example of systematic literature review

Systematic Reviews

• Introduction
• Guidelines and procedures
• Management tools
• Define the question
• Check the topic
• Determine inclusion/exclusion criteria
• Develop a protocol
• Identify keywords
• Databases and search strategies
• Grey literature
• Manage and organise
• Screen & Select
• Locate full text
• Extract data

Example reviews

• Examples of systematic reviews
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Please choose the tab below for your discipline to see relevant examples.

For more information about how to conduct and write reviews, please see the Guidelines section of this guide.

• Health & Medicine
• Social sciences
• Vibration and bubbles: a systematic review of the effects of helicopter retrieval on injured divers. (2018).
• Nicotine effects on exercise performance and physiological responses in nicotine‐naïve individuals: a systematic review. (2018).
• Association of total white cell count with mortality and major adverse events in patients with peripheral arterial disease: A systematic review. (2014).
• Do MOOCs contribute to student equity and social inclusion? A systematic review 2014–18. (2020).
• Interventions in Foster Family Care: A Systematic Review. (2020).
• Determinants of happiness among healthcare professionals between 2009 and 2019: a systematic review. (2020).
• Systematic review of the outcomes and trade-offs of ten types of decarbonization policy instruments. (2021).
• A systematic review on Asian's farmers' adaptation practices towards climate change. (2018).
• Are concentrations of pollutants in sharks, rays and skates (Elasmobranchii) a cause for concern? A systematic review. (2020).
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How to write a systematic literature review [9 steps]

What is a systematic literature review?

Where are systematic literature reviews used, what types of systematic literature reviews are there, how to write a systematic literature review, 1. decide on your team, 2. formulate your question, 3. plan your research protocol, 4. search for the literature, 5. screen the literature, 6. assess the quality of the studies, 7. extract the data, 8. analyze the results, 9. interpret and present the results, registering your systematic literature review, frequently asked questions about writing a systematic literature review, related articles.

A systematic literature review is a summary, analysis, and evaluation of all the existing research on a well-formulated and specific question.

Put simply, a systematic review is a study of studies that is popular in medical and healthcare research. In this guide, we will cover:

• the definition of a systematic literature review
• the purpose of a systematic literature review
• the different types of systematic reviews
• how to write a systematic literature review

➡️ Visit our guide to the best research databases for medicine and health to find resources for your systematic review.

Systematic literature reviews can be utilized in various contexts, but they’re often relied on in clinical or healthcare settings.

Medical professionals read systematic literature reviews to stay up-to-date in their field, and granting agencies sometimes need them to make sure there’s justification for further research in an area. They can even be used as the starting point for developing clinical practice guidelines.

A classic systematic literature review can take different approaches:

• Effectiveness reviews assess the extent to which a medical intervention or therapy achieves its intended effect. They’re the most common type of systematic literature review.
• Diagnostic test accuracy reviews produce a summary of diagnostic test performance so that their accuracy can be determined before use by healthcare professionals.
• Experiential (qualitative) reviews analyze human experiences in a cultural or social context. They can be used to assess the effectiveness of an intervention from a person-centric perspective.
• Costs/economics evaluation reviews look at the cost implications of an intervention or procedure, to assess the resources needed to implement it.
• Etiology/risk reviews usually try to determine to what degree a relationship exists between an exposure and a health outcome. This can be used to better inform healthcare planning and resource allocation.
• Psychometric reviews assess the quality of health measurement tools so that the best instrument can be selected for use.
• Prevalence/incidence reviews measure both the proportion of a population who have a disease, and how often the disease occurs.
• Prognostic reviews examine the course of a disease and its potential outcomes.
• Expert opinion/policy reviews are based around expert narrative or policy. They’re often used to complement, or in the absence of, quantitative data.
• Methodology systematic reviews can be carried out to analyze any methodological issues in the design, conduct, or review of research studies.

Writing a systematic literature review can feel like an overwhelming undertaking. After all, they can often take 6 to 18 months to complete. Below we’ve prepared a step-by-step guide on how to write a systematic literature review.

• Decide on your team.
• Formulate your question.
• Plan your research protocol.
• Search for the literature.
• Screen the literature.
• Assess the quality of the studies.
• Extract the data.
• Analyze the results.
• Interpret and present the results.

When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

You may also need to team up with a librarian to help with the search, literature screeners, a statistician to analyze the data, and the relevant subject experts.

Define your answerable question. Then ask yourself, “has someone written a systematic literature review on my question already?” If so, yours may not be needed. A librarian can help you answer this.

You should formulate a “well-built clinical question.” This is the process of generating a good search question. To do this, run through PICO:

• Patient or Population or Problem/Disease : who or what is the question about? Are there factors about them (e.g. age, race) that could be relevant to the question you’re trying to answer?
• Intervention : which main intervention or treatment are you considering for assessment?
• Comparison(s) or Control : is there an alternative intervention or treatment you’re considering? Your systematic literature review doesn’t have to contain a comparison, but you’ll want to stipulate at this stage, either way.
• Outcome(s) : what are you trying to measure or achieve? What’s the wider goal for the work you’ll be doing?

Now you need a detailed strategy for how you’re going to search for and evaluate the studies relating to your question.

The protocol for your systematic literature review should include:

• the objectives of your project
• the specific methods and processes that you’ll use
• the eligibility criteria of the individual studies
• how you plan to extract data from individual studies
• which analyses you’re going to carry out

For a full guide on how to systematically develop your protocol, take a look at the PRISMA checklist . PRISMA has been designed primarily to improve the reporting of systematic literature reviews and meta-analyses.

When writing a systematic literature review, your goal is to find all of the relevant studies relating to your question, so you need to search thoroughly .

This is where your librarian will come in handy again. They should be able to help you formulate a detailed search strategy, and point you to all of the best databases for your topic.

➡️ Read more on on how to efficiently search research databases .

The places to consider in your search are electronic scientific databases (the most popular are PubMed , MEDLINE , and Embase ), controlled clinical trial registers, non-English literature, raw data from published trials, references listed in primary sources, and unpublished sources known to experts in the field.

➡️ Take a look at our list of the top academic research databases .

Tip: Don’t miss out on “gray literature.” You’ll improve the reliability of your findings by including it.

Don’t miss out on “gray literature” sources: those sources outside of the usual academic publishing environment. They include:

• non-peer-reviewed journals
• pharmaceutical industry files
• conference proceedings
• pharmaceutical company websites
• internal reports

Gray literature sources are more likely to contain negative conclusions, so you’ll improve the reliability of your findings by including it. You should document details such as:

• The databases you search and which years they cover
• The dates you first run the searches, and when they’re updated
• Which strategies you use, including search terms
• The numbers of results obtained

➡️ Read more about gray literature .

This should be performed by your two reviewers, using the criteria documented in your research protocol. The screening is done in two phases:

• Pre-screening of all titles and abstracts, and selecting those appropriate
• Screening of the full-text articles of the selected studies

Make sure reviewers keep a log of which studies they exclude, with reasons why.

➡️ Visit our guide on what is an abstract?

Your reviewers should evaluate the methodological quality of your chosen full-text articles. Make an assessment checklist that closely aligns with your research protocol, including a consistent scoring system, calculations of the quality of each study, and sensitivity analysis.

The kinds of questions you'll come up with are:

• Were the participants really randomly allocated to their groups?
• Were the groups similar in terms of prognostic factors?
• Could the conclusions of the study have been influenced by bias?

Every step of the data extraction must be documented for transparency and replicability. Create a data extraction form and set your reviewers to work extracting data from the qualified studies.

Here’s a free detailed template for recording data extraction, from Dalhousie University. It should be adapted to your specific question.

Establish a standard measure of outcome which can be applied to each study on the basis of its effect size.

Measures of outcome for studies with:

• Binary outcomes (e.g. cured/not cured) are odds ratio and risk ratio
• Continuous outcomes (e.g. blood pressure) are means, difference in means, and standardized difference in means
• Survival or time-to-event data are hazard ratios

Design a table and populate it with your data results. Draw this out into a forest plot , which provides a simple visual representation of variation between the studies.

Then analyze the data for issues. These can include heterogeneity, which is when studies’ lines within the forest plot don’t overlap with any other studies. Again, record any excluded studies here for reference.

Consider different factors when interpreting your results. These include limitations, strength of evidence, biases, applicability, economic effects, and implications for future practice or research.

Apply appropriate grading of your evidence and consider the strength of your recommendations.

It’s best to formulate a detailed plan for how you’ll present your systematic review results. Take a look at these guidelines for interpreting results from the Cochrane Institute.

Before writing your systematic literature review, you can register it with OSF for additional guidance along the way. You could also register your completed work with PROSPERO .

Systematic literature reviews are often found in clinical or healthcare settings. Medical professionals read systematic literature reviews to stay up-to-date in their field and granting agencies sometimes need them to make sure there’s justification for further research in an area.

The first stage in carrying out a systematic literature review is to put together your team. You should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

Your systematic review should include the following details:

A literature review simply provides a summary of the literature available on a topic. A systematic review, on the other hand, is more than just a summary. It also includes an analysis and evaluation of existing research. Put simply, it's a study of studies.

The final stage of conducting a systematic literature review is interpreting and presenting the results. It’s best to formulate a detailed plan for how you’ll present your systematic review results, guidelines can be found for example from the Cochrane institute .

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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.

Prevent plagiarism. Run a free check.

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.

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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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Writing a Systematic Literature Review

Investigating concepts associated with psychology requires an indefinite amount of reading. Hence, good literature reviews are an inevitably needed part of providing the modern scientists with a broad spectrum of knowledge. In order to help, this blog post will introduce you to the basics of literature reviews and explain a specific methodological approach towards writing one, known as the systematic literature review.

Literature review is a term associated with the process of collecting, checking and (re)analysing data from the existing literature with a particular search question in mind. The latter could be for example:

• What are the effects of yoga associated with individual’s subjective well-being?
• Does brief psychotherapy produce beneficial outcomes for individuals diagnosed with agoraphobia?
• What personality traits are most commonly associated with homelessness in the modern literature?

A literature review (a) defines a specific issue, concept, theory, phenomena; (b) compiles published literature on a topic; (c) summarises critical points of current knowledge about the problem and (d) suggests next steps in addressing it.

Literature reviews can be based on all sorts of information found in scientific journals, books, academic dissertations, electronic bibliographic databases and the rest of the Internet.  Electronic databases such as PsycINFO , PubMed , Web of Science could be a good starting point. Some of them, like EBSCOhost , ScienceDirect , SciELO , and ProQuest , provide full-text information, while others provide the users mostly with the abstracts of the material. Besides scientific literature, literature reviews often include the so called gray literature . This refers to the material that is either unpublished or published in non-commercial form (e.g., theses, dissertations, government reports, fact sheets, pre-prints of articles). Excluding it completely from a literature review is inappropriate because the search should be always as complete as possible in order to reduce the risk of publication bias. However, when reviewing the material on for example Google Scholar , Science.gov , Social Science Research Network , or PsycEXTRA it should be kept in mind that such search engines also display the material without peer-review and have therefore less credibility regarding the information they are disclosing.

When performing literature reviews, the use of appropriately selected terminology is essential, since it allows the researchers much clearer communication. In psychology, without some commonly agreed lists of terms, we would all get lost in the variety of concepts and vocabularies that could be applied. A typical recommendation for where to look for such index terms would be ‘ Thesaurus of Psychological Index Terms (2007) ’, which includes nearly 9,000 most commonly cross-referenced terms in psychology. In addition, electronic databases mentioned before sometimes prompt the use of the so-called Boolean operators , simple words such as AND, OR, NOT, or AND NOT. These are used for combining and/or excluding specific terms in your search and sometimes allow to obtain more focused and productive results in the search. Other tools to make search strategy more comprehensive and focused are also truncations – a tool for searching terminologies that have same initial roots (e.g., anxiety and anxious) and wildcards for words with spelling deviations (e.g., man and men). It is worth noting that the databases slightly differ in how they label the index terms and utilize specific search tools in their systems.

Among authors, there is not much coherence about different types of literature reviews but in general, most recognize at least two: traditional and systematic. The main difference between them is situated in the process of collecting and selecting data and the material for the review. Systematic literature review, as the name implies, is the more structured of the two and is thought to be more credible. On the other hand, traditional is thought to heavily depend on the researcher’s decisions regarding the data selection and, consequently, evaluation and results. Systematic protocol of the systematic literature review can be therefore understood as an optional solution for controlling the incomplete and possibly biased reports of traditional reviews.

