Identifies problem (in general and within the local context)
The EBPQI critical appraisal tool has important educational and practice implications. Educators have voiced challenges with teaching critical appraisal of evidence to students at entry and advanced nursing levels. Specifically, faculty frequently struggle to garner access to tools for appraising other types of evidence outside of research for student use, as some are proprietary. Positioned upstream to the health care system, educators must be prepared to guide students in critically appraising research and other evidence before entering the health care arena where patient care occurs.
Faculty development is also needed to prepare educators to optimally teach research, EBP, and QI and the differences and interrelatedness of these processes. 18 The Mountain Model maps to all 10 American Association of Colleges of Nursing New Essentials domains and offers a meaningful approach to faculty development and project oversight at prelicensure and advanced levels. 19 , 20
While not generalizable, findings from EBPQI initiatives may be transferable to other institutions, which may help close costly evidence-to-practice gaps. In a survey of over 2300 nurses, Melnyk and colleagues 21 found that nurses felt they were not competent in critical appraisal of evidence/published research. The newly developed EBPQI critical appraisal tool can provide needed guidance to nurses who may be unfamiliar with or unconfident in critically appraising evidence.
Indeed, many articles that directly relate to a nurse’s daily practice are EBPQI rather than formal research; as such, there is a need for a strong critical appraisal tool for this type of evidence. Critical appraisal tools and checklists are meant to assist nurses in identifying the presence of key components of a research study, or as in this case an EBPQI initiative, which if absent could jeopardize the success of the initiative. This is different from surveys or questionnaires that measure a concept or construct; therefore, expert and face validity are the primary concerns. Having access to a free, easy-to-use checklist-style tool may allow students and nurses the confidence and ability to formally appraise EBPQI, which can, in turn, help their own EBPQI initiatives to be completed with more rigor.
In an often fragmented and overburdened health care system, other types of evidence, in addition to research, hold promise to improve outcomes. While not generalizable to other settings, well-designed EBPQI initiatives may produce valuable findings that can be adapted appropriately to other settings and populations. The tool introduced in this article was designed to be accessible to health care teams and nursing students. Using a comprehensive critical appraisal tool to evaluate EBPQI initiatives provides greater confidence that the resulting recommendations are credible.
critical appraisal tool; evidence-based practice; evidence-based practice quality improvement; quality improvement
Optimizing quality improvement methods in practice: a case study approach, nurse-driven process for the successful removal of urinary catheters among..., innovation, quality improvement, research, and evidence-based practice..., use of elastomeric half-mask respirator in the clinical care environment:....
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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
Chapter 9 methods for literature reviews.
Guy Paré and Spyros Kitsiou .
Literature reviews play a critical role in scholarship because science remains, first and foremost, a cumulative endeavour ( vom Brocke et al., 2009 ). As in any academic discipline, rigorous knowledge syntheses are becoming indispensable in keeping up with an exponentially growing eHealth literature, assisting practitioners, academics, and graduate students in finding, evaluating, and synthesizing the contents of many empirical and conceptual papers. Among other methods, literature reviews are essential for: (a) identifying what has been written on a subject or topic; (b) determining the extent to which a specific research area reveals any interpretable trends or patterns; (c) aggregating empirical findings related to a narrow research question to support evidence-based practice; (d) generating new frameworks and theories; and (e) identifying topics or questions requiring more investigation ( Paré, Trudel, Jaana, & Kitsiou, 2015 ).
Literature reviews can take two major forms. The most prevalent one is the “literature review” or “background” section within a journal paper or a chapter in a graduate thesis. This section synthesizes the extant literature and usually identifies the gaps in knowledge that the empirical study addresses ( Sylvester, Tate, & Johnstone, 2013 ). It may also provide a theoretical foundation for the proposed study, substantiate the presence of the research problem, justify the research as one that contributes something new to the cumulated knowledge, or validate the methods and approaches for the proposed study ( Hart, 1998 ; Levy & Ellis, 2006 ).
The second form of literature review, which is the focus of this chapter, constitutes an original and valuable work of research in and of itself ( Paré et al., 2015 ). Rather than providing a base for a researcher’s own work, it creates a solid starting point for all members of the community interested in a particular area or topic ( Mulrow, 1987 ). The so-called “review article” is a journal-length paper which has an overarching purpose to synthesize the literature in a field, without collecting or analyzing any primary data ( Green, Johnson, & Adams, 2006 ).
When appropriately conducted, review articles represent powerful information sources for practitioners looking for state-of-the art evidence to guide their decision-making and work practices ( Paré et al., 2015 ). Further, high-quality reviews become frequently cited pieces of work which researchers seek out as a first clear outline of the literature when undertaking empirical studies ( Cooper, 1988 ; Rowe, 2014 ). Scholars who track and gauge the impact of articles have found that review papers are cited and downloaded more often than any other type of published article ( Cronin, Ryan, & Coughlan, 2008 ; Montori, Wilczynski, Morgan, Haynes, & Hedges, 2003 ; Patsopoulos, Analatos, & Ioannidis, 2005 ). The reason for their popularity may be the fact that reading the review enables one to have an overview, if not a detailed knowledge of the area in question, as well as references to the most useful primary sources ( Cronin et al., 2008 ). Although they are not easy to conduct, the commitment to complete a review article provides a tremendous service to one’s academic community ( Paré et al., 2015 ; Petticrew & Roberts, 2006 ). Most, if not all, peer-reviewed journals in the fields of medical informatics publish review articles of some type.
The main objectives of this chapter are fourfold: (a) to provide an overview of the major steps and activities involved in conducting a stand-alone literature review; (b) to describe and contrast the different types of review articles that can contribute to the eHealth knowledge base; (c) to illustrate each review type with one or two examples from the eHealth literature; and (d) to provide a series of recommendations for prospective authors of review articles in this domain.
