self-awareness. Records examinedd the importance of continual personal leadership development, including mentoring and experiential learning, to facilitate understanding of one’s own skills [ 78 , 80 , 97 ]. Tools to facilitate self-reflection in physician leaders were advocated including the FMLM smartphone app [ 92 ] and leadership longitudinal assessments [ 91 ]. Self-care and resilience practices (e.g., meditation, social support) were also advocated for physician leaders as a means to manage “greater levels of stress and responsibility” [ 94 ].

Consumer engagement and advocacy  was a fourth theme and a focus of nine targeted gray literature records (35%). Records discussed patient and community engagement as essential for health system improvement, and examples included involving patients in health service design [ 74 , 77 ], creating channels of ongoing dialogue [ 79 , 83 ] and building stronger health system-community relationships [ 79 , 88 ]. Two records described the importance of public health messaging in improving health literacy [ 83 ] and countering misinformation [ 86 ], and two focused on the role of leaders in advocating for social justice and striving to improve equitable outcomes [ 75 , 93 ].

This scoping review identified 39 key resources that explored future trends in healthcare leadership roles and competencies. These records were derived from a combination of academic and targeted gray literature searches, juxtaposed and synthesized to build understanding of leadership to improve health systems into the future. Four themes of competencies emerged from the findings – innovation and adaptation, communication and collaboration, self-development and self-awareness, and consumer engagement and advocacy.

The competencies of healthcare leaders given the most attention in the literature over the last five years relate to innovation and adaptability . Both the academic and targeted gray literature focused on how leaders, clinical and non-clinical, demonstrated innovativeness and adapted to the demands of COVID-19, including rethinking and redesigning systems to support staff and patients [ 64 , 77 ]. The second focus of the literature on innovation and adaptability was geared toward the development of these capacities in leaders through education and training, as well as through opportunities for leaders to actualize their skills [ 70 , 90 ]. The literature indicated that as the complexity of healthcare is accelerating, leaders must both understand, and have opportunities to demonstrate, innovation amidst dynamic, variable, and demanding environments [ 59 , 60 , 71 ]. This aligns with prior research demonstrating that innovation uptake requires strong change management, and the ability to rapidly assess, understand, and apply innovative changes (e.g., medical technologies) [ 1 , 98 ]. While innovations might improve the system’s ability to deal with complex challenges in the long-term, their implementation can be challenged by a number of moving parts – including workforce changes, new rules and regulations, fluctuating resources and new patient groups – which leaders must consider and appropriately plan for [ 99 , 100 ]. Perhaps an even greater challenge for leaders to overcome when embracing innovation is the tendency for growing complexity to lock the organization into suboptimal conditions (i.e., inertia) [ 101 ]. Building awareness of the interacting components of complex systems and the flexibility required for adaptation and resilience should be a key focus of healthcare leadership education and training [ 102 ].

Competencies associated with communication and collaboration have also been a focus of the healthcare leadership literature. Academic literature dealt primarily with how collaborative structures and behaviors can help leaders innovate and build organizational cultures geared for success [ 59 , 61 , 71 ]. Targeted gray literature focused on how leaders can foster communication within teams, and the positive impacts of an open and accountable culture on staff wellbeing and productivity [ 73 , 74 ]. These findings echo research on resilient health systems emphasizing that ‘over-managing’ restricts the adaptive capacities needed by teams within dynamic healthcare environments [ 100 , 103 ]. The literature pointed to the need for leaders to strengthen communication and collaboration at varying levels – environmental, team, and organizational – to enable more efficient and better-quality healthcare delivery, and during this process they should endeavor to model the balance between autonomy and accountability [ 104 ]. Implementing regular touchpoints that engage multiple stakeholders, such as communities of practice, can help to create positive feedback loops that enable systems change [ 105 ], and overcome organizational barriers to collaboration and information sharing, such as weak relationships and inadequate communication [ 106 , 107 ].