THE SYSTEMATIC LITERATURE REVIEW

The systematic literature review is a method/process/protocol in which a body of literature is aggregated, reviewed and assessed while utilizing pre-specified and standardized techniques. In other words, to reduce bias, the rationale, the hypothesis, and the methods of data collection are prepared before the review and are used as a guide for performing the process. Just like it is for the traditional literature reviews, the goal is to identify, critically appraise, and summarize the existing evidence concerning a clearly defined problem.

Systematic literature reviews allow us to examine conflicting and/or coincident findings, as well as to identify themes that require further investigation. Furthermore, they include the possibility of evaluating consistency and generalization of the evidence regarding specific scientific questions and are, therefore, also of great practical value within the psychological field. The method is particularly useful to integrate the information of a group of studies investigating the same phenomena and it typically focuses on a very specific empirical question, such as ‘Does the Rational Emotive Therapy intervention benefit the well-being of the patients diagnosed with depression?’.

Systematic literature reviews include all (or most) of the following characteristics:

• Objectives clearly defined a priori;
• Explicit pre-defined criteria for inclusion/exclusion of the literature;
• Predetermined search strategy in the collection of the information and systematic following of the process;
• Predefined characteristic criteria applied to all the sources utilized and clearly presented in the review;
• Systematic evaluation of the quality of the studies included in the review;
• Identification of the excluded sources of literature and justification for excluding them;
• Analysis/synthesis of the information (i.e., comparison of the results, qualitative synthesis of the results, meta-analysis);
• References to the incoherences and the errors found in the selected material.

The process of performing a systematic literature review consists of several stages and can be reported in a form of an original research article with the same name (i.e., systematic literature review):

1: Start by clearly defining the objective of the review or form a structured research question.

Place in the research article: Title, Abstract, Introduction.

Example of the objective: The objective of this literature revision is to systematically review and analyse the current research on the effects of music on the anxiety levels of children in hospital settings.

Example of a structured research question: What are the most important factors associated with the development of PTSD in soldiers?

Tip: In the title, identify that the report is a systematic literature review.

2: Clearly specify the methodology of the review and define eligibility criteria (i.e., study selection criteria that the published material must meet in order to be included or excluded from the study). The search should be extensive.

Place in the research article: Methods.

Examples of inclusion criteria: Publication was an academic and peer-reviewed study. Publication was a study that examined the effects of regular physical exercise intervention on depression and included a control group.

Examples of exclusion criteria: Publication was involving male adults. Studies that also examined non-physical activities as interventions. Studies that were only published in a language other than English.

Tips: The eligibility criteria sometimes fit to be presented in tables.

3: Retrieve eligible literature and thoroughly report your search strategy throughout the process. (Ideally, the selection process is performed by at least two independent investigators.)

Example: The EBSCOhost and PsychInfo electronic databases from 2010 to 2017 were searched. These were chosen because of the psychological focus that encompasses psychosocial effects of emotional abuse in childhood. Search terms were ‘emotional abuse’, ‘childhood’, ‘psychosocial effects’, and ‘psychosocial consequences’.  The EBSCOhost produced 200 results from the search criteria, while PsychInfo produced 467, for a total of 667 articles. […] Articles were rejected if it was determined from the title and the abstract that the study failed to meet the inclusion criteria. Any ambiguities regarding the application of the selection criteria were resolved through discussions between all the researchers involved.

Tip: Sometimes it is nice to represent the selection process in a graphical representation; in the form of a decision tree or a flow diagram (check PRISMA ).

4: Assess the methodological quality of the selected literature whenever possible and exclude the articles with low methodological quality. Keep in mind that the quality of the systematic review depends on the validity and the quality of the studies included in the review.

Examples of the instruments available for evaluating the quality of the studies: PEDro, Jadad scale, the lists of Delphi, OTseeker, Maastricht criteria.

Tip: Present the excluded articles as a part of the selection process mentioned in step 3.

5: Proceed with the so-called characterization of the studies. Decide which data to look for in all the selected studies and present it in a summarized way. If the information is missing in some specific paper, always register it in your reports. (Ideally, the characterization of the studies is performed by at least two independent investigators.)

Place in the research article: Results.

Examples of the information that should and/or could be collected for characterization of the literature: authors, year, sample size, study design, aims and objectives, findings/results, limitations.

Tip: Sometimes results can be presented nicely in a form of a table depicting the main characteristics.

6: Write a synthesis of the results – integrate the results of different studies and  interpret them in a narrative form.

Place in the research article: Interpretation, Conclusions.

Patterns discovered as results should be summarized in a qualitative, narrative form. Modulate one (or more) general arguments for organizing the review. Some trick to help you do this is to choose two or three main information sources (e.g., articles, books, other literature reviews) to explain the results of other studies through a similar way of organization. Connect the information reported by different sources and do not just summarize the results. Find patterns in the results of different studies, identify them, address the theoretical and/or methodological conflicts and try to interpret them. Summarize the principal conclusions and evaluate the current state on the subject by pointing out possible further directions.

CONCLUSIONS

The results emerging from the data that were included in such retrospective studies can lead to a certain level of credibility regarding their conclusions. Actually, systematic literature reviews are thought to be one of our best methods to summarize and synthesize evidence about some specific research question and are often used as the main ‘practice making guidelines’ in many health care disciplines. Therefore, it is no wonder why systematic reviews are gaining popularity among researchers and why journals are moving in this direction as well. This also shows in the development of more and more specific guidelines and checklists for writing systematic literature reviews (see for example PRISMA or Cochrane Handbook for Systematic Reviews of Interventions ). To find examples of systematic literature review articles you can check Cochrane Database of Systematic Reviews , BioMed Central’s Systematic Reviews Journal , and PROSPERO . If you are aware of the concept of ‘registered reports’, it is worth mentioning that submitting with PROSPERO provides you with the option of publishing the latter as well. I suggest that you go through the list of useful resources provided below and hopefully, you can get enough information about anything related that remained unanswered. Now, I encourage you to try to be a little more to be systematic whenever researching some topic, to try to write a systematic literature review yourself and to maybe even consider submitting it to JEPS .

USEFUL RESOURCES

• Cochrane Database of Systematic Reviews : http://www.cochranelibrary.com/cochrane-database-of-systematic-reviews/

EBSCOhost : https://search.ebscohost.com/

Google Scholar : https://scholar.google.com/

PRISMA : http://www.prisma-statement.org/

PROSPERO : https://www.crd.york.ac.uk/prospero/

ProQuest : http://www.proquest.com/

PsycEXTRA : http://www.apa.org/pubs/databases/psycextra/index.aspx :

PsycINFO : http://www.apa.org/pubs/databases/psycinfo/index.aspx

PubMed : https://www.ncbi.nlm.nih.gov/pubmed/

SciELO : http://www.scielo.org/php/index.php?lang=en

Science.gov : https://www.science.gov/

ScienceDirect : http://www.sciencedirect.com/

Scorpus : http://www.scopus.com/freelookup/form/author.uri

Social Science Research Network : https://www.ssrn.com/en/

Systematic Reviews Journal (BIOMED) : https://systematicreviewsjournal.biomedcentral.com/

Web of Science : https://webofknowledge.com/

Other sources

• Sampaio, R. F., & Mancini, M. C. (2007). Systematic review studies: A guide for a careful synthesis of scientific evidence. Brasilian Journal of Physical Therapy, 11 (1), 77-82. doi:http://dx.doi.org/10.1590/S1413-35552
• Tuleya, L. G. (2007). Thesaurus of psychological index terms . Washington, DC: American Psychological Association.

Eva Štrukelj

Eva Štrukelj is currently studying Clinical and Health Psychology at the University of Algarve in Portugal. Her main areas of interest are social psychology and health psychology. Regarding research, she is particularly curious about stigma and with it related topics.

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• Systematic Review | Definition, Examples & Guide

Systematic Review | Definition, Examples & Guide

Published on 15 June 2022 by Shaun Turney . Revised on 18 July 2024.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesise all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question ‘What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?’

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

Table of contents

What is a systematic review, systematic review vs meta-analysis, systematic review vs literature review, systematic review vs scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce research bias . The methods are repeatable , and the approach is formal and systematic:

• Formulate a research question
• Develop a protocol
• Search for all relevant studies
• Apply the selection criteria
• Extract the data
• Synthesise the data
• Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesising all available evidence and evaluating the quality of the evidence. Synthesising means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

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Systematic reviews often quantitatively synthesise the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesise results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarise and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimise bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

• A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
• If you’re doing a systematic review on your own (e.g., for a research paper or thesis), you should take appropriate measures to ensure the validity and reliability of your research.
• Access to databases and journal archives. Often, your educational institution provides you with access.
• Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
• Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

• They minimise research b ias by considering all available evidence and evaluating each study for bias.
• Their methods are transparent , so they can be scrutinised by others.
• They’re thorough : they summarise all available evidence.
• They can be replicated and updated by others.

Systematic reviews also have a few cons .

• They’re time-consuming .
• They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

• Allow you to more effectively communicate your research to other researchers and practitioners
• Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

• Population(s) or problem(s)
• Intervention(s)
• Comparison(s)

You can rearrange these four components to write your research question:

• What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fourth component, the type of study design . In this case, the acronym is PICOT .

• Type of study design(s)
• The population of patients with eczema
• The intervention of probiotics
• In comparison to no treatment, placebo , or non-probiotic treatment
• The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
• Randomised control trials, a type of study design

Their research question was:

• What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

• Background information : Provide the context of the research question, including why it’s important.
• Research objective(s) : Rephrase your research question as an objective.
• Selection criteria: State how you’ll decide which studies to include or exclude from your review.
• Search strategy: Discuss your plan for finding studies.
• Analysis: Explain what information you’ll collect from the studies and how you’ll synthesise the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

• Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
• Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
• Grey literature: Grey literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of grey literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of grey literature.
• Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

• Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
• Handsearch: Conference proceedings and reference lists of articles
• Grey literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
• Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

• Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
• Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarise what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

• Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
• Your judgement of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomised into the control and treatment groups.

Step 6: Synthesise the data

Synthesising the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesising the data:

• Narrative ( qualitative ): Summarise the information in words. You’ll need to discuss the studies and assess their overall quality.
• Quantitative : Use statistical methods to summarise and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analysed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

• Abstract : A summary of the review
• Introduction : Including the rationale and objectives
• Methods : Including the selection criteria, search method, data extraction method, and synthesis method
• Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
• Discussion : Including interpretation of the results and limitations of the review
• Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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

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

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

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

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

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Systematic Reviews

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What Makes a Systematic Review Different from Other Types of Reviews?

• Planning Your Systematic Review
• Database Searching
• Creating the Search
• Search Filters and Hedges
• Grey Literature
• Managing and Appraising Results
• Further Resources

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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Research Methods: A Student's Comprehensive Guide: Literature Reviews

• Research Approaches
• Types of Sources
• Accessing Resources
• Evaluating Sources
• Question Crafting
• Search Strategies
• Annotated Bibliography
• Literature Reviews
• Citations This link opens in a new window

Literature Review

What is a Literature Review?  A literature review is a critical analysis of existing research related to a specific topic or research question. Rather than simply summarizing the sources, a literature review evaluates, compares, and synthesizes the literature to highlight trends, gaps, and insights that inform your research.

Purpose and Importance:  Literature reviews serve multiple key functions:

• Contextualization:  They provide background on your research topic, helping to situate your work within the broader field.
• Identification of Gaps:  A thorough review highlights areas where further research is needed, guiding your own contributions.
• Critical Evaluation:  By comparing and contrasting sources, you develop a deeper understanding of the subject and establish the credibility of your research.
• Foundation for Research:  A literature review demonstrates your knowledge of the field, forming a strong basis for your methodology and research approach.

Difference Between a Literature Review and an Annotated Bibliography:  While both a literature review and an annotated bibliography involve analyzing sources, they serve different purposes. An annotated bibliography focuses on summarizing and evaluating individual sources in isolation. In contrast, a literature review synthesizes multiple sources to form a cohesive narrative, identifying patterns, themes, and debates within the literature. The literature review also typically organizes the information thematically or methodologically rather than listing sources one by one.

Q: What is the main difference between a literature review and a systematic review? A: A literature review provides a broad overview of existing research on a topic, while a systematic review follows a structured methodology to identify, evaluate, and synthesize all relevant studies on a specific question.

Q: How do I choose the best type of literature review for my research? A: Consider your research question and objectives. A narrative review is suitable for broad overviews, while a systematic review is best for comprehensive analyses. A scoping review helps map out the existing literature, and a meta-analysis combines quantitative results from multiple studies.

Q: How many sources should I include in my literature review? A: The number of sources depends on your topic and the scope of your review. Generally, aim to include a comprehensive selection that represents the current state of research. Ensure sources are relevant and contribute to answering your research question.