As explained in Templier and Paré (2015) , there are six generic steps involved in conducting a review article:
Although these steps are presented here in sequential order, one must keep in mind that the review process can be iterative and that many activities can be initiated during the planning stage and later refined during subsequent phases ( Finfgeld-Connett & Johnson, 2013 ; Kitchenham & Charters, 2007 ).
Formulating the research question(s) and objective(s): As a first step, members of the review team must appropriately justify the need for the review itself ( Petticrew & Roberts, 2006 ), identify the review’s main objective(s) ( Okoli & Schabram, 2010 ), and define the concepts or variables at the heart of their synthesis ( Cooper & Hedges, 2009 ; Webster & Watson, 2002 ). Importantly, they also need to articulate the research question(s) they propose to investigate ( Kitchenham & Charters, 2007 ). In this regard, we concur with Jesson, Matheson, and Lacey (2011) that clearly articulated research questions are key ingredients that guide the entire review methodology; they underscore the type of information that is needed, inform the search for and selection of relevant literature, and guide or orient the subsequent analysis. Searching the extant literature: The next step consists of searching the literature and making decisions about the suitability of material to be considered in the review ( Cooper, 1988 ). There exist three main coverage strategies. First, exhaustive coverage means an effort is made to be as comprehensive as possible in order to ensure that all relevant studies, published and unpublished, are included in the review and, thus, conclusions are based on this all-inclusive knowledge base. The second type of coverage consists of presenting materials that are representative of most other works in a given field or area. Often authors who adopt this strategy will search for relevant articles in a small number of top-tier journals in a field ( Paré et al., 2015 ). In the third strategy, the review team concentrates on prior works that have been central or pivotal to a particular topic. This may include empirical studies or conceptual papers that initiated a line of investigation, changed how problems or questions were framed, introduced new methods or concepts, or engendered important debate ( Cooper, 1988 ). Screening for inclusion: The following step consists of evaluating the applicability of the material identified in the preceding step ( Levy & Ellis, 2006 ; vom Brocke et al., 2009 ). Once a group of potential studies has been identified, members of the review team must screen them to determine their relevance ( Petticrew & Roberts, 2006 ). A set of predetermined rules provides a basis for including or excluding certain studies. This exercise requires a significant investment on the part of researchers, who must ensure enhanced objectivity and avoid biases or mistakes. As discussed later in this chapter, for certain types of reviews there must be at least two independent reviewers involved in the screening process and a procedure to resolve disagreements must also be in place ( Liberati et al., 2009 ; Shea et al., 2009 ). Assessing the quality of primary studies: In addition to screening material for inclusion, members of the review team may need to assess the scientific quality of the selected studies, that is, appraise the rigour of the research design and methods. Such formal assessment, which is usually conducted independently by at least two coders, helps members of the review team refine which studies to include in the final sample, determine whether or not the differences in quality may affect their conclusions, or guide how they analyze the data and interpret the findings ( Petticrew & Roberts, 2006 ). Ascribing quality scores to each primary study or considering through domain-based evaluations which study components have or have not been designed and executed appropriately makes it possible to reflect on the extent to which the selected study addresses possible biases and maximizes validity ( Shea et al., 2009 ). Extracting data: The following step involves gathering or extracting applicable information from each primary study included in the sample and deciding what is relevant to the problem of interest ( Cooper & Hedges, 2009 ). Indeed, the type of data that should be recorded mainly depends on the initial research questions ( Okoli & Schabram, 2010 ). However, important information may also be gathered about how, when, where and by whom the primary study was conducted, the research design and methods, or qualitative/quantitative results ( Cooper & Hedges, 2009 ). Analyzing and synthesizing data : As a final step, members of the review team must collate, summarize, aggregate, organize, and compare the evidence extracted from the included studies. The extracted data must be presented in a meaningful way that suggests a new contribution to the extant literature ( Jesson et al., 2011 ). Webster and Watson (2002) warn researchers that literature reviews should be much more than lists of papers and should provide a coherent lens to make sense of extant knowledge on a given topic. There exist several methods and techniques for synthesizing quantitative (e.g., frequency analysis, meta-analysis) and qualitative (e.g., grounded theory, narrative analysis, meta-ethnography) evidence ( Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005 ; Thomas & Harden, 2008 ).
EHealth researchers have at their disposal a number of approaches and methods for making sense out of existing literature, all with the purpose of casting current research findings into historical contexts or explaining contradictions that might exist among a set of primary research studies conducted on a particular topic. Our classification scheme is largely inspired from Paré and colleagues’ (2015) typology. Below we present and illustrate those review types that we feel are central to the growth and development of the eHealth domain.
The narrative review is the “traditional” way of reviewing the extant literature and is skewed towards a qualitative interpretation of prior knowledge ( Sylvester et al., 2013 ). Put simply, a narrative review attempts to summarize or synthesize what has been written on a particular topic but does not seek generalization or cumulative knowledge from what is reviewed ( Davies, 2000 ; Green et al., 2006 ). Instead, the review team often undertakes the task of accumulating and synthesizing the literature to demonstrate the value of a particular point of view ( Baumeister & Leary, 1997 ). As such, reviewers may selectively ignore or limit the attention paid to certain studies in order to make a point. In this rather unsystematic approach, the selection of information from primary articles is subjective, lacks explicit criteria for inclusion and can lead to biased interpretations or inferences ( Green et al., 2006 ). There are several narrative reviews in the particular eHealth domain, as in all fields, which follow such an unstructured approach ( Silva et al., 2015 ; Paul et al., 2015 ).