Self-development and self-awareness  also emerged as an important aspect of leadership. Academic literature focused primarily on how these capacities are developed in leaders through structured education and training, including self-assessments and targeted educational modules [ 65 , 69 ]. Targeted gray literature discussed a range of activities outside of structured training (e.g., experiential learning) that can support leaders’ self-reflection and development, for physician leaders in particular to assess their performance and improve their leadership approaches [ 91 , 92 ]. These findings suggest that personal leadership development must go beyond formal curriculum requirements to incorporate everyday learning inputs [ 78 ], and align with other recent literature suggesting that self-regulation in leaders can be fostered through practicing self-discipline, boundary-setting, and managing disruptions, particularly in the digital age [ 108 , 109 ]. Practicing self-awareness can help leaders not only to sense-make in complex systems – to adapt to new situations and make appropriate trade-offs – but also to sense-give – to articulate and express the organization’s vision [ 40 ]. A minor theme, observed only in the targeted gray literature, was related to leaders’ roles and competencies in consumer engagement and advocacy . The importance of increasing consumer engagement in healthcare was emphasized, as well as the structures that are needed to facilitate these changes [ 79 ]. Working alongside consumers was highlighted as critical during times of changing care and need, such as during COVID-19 [ 77 , 86 ]. Although the involvement of consumers and the public in the co-production of care is increasing [ 110 ], there is limited academic literature focused on the roles of leaders in creating optimal environments for co-production. Consumer and community involvement in change efforts helps to improve care processes and outcomes [ 111 ], but leaders might face challenges understanding and operationalizing local engagement mechanisms [ 112 ]. Identifying the organizational and system levers that enable greater consumer involvement, and how leaders can advocate for these levers in their local context, is a fruitful area for future investigation.

The findings of the current review have implications for professional organizations that train healthcare leaders, such as the Australian College of Health Services Management (ACHSM) in Australia, and train clinicians to be leaders, including the UK’s FMLM. Creating a future-focused curriculum addressing the competencies related to the themes identified, in particular innovation and adaptability, is essential to prepare healthcare leaders for growing and changing scopes of responsibility. Such competencies are less amenable to formal theoretical teaching solely and require carefully crafted experiential learning programs in health settings, with supervision by experienced and effective healthcare leaders.

Strengths and limitations

A notable strength of this scoping review was the inclusion of a broad range of sources and perspectives on the future of healthcare leadership. We captured empirical studies, theoretical academic contributions (e.g., commentaries from healthcare leaders), and targeted grey literature, which is often a more useful source of information on emerging topics [ 52 ]. As a result, our findings identified key future trends in the roles and competencies of leaders, both clinical and non-clinical, across a wide range of contexts and situations. Another strength of this review was its specific focus on contemporary literature that examined future trends in leadership, to inform how leaders can prepare for upcoming challenges, rather than focusing on leadership that was effective in the past.

There are limitations to this review. Our search strategies may not have adequately captured other leadership trends applicable across contemporary healthcare settings or those faced by leaders and teams on the front lines of care [ 113 ]. Incorporating search terms related to specific settings, as well as complex systems concepts, may have enabled greater inferences to be made about how unique future challenges require new approaches to the development of healthcare leaders. To scope future-focused research and perspectives, database searches were narrowly restricted, and it is likely that key articles were missed. Targeted gray literature searches represent key thought leaders in healthcare and leadership, and while this enabled relevant information to be efficiently collected, undertaking highly focused searches may have introduced bias associated with geographical area (i.e., the UK) and particular stakeholder groups (e.g., policy-makers) [ 55 ]. Our choice to limit the current review to studies reporting in OECD countries further limited generalizability to other settings including in low-income and middle-income countries (LMICs) [ 1 ].

The roles and competencies of leaders are deeply enmeshed in, and reflective of, a complex and continuously transforming healthcare system. This research highlights the types of roles and competencies important for leaders facing a myriad of challenges, and the range of contexts and situations in which these types of roles and competencies can be applied. The ways in which roles and competencies manifest is highly contextual, dependent on both role responsibilities and the situational demands of healthcare environments.

Data availability

Data supporting these research findings are available upon reasonable request. Further inquiries can be directed to the corresponding author.

Abbreviations

Faculty of Medical Leadership and Management

National Health Service

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews

Royal Australasian College of Medical Administrators

United States of America

United Kingdom

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Acknowledgements

The authors thank Mary Simons and Jeremy Cullis for their specialist guidance on database searches.

This work was funded in part by RACMA. RACMA contributed to the conceptualization and design of the research. JB is funded and supported by an NHMRC Leadership Investigator Award (1176620).