Q: Can I include unpublished sources in my literature review? A:  Yes, including unpublished sources such as dissertations, theses, or reports can provide valuable insights and fill gaps in the published literature. Ensure these sources are credible and relevant.

Q: How do I ensure my literature review is critical and not just descriptive? A: Focus on evaluating and synthesizing the sources rather than just summarizing them. Analyze the strengths, weaknesses, and contributions of each study. Highlight trends, debates, and gaps in the literature.

Scribbr: How to Write a Literature Review

Gain valuable insights on how to write an impactful literature review with this comprehensive guide!

Scribbr: Tips for Writing a Literature Review

Explore practical tips and strategies for structuring a literature review in this detailed tutorial.

• Common Mistakes

Types of Literature Reviews

• Overview:  Provides a comprehensive summary of the research on a specific topic. It offers a broad overview of the field, summarizing the key findings and trends without a strict methodological approach.
• Purpose:  Useful for providing a general understanding of a topic, identifying major themes, and outlining the historical development of research.
• Overview:  Follows a structured and transparent methodology to identify, evaluate, and synthesize all relevant studies on a specific research question. It aims to minimize bias and provide a comprehensive overview of the evidence.
• Purpose:  Ideal for answering specific research questions by systematically collecting and analyzing data from multiple studies. It often includes a meta-analysis component to quantitatively summarize the results.
• Overview:  Maps the existing literature on a broad topic, identifying key concepts, gaps, and areas for further research. It is less focused on synthesizing results and more on exploring the extent and nature of the research.
• Purpose:  Useful for understanding the breadth of research on a topic, especially when the area is complex or emerging. It helps to clarify the scope of existing evidence and inform future research directions.
• Overview:  Uses statistical techniques to combine and analyze the results of multiple studies, providing a quantitative summary of the evidence. It aims to identify patterns and determine the overall effect size.
• Purpose:  Ideal for drawing general conclusions from a body of research, especially when individual studies have varying results. It provides a higher level of statistical power and precision.

Crafting a Literature Review

• Clarify Your Research Question:  Start by articulating the specific research question or objective that your literature review will address. This will help guide your search and ensure that the review remains focused.
• Set Boundaries:  Determine the scope of your review by defining parameters such as time frame, geographical area, or specific subtopics. This helps in managing the breadth of your review and maintaining relevance.
• Utilize Academic Databases:  Access scholarly articles, books, and other research materials using databases like JSTOR, PubMed, or Google Scholar.
• Expand Your Search:  Explore references in key studies, look for gray literature, and consult library catalogs to ensure a comprehensive search.
• Categorize Sources:  Group your sources by themes, methodologies, or chronological order. This organization helps in synthesizing information and presenting a coherent review.
• Use Reference Management Tools:  Tools such as Zotero or EndNote can assist in managing and sorting your sources effectively.
• Identify Patterns and Themes:  Look for recurring themes, trends, and debates within the literature. Analyze how different studies relate to one another.
• Compare and Contrast:  Evaluate the methodologies, findings, and perspectives of different sources. Highlight agreements and disagreements to provide a balanced view.
• Choose an Organizational Method:  Decide on a structure that best fits your review’s purpose:
• Chronological:  Organize by the timeline of research developments.
• Thematic:  Group by themes or topics.
• Methodological:  Arrange based on research methods used.
• Create an Outline:  Develop a clear outline based on your chosen structure to guide your writing and ensure logical flow.
• Analyze, Don’t Just Summarize:  Go beyond summarizing each source. Critically analyze how each piece of literature contributes to your understanding of the topic.
• Provide Context:  Explain how the literature connects to your research question or hypothesis. Show how your work builds on or challenges existing knowledge.
• Seek Feedback:  Share your draft with peers or mentors to obtain constructive feedback.
• Edit for Clarity:  Review your work for clarity, coherence, and completeness. Ensure that your review is logically organized and free of errors.

Example of a Literature Review

To illustrate how a literature review is structured and written, here's a simplified example based on a hypothetical research topic:  The Impact of Social Media on Adolescent Mental Health.

Introduction: The introduction provides an overview of the research topic and its significance.

Social media has become an integral part of adolescents' lives, raising concerns about its impact on mental health. This literature review examines existing research on how social media use affects adolescent well-being, focusing on both positive and negative outcomes.

Body: The body of the review is organized thematically or methodologically.

Positive Impacts of Social Media:

• Social Connectivity:  Studies highlight that social media platforms enable adolescents to maintain and strengthen social connections, providing emotional support and reducing feelings of isolation (Smith, 2021; Lee & Johnson, 2022).
• Educational Benefits:  Research indicates that social media can facilitate educational opportunities and learning through online communities and resources (Adams, 2020).

Negative Impacts of Social Media:

• Mental Health Issues:  Several studies link excessive social media use with increased levels of anxiety, depression, and low self-esteem among adolescents (Brown et al., 2019; Thompson & Miller, 2021).
• Cyberbullying:  Evidence shows that social media platforms can be a breeding ground for cyberbullying, leading to significant psychological distress (Green & Taylor, 2022).

Mixed Findings:

• Variability in Effects:  Some research finds that the impact of social media on mental health varies depending on individual factors such as frequency of use, type of content consumed, and pre-existing mental health conditions (Davis, 2021; Wilson, 2022).

Discussion:   The discussion synthesizes the findings, identifies trends, and highlights gaps:

The reviewed literature reveals a complex relationship between social media and adolescent mental health. While social media can offer support and educational benefits, its negative impacts—particularly related to mental health issues and cyberbullying—are significant. Further research is needed to understand how different variables affect these outcomes and to develop strategies for mitigating negative effects.

Conclusion: The conclusion summarizes the key findings and suggests areas for future research:

In summary, social media has both positive and negative effects on adolescent mental health. Addressing these impacts requires a nuanced understanding of the various factors involved and targeted interventions to support healthy social media use. Future research should focus on longitudinal studies to better assess the long-term effects of social media on mental health.

• References:  Ensure to include a list of all sources cited in the example. In a real review, this would be formatted according to the appropriate citation style (e.g., APA, MLA).
• Formatting:  Use headings and subheadings to clearly organize each section of the review.

This example provides a framework for how a literature review should be structured and the type of content that should be included. It demonstrates the synthesis of various sources to present a cohesive narrative on the research topic.

Common Mistakes to Avoid

• Tip:  Ensure every source and discussion point directly relates to your research question or objective. Maintain a clear focus throughout the review.
• Tip:  Prioritize primary sources and original studies to provide a robust foundation. Use secondary sources sparingly for context or background.
• Tip:  Critically assess each study’s methodology, findings, and impact on the field. Highlight strengths and weaknesses for a balanced view.
• Tip:  Use clear headings and subheadings. Choose a logical structure (e.g., thematic, chronological) and ensure smooth transitions between sections.
• Tip:  Discuss gaps in the literature to strengthen your review and position your research within the broader field.
• Tip:  Follow the appropriate citation style meticulously. Ensure all sources are cited correctly and consistently.
• Tip:  Base conclusions on a comprehensive review of the literature. Avoid generalizations unless supported by substantial evidence from multiple sources.
• Tip:  Stay updated with recent publications and incorporate the most current research to ensure relevance and accuracy.

Literature Review Matrix

A  Literature Review Matrix  is a powerful tool that helps you organize and evaluate the sources you've gathered for your literature review. Think of it as a structured table that allows you to visually track key details from each source, helping you compare and contrast research findings, methods, and relevance to your work.

The primary goal of a Literature Review Matrix is to provide a clear and organized way to view your sources side-by-side. This makes it easier to spot patterns, identify gaps in the literature, and see how different studies connect or diverge. By using this matrix, you can:

• Summarize key information from each source.
• See the progression of research on a topic.
• Track how each source contributes to your own research goals.

When crafting your literature review, the matrix becomes a valuable reference. It offers a concise summary of each source, facilitating the synthesis of information and revealing connections between works. This organized approach helps ensure you cover all important themes and insights.

Key Components

A typical Literature Review Matrix includes:

• Author(s) & Date:  For tracking contributions and publication dates.
• Theoretical/Conceptual Framework:  Outlines the theories or concepts guiding the study.
• Research Question(s)/Hypotheses:  Identifies the focus and aims of the research.
• Methodology:  Describes the study design and methods used.
• Analysis & Results:  Summarizes the data analysis and key findings.
• Conclusions:  Highlights the main conclusions drawn from the research.
• Implications for Future Research:  Suggests areas for further investigation.
• Implications for Practice:  Discusses practical applications of the findings.

A Literature Review Matrix establishes a solid foundation for a well-organized literature review, ensuring you capture all critical insights and connections between sources. 

How to Use the Matrix

To make the most of your Literature Review Matrix, follow these steps to complete each category:

Author(s) & Date : Record the author(s) of the study and the publication date. This helps track contributions and the relevance of the research over time.

Theoretical/Conceptual Framework : Note the theories or concepts guiding the study. This provides insight into the foundation of the research and its theoretical background.

Research Question(s)/Hypotheses : Summarize the main research questions or hypotheses the study addresses. This clarifies the focus and objectives of the research.

Methodology : Describe the research design and methods used. This includes the type of study, data collection methods, and analysis techniques.

Analysis & Results : Outline the main findings and how the data was analyzed. This section highlights the key discoveries of the research.

Conclusions : Record the study’s conclusions and implications. This provides a summary of the research outcomes and their significance.

Implications for Future Research : Identify suggestions for further research proposed by the study. This helps in understanding how the research contributes to ongoing scholarly conversation.

Implications for Practice : Note any practical applications or recommendations made. This connects the research findings to real-world applications.

Accurately filling in each category of the Literature Review Matrix ensures a comprehensive and organized overview of your sources, making it easier to synthesize and integrate information into your literature review.

Why Use a Literature Review Matrix?

A Literature Review Matrix is not just a tool but a strategic aid in organizing and synthesizing your research. Here’s why it’s invaluable:

Enhanced Clarity : By laying out your sources in a matrix format, you gain a clear, visual representation of the key components of each study. This clarity helps in quickly identifying patterns, contradictions, and gaps in the literature.

Streamlined Synthesis : The matrix allows you to compare and contrast findings across multiple sources efficiently. This makes synthesizing information from different studies simpler, leading to a more cohesive and comprehensive literature review.

Efficient Writing : With all essential information organized in one place, writing your literature review becomes more straightforward. The matrix provides a structured reference that helps in drafting sections and ensuring that all relevant points are addressed.

Identification of Trends and Gaps : The matrix helps in spotting trends in research and identifying areas where further investigation is needed. This insight is crucial for framing your research questions and shaping your own study.

Improved Organization : It facilitates a systematic approach to managing your sources, reducing the risk of overlooking important details and ensuring that your review is well-organized and thorough.

Using a Literature Review Matrix enhances the efficiency and quality of your literature review process. It’s a powerful tool that supports clarity, synthesis, and effective writing, ultimately contributing to a more insightful and organized review.

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How to Write a Systematic Review of the Literature

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• 1 1 Texas Tech University, Lubbock, TX, USA.
• 2 2 University of Florida, Gainesville, FL, USA.
• PMID: 29283007
• DOI: 10.1177/1937586717747384

This article provides a step-by-step approach to conducting and reporting systematic literature reviews (SLRs) in the domain of healthcare design and discusses some of the key quality issues associated with SLRs. SLR, as the name implies, is a systematic way of collecting, critically evaluating, integrating, and presenting findings from across multiple research studies on a research question or topic of interest. SLR provides a way to assess the quality level and magnitude of existing evidence on a question or topic of interest. It offers a broader and more accurate level of understanding than a traditional literature review. A systematic review adheres to standardized methodologies/guidelines in systematic searching, filtering, reviewing, critiquing, interpreting, synthesizing, and reporting of findings from multiple publications on a topic/domain of interest. The Cochrane Collaboration is the most well-known and widely respected global organization producing SLRs within the healthcare field and a standard to follow for any researcher seeking to write a transparent and methodologically sound SLR. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), like the Cochrane Collaboration, was created by an international network of health-based collaborators and provides the framework for SLR to ensure methodological rigor and quality. The PRISMA statement is an evidence-based guide consisting of a checklist and flowchart intended to be used as tools for authors seeking to write SLR and meta-analyses.

Keywords: evidence based design; healthcare design; systematic literature review.

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• Systematic Reviews and Other Evidence Synthesis Methods

Learn more about evidence synthesis methods

What are evidence syntheses, how does a traditional literature review differ from evidence synthesis, types of evidence synthesis.

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Do you want to learn more about systematic reviews or other types of evidence synthesis methods? Check out our detailed guide on this topic, which provides a deeper overview, and reviews the various steps involved in these methods. This guide will also review UCI Libraries' Evidence Synthesis Service, and let you know how our librarians can help. The information below is a quick overview of the methodology.

