Adult learning online education:
Adult learning online education:
Adult learning online education:
About the example: Boolean searches were conducted on November 4, 2019; result numbers may vary at a later date. No additional database limiters were set to further narrow search returns.
Database strategies for targeted search results.
Most databases include limiters, or additional parameters, you may use to strategically focus search results. EBSCO databases, such as Education Research Complete & Academic Search Complete provide options to:
Keep in mind that these tools are defined as limiters for a reason; adding them to a search will limit the number of results returned. This can be a double-edged sword. How?
Use limiters with care. When starting a search, consider opting out of limiters until the initial literature screening is complete. The second or third time through your research may be the ideal time to focus on specific time periods or material (scholarly vs newspaper).
Expanding your search term at the root.
Truncating is often referred to as 'wildcard' searching. Databases may have their own specific wildcard elements however, the most commonly used are the asterisk (*) or question mark (?). When used within your search. they will expand returned results.
Using the asterisk wildcard will return varied spellings of the truncated word. In the following example, the search term education was truncated after the letter "t."
Original Search | |
adult education | adult educat* |
Results included: educate, education, educator, educators'/educators, educating, & educational |
Explore these database help pages for additional information on crafting search terms.
Tips for saving research directly to Google drive.
It is possible to save articles (PDF and HTML) and abstracts in EBSCOhost databases directly to Google drive. Select the Google Drive icon, authenticate using a Google account, and an EBSCO folder will be created in your account. This is a great option for managing your research. If documenting your research in a Google Doc, consider linking the information to actual articles saved in drive.
EBSCOHost Databases & Google Drive: Managing your Research
This video features an overview of how to use Google Drive with EBSCO databases to help manage your research. It presents information for connecting an active Google account to EBSCO and steps needed to provide permission for EBSCO to manage a folder in Drive.
About the Video: Closed captioning is available, select CC from the video menu. If you need to review a specific area on the video, view on YouTube and expand the video description for access to topic time stamps. A video transcript is provided below.
What is a literature review.
A definition from the Online Dictionary for Library and Information Sciences .
A literature review is "a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works" (Reitz, 2014).
A systemic review is "a literature review focused on a specific research question, which uses explicit methods to minimize bias in the identification, appraisal, selection, and synthesis of all the high-quality evidence pertinent to the question" (Reitz, 2014).
EBSCO Connect [Discovery and Search]. (2022). Searching with boolean operators. Retrieved May, 3