Despite these criticisms, this type of review can be very useful in gathering together a volume of literature in a specific subject area and synthesizing it. As mentioned above, its primary purpose is to provide the reader with a comprehensive background for understanding current knowledge and highlighting the significance of new research ( Cronin et al., 2008 ). Faculty like to use narrative reviews in the classroom because they are often more up to date than textbooks, provide a single source for students to reference, and expose students to peer-reviewed literature ( Green et al., 2006 ). For researchers, narrative reviews can inspire research ideas by identifying gaps or inconsistencies in a body of knowledge, thus helping researchers to determine research questions or formulate hypotheses. Importantly, narrative reviews can also be used as educational articles to bring practitioners up to date with certain topics of issues ( Green et al., 2006 ).
Recently, there have been several efforts to introduce more rigour in narrative reviews that will elucidate common pitfalls and bring changes into their publication standards. Information systems researchers, among others, have contributed to advancing knowledge on how to structure a “traditional” review. For instance, Levy and Ellis (2006) proposed a generic framework for conducting such reviews. Their model follows the systematic data processing approach comprised of three steps, namely: (a) literature search and screening; (b) data extraction and analysis; and (c) writing the literature review. They provide detailed and very helpful instructions on how to conduct each step of the review process. As another methodological contribution, vom Brocke et al. (2009) offered a series of guidelines for conducting literature reviews, with a particular focus on how to search and extract the relevant body of knowledge. Last, Bandara, Miskon, and Fielt (2011) proposed a structured, predefined and tool-supported method to identify primary studies within a feasible scope, extract relevant content from identified articles, synthesize and analyze the findings, and effectively write and present the results of the literature review. We highly recommend that prospective authors of narrative reviews consult these useful sources before embarking on their work.
Darlow and Wen (2015) provide a good example of a highly structured narrative review in the eHealth field. These authors synthesized published articles that describe the development process of mobile health ( m-health ) interventions for patients’ cancer care self-management. As in most narrative reviews, the scope of the research questions being investigated is broad: (a) how development of these systems are carried out; (b) which methods are used to investigate these systems; and (c) what conclusions can be drawn as a result of the development of these systems. To provide clear answers to these questions, a literature search was conducted on six electronic databases and Google Scholar . The search was performed using several terms and free text words, combining them in an appropriate manner. Four inclusion and three exclusion criteria were utilized during the screening process. Both authors independently reviewed each of the identified articles to determine eligibility and extract study information. A flow diagram shows the number of studies identified, screened, and included or excluded at each stage of study selection. In terms of contributions, this review provides a series of practical recommendations for m-health intervention development.
The primary goal of a descriptive review is to determine the extent to which a body of knowledge in a particular research topic reveals any interpretable pattern or trend with respect to pre-existing propositions, theories, methodologies or findings ( King & He, 2005 ; Paré et al., 2015 ). In contrast with narrative reviews, descriptive reviews follow a systematic and transparent procedure, including searching, screening and classifying studies ( Petersen, Vakkalanka, & Kuzniarz, 2015 ). Indeed, structured search methods are used to form a representative sample of a larger group of published works ( Paré et al., 2015 ). Further, authors of descriptive reviews extract from each study certain characteristics of interest, such as publication year, research methods, data collection techniques, and direction or strength of research outcomes (e.g., positive, negative, or non-significant) in the form of frequency analysis to produce quantitative results ( Sylvester et al., 2013 ). In essence, each study included in a descriptive review is treated as the unit of analysis and the published literature as a whole provides a database from which the authors attempt to identify any interpretable trends or draw overall conclusions about the merits of existing conceptualizations, propositions, methods or findings ( Paré et al., 2015 ). In doing so, a descriptive review may claim that its findings represent the state of the art in a particular domain ( King & He, 2005 ).
In the fields of health sciences and medical informatics, reviews that focus on examining the range, nature and evolution of a topic area are described by Anderson, Allen, Peckham, and Goodwin (2008) as mapping reviews . Like descriptive reviews, the research questions are generic and usually relate to publication patterns and trends. There is no preconceived plan to systematically review all of the literature although this can be done. Instead, researchers often present studies that are representative of most works published in a particular area and they consider a specific time frame to be mapped.
An example of this approach in the eHealth domain is offered by DeShazo, Lavallie, and Wolf (2009). The purpose of this descriptive or mapping review was to characterize publication trends in the medical informatics literature over a 20-year period (1987 to 2006). To achieve this ambitious objective, the authors performed a bibliometric analysis of medical informatics citations indexed in medline using publication trends, journal frequencies, impact factors, Medical Subject Headings (MeSH) term frequencies, and characteristics of citations. Findings revealed that there were over 77,000 medical informatics articles published during the covered period in numerous journals and that the average annual growth rate was 12%. The MeSH term analysis also suggested a strong interdisciplinary trend. Finally, average impact scores increased over time with two notable growth periods. Overall, patterns in research outputs that seem to characterize the historic trends and current components of the field of medical informatics suggest it may be a maturing discipline (DeShazo et al., 2009).
Scoping reviews attempt to provide an initial indication of the potential size and nature of the extant literature on an emergent topic (Arksey & O’Malley, 2005; Daudt, van Mossel, & Scott, 2013 ; Levac, Colquhoun, & O’Brien, 2010). A scoping review may be conducted to examine the extent, range and nature of research activities in a particular area, determine the value of undertaking a full systematic review (discussed next), or identify research gaps in the extant literature ( Paré et al., 2015 ). In line with their main objective, scoping reviews usually conclude with the presentation of a detailed research agenda for future works along with potential implications for both practice and research.