• Systematic Reviews & Evidence Synthesis Methods guide

According to the Royal Society, 'evidence synthesis' refers to the process of bringing together information from a range of sources and disciplines to inform debates and decisions on specific issues. They generally include a methodical and comprehensive literature synthesis focused on a well-formulated research question. Their aim is to identify and synthesize all of the scholarly research on a particular topic, including both published and unpublished studies. Evidence syntheses are conducted in an unbiased, reproducible way to provide evidence for practice and policy-making, as well as to identify gaps in the research. Evidence syntheses may also include a meta-analysis, a more quantitative process of synthesizing and visualizing data retrieved from various studies.

Evidence syntheses are much more time-intensive than traditional literature reviews and require a multi-person research team. See this PredicTER tool to get a sense of a systematic review timeline (one type of evidence synthesis). Before embarking on an evidence synthesis, it's important to clearly identify your reasons for conducting one. For a list of types of evidence synthesis projects, see the Types of Evidence Synthesis tab.

One commonly used form of evidence synthesis is a systematic review. This table compares a traditional literature review with a systematic review.

Evidence synthesis refers to any method of identifying, selecting, and combining results from multiple studies. For help selecting a methodology, please refer to:

• A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies For help differentiating between the various types of review, consult this article by Grant & Booth, 2009.
• Methodology Decision Tree From our colleagues at Cornell, a decision tree with questions leading to various review types.

Types of evidence synthesis include: 

​​Systematic Review

• Systematically and transparently collect and categorize existing evidence on a broad question of scientific, policy or management importance
• Compares, evaluates, and synthesizes evidence in a search for the effect of an intervention
• Time-intensive and often take months to a year or more to complete
• The most commonly referred to type of evidence synthesis. Sometimes confused as a blanket term for other types of reviews

Systematized Literature Review

• Not a true evidence synthesis review, but employs certain elements of a systematic review
• No specific methodology; does not require a protocol or critical appraisal of the evidence
• Conducted by only 1 or 2 people
• May be completed in about 2-6 months

​​Literature (Narrative) Review

• Not a true evidence synthesis review, but a broad term referring to reviews with a wide scope and non-standardized methodology
• Search strategies, comprehensiveness, and time range covered will vary and do not follow an established protocol

​Scoping Review or Evidence Map

• Systematically and transparently collect and categorize existing evidence on a broad question of scientific, policy or management importance
• Seeks to identify research gaps and opportunities for evidence synthesis rather than searching for the effect of an intervention
• May critically evaluate existing evidence, but does not attempt to synthesize the results in the way a systematic review would.(see EE Journal and CIFOR )
• May take longer than a systematic review
• See Arksey and O'Malley (2005)  or Peters et al (2020) for methodological guidance

​Rapid Review

• Applies Systematic Review methodology within a time-constrained setting
• Employs methodological "shortcuts" (limiting search terms for example) at the risk of introducing bias
• Useful for addressing issues needing quick decisions, such as developing policy recommendations
• See Evidence Summaries: The Evolution of a Rapid Review Approach

Umbrella Review

• Reviews other systematic reviews on a topic
• Often defines a broader question than is typical of a traditional systematic review
• Most useful when there are competing interventions to consider

Meta-analysis

• Statistical technique for combining the findings from disparate quantitative studies
• Uses statistical methods to objectively evaluate, synthesize, and summarize results
• Conducted as an additional step of a systematic review
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Digital Transformation of Tax Administration and Compliance: A Systematic Literature Review on E-Invoicing and Prefilled Returns

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Bibliometrics & citations, view options, 1 introduction, 1.1 basic concepts and definitions, 1.2 e-invoicing, 1.3 prefilling of returns, 2 research methodology, 2.1 research question, 2.2 conducting the search.

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3 Findings of Review Based On Major Themes from the Literature

3.1 e-invoicing and efficiency of taxation, 3.1.1 e-invoicing for vat., 3.1.2 e-invoicing and smes., 3.1.3 e-invoicing and tax fraud., 3.2 prefilling of returns and effectiveness of taxation, 3.2.1 prefilling of tax returns and compliance/administrative cost., 3.2.2 prefilling of tax returns for smes., 3.2.3 prefilling of returns to minimize tax fraud., 4 discussion, 4.1 e-invoicing, 4.2 prefilling of returns, 5 conclusion, 5.1 limitations, 5.2 future research, a.1 list of articles (appendix a ).

• Terán L Vaca C Riofrio D Stürmer M (2024) Introduction to the Special Issue on Smart Government Development and Applications Digital Government: Research and Practice 10.1145/3691353 5 :3 (1-9) Online publication date: 13-Sep-2024 https://dl.acm.org/doi/10.1145/3691353

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What Helps Children and Young People to Disclose their Experience of Sexual Abuse and What Gets in the Way? A Systematic Scoping Review

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• Published: 18 September 2024

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• Lynne McPherson   ORCID: orcid.org/0000-0002-3356-2216 1 ,
• Kathomi Gatwiri   ORCID: orcid.org/0000-0002-7794-6481 1 ,
• Anne Graham   ORCID: orcid.org/0000-0002-9308-8536 1 ,
• Darlene Rotumah   ORCID: orcid.org/0000-0002-2346-7856 2 ,
• Kelly Hand   ORCID: orcid.org/0009-0008-1269-8983 1 ,
• Corina Modderman   ORCID: orcid.org/0000-0002-7375-5047 3 ,
• Jaime Chubb 4 &
• Samara James 1  

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Global research has found that prevalence rates of child sexual abuse suggest that this is a significant ongoing public health concern. A recent Australian study, for example, revealed that more than three girls and almost one in five boys reported experiencing sexual abuse before the age of 18. Self-reported rates of abuse, however, far exceed official figures, suggesting that large numbers of children who experience sexual abuse do not come to the attention of relevant authorities. Whether and how those children have tried to tell their stories remains unclear.

The goal of the review was to explore scholarly literature to determine what was known about what enables or constrains children to disclose their experience of sexual abuse.

A systematic scoping review was undertaken to better understand the current state of knowledge in the scholarly literature on child sexual abuse disclosure. Thirty-two scholarly publications were included for analysis following a rigorous process of sourcing articles from five databases and systematically screening them based on transparent inclusion and exclusion criteria. Ecological systems and trauma-informed theoretical paradigms underpinned an inductive thematic analysis of the included manuscripts.

Three multi-dimensional themes were identified from the thirty-two publications. These themes were: factors enabling disclosure are multifaceted; barriers to disclosure include a complex interplay of individual, familial, contextual and cultural issues; and Indigenous victims and survivors, male survivors, and survivors with a minoritised cultural background may face additional barriers to disclosing their experiences of abuse.

Conclusions

The literature suggests that a greater understanding of the barriers to disclosures exists. Further research that supports a deeper understanding of the complex interplay of enablers and the barriers to disclosure across diverse populations is needed. In particular, future research should privilege the voices of victims and survivors of child sexual abuse, mobilising their lived experiences to co-create improved practice and policy.

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Introduction

The prevalence of child sexual abuse is a matter of critical interest for researchers, policymakers and practitioners working with children, young people and their families. Worldwide estimates of child sexual abuse (CSA) prevalence are alarming, with an average of 18–20% of females and 8–10% of males reporting experiences of abuse (Pereda et al., 2009 ). A recent study in the USA, drawing from a sample of 2639 respondents aged 18–28, concluded that the overall prevalence rate of child sexual abuse was 21.7%. For females, this rate was found to be 31.6% and for males, 10.8% (Finkelhor et al., 2024 ). In Australia, the recently published Australian Child Maltreatment Study collected nationally representative data on rates of abuse and neglect and found that 37.3% of girls and 18.8% of boys had experienced child sexual abuse (Matthews et al., 2023 ).

Self-reported rates of abuse far exceed official figures, suggesting that large numbers of children who experience sexual abuse do not come to the attention of relevant authorities. As an example of the discrepancy between official statistics versus reports by survivors, offender conviction rates appear to be far lower than reported abuse. One study, for example, found that police did not lay charges in more than half of 659 cases where child sexual abuse was reported to them (Christensen et al., 2016 ). The two reasons provided were, first, insufficient evidence, and second, aspects of the child’s disclosure, particularly timing and detail, were inadequate for successful prosecution. In another example, a study based on an analysis of administrative data over a fourteen-year timeframe found that only one in five reported child sexual abuse matters proceeded further than the initial investigation phase. In this study, only 12% of reported offences resulted in a conviction, with the authors claiming that their findings were consistent with other studies (Cashmore et al., 2020 ). Further research to enable a better understanding of “how these (prosecution) decisions are made, over and above the characteristics of the complainant, suspect and type of offence” was recommended (Cashmore et al., 2020 , p. 93).

In another example, a meta-analysis that combined estimates of prevalence rates of child sexual abuse across 217 studies, then comparing these rates with official data from sources such as the police and child protection, found that analyses based on self-reports of victims and survivors revealed prevalence rates of up to 30 times greater than official reports (Stoltenborgh et al., 2015 ), indicating a sizeable gap between self-reported experiences of child sexual abuse by survivors and rates recorded by official authorities. Such a sizable gap suggests that further investigation into research that examines the process of disclosure is much needed, with a focus on what factors enable and constrain children and young people from talking about the abuse that they have experienced.

Child sexual abuse disclosure is theorised as a multifaceted, iterative and contextualised phenomenon that interacts directly or indirectly across a range of ecological variables. Both ecological (Bronfenbrenner., 1979 ) and trauma theories (Alaggia et al., 2019 ) consider a child victim within their context by considering the micro, meso and macro implications issues faced by children who have experienced the trauma of child sexual abuse.

In summary, the rationale for this review emerges from the child sexual abuse research literature, which reports very high prevalence rates of abuse, particularly where research participants are offered anonymity as young adults to recall their experiences (Finkelhor et al., 2024 ; Matthews et al., 2023 ). Evidence of these high rates of abuse, drawn from research, are not matched by official administrative data published in government reports, with research outcomes reporting on child sexual abuse prevalence up to 30 times greater than official statistics from relevant authorities (Stoltenborgh et al., 2015 ).

These issues raise serious and urgent questions about how children and young people who have experienced child sexual abuse are listened to, heard and responded to. Children and young people may raise their concerns in attempts to tell, only to meet with barriers that prevent them from feeling supported and safe.

This scoping review aimed to address that gap by examining the literature reporting on disclosures of child sexual abuse by examining the literature reporting on disclosures of child sexual abuse by considering the question: What do we know about what influences or enables children and young people to disclose their experience of child sexual abuse, and what are the barriers to disclosure?

A Systematic Scoping Review

Using the framework developed by Arksey and O’Malley ( 2005 ), a systematic scoping review methodology was used to identify the available research literature on the disclosure of child sexual abuse. To clarify the use of the term ‘systematic’ in the context of a scoping review, we adopted a methodologically sound process for searching the literature to scope the current state of knowledge concerning child sexual abuse disclosure (Allagia et al., 2019 ). The purpose of this review was to map the literature on child sexual abuse disclosure, identify key concepts that hinder or enable disclosure, and highlight gaps in the research. Scoping studies are particularly well-suited for complex topics, as they provide valuable insights for policymakers, practitioners, and future research (McPherson et al., 2019 ). Mapping the literature involved a five-stage sequential process as follows: developing a research question, systematically identifying potentially relevant studies, screening and selecting relevant studies based on identified inclusion and exclusion criteria, charting the data and collating, summarising and reporting the results (Arksey & O’Malley, 2005 , p. 8). This five-stage approach emphasises the importance of building a credible critique when investigating a largely unexplored topic (Munn et al., 2018 ).

Theoretical Frame

This review took a multi-theoretical approach. Drawing on ecological systems and trauma-informed theoretical paradigms provided a robust framework for understanding the complex barriers to disclosing childhood sexual abuse. By integrating these two theories, we gained an understanding of how, at the individual level, trauma symptoms like shame, guilt, and fear can inhibit disclosure and, additionally, how relational dynamics (microsystems) and broader systemic and societal factors at the exo-system and macrosystem levels, can either support or hinder disclosure. CSA disclosure is often not a one-off event but rather a dynamic process reflecting the trauma of the abuse that may take place over time and can include incidents of retraction where survivors recant their stories (Alaggia et al., 2019 ). This phenomenon was first theorised by Roland Summit in 1983 and was revisited some decades later as child victims of abuse were reported to ‘accommodate’ abuse to the extent that disclosure was often delayed, conflicted and ultimately retracted (McPherson et al., 2017 ).