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Spanos, S., Leask, E., Patel, R. et al. Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies. BMC Med Educ 24 , 720 (2024). https://doi.org/10.1186/s12909-024-05689-4

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Rule of Law Enhancement, Innovation Incentives, and Business Performance: Evidence from China’s IPCs

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• Wang Hao 1 ,
• Liu Chengkui 1 ,
• Yu Yue 1 &
• Lin Xiaodan 1  

This study aims to determine the relationship between judicial protection of intellectual property rights (IPRs), innovation, and firm performance. Using the establishment of intellectual property courts (IPCs) by the Chinese government in Beijing, Shanghai, and Guangzhou in 2014 as a quasi-natural experiment, we build a difference in differences model to assess the impact of legal regulation on firm performance from a judicial perspective. The results show that the IPC reform significantly promotes the growth of firm performance, and this incentive effect is realized through the innovation quality mechanism. For different enterprises, the effect of IPC policy is more evident among firms with strong external funding dependence, large enterprise size, large spillover effects, and state ownership. In addition, we calculated sustainability indicators for firms and found that IPCs increased firms’ total factor productivity through quality-based innovation mechanisms. The important contribution of this study is that it fills a research gap in examining the impact of legal regulation on firms from a judicial perspective by identifying the relationship between judicial protection of IPRs, innovation, and business performance. This paper has implications for the promotion of judicial reform in countries with weak IPR systems, for developing countries like China, the judicial protection of IPRs should be increased to provide an institutional environment more conducive to enterprise development.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

According to the Global Innovation Index Report 2021 released by the World Intellectual Property Organization (WIPO), China ranks 12th in the world in terms of the innovation index and has achieved a steady increase in innovation performance for nine consecutive years beginning in 2013, with the number of patents and trademark applications at the world’s leading level.

Abdallah, A. B., & Al-Ghwayeen, W. S. (2020). Green supply chain management and business performance: The mediating roles of environmental and operational performances. Business Process Management Journal, 26 (2), 489–512. https://doi.org/10.1108/BPMJ-03-2018-0091

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Hao, W., Chengkui, L., Yue, Y. et al. Rule of Law Enhancement, Innovation Incentives, and Business Performance: Evidence from China’s IPCs. J Knowl Econ (2024). https://doi.org/10.1007/s13132-024-02195-2

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Evaluating the spatial heterogeneity and driving factors of sustainable development level in chengdu with point of interest data and geographic detector model.

1. Introduction

2. literature review, 2.1. spatial and temporal evolution of urban land function, 2.2. functional division of land based on administrative space and its defects, 3. methodology, 3.1. case study, 3.2. methods, 3.2.1. evaluation index system of urban sustainable development, 3.2.2. entropy weight method, 3.2.3. k-means algorithm and urban edge identification, 3.2.4. poi and urban functional area division, 3.2.5. geodetector model and driving forces analysis, 4. results and discussion, 4.1. spatial-temporal patterns of urban sustainable development, 4.1.1. temporal perspective analysis, 4.1.2. spatial perspective analysis, 4.1.3. spatiotemporal perspective analysis, 4.2. urban edge identification and urban expansion trend, 4.2.1. threshold determination for urban night light data based on the k-means algorithm, 4.2.2. identification of urban boundaries based on night light data, 4.2.3. urban expansion trend analysis based on land data, 4.3. poi and identification of urban functional zones, 4.4. driving factor analysis, 5. discussion, 6. conclusions, author contributions, data availability statement, conflicts of interest.

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Ling, Y.; Zhao, Y.; Ren, Q.; Qiu, Y.; Zhang, Y.; Zhai, K. Evaluating the Spatial Heterogeneity and Driving Factors of Sustainable Development Level in Chengdu with Point of Interest Data and Geographic Detector Model. Land 2024 , 13 , 1018. https://doi.org/10.3390/land13071018

Ling Y, Zhao Y, Ren Q, Qiu Y, Zhang Y, Zhai K. Evaluating the Spatial Heterogeneity and Driving Factors of Sustainable Development Level in Chengdu with Point of Interest Data and Geographic Detector Model. Land . 2024; 13(7):1018. https://doi.org/10.3390/land13071018

Ling, Yantao, Yilang Zhao, Qingzhong Ren, Yue Qiu, Yuerong Zhang, and Keyu Zhai. 2024. "Evaluating the Spatial Heterogeneity and Driving Factors of Sustainable Development Level in Chengdu with Point of Interest Data and Geographic Detector Model" Land 13, no. 7: 1018. https://doi.org/10.3390/land13071018

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