Unlike narrative and descriptive reviews, the whole point of scoping the field is to be as comprehensive as possible, including grey literature (Arksey & O’Malley, 2005). Inclusion and exclusion criteria must be established to help researchers eliminate studies that are not aligned with the research questions. It is also recommended that at least two independent coders review abstracts yielded from the search strategy and then the full articles for study selection ( Daudt et al., 2013 ). The synthesized evidence from content or thematic analysis is relatively easy to present in tabular form (Arksey & O’Malley, 2005; Thomas & Harden, 2008 ).
One of the most highly cited scoping reviews in the eHealth domain was published by Archer, Fevrier-Thomas, Lokker, McKibbon, and Straus (2011) . These authors reviewed the existing literature on personal health record ( phr ) systems including design, functionality, implementation, applications, outcomes, and benefits. Seven databases were searched from 1985 to March 2010. Several search terms relating to phr s were used during this process. Two authors independently screened titles and abstracts to determine inclusion status. A second screen of full-text articles, again by two independent members of the research team, ensured that the studies described phr s. All in all, 130 articles met the criteria and their data were extracted manually into a database. The authors concluded that although there is a large amount of survey, observational, cohort/panel, and anecdotal evidence of phr benefits and satisfaction for patients, more research is needed to evaluate the results of phr implementations. Their in-depth analysis of the literature signalled that there is little solid evidence from randomized controlled trials or other studies through the use of phr s. Hence, they suggested that more research is needed that addresses the current lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting patient self-management ( Archer et al., 2011 ).
Healthcare providers, practitioners, and policy-makers are nowadays overwhelmed with large volumes of information, including research-based evidence from numerous clinical trials and evaluation studies, assessing the effectiveness of health information technologies and interventions ( Ammenwerth & de Keizer, 2004 ; Deshazo et al., 2009 ). It is unrealistic to expect that all these disparate actors will have the time, skills, and necessary resources to identify the available evidence in the area of their expertise and consider it when making decisions. Systematic reviews that involve the rigorous application of scientific strategies aimed at limiting subjectivity and bias (i.e., systematic and random errors) can respond to this challenge.
Systematic reviews attempt to aggregate, appraise, and synthesize in a single source all empirical evidence that meet a set of previously specified eligibility criteria in order to answer a clearly formulated and often narrow research question on a particular topic of interest to support evidence-based practice ( Liberati et al., 2009 ). They adhere closely to explicit scientific principles ( Liberati et al., 2009 ) and rigorous methodological guidelines (Higgins & Green, 2008) aimed at reducing random and systematic errors that can lead to deviations from the truth in results or inferences. The use of explicit methods allows systematic reviews to aggregate a large body of research evidence, assess whether effects or relationships are in the same direction and of the same general magnitude, explain possible inconsistencies between study results, and determine the strength of the overall evidence for every outcome of interest based on the quality of included studies and the general consistency among them ( Cook, Mulrow, & Haynes, 1997 ). The main procedures of a systematic review involve:
Many systematic reviews, but not all, use statistical methods to combine the results of independent studies into a single quantitative estimate or summary effect size. Known as meta-analyses , these reviews use specific data extraction and statistical techniques (e.g., network, frequentist, or Bayesian meta-analyses) to calculate from each study by outcome of interest an effect size along with a confidence interval that reflects the degree of uncertainty behind the point estimate of effect ( Borenstein, Hedges, Higgins, & Rothstein, 2009 ; Deeks, Higgins, & Altman, 2008 ). Subsequently, they use fixed or random-effects analysis models to combine the results of the included studies, assess statistical heterogeneity, and calculate a weighted average of the effect estimates from the different studies, taking into account their sample sizes. The summary effect size is a value that reflects the average magnitude of the intervention effect for a particular outcome of interest or, more generally, the strength of a relationship between two variables across all studies included in the systematic review. By statistically combining data from multiple studies, meta-analyses can create more precise and reliable estimates of intervention effects than those derived from individual studies alone, when these are examined independently as discrete sources of information.
The review by Gurol-Urganci, de Jongh, Vodopivec-Jamsek, Atun, and Car (2013) on the effects of mobile phone messaging reminders for attendance at healthcare appointments is an illustrative example of a high-quality systematic review with meta-analysis. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs to health systems. These authors sought to assess whether mobile phone-based appointment reminders delivered through Short Message Service ( sms ) or Multimedia Messaging Service ( mms ) are effective in improving rates of patient attendance and reducing overall costs. To this end, they conducted a comprehensive search on multiple databases using highly sensitive search strategies without language or publication-type restrictions to identify all rct s that are eligible for inclusion. In order to minimize the risk of omitting eligible studies not captured by the original search, they supplemented all electronic searches with manual screening of trial registers and references contained in the included studies. Study selection, data extraction, and risk of bias assessments were performed independently by two coders using standardized methods to ensure consistency and to eliminate potential errors. Findings from eight rct s involving 6,615 participants were pooled into meta-analyses to calculate the magnitude of effects that mobile text message reminders have on the rate of attendance at healthcare appointments compared to no reminders and phone call reminders.
Meta-analyses are regarded as powerful tools for deriving meaningful conclusions. However, there are situations in which it is neither reasonable nor appropriate to pool studies together using meta-analytic methods simply because there is extensive clinical heterogeneity between the included studies or variation in measurement tools, comparisons, or outcomes of interest. In these cases, systematic reviews can use qualitative synthesis methods such as vote counting, content analysis, classification schemes and tabulations, as an alternative approach to narratively synthesize the results of the independent studies included in the review. This form of review is known as qualitative systematic review.