An ecological framework (Bronfenbrenner, 1979 ) considers a child contextually by taking into account the “ontogenic, micro-system, exo-system and macro-system” layers that inform childhood experiences (Alaggia, 2010 . p. 36). At the micro level, family dynamics can obstruct disclosure due to concerns about not being believed or feelings of loyalty to the abuser. In a different study, Alaggia ( 2004 ) points out that although children disclose in many different ways, the closer the familial relationship between the child and the perpetrator, the more difficult disclosure gets. CSA disclosure within a mesosystem encompasses the interactions among different components of the microsystem, such as churches, schools, and neighbourhoods, which can impede the disclosure process. In such interacting systems, the child who discloses can be placed in a liminal place, on the boundaries of the systems that the family is situated in, leading to demands for “compromise” for the “purposes of damage limitation” (Gardner, 2012 , p. 102). The exosystem, encompassing broader social systems like social services, can introduce complexities in the disclosure process due to inadequate reporting structures and limited interagency collaboration and resources for investigating child sexual abuse claims and frameworks of support to children who disclose. Gardner ( 2012 , p. 105) refers to these as “anxiety-provoking institutional dilemmas” wherein institutions respond with procedures that contain anxiety rather than through a trauma-informed practice of prioritising safety to reduce the risk of re-traumatisation. The macro-system envelopes the societal norms, laws, and policies, which influence the stigma and cultural taboos around child sexual abuse, potentially affecting how authorities or the adults in a child’s life respond to disclosures of child sexual abuse. Child sexual abuse disclosure is, therefore, a multifaceted, iterative and contextualised phenomenon that interacts directly or indirectly across all these ecological variables (Alaggia et al., 2019 ).

Five-Phased Approach

Phase one: developing the research question.

The following research question framed the systematic scoping review:

What do we know about what influences or enables children and young people to disclose their experience of child sexual abuse, and what are the barriers to disclosure?

Phase Two: The Framework for Systematically Identifying Relevant Studies

A search strategy that aimed to identify peer-reviewed literature was developed. With the support of a research librarian, five electronic databases (InfoRMIT; Psychology and Behavioural Sciences Collection; APA PsycInfo; Academic Search Premier; ProQuest) were searched using a combination of carefully selected keywords: Child*ren, youth, AND Sexual Abuse OR Sexual Assault AND Disclosure OR Telling OR Sharing AND Barrier s OR Hindrance OR Facilitators OR Enablers . Searches were run from 2013 to (July) 2023.

Inclusion criteria The search was restricted to peer-reviewed academic journal articles published in English between 2013 and 2023. Articles focusing on what helped or hindered disclosure that helped to better understand children’s experience of disclosing were included. The inclusion criteria included both articles about children and young people (aged under 18) and articles about adults with lived experience of child sexual abuse who were recalling their experiences of disclosure.

Exclusion criteria Articles were excluded if published before 2013, were not published in a peer-reviewed scholarly journal or did not address the research question. Therefore, articles reporting rates and prevalence, prevention literature (unless it addressed responses to disclosure), diagnostic tools, practice frameworks, and legislative requirements were excluded. Non-English articles were also excluded due to the resources required for translation.

Grey literature was excluded due to quality, reliability, and publication bias concerns. Additionally, challenges in standardising and accessing globally available grey literature made it difficult to ensure evidence-based verification and reproducibility in the review (Mahood, 2014 ). Only peer-reviewed scholarly articles were included to maintain a systematic and transparent methodology.

Phase Three: Selection of Relevant Studies and Charting of the Data

Two researchers applied the inclusion and exclusion criteria to all the citations that the search strategy identified, continually reflecting on search strategies and methodological choices at each stage of sifting, charting and sorting (Arksey & O’Malley, 2005 ). Initial searches from the databases with the date, source and language criteria applied provided a list of 1625 publications. Titles were screened to ensure broad relevance to the research question and duplicates, with 1532 articles excluded. A review of abstracts was then undertaken for the remaining 93 articles, which led to a further 24 articles being removed.

Full-text articles (n = 69) were retrieved for those articles that had been included. Authors 1 and 4 examined these articles independently to decide if the articles confirmed the inclusion criteria. Author 2 resolved disagreement, resulting in 32 articles being included in the scoping review for inclusion in a thematic analysis. See Fig.  1 for the PRISMA that charts the screening process.

Prisma flow chart. Moher et al. ( 2009 )

Phases 4 and 5: Collating and Analysing the Results

Two researchers (Researchers 1 and 2) reviewed the selected thirty-two articles using Braun and Clarke’s ( 2021 ) ‘reflexive thematic analysis’ framework to code and identify emerging themes in the data. The six-phase process includes 1) data familiarisation and writing familiarisation notes; 2) systematic data coding; 3) generating initial themes from coded and collated data; 4) developing and reviewing themes; 5) refining, defining and naming themes; and 6) writing the report (Braun & Clarke, 2021 ).

As part of phase one, two researchers familiarised themselves with the data using a ‘descriptive-analytical’ method to consistently describe and categorise the key findings relevant to the research question, which formed the basis of the analysis (Arksey & O'Malley, 2005 ). Through this process, the researchers mapped the types, locations and key findings of included studies. The final set of 32 publications was collated and presented as a first-level analysis in Table  1 . There was no attempt to ‘weigh’ or assess the quality of each study as it is not the purpose of a scoping review, which seeks to present an overview of the material reviewed and, consequently, enable the identification of gaps in existing literature (Arksey & O'Malley, 2005 , p. 17).

In phases 2 and 3, the two researchers began reviewing and generating initial codes to “identify and make sense of patterns of meaning across a dataset” (Braun & Clarke, 2021 , p. 331) before organising the data thematically using the database program Excel. In phases 4 and 5, the researchers continued to refine and develop themes, encompassing the reflexive qualitative skills of the researchers as analytic resources. The themes were reviewed carefully together and independently by the broader research team to evolve the analysis, an “analytic process involving immersion in the data, reading, reflecting, questioning, imagining, wondering, writing, retreating, returning.” (Braun & Clarke, 2021 , p. 332).

Results and Thematic Discussion

The researchers undertook reflexive consultation together and independently to enhance the overall research process. This critical process involved two researchers screening, charting, and collating data. By incorporating this reflexive consultative approach, the researchers ensured they continually reflected on search strategies and methodological choices. This method is not linear but iterative and requires the researchers to engage with each stage of the scoping review reflexively (Arksey & O’Malley, 2005 ).

The researchers “made sense of” the data by summarising and interpreting key themes, patterns, and gaps using various frameworks, including a ‘descriptive-analysis’ (Arksey & O’Malley, 2005 ) and ‘reflexive thematic analysis’ (Braun & Clarke, 2021 ). Preliminary themes and findings were then developed, reported and refined with the broader research team of eight academic researchers and practitioners as subject matter experts to gather their insights, perspectives, and feedback on the preliminary findings. Using a ‘reflexive thematic analysis’ to gather insights, perspectives, and feedback, the researchers enhanced and evolved understandings of child sexual abuse disclosure (Braun & Clarke, 2021 ). This ‘consultation exercise’ is supported by other researchers who have recognised the value of consultation in enriching and confirming research outcomes (Oliver, 2001 ).

Following the research team's engagement with the ‘reflexive thematic analysis’ process in the analysis phase, the researchers continued to workshop emergent themes concerning the research question and theoretical framework. Three core themes were identified in the analyses of the 32 articles: (i) Factors enabling disclosure are multifaceted; (ii) Barriers to disclosure include a complex interplay of individual, familial, contextual and cultural issues; (iii) Indigenous victims and survivors, male survivors and survivors with a minoritised cultural background may face additional barriers to disclosing their experiences of abuse.

A summary of the multifaceted barriers and enablers impacting the disclosure of child sexual abuse across various domains is presented below in Table  2 .

Within each theme, these factors are discussed below using a social-ecological and reflexive critical theoretical lens.

Factors Enabling Disclosure are Multifaceted

While most research in this review identified barriers to disclosure, some enabling influences were also identified. Disclosure is conceptualised as a process rather than a one-time event (Tat & Ozturk, 2019 ) that can be affected by personal (individual), interpersonal (mutual or related) and societal (socio-political) factors (Easton et al., 2014 ; Ullman, 2023 ). For example, strong personal factors that influence disclosure may be the desire to protect oneself and prevent further abuse, seek support, clarification, and validation, unburden themselves, seek justice, and document the abuse. (Easton et al., 2014 ; Kasstan, 2022 ; Lusky-Weisrose et al., 2022 ; Ullman, 2023 ). Often, the likelihood of disclosing increases with age (Wallis & Woodworth, 2020 ).

A trusted and supportive individual, such as a parent, friend, teacher, or counsellor, is a significant interpersonal factor that encourages disclosure. The perception of protectiveness and safety from ‘trusted adults’ is crucial, particularly from mothers, who are often recipients of disclosure (Russell & Higgins, 2023 ). According to Rakovec-Felser and Vidovič ( 2016 ), this is especially important for female child victims of sexual abuse. These researchers found that those with safe and supportive mothers needed about nine months to disclose the abuse, whereas those without such support took approximately 6.9 years to disclose.

Having safe or ‘trusted adults’ also appeared in other research as an enabler of what helps children to ‘tell’ or disclose instances of abuse or CSA-related concerns (Russell & Higgins, 2023 ). However, an important finding was that disclosures to ‘trusted adults’ primarily occurred when the perpetrator was also an adult. In instances when the perpetrators of CSA were peers, children and young people were less likely to ‘tell’ adults, professionals, or organisations and more likely to ‘tell’ a friend (Russell & Higgins, 2023 ).

Societal or environmental factors that enable disclosure were linked to ‘memorable life events’ by Allnock ( 2017 ). These events are significant moments that can change one's life, which Allnock ( 2017 ) calls ‘turning points’, critical moments where survivors feel motivated to disclose their experiences. Turning points could occur accidentally following discussions, conversations, or watching television programs where sexual abuse appeared as a theme, enabling awareness of abusive behaviours and acting as a catalyst to tell (Allnock, 2017 ). Turning points could also represent the escalation of the offender’s behaviour, survivors becoming aware of other victims, or interventions by police investigations or child protection that may mutually ‘help others’ (Ullman, 2023 ).

Barriers to Disclosure include a Complex Interplay of Individual, Interpersonal, and Contextual Issues

Reflecting previous research, barriers to disclosure were found to outweigh facilitators of disclosure and tend to be multifaceted (Collin-Vézina et al., 2015 ; Easton et al., 2014 ). Barriers involve a complex interplay of individual, familial, contextual, and cultural issues, with age and gender predictive of delayed disclosure for younger children and adolescents (Sivagurunathan et al., 2019 ).

Multiple studies identified barriers across three broad domains, including personal (internal) barriers, which may include not identifying the experience as sexual abuse, and internal emotions such as shame, self-blame, fear and hopelessness (Collin-Vézina et al., 2015 ; Devgun et al., 2021 ; Easton, 2013 ) or the ‘the normality/ambiguity of the situation’ (Wager, 2015 ). Young children, particularly preschoolers, often have specific fears and barriers to telling or disclosing even when asked by professionals, as they might not understand the purpose of the interview, the crime they have been victim to, or the consequences of disclosing (Magnusson et al., 2017 ). Interpersonal barriers, including dynamics with the perpetrator, the relationship between the perpetrator and family, and the fear of consequences or negative self-representation, were found to impact disclosure significantly (Allnock, 2017 ; Collin-Vézina et al., 2015 ; Devgun et al., 2021 ; Easton, 2013 ; Gemara & Katz, 2023 ; Gruenfeld et al., 2017 ; Halvorsen et al., 2020 ; Wager, 2015 ).

Social or environmental barriers including limited social networks, a lack of opportunities or access to safe adults to disclose to can also lead to disclosures being downplayed or ignored by those who received them, often reinforcing internalised victim-blaming (Collin-Vézina et al., 2015 ). These barriers may include social and cultural norms related to sex, misconceptions and stereotypes about child sexual abuse survivors and perpetrators, and a lack of viable services to respond to disclosures (Collin-Vézina et al., 2015 ; Devgun et al., 2021 ; Easton, 2013 ; Mooney, 2021 ). In fact, according to Easton ( 2013 ) and Marmor ( 2023 ), many survivors who disclosed their experiences of CSA were unable to receive help despite their disclosures. In some cases, the mishandling of disclosures by law enforcement officers, child protection specialists, medical staff, and mental health professionals also created further barriers to disclosing from a sense of hopelessness (Pacheco et al., 2023 ; Wager, 2015 ). Furthermore, a range of context-specific issues were identified in the literature as barriers to disclosure. These included the impact of colonisation, cultural issues, and gender, which are discussed below.