A rigorous example of one such review in the eHealth domain is presented by Mickan, Atherton, Roberts, Heneghan, and Tilson (2014) on the use of handheld computers by healthcare professionals and their impact on access to information and clinical decision-making. In line with the methodological guidelines for systematic reviews, these authors: (a) developed and registered with prospero ( www.crd.york.ac.uk/ prospero / ) an a priori review protocol; (b) conducted comprehensive searches for eligible studies using multiple databases and other supplementary strategies (e.g., forward searches); and (c) subsequently carried out study selection, data extraction, and risk of bias assessments in a duplicate manner to eliminate potential errors in the review process. Heterogeneity between the included studies in terms of reported outcomes and measures precluded the use of meta-analytic methods. To this end, the authors resorted to using narrative analysis and synthesis to describe the effectiveness of handheld computers on accessing information for clinical knowledge, adherence to safety and clinical quality guidelines, and diagnostic decision-making.
In recent years, the number of systematic reviews in the field of health informatics has increased considerably. Systematic reviews with discordant findings can cause great confusion and make it difficult for decision-makers to interpret the review-level evidence ( Moher, 2013 ). Therefore, there is a growing need for appraisal and synthesis of prior systematic reviews to ensure that decision-making is constantly informed by the best available accumulated evidence. Umbrella reviews , also known as overviews of systematic reviews, are tertiary types of evidence synthesis that aim to accomplish this; that is, they aim to compare and contrast findings from multiple systematic reviews and meta-analyses ( Becker & Oxman, 2008 ). Umbrella reviews generally adhere to the same principles and rigorous methodological guidelines used in systematic reviews. However, the unit of analysis in umbrella reviews is the systematic review rather than the primary study ( Becker & Oxman, 2008 ). Unlike systematic reviews that have a narrow focus of inquiry, umbrella reviews focus on broader research topics for which there are several potential interventions ( Smith, Devane, Begley, & Clarke, 2011 ). A recent umbrella review on the effects of home telemonitoring interventions for patients with heart failure critically appraised, compared, and synthesized evidence from 15 systematic reviews to investigate which types of home telemonitoring technologies and forms of interventions are more effective in reducing mortality and hospital admissions ( Kitsiou, Paré, & Jaana, 2015 ).
Realist reviews are theory-driven interpretative reviews developed to inform, enhance, or supplement conventional systematic reviews by making sense of heterogeneous evidence about complex interventions applied in diverse contexts in a way that informs policy decision-making ( Greenhalgh, Wong, Westhorp, & Pawson, 2011 ). They originated from criticisms of positivist systematic reviews which centre on their “simplistic” underlying assumptions ( Oates, 2011 ). As explained above, systematic reviews seek to identify causation. Such logic is appropriate for fields like medicine and education where findings of randomized controlled trials can be aggregated to see whether a new treatment or intervention does improve outcomes. However, many argue that it is not possible to establish such direct causal links between interventions and outcomes in fields such as social policy, management, and information systems where for any intervention there is unlikely to be a regular or consistent outcome ( Oates, 2011 ; Pawson, 2006 ; Rousseau, Manning, & Denyer, 2008 ).
To circumvent these limitations, Pawson, Greenhalgh, Harvey, and Walshe (2005) have proposed a new approach for synthesizing knowledge that seeks to unpack the mechanism of how “complex interventions” work in particular contexts. The basic research question — what works? — which is usually associated with systematic reviews changes to: what is it about this intervention that works, for whom, in what circumstances, in what respects and why? Realist reviews have no particular preference for either quantitative or qualitative evidence. As a theory-building approach, a realist review usually starts by articulating likely underlying mechanisms and then scrutinizes available evidence to find out whether and where these mechanisms are applicable ( Shepperd et al., 2009 ). Primary studies found in the extant literature are viewed as case studies which can test and modify the initial theories ( Rousseau et al., 2008 ).
The main objective pursued in the realist review conducted by Otte-Trojel, de Bont, Rundall, and van de Klundert (2014) was to examine how patient portals contribute to health service delivery and patient outcomes. The specific goals were to investigate how outcomes are produced and, most importantly, how variations in outcomes can be explained. The research team started with an exploratory review of background documents and research studies to identify ways in which patient portals may contribute to health service delivery and patient outcomes. The authors identified six main ways which represent “educated guesses” to be tested against the data in the evaluation studies. These studies were identified through a formal and systematic search in four databases between 2003 and 2013. Two members of the research team selected the articles using a pre-established list of inclusion and exclusion criteria and following a two-step procedure. The authors then extracted data from the selected articles and created several tables, one for each outcome category. They organized information to bring forward those mechanisms where patient portals contribute to outcomes and the variation in outcomes across different contexts.
Lastly, critical reviews aim to provide a critical evaluation and interpretive analysis of existing literature on a particular topic of interest to reveal strengths, weaknesses, contradictions, controversies, inconsistencies, and/or other important issues with respect to theories, hypotheses, research methods or results ( Baumeister & Leary, 1997 ; Kirkevold, 1997 ). Unlike other review types, critical reviews attempt to take a reflective account of the research that has been done in a particular area of interest, and assess its credibility by using appraisal instruments or critical interpretive methods. In this way, critical reviews attempt to constructively inform other scholars about the weaknesses of prior research and strengthen knowledge development by giving focus and direction to studies for further improvement ( Kirkevold, 1997 ).
Kitsiou, Paré, and Jaana (2013) provide an example of a critical review that assessed the methodological quality of prior systematic reviews of home telemonitoring studies for chronic patients. The authors conducted a comprehensive search on multiple databases to identify eligible reviews and subsequently used a validated instrument to conduct an in-depth quality appraisal. Results indicate that the majority of systematic reviews in this particular area suffer from important methodological flaws and biases that impair their internal validity and limit their usefulness for clinical and decision-making purposes. To this end, they provide a number of recommendations to strengthen knowledge development towards improving the design and execution of future reviews on home telemonitoring.
Table 9.1 outlines the main types of literature reviews that were described in the previous sub-sections and summarizes the main characteristics that distinguish one review type from another. It also includes key references to methodological guidelines and useful sources that can be used by eHealth scholars and researchers for planning and developing reviews.
Typology of Literature Reviews (adapted from Paré et al., 2015).
As shown in Table 9.1 , each review type addresses different kinds of research questions or objectives, which subsequently define and dictate the methods and approaches that need to be used to achieve the overarching goal(s) of the review. For example, in the case of narrative reviews, there is greater flexibility in searching and synthesizing articles ( Green et al., 2006 ). Researchers are often relatively free to use a diversity of approaches to search, identify, and select relevant scientific articles, describe their operational characteristics, present how the individual studies fit together, and formulate conclusions. On the other hand, systematic reviews are characterized by their high level of systematicity, rigour, and use of explicit methods, based on an “a priori” review plan that aims to minimize bias in the analysis and synthesis process (Higgins & Green, 2008). Some reviews are exploratory in nature (e.g., scoping/mapping reviews), whereas others may be conducted to discover patterns (e.g., descriptive reviews) or involve a synthesis approach that may include the critical analysis of prior research ( Paré et al., 2015 ). Hence, in order to select the most appropriate type of review, it is critical to know before embarking on a review project, why the research synthesis is conducted and what type of methods are best aligned with the pursued goals.
In light of the increased use of evidence-based practice and research generating stronger evidence ( Grady et al., 2011 ; Lyden et al., 2013 ), review articles have become essential tools for summarizing, synthesizing, integrating or critically appraising prior knowledge in the eHealth field. As mentioned earlier, when rigorously conducted review articles represent powerful information sources for eHealth scholars and practitioners looking for state-of-the-art evidence. The typology of literature reviews we used herein will allow eHealth researchers, graduate students and practitioners to gain a better understanding of the similarities and differences between review types.
We must stress that this classification scheme does not privilege any specific type of review as being of higher quality than another ( Paré et al., 2015 ). As explained above, each type of review has its own strengths and limitations. Having said that, we realize that the methodological rigour of any review — be it qualitative, quantitative or mixed — is a critical aspect that should be considered seriously by prospective authors. In the present context, the notion of rigour refers to the reliability and validity of the review process described in section 9.2. For one thing, reliability is related to the reproducibility of the review process and steps, which is facilitated by a comprehensive documentation of the literature search process, extraction, coding and analysis performed in the review. Whether the search is comprehensive or not, whether it involves a methodical approach for data extraction and synthesis or not, it is important that the review documents in an explicit and transparent manner the steps and approach that were used in the process of its development. Next, validity characterizes the degree to which the review process was conducted appropriately. It goes beyond documentation and reflects decisions related to the selection of the sources, the search terms used, the period of time covered, the articles selected in the search, and the application of backward and forward searches ( vom Brocke et al., 2009 ). In short, the rigour of any review article is reflected by the explicitness of its methods (i.e., transparency) and the soundness of the approach used. We refer those interested in the concepts of rigour and quality to the work of Templier and Paré (2015) which offers a detailed set of methodological guidelines for conducting and evaluating various types of review articles.
To conclude, our main objective in this chapter was to demystify the various types of literature reviews that are central to the continuous development of the eHealth field. It is our hope that our descriptive account will serve as a valuable source for those conducting, evaluating or using reviews in this important and growing domain.
This publication is licensed under a Creative Commons License, Attribution-Noncommercial 4.0 International License (CC BY-NC 4.0): see https://creativecommons.org/licenses/by-nc/4.0/
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Accessibility of entrepreneurship training programs for individuals with disabilities: a literature review.
2. methodology, 2.1. eligibility criteria, 2.2. information sources and search strategy, 2.3. selection process and quality assessment, 2.4. synthesis methods, 3.1. limited access to quality education, 3.2. challenges in tailoring entrepreneurship education, 3.3. strategy to overcome barriers and application to entrepreneurship training programs.
3.5. the shift toward active, learner-centred methodologies, 3.6. use of information technology, 3.7. supportive communities, 4. limitations of this study, 5. further research, 6. conclusions, author contributions, institutional review board statement, data availability statement, conflicts of interest.