Indigenous Victims and Survivors, Male Survivors and Survivors with a Minoritised Cultural Background May Face Additional Barriers to Disclosing their Experiences of Abuse

Some authors highlighted the ongoing legacy of colonial violence as a personal and structural barrier to the disclosure of child sexual abuse (Braithwaite, 2018 ; Tolliday, 2016 ). For Australian First Nations Peoples who were victims and survivors, “child sexual abuse in Aboriginal and Torres Strait Islander communities is a complex issue that cannot be understood in isolation from the ongoing impacts of colonial invasion, genocide, assimilation, institutionalised racism, and severe socio-economic deprivation. Service responses to child sexual abuse are often experienced as racist, culturally, financially, and/or geographically inaccessible” (Funston, 2013 , p. 381). Consistent with these findings, Tolliday ( 2016 ) examines historical efforts to address sexual safety for Aboriginal and Torres Strait Islander women and children, concluding that these problems cannot be resolved unless the underlying trauma experienced by First Nations Peoples is attended to. An additional barrier for Australian First Nations Peoples may be a level of mistrust in authorities such as police and child protection services, who were found to be involved in the forced removal of Aboriginal and Torres Strait Islander children from their families (Human Rights & Equal Opportunity Commission, 1997 ).

In investigating delayed disclosure, Braithwaite ( 2018 ) found that for rural Alaskan Native survivors, the impact of colonisation may be a significant barrier to survivors disclosing abuse. The inability to trust authorities directly results from colonisation and systemic, intergenerational poverty, where disclosing abuse may negatively impact already impoverished families.

Cultural and Racial Issues

In reporting on these issues, it is important not to present child sexual abuse as an inherent racial, religious, or cultural concern. As Taylor and Norma ( 2013 ) argue, describing interpersonal barriers for women of culturally or racially diverse backgrounds in Australia to disclose childhood sexual abuse has often been described as “cultural”, but it is more a “familial culture” rather than an aspect of ethnic culture, wherein barriers to reporting sexual abuse are from wanting to protect their family and community from shame, stigma, or loss of dignity in a society where a community as a whole can be racially and culturally vilified for the actions of a few offenders.

In other contexts, researchers found that “familial culture” barriers were experienced by many survivors in other highly racialized contexts. For example, researchers found that in South Africa, the desire for families to preserve the dignity of the family and avoid shame in the community may have inhibited children from wanting to disclose sexual abuse, consequently prioritising the reputation of the family over disclosure (Ramphabana et al., 2019 ). Likewise, in East Asian communities in Canada, the concern that such a negative incident can ruin the family and the victim’s reputation and damage relationships with other community members can also dissuade disclosure from children and reporting from their families (Roberts et al., 2016 ). When living within cultural norms that promote self-scrutiny, children feel responsible for their actions and may blame themselves for the abuse or for the impacts of disclosing (Roberts et al., 2016 ).

Fear of family disruption or breaking up the family, including placement in foster care or the criminal justice system (Allnock, 2017 ), were also mentioned as barriers to disclosure. This was found particularly in contexts where perpetrators contribute financially to the family or are the breadwinners upon whom the children rely for survival. These fears may be compounded within cultures enshrined within strong patriarchal values, where male dominance over women and children is normalised or socially accepted. This has been witnessed in East Asian communities in Canada, which are greatly influenced by Confucian philosophy and patriarchal lineage and where societal and familial harmony is expected to outweigh personal needs. Taken together, this could contribute significantly to the low reporting rate of Asian child sexual abuse, which is disproportionate to that of Caucasian children in Canada (Roberts et al., 2016 ). Other factors for low disclosure are linked to fears of condemnation or desire to protect parents, family, and community from reprisal, including, in extreme circumstances, fear of ostracization, death threats, honour killings (Marmor, 2023 ), physical violence, the risk of being disowned by family or expelled from school, discrimination, isolation from social networks, and emotional abuse within the community (Obong'o et al., 2020 ). For already vulnerable, minoritised communities, this creates a double layer of vulnerability in broader society.

How a community views sex can also make it difficult for children, families, and communities to identify and disclose child sexual abuse, particularly in sexually conservative, religious-cultural contexts where sex may be taboo, stigmatising, or disrespectful to discuss with children (Ramphabana et al., 2019 ). In a study from Zimbabwe, stigma and discrimination from being labelled as having sexually transmitted diseases or for losing their virginity were expressed as a fear of disclosure (Obong'o et al., 2020 ). There are also religious prohibitions against reporting sexual abuse or violence to secular authorities (Marmor, 2023 ), as this would tarnish the religious image in secular contexts. This suggests that the emphasis on purity culture, silencing of discussions on sexuality, diminished reporting due to fear of the influence of secular values, and reliance on disclosing to religious authority figures rather than professionals act as religious and cultural barriers to reporting child sexual abuse (Lusky-Weisrose et al., 2022 ). When combined, it reduces survivors’ ability to identify and disclose child sexual abuse alongside institutional barriers and adds layers of possible isolation in cultural contexts that also serve as social protection for minoritised groups.

Gender Issues

The role of gender in child sexual abuse disclosure was identified as a noteworthy barrier. Researchers highlight the difference in disclosure patterns of male child sexual abuse survivors, which tend to be delayed for years or even decades compared to female survivors, and some male survivors were found to have lower rates of ever disclosing the abuse (Easton, 2013 ; Easton et al., 2014 ). Like many survivors of child sexual abuse, male survivors feared not being believed, justifiably, as historically there was a lack of awareness of the existence of male child sexual abuse, despite researchers finding that approximately 15% of adult men report being sexually abused during childhood (Easton et al., 2014 ). The mass media coverage of institutional abuse scandals, such as those at the Catholic Church, Boy Scouts of America, and Penn State University, have now raised public awareness of the sexual abuse of boys and how the impacts of child sexual abuse, such as deep-seated rage, shame, spiritual distress, and stigma (Easton, 2013 ) have influenced delayed or non-disclosure.

Gendered societal norms also strongly influence individual, group, and societal ideas and behaviours towards male sexual abuse (Sivagurunathan et al., 2019 ). These include, notably, ideas of male gender identity, masculinity, and masculine norms such as winning, emotional control, homophobia, and self-reliance, including negative attitudes towards victimhood and help-seeking. Additionally, as boys are often sexually abused by other males, many survivors fear the stigma of being labelled homosexual (Easton, 2013 ; Easton et al., 2014 ). Some survivors who self-identified as gay or bisexual also feared that others would use their abuse to explain their sexual orientation, saying it “made me gay” (Easton, 2013 ; Easton et al., 2014 ). Other survivors also questioned their sexual orientation due to their abuse experiences, blamed themselves, or feared being seen by others as having unconsciously invited the abuse (Sivagurunathan et al., 2019 ).

External barriers to disclosure were also identified regarding child protection workers, law enforcement, and clinicians (Easton, 2013 ), as well as religious institutions, such as churches and mosques, who were also found to have obstructed the identification and treatment of child sexual abuse in males due to societal attitudes about sex and the stigma of child sexual abuse. Additionally, there is a double standard when it comes to how sexual abuse among men is framed in mainstream media in a society that tends to glorify the sexual abuse of male children as a sexual initiation or sexual prowess if the perpetrator is an older woman. These double standards may, in turn, result in the further reluctance of male child sexual abuse survivors to disclose such experiences (Sivagurunathan et al., 2019 ), which is part of the reason why the helpfulness of responses to child sexual abuse disclosure across a male survivor’s lifespan is mixed (Easton, 2013 ). Combined, they all link to larger societal issues around gendered social expectations and how they impact child sexual abuse disclosure. If hegemonic masculinity and the conforming of traditional gendered roles lead to delayed disclosure or not disclosing at all for male survivors, a question arises concerning the child sexual abuse experiences of transgender and gender-diverse people, who are disproportionately affected by prejudice-motivated discrimination and violence.

Implications for Policy, Practice and Further Research

Thirty-two manuscripts were reviewed to respond to the question: What is known about what influences or enables children and young people to disclose their experience of child sexual abuse, and what are the barriers to disclosure?

This review found that a significant enabler for disclosure is the presence of a safe relationship. This finding is consistent with emerging knowledge about the impact of trauma, which suggests that children may first choose to disclose to a friend or person they trust. Another clear finding in the literature is that disclosure should not be conceptualised as a single event at a point in time. Disclosure is seen as multifaceted, contextual and likely to be iterative, taking place over time. This raises critical questions about the extent to which legislative, policy and practice frameworks are sensitised to this finding.

These findings should contribute to the design of policies that support practices enabling children to experience safe spaces and relationships within which they may feel able to disclose, in their own time, the abuse that they have experienced. Services designed to engage and support all children and young people, including schools, sports and recreation facilities, should give attention to various strategies to promote a sense of safety for their child participants. These services should be accompanied by clearly articulated policies to support children and young people through the process of disclosure. In addition, services designed to respond to child victims, such as statutory child protection and police, must be designed with children in mind. In practice, adult-centric forensic models of interviews conducted by police and child protection may be premised on a single contact with the child. This approach may not match the child’s need to reveal details of their experience over time in what we know to be an often iterative process. All children’s services should become familiar with the behavioural indicators that some children, particularly younger children, may demonstrate rather than using words to disclose.

The notable research gaps are of importance for future research. For example, critical questions are raised concerning the lack of studies on diverse cohorts, including LGBTQIA + survivors, Indigenous survivors or survivors living with a disability. Whilst the prevailing research does address the facilitators of disclosure to an extent, the volume of literature reporting on the barriers to disclosure is greater. A more in-depth understanding by policymakers, practitioners and researchers of some of the obstacles, including broader social and sociocultural barriers, is needed.

Further research to hear from a diverse cohort of survivors to explore their experiences of disclosing child sexual abuse is urgently needed. Overall, this review highlights the need to advance the understanding of the processes of child sexual abuse across diverse cohorts and contexts to improve service systems’ capacity to listen, hear, and respond appropriately to children and young people.

Overall, this review highlights the need to advance the understanding of the processes of child sexual abuse across diverse cohorts and contexts to improve service systems’ capacity to listen, hear, and respond appropriately to children and young people.

Limitations of the Study

Several methodological limitations apply to this analysis. This review has not identified all relevant literature due to the scope of databases searched and the likelihood that not all contemporary search terms were utilised, which might limit the comprehensiveness of the review. The research question sought information about disclosures of child sexual abuse; however, many practice responses to disclosure are likely unpublished in scholarly journals. As grey literature was excluded, potentially valuable insights from reports, theses, conference papers, and other non-peer-reviewed sources were not considered. This limitation is compounded by the inherent difficulty in drawing generalisable conclusions from scoping reviews, which encompass a variety of methodologies, populations, and contexts.

Another limitation is that only articles published in English were included, potentially resulting in the exclusion of crucial studies published in other languages. Additionally, the reliance on peer-reviewed journals may introduce publication bias, as studies with significant or positive results from the UK or North America are more likely to be published. There is also the possibility of subjective bias, as the identification and interpretation of themes depend on the researchers' perspectives.

Furthermore, as it is not within the remit of a scoping review to assess the quality of included studies, findings from lower-quality studies are considered alongside those from higher-quality studies without differentiation. However, the choice to include and conduct scholarly literature that undergoes independent double-blind peer review was made to reduce quality and publication bias risks.

Rather than simply being a one-off event, the disclosure of child sexual abuse is often a complex and ongoing process (Alaggia et al., 2019 ). More is known about barriers than enablers to disclosure, with barriers dominating the published literature sourced in this review. It is evident that, for children and young people, talking about the abuse that they have endured can be overwhelmingly challenging for them across personal, interpersonal and broader levels.

When children and young people begin to disclose, this review raised critical questions about how service systems respond to initial disclosure, particularly the extent to which policies and systems are designed to reflect children’s best interests.

Adults noticing when children and young people are distressed helps victims and survivors to disclose, as does creating trusting relationships to provide opportunities to tell their stories (Russell et al., 2023 ). To whom children elect to disclose is an important question, with recent research suggesting that when children and young people feel unsafe, they are more likely to tell a friend than an adult (Russell et al., 2023 ). Research is urgently required to develop a more robust understanding of the enablers of disclosure across diverse populations. This research needs to privilege the voices of victims and survivors with lived and living experiences of child sexual abuse.

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McPherson, L., Gatwiri, K., Graham, A. et al. What Helps Children and Young People to Disclose their Experience of Sexual Abuse and What Gets in the Way? A Systematic Scoping Review. Child Youth Care Forum (2024). https://doi.org/10.1007/s10566-024-09825-5

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An overview of methodological approaches in systematic reviews

Prabhakar veginadu.