Author (Year) | Title | Methodology | Location | Pertinent Findings |
---|---|---|---|---|
( ) | Role of essence, objectives, and content of entrepreneurship education programs on their performance: Moderating role of learner disability in Thailand | Quantitative | Thailand | The study explores how entrepreneurship education programs’ core objectives and content impact their performance, particularly when considering the moderating role of learners’ disability. It emphasizes the importance of tailoring educational content to meet the unique needs of learners with disabilities. |
( ) | Entrepreneurship education and the moderating role of inclusion in the entrepreneurial action of disabled students | Quantitative | North-Central Nigeria | The study investigated the influence of inclusive entrepreneurship education on the entrepreneurial actions of disabled students. It found a positive correlation between inclusive educational practices and entrepreneurial initiatives among students with disabilities. |
( ) | Passion and intention among aspiring entrepreneurs with disabilities: The role of entrepreneurial support programs | Quantitative | Nigeria | The study highlights the critical role of support programs in boosting the passion and intentions of aspiring entrepreneurs with disabilities, emphasizing the need for tailored support that addresses the unique challenges faced by this group. |
( ) | Robustness of personal initiative in moderating entrepreneurial intentions and actions of disabled students | Quantitative | Plateau State and Abuja, Nigeria | The study suggests that learner-centred pedagogical approaches positively impact entrepreneurial actions, and personal initiative traits such as proactiveness, resilience, and innovation play a crucial role in strengthening the link between the entrepreneurial intentions and actions of disabled students. |
( ) | Self-employability initiative: Developing a practical model of disabled students’ self-employment careers | Quantitative | North-Central Nigeria | The study proposes a practical model for enhancing the self-employability of students with disabilities, focusing on developing entrepreneurial skills and attitudes that support self-employment careers. |
( ) | Developing disabled entrepreneurial graduates: A mission for the Nigerian universities? | Quantitative | North-Central Nigeria | The study underscores universities’ pivotal role in enhancing disabled students’ entrepreneurial intentions through dedicated entrepreneurship education, infrastructure, and role models. It suggests that engaging teaching methods and inspiring role models effectively prepare students for entrepreneurial careers post-graduation. |
( ) | Disabled students’ entrepreneurial action: The role of religious beliefs | Quantitative | Plateau State and Abuja, Nigeria | The study’s findings indicate that vocational training, social services, and social networks, bolstered by religious group support, positively influence the entrepreneurial actions of disabled students. |
( ) | Physical accessibility, key factor for entrepreneurship in people with disabilities | Qualitative | Not specified | The study stresses the importance of physical accessibility in entrepreneurship education and workspaces for people with disabilities, identifying it as a key factor for their successful participation in entrepreneurial activities. |
( ) | Inclusive education and digital social innovation | Conceptual | Not specified | The study discusses the potential of digital social innovation to promote inclusive education, including entrepreneurship education for people with disabilities, by leveraging technology to break down barriers. |
( ) | Entrepreneurial education for persons with disabilities—A social innovation approach for inclusive ecosystems | Conceptual | Not specified | The study advocates for a social innovation approach to develop inclusive entrepreneurial education ecosystems, emphasizing the importance of universal design principles and the integration of digital technologies. |
( ) | Entrepreneurship education and entrepreneurial intention among disability students in higher education | Qualitative | Jakarta State University, Indonesia | The study examines the impact of entrepreneurship education on the entrepreneurial intentions of higher-education students with disabilities, highlighting the importance of family and peers. |
( ) | Handicaps and new opportunity businesses: What do we (not) know about disabled entrepreneurs? | Literature review | General | The study highlights physical accessibility as a key obstacle in entrepreneurship education for disabled individuals, emphasizing the importance of education and training in overcoming these barriers and fostering entrepreneurial attitudes among them. |
( ) | Sustainability, entrepreneurship, and disability: A new challenge for universities | Quantitative | The University of Castilla-La Mancha, Spain | The study emphasizes the role of universities in promoting sustainability entrepreneurship among students with disabilities, calling for the integration of sustainability principles into entrepreneurship education. |
( ) | Entrepreneurship education and disability: An experience at a Spanish university | Quantitative | The University of Castilla-La Mancha, Spain | The study examined the impact of entrepreneurship education on students’ entrepreneurial attitudes, revealing that education level, business experience, and study field significantly influence these attitudes, with no significant differences between disabled and non-disabled students. |
( ) | Entrepreneurship teaching method for special needs students in BINUS University: A qualitative research approach | Qualitative | BINUS University, Indonesia | The study reveals that BINUS University’s entrepreneurship educators initially lacked awareness of students with special needs, complicating tailored educational planning. It emphasizes the need for lecturer training to accommodate these students better, noting differing engagement levels and learning outcomes between deaf students and those with other disorders, especially in group activities and assessments. |
( ) | Entrepreneurship education intention and entrepreneurial intention amongst disadvantaged students: an empirical study | Quantitative | Central and Western India | The study finds that socioeconomic disadvantages, including disabilities, negatively impact students’ intentions to pursue entrepreneurship education and entrepreneurial activities, underscoring the need for inclusive and supportive educational practices. |
( ) | Barriers to entrepreneurship education for disabilities in Indonesia | Literature review | Indonesia | The study identifies specific barriers faced by students with disabilities in Indonesia to access entrepreneurship education, including societal attitudes and lack of resources, and calls for targeted interventions to overcome these barriers. |
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Database | Search Terms | Records Identified | Filters Applied | Records Screened |
---|---|---|---|---|
Scopus | “entrepreneur” OR “entrepreneurship” OR “entrepreneurial” AND “education” OR “training” AND “disabled” OR “disability” OR “disabilities” | 148 | Year: 2014–2024 Language: English | 137 |
JSTOR | “entrepreneurship” AND “education” AND “disabled” OR “disability” AND “barrier” | 3945 | Year: 2014–2024 Language: English Academic content: Journals | 162 |
ProQuest | “entrepreneurship” AND “education” AND “disabled” OR “disability” AND “barrier” OR “barriers” | 55,691 | Date: 1–31 January 2024 Language: English Limit to: Full text and Peer reviewed Source type: Scholarly Journals Document type: Article Subject: Education | 315 |
DOAJ | “entrepreneurship” “education” “disabled” | 16 | Year: 2014–2024 | 16 |
Google Scholar | “entrepreneurship education” “disabled” “barriers” | 2020 | Year: 2014–2024 Include: Citations | 1510 |
61,820 | 2140 |
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Tiasakul, S.; Abdulzaher, R.; Bazan, C. Accessibility of Entrepreneurship Training Programs for Individuals with Disabilities: A Literature Review. Adm. Sci. 2024 , 14 , 187. https://doi.org/10.3390/admsci14080187
Tiasakul S, Abdulzaher R, Bazan C. Accessibility of Entrepreneurship Training Programs for Individuals with Disabilities: A Literature Review. Administrative Sciences . 2024; 14(8):187. https://doi.org/10.3390/admsci14080187
Tiasakul, Somrudee, Ramy Abdulzaher, and Carlos Bazan. 2024. "Accessibility of Entrepreneurship Training Programs for Individuals with Disabilities: A Literature Review" Administrative Sciences 14, no. 8: 187. https://doi.org/10.3390/admsci14080187
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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays).
Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications .For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively .Given such mountains of papers, scientists cannot be expected to examine in detail every ...
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.
To understand better how to achieve a good quality literature review, it is helpful to look at the specific processes of the archetypes of literature reviews introduced in Section 2.5; they can also be found in Fig. 3.1, which presents a further classification of the protocol-driven approaches to literature reviews.Even though different archetypes serve different purposes, there are similar ...
The best proposals are timely and clearly explain why readers should pay attention to the proposed topic. It is not enough for a review to be a summary of the latest growth in the literature: the ...
Quality research is about building onto the existing work of others, "standing on the shoulders of giants", as Newton put it.The literature review chapter of your dissertation, thesis or research project is where you synthesise this prior work and lay the theoretical foundation for your own research.. Long story short, this chapter is a pretty big deal, which is why you want to make sure ...
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 sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field.
Literature reviews establish the foundation of academic inquires. However, in the planning field, we lack rigorous systematic reviews. In this article, through a systematic search on the methodology of literature review, we categorize a typology of literature reviews, discuss steps in conducting a systematic literature review, and provide suggestions on how to enhance rigor in literature ...
Introduction. Systematic reviews that summarize the available information on a topic are an important part of evidence-based health care. There are both research and non-research reasons for undertaking a literature review. It is important to systematically review the literature when one would like to justify the need for a study, to update ...
A literature review is not just about reporting published facts; it requires careful consideration of the published literature to construct an unbiased narrative supported by published evidence. Whilst summarising published findings, it is important for you to add perspective by commenting on the quality of the evidence presented.
This is why the literature review as a research method is more relevant than ever. Traditional literature reviews often lack thoroughness and rigor and are conducted ad hoc, rather than following a specific methodology. Therefore, questions can be raised about the quality and trustworthiness of these types of reviews.
A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research. The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research.
Writing the Literature Review : a practical guide by Sara Efrat Efron; Ruth Ravid This accessible text provides a roadmap for producing a high-quality literature review--an integral part of a successful thesis, dissertation, term paper, or grant proposal. Each step of searching for, evaluating, analyzing, and synthesizing prior studies is ...
A good literature review evaluates a wide variety of sources (academic articles, scholarly books, government/NGO reports). It also evaluates literature reviews that study similar topics. This page offers you a list of resources and tips on how to evaluate the sources that you may use to write your review.
Rapid review. Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research. Completeness of searching determined by time constraints. Time-limited formal quality assessment. Typically narrative and tabular.
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 ...
In this article, we covered 6 pointers to help you find and evaluate high-quality resources for your literature review. To recap: Develop and follow a clear literature search strategy. Understand and use different types of literature for the right purpose. Carefully evaluate the quality of your potential sources.
In step 6 you will evaluate the articles you included in your review for quality and bias. To do so, you will: Use quality assessment tools to grade each article. Create a summary of the quality of literature included in your review. This page has links to quality assessment tools you can use to evaluate different study types.
One platform for judging study quality is the systematic literature review, or systematic review, whose primary task is to evaluate "a field's knowledge claims while ... (2008). Undertaking a structured literature review or structuring a literature review: Tales from the field. The Electronic Journal of Business Research Methods, 6(2 ...
Context: Quality Assessment (QA) of reviewed literature is paramount to a Systematic Literature Review (SLR) as the quality of conclusions completely depends on the quality of selected literature.A number of researchers in Software Engineering (SE) have developed a variety of QA instruments and also reported their challenges. We previously conducted a tertiary study on SLRs with QA from 2004 ...
There are many different types of literature reviews from traditional literature reviews to rigorous systematic reviews. Each has its own methodology. Please review resources on this page and familiarize yourself with the task, commitment, and purpose of each before trying to decide on the type of review best fitting your research question.
Key Points. A literature review forms the basis for high-quality medical education research and helps maximize relevance, originality, generalizability, and impact. A literature review provides context, informs methodology, maximizes innovation, avoids duplicative research, and ensures that professional standards are met.
It may be difficult to distinguish between poor-quality research or outright fraudulent research or poor-quality reporting of good work. This is why, particularly for this domain, it is especially important to reach out to authors, as further communication may satisfy the reviewers that the data can be trusted.
This review suffers from selection bias based on the exclusion of non-English publications and gray literature. However, given the inclusion of numerous studies from countries of different income levels, it is likely that the review captured most of the key factors that influence institutionalization of HTA.
Since the tool was disseminated, there have been only 2 publications that used the tool to review the quality of QI reports, with one specific to Ireland. 7, 8. The Johns ... Rethorn ZD, Quatman-Yates CC. The use of quality improvement in the physical therapy literature: a scoping review. J Healthc Qual. 2023;45(5):280-296. doi:10.1097/JHQ ...
This article presents a literature review on working through interpreters in old age psychiatry. The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age.
Literature reviews play a critical role in scholarship because science remains, first and foremost, a cumulative endeavour (vom Brocke et al., 2009). As in any academic discipline, rigorous knowledge syntheses are becoming indispensable in keeping up with an exponentially growing eHealth literature, assisting practitioners, academics, and graduate students in finding, evaluating, and ...
Entrepreneurial endeavours often begin with entrepreneurship training. Such trainings, however, remain largely inaccessible to Persons with Disabilities (PWDs), and thus, their entrepreneurial potential remains untapped. This comprehensive literature review examines the barriers to entrepreneurship education for PWDs and identifies strategies to overcome these challenges. The review follows ...
This paper reviews the impact of structural adjustment on sustainability of rural livelihoods. It unpacks the elements of adjustment and looks at the effects of each of these on the quantity, quality and sustainability of rural livelihoods. There is no systematic improvement or decline in rural livelihoods as a result of adjustment measures. Changes in the relative prices of tradables and ...