1 Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo Victoria, Australia

Hanny Calache

2 Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln UK

Akshaya Pandian

3 Department of Orthodontics, Saveetha Dental College, Chennai Tamil Nadu, India

Mohd Masood

Associated data.

APPENDIX B: List of excluded studies with detailed reasons for exclusion

APPENDIX C: Quality assessment of included reviews using AMSTAR 2

The aim of this overview is to identify and collate evidence from existing published systematic review (SR) articles evaluating various methodological approaches used at each stage of an SR.

The search was conducted in five electronic databases from inception to November 2020 and updated in February 2022: MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and APA PsycINFO. Title and abstract screening were performed in two stages by one reviewer, supported by a second reviewer. Full‐text screening, data extraction, and quality appraisal were performed by two reviewers independently. The quality of the included SRs was assessed using the AMSTAR 2 checklist.

The search retrieved 41,556 unique citations, of which 9 SRs were deemed eligible for inclusion in final synthesis. Included SRs evaluated 24 unique methodological approaches used for defining the review scope and eligibility, literature search, screening, data extraction, and quality appraisal in the SR process. Limited evidence supports the following (a) searching multiple resources (electronic databases, handsearching, and reference lists) to identify relevant literature; (b) excluding non‐English, gray, and unpublished literature, and (c) use of text‐mining approaches during title and abstract screening.

The overview identified limited SR‐level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process, as well as some methodological modifications currently used in expedited SRs. Overall, findings of this overview highlight the dearth of published SRs focused on SR methodologies and this warrants future work in this area.

1. INTRODUCTION

Evidence synthesis is a prerequisite for knowledge translation. 1 A well conducted systematic review (SR), often in conjunction with meta‐analyses (MA) when appropriate, is considered the “gold standard” of methods for synthesizing evidence related to a topic of interest. 2 The central strength of an SR is the transparency of the methods used to systematically search, appraise, and synthesize the available evidence. 3 Several guidelines, developed by various organizations, are available for the conduct of an SR; 4 , 5 , 6 , 7 among these, Cochrane is considered a pioneer in developing rigorous and highly structured methodology for the conduct of SRs. 8 The guidelines developed by these organizations outline seven fundamental steps required in SR process: defining the scope of the review and eligibility criteria, literature searching and retrieval, selecting eligible studies, extracting relevant data, assessing risk of bias (RoB) in included studies, synthesizing results, and assessing certainty of evidence (CoE) and presenting findings. 4 , 5 , 6 , 7

The methodological rigor involved in an SR can require a significant amount of time and resource, which may not always be available. 9 As a result, there has been a proliferation of modifications made to the traditional SR process, such as refining, shortening, bypassing, or omitting one or more steps, 10 , 11 for example, limits on the number and type of databases searched, limits on publication date, language, and types of studies included, and limiting to one reviewer for screening and selection of studies, as opposed to two or more reviewers. 10 , 11 These methodological modifications are made to accommodate the needs of and resource constraints of the reviewers and stakeholders (e.g., organizations, policymakers, health care professionals, and other knowledge users). While such modifications are considered time and resource efficient, they may introduce bias in the review process reducing their usefulness. 5

Substantial research has been conducted examining various approaches used in the standardized SR methodology and their impact on the validity of SR results. There are a number of published reviews examining the approaches or modifications corresponding to single 12 , 13 or multiple steps 14 involved in an SR. However, there is yet to be a comprehensive summary of the SR‐level evidence for all the seven fundamental steps in an SR. Such a holistic evidence synthesis will provide an empirical basis to confirm the validity of current accepted practices in the conduct of SRs. Furthermore, sometimes there is a balance that needs to be achieved between the resource availability and the need to synthesize the evidence in the best way possible, given the constraints. This evidence base will also inform the choice of modifications to be made to the SR methods, as well as the potential impact of these modifications on the SR results. An overview is considered the choice of approach for summarizing existing evidence on a broad topic, directing the reader to evidence, or highlighting the gaps in evidence, where the evidence is derived exclusively from SRs. 15 Therefore, for this review, an overview approach was used to (a) identify and collate evidence from existing published SR articles evaluating various methodological approaches employed in each of the seven fundamental steps of an SR and (b) highlight both the gaps in the current research and the potential areas for future research on the methods employed in SRs.

An a priori protocol was developed for this overview but was not registered with the International Prospective Register of Systematic Reviews (PROSPERO), as the review was primarily methodological in nature and did not meet PROSPERO eligibility criteria for registration. The protocol is available from the corresponding author upon reasonable request. This overview was conducted based on the guidelines for the conduct of overviews as outlined in The Cochrane Handbook. 15 Reporting followed the Preferred Reporting Items for Systematic reviews and Meta‐analyses (PRISMA) statement. 3

2.1. Eligibility criteria

Only published SRs, with or without associated MA, were included in this overview. We adopted the defining characteristics of SRs from The Cochrane Handbook. 5 According to The Cochrane Handbook, a review was considered systematic if it satisfied the following criteria: (a) clearly states the objectives and eligibility criteria for study inclusion; (b) provides reproducible methodology; (c) includes a systematic search to identify all eligible studies; (d) reports assessment of validity of findings of included studies (e.g., RoB assessment of the included studies); (e) systematically presents all the characteristics or findings of the included studies. 5 Reviews that did not meet all of the above criteria were not considered a SR for this study and were excluded. MA‐only articles were included if it was mentioned that the MA was based on an SR.

SRs and/or MA of primary studies evaluating methodological approaches used in defining review scope and study eligibility, literature search, study selection, data extraction, RoB assessment, data synthesis, and CoE assessment and reporting were included. The methodological approaches examined in these SRs and/or MA can also be related to the substeps or elements of these steps; for example, applying limits on date or type of publication are the elements of literature search. Included SRs examined or compared various aspects of a method or methods, and the associated factors, including but not limited to: precision or effectiveness; accuracy or reliability; impact on the SR and/or MA results; reproducibility of an SR steps or bias occurred; time and/or resource efficiency. SRs assessing the methodological quality of SRs (e.g., adherence to reporting guidelines), evaluating techniques for building search strategies or the use of specific database filters (e.g., use of Boolean operators or search filters for randomized controlled trials), examining various tools used for RoB or CoE assessment (e.g., ROBINS vs. Cochrane RoB tool), or evaluating statistical techniques used in meta‐analyses were excluded. 14

2.2. Search

The search for published SRs was performed on the following scientific databases initially from inception to third week of November 2020 and updated in the last week of February 2022: MEDLINE (via Ovid), Embase (via Ovid), Web of Science Core Collection, Cochrane Database of Systematic Reviews, and American Psychological Association (APA) PsycINFO. Search was restricted to English language publications. Following the objectives of this study, study design filters within databases were used to restrict the search to SRs and MA, where available. The reference lists of included SRs were also searched for potentially relevant publications.

The search terms included keywords, truncations, and subject headings for the key concepts in the review question: SRs and/or MA, methods, and evaluation. Some of the terms were adopted from the search strategy used in a previous review by Robson et al., which reviewed primary studies on methodological approaches used in study selection, data extraction, and quality appraisal steps of SR process. 14 Individual search strategies were developed for respective databases by combining the search terms using appropriate proximity and Boolean operators, along with the related subject headings in order to identify SRs and/or MA. 16 , 17 A senior librarian was consulted in the design of the search terms and strategy. Appendix A presents the detailed search strategies for all five databases.

2.3. Study selection and data extraction

Title and abstract screening of references were performed in three steps. First, one reviewer (PV) screened all the titles and excluded obviously irrelevant citations, for example, articles on topics not related to SRs, non‐SR publications (such as randomized controlled trials, observational studies, scoping reviews, etc.). Next, from the remaining citations, a random sample of 200 titles and abstracts were screened against the predefined eligibility criteria by two reviewers (PV and MM), independently, in duplicate. Discrepancies were discussed and resolved by consensus. This step ensured that the responses of the two reviewers were calibrated for consistency in the application of the eligibility criteria in the screening process. Finally, all the remaining titles and abstracts were reviewed by a single “calibrated” reviewer (PV) to identify potential full‐text records. Full‐text screening was performed by at least two authors independently (PV screened all the records, and duplicate assessment was conducted by MM, HC, or MG), with discrepancies resolved via discussions or by consulting a third reviewer.

Data related to review characteristics, results, key findings, and conclusions were extracted by at least two reviewers independently (PV performed data extraction for all the reviews and duplicate extraction was performed by AP, HC, or MG).

2.4. Quality assessment of included reviews

The quality assessment of the included SRs was performed using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). The tool consists of a 16‐item checklist addressing critical and noncritical domains. 18 For the purpose of this study, the domain related to MA was reclassified from critical to noncritical, as SRs with and without MA were included. The other six critical domains were used according to the tool guidelines. 18 Two reviewers (PV and AP) independently responded to each of the 16 items in the checklist with either “yes,” “partial yes,” or “no.” Based on the interpretations of the critical and noncritical domains, the overall quality of the review was rated as high, moderate, low, or critically low. 18 Disagreements were resolved through discussion or by consulting a third reviewer.

2.5. Data synthesis

To provide an understandable summary of existing evidence syntheses, characteristics of the methods evaluated in the included SRs were examined and key findings were categorized and presented based on the corresponding step in the SR process. The categories of key elements within each step were discussed and agreed by the authors. Results of the included reviews were tabulated and summarized descriptively, along with a discussion on any overlap in the primary studies. 15 No quantitative analyses of the data were performed.

From 41,556 unique citations identified through literature search, 50 full‐text records were reviewed, and nine systematic reviews 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 were deemed eligible for inclusion. The flow of studies through the screening process is presented in Figure  1 . A list of excluded studies with reasons can be found in Appendix B .

Study selection flowchart

3.1. Characteristics of included reviews

Table  1 summarizes the characteristics of included SRs. The majority of the included reviews (six of nine) were published after 2010. 14 , 22 , 23 , 24 , 25 , 26 Four of the nine included SRs were Cochrane reviews. 20 , 21 , 22 , 23 The number of databases searched in the reviews ranged from 2 to 14, 2 reviews searched gray literature sources, 24 , 25 and 7 reviews included a supplementary search strategy to identify relevant literature. 14 , 19 , 20 , 21 , 22 , 23 , 26 Three of the included SRs (all Cochrane reviews) included an integrated MA. 20 , 21 , 23

Characteristics of included studies

SR = systematic review; MA = meta‐analysis; RCT = randomized controlled trial; CCT = controlled clinical trial; N/R = not reported.

The included SRs evaluated 24 unique methodological approaches (26 in total) used across five steps in the SR process; 8 SRs evaluated 6 approaches, 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 while 1 review evaluated 18 approaches. 14 Exclusion of gray or unpublished literature 21 , 26 and blinding of reviewers for RoB assessment 14 , 23 were evaluated in two reviews each. Included SRs evaluated methods used in five different steps in the SR process, including methods used in defining the scope of review ( n  = 3), literature search ( n  = 3), study selection ( n  = 2), data extraction ( n  = 1), and RoB assessment ( n  = 2) (Table  2 ).

Summary of findings from review evaluating systematic review methods

There was some overlap in the primary studies evaluated in the included SRs on the same topics: Schmucker et al. 26 and Hopewell et al. 21 ( n  = 4), Hopewell et al. 20 and Crumley et al. 19 ( n  = 30), and Robson et al. 14 and Morissette et al. 23 ( n  = 4). There were no conflicting results between any of the identified SRs on the same topic.

3.2. Methodological quality of included reviews

Overall, the quality of the included reviews was assessed as moderate at best (Table  2 ). The most common critical weakness in the reviews was failure to provide justification for excluding individual studies (four reviews). Detailed quality assessment is provided in Appendix C .

3.3. Evidence on systematic review methods

3.3.1. methods for defining review scope and eligibility.

Two SRs investigated the effect of excluding data obtained from gray or unpublished sources on the pooled effect estimates of MA. 21 , 26 Hopewell et al. 21 reviewed five studies that compared the impact of gray literature on the results of a cohort of MA of RCTs in health care interventions. Gray literature was defined as information published in “print or electronic sources not controlled by commercial or academic publishers.” Findings showed an overall greater treatment effect for published trials than trials reported in gray literature. In a more recent review, Schmucker et al. 26 addressed similar objectives, by investigating gray and unpublished data in medicine. In addition to gray literature, defined similar to the previous review by Hopewell et al., the authors also evaluated unpublished data—defined as “supplemental unpublished data related to published trials, data obtained from the Food and Drug Administration  or other regulatory websites or postmarketing analyses hidden from the public.” The review found that in majority of the MA, excluding gray literature had little or no effect on the pooled effect estimates. The evidence was limited to conclude if the data from gray and unpublished literature had an impact on the conclusions of MA. 26

Morrison et al. 24 examined five studies measuring the effect of excluding non‐English language RCTs on the summary treatment effects of SR‐based MA in various fields of conventional medicine. Although none of the included studies reported major difference in the treatment effect estimates between English only and non‐English inclusive MA, the review found inconsistent evidence regarding the methodological and reporting quality of English and non‐English trials. 24 As such, there might be a risk of introducing “language bias” when excluding non‐English language RCTs. The authors also noted that the numbers of non‐English trials vary across medical specialties, as does the impact of these trials on MA results. Based on these findings, Morrison et al. 24 conclude that literature searches must include non‐English studies when resources and time are available to minimize the risk of introducing “language bias.”

3.3.2. Methods for searching studies

Crumley et al. 19 analyzed recall (also referred to as “sensitivity” by some researchers; defined as “percentage of relevant studies identified by the search”) and precision (defined as “percentage of studies identified by the search that were relevant”) when searching a single resource to identify randomized controlled trials and controlled clinical trials, as opposed to searching multiple resources. The studies included in their review frequently compared a MEDLINE only search with the search involving a combination of other resources. The review found low median recall estimates (median values between 24% and 92%) and very low median precisions (median values between 0% and 49%) for most of the electronic databases when searched singularly. 19 A between‐database comparison, based on the type of search strategy used, showed better recall and precision for complex and Cochrane Highly Sensitive search strategies (CHSSS). In conclusion, the authors emphasize that literature searches for trials in SRs must include multiple sources. 19

In an SR comparing handsearching and electronic database searching, Hopewell et al. 20 found that handsearching retrieved more relevant RCTs (retrieval rate of 92%−100%) than searching in a single electronic database (retrieval rates of 67% for PsycINFO/PsycLIT, 55% for MEDLINE, and 49% for Embase). The retrieval rates varied depending on the quality of handsearching, type of electronic search strategy used (e.g., simple, complex or CHSSS), and type of trial reports searched (e.g., full reports, conference abstracts, etc.). The authors concluded that handsearching was particularly important in identifying full trials published in nonindexed journals and in languages other than English, as well as those published as abstracts and letters. 20

The effectiveness of checking reference lists to retrieve additional relevant studies for an SR was investigated by Horsley et al. 22 The review reported that checking reference lists yielded 2.5%–40% more studies depending on the quality and comprehensiveness of the electronic search used. The authors conclude that there is some evidence, although from poor quality studies, to support use of checking reference lists to supplement database searching. 22

3.3.3. Methods for selecting studies

Three approaches relevant to reviewer characteristics, including number, experience, and blinding of reviewers involved in the screening process were highlighted in an SR by Robson et al. 14 Based on the retrieved evidence, the authors recommended that two independent, experienced, and unblinded reviewers be involved in study selection. 14 A modified approach has also been suggested by the review authors, where one reviewer screens and the other reviewer verifies the list of excluded studies, when the resources are limited. It should be noted however this suggestion is likely based on the authors’ opinion, as there was no evidence related to this from the studies included in the review.

Robson et al. 14 also reported two methods describing the use of technology for screening studies: use of Google Translate for translating languages (for example, German language articles to English) to facilitate screening was considered a viable method, while using two computer monitors for screening did not increase the screening efficiency in SR. Title‐first screening was found to be more efficient than simultaneous screening of titles and abstracts, although the gain in time with the former method was lesser than the latter. Therefore, considering that the search results are routinely exported as titles and abstracts, Robson et al. 14 recommend screening titles and abstracts simultaneously. However, the authors note that these conclusions were based on very limited number (in most instances one study per method) of low‐quality studies. 14

3.3.4. Methods for data extraction

Robson et al. 14 examined three approaches for data extraction relevant to reviewer characteristics, including number, experience, and blinding of reviewers (similar to the study selection step). Although based on limited evidence from a small number of studies, the authors recommended use of two experienced and unblinded reviewers for data extraction. The experience of the reviewers was suggested to be especially important when extracting continuous outcomes (or quantitative) data. However, when the resources are limited, data extraction by one reviewer and a verification of the outcomes data by a second reviewer was recommended.

As for the methods involving use of technology, Robson et al. 14 identified limited evidence on the use of two monitors to improve the data extraction efficiency and computer‐assisted programs for graphical data extraction. However, use of Google Translate for data extraction in non‐English articles was not considered to be viable. 14 In the same review, Robson et al. 14 identified evidence supporting contacting authors for obtaining additional relevant data.

3.3.5. Methods for RoB assessment

Two SRs examined the impact of blinding of reviewers for RoB assessments. 14 , 23 Morissette et al. 23 investigated the mean differences between the blinded and unblinded RoB assessment scores and found inconsistent differences among the included studies providing no definitive conclusions. Similar conclusions were drawn in a more recent review by Robson et al., 14 which included four studies on reviewer blinding for RoB assessment that completely overlapped with Morissette et al. 23

Use of experienced reviewers and provision of additional guidance for RoB assessment were examined by Robson et al. 14 The review concluded that providing intensive training and guidance on assessing studies reporting insufficient data to the reviewers improves RoB assessments. 14 Obtaining additional data related to quality assessment by contacting study authors was also found to help the RoB assessments, although based on limited evidence. When assessing the qualitative or mixed method reviews, Robson et al. 14 recommends the use of a structured RoB tool as opposed to an unstructured tool. No SRs were identified on data synthesis and CoE assessment and reporting steps.

4. DISCUSSION

4.1. summary of findings.

Nine SRs examining 24 unique methods used across five steps in the SR process were identified in this overview. The collective evidence supports some current traditional and modified SR practices, while challenging other approaches. However, the quality of the included reviews was assessed to be moderate at best and in the majority of the included SRs, evidence related to the evaluated methods was obtained from very limited numbers of primary studies. As such, the interpretations from these SRs should be made cautiously.

The evidence gathered from the included SRs corroborate a few current SR approaches. 5 For example, it is important to search multiple resources for identifying relevant trials (RCTs and/or CCTs). The resources must include a combination of electronic database searching, handsearching, and reference lists of retrieved articles. 5 However, no SRs have been identified that evaluated the impact of the number of electronic databases searched. A recent study by Halladay et al. 27 found that articles on therapeutic intervention, retrieved by searching databases other than PubMed (including Embase), contributed only a small amount of information to the MA and also had a minimal impact on the MA results. The authors concluded that when the resources are limited and when large number of studies are expected to be retrieved for the SR or MA, PubMed‐only search can yield reliable results. 27

Findings from the included SRs also reiterate some methodological modifications currently employed to “expedite” the SR process. 10 , 11 For example, excluding non‐English language trials and gray/unpublished trials from MA have been shown to have minimal or no impact on the results of MA. 24 , 26 However, the efficiency of these SR methods, in terms of time and the resources used, have not been evaluated in the included SRs. 24 , 26 Of the SRs included, only two have focused on the aspect of efficiency 14 , 25 ; O'Mara‐Eves et al. 25 report some evidence to support the use of text‐mining approaches for title and abstract screening in order to increase the rate of screening. Moreover, only one included SR 14 considered primary studies that evaluated reliability (inter‐ or intra‐reviewer consistency) and accuracy (validity when compared against a “gold standard” method) of the SR methods. This can be attributed to the limited number of primary studies that evaluated these outcomes when evaluating the SR methods. 14 Lack of outcome measures related to reliability, accuracy, and efficiency precludes making definitive recommendations on the use of these methods/modifications. Future research studies must focus on these outcomes.

Some evaluated methods may be relevant to multiple steps; for example, exclusions based on publication status (gray/unpublished literature) and language of publication (non‐English language studies) can be outlined in the a priori eligibility criteria or can be incorporated as search limits in the search strategy. SRs included in this overview focused on the effect of study exclusions on pooled treatment effect estimates or MA conclusions. Excluding studies from the search results, after conducting a comprehensive search, based on different eligibility criteria may yield different results when compared to the results obtained when limiting the search itself. 28 Further studies are required to examine this aspect.

Although we acknowledge the lack of standardized quality assessment tools for methodological study designs, we adhered to the Cochrane criteria for identifying SRs in this overview. This was done to ensure consistency in the quality of the included evidence. As a result, we excluded three reviews that did not provide any form of discussion on the quality of the included studies. The methods investigated in these reviews concern supplementary search, 29 data extraction, 12 and screening. 13 However, methods reported in two of these three reviews, by Mathes et al. 12 and Waffenschmidt et al., 13 have also been examined in the SR by Robson et al., 14 which was included in this overview; in most instances (with the exception of one study included in Mathes et al. 12 and Waffenschmidt et al. 13 each), the studies examined in these excluded reviews overlapped with those in the SR by Robson et al. 14

One of the key gaps in the knowledge observed in this overview was the dearth of SRs on the methods used in the data synthesis component of SR. Narrative and quantitative syntheses are the two most commonly used approaches for synthesizing data in evidence synthesis. 5 There are some published studies on the proposed indications and implications of these two approaches. 30 , 31 These studies found that both data synthesis methods produced comparable results and have their own advantages, suggesting that the choice of the method must be based on the purpose of the review. 31 With increasing number of “expedited” SR approaches (so called “rapid reviews”) avoiding MA, 10 , 11 further research studies are warranted in this area to determine the impact of the type of data synthesis on the results of the SR.

4.2. Implications for future research

The findings of this overview highlight several areas of paucity in primary research and evidence synthesis on SR methods. First, no SRs were identified on methods used in two important components of the SR process, including data synthesis and CoE and reporting. As for the included SRs, a limited number of evaluation studies have been identified for several methods. This indicates that further research is required to corroborate many of the methods recommended in current SR guidelines. 4 , 5 , 6 , 7 Second, some SRs evaluated the impact of methods on the results of quantitative synthesis and MA conclusions. Future research studies must also focus on the interpretations of SR results. 28 , 32 Finally, most of the included SRs were conducted on specific topics related to the field of health care, limiting the generalizability of the findings to other areas. It is important that future research studies evaluating evidence syntheses broaden the objectives and include studies on different topics within the field of health care.

4.3. Strengths and limitations

To our knowledge, this is the first overview summarizing current evidence from SRs and MA on different methodological approaches used in several fundamental steps in SR conduct. The overview methodology followed well established guidelines and strict criteria defined for the inclusion of SRs.

There are several limitations related to the nature of the included reviews. Evidence for most of the methods investigated in the included reviews was derived from a limited number of primary studies. Also, the majority of the included SRs may be considered outdated as they were published (or last updated) more than 5 years ago 33 ; only three of the nine SRs have been published in the last 5 years. 14 , 25 , 26 Therefore, important and recent evidence related to these topics may not have been included. Substantial numbers of included SRs were conducted in the field of health, which may limit the generalizability of the findings. Some method evaluations in the included SRs focused on quantitative analyses components and MA conclusions only. As such, the applicability of these findings to SR more broadly is still unclear. 28 Considering the methodological nature of our overview, limiting the inclusion of SRs according to the Cochrane criteria might have resulted in missing some relevant evidence from those reviews without a quality assessment component. 12 , 13 , 29 Although the included SRs performed some form of quality appraisal of the included studies, most of them did not use a standardized RoB tool, which may impact the confidence in their conclusions. Due to the type of outcome measures used for the method evaluations in the primary studies and the included SRs, some of the identified methods have not been validated against a reference standard.

Some limitations in the overview process must be noted. While our literature search was exhaustive covering five bibliographic databases and supplementary search of reference lists, no gray sources or other evidence resources were searched. Also, the search was primarily conducted in health databases, which might have resulted in missing SRs published in other fields. Moreover, only English language SRs were included for feasibility. As the literature search retrieved large number of citations (i.e., 41,556), the title and abstract screening was performed by a single reviewer, calibrated for consistency in the screening process by another reviewer, owing to time and resource limitations. These might have potentially resulted in some errors when retrieving and selecting relevant SRs. The SR methods were grouped based on key elements of each recommended SR step, as agreed by the authors. This categorization pertains to the identified set of methods and should be considered subjective.

5. CONCLUSIONS

This overview identified limited SR‐level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process. Limited evidence was also identified on some methodological modifications currently used to expedite the SR process. Overall, findings highlight the dearth of SRs on SR methodologies, warranting further work to confirm several current recommendations on conventional and expedited SR processes.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

Supporting information

APPENDIX A: Detailed search strategies

ACKNOWLEDGMENTS

The first author is supported by a La Trobe University Full Fee Research Scholarship and a Graduate Research Scholarship.

Open Access Funding provided by La Trobe University.

Veginadu P, Calache H, Gussy M, Pandian A, Masood M. An overview of methodological approaches in systematic reviews . J Evid Based Med . 2022; 15 :39–54. 10.1111/jebm.12468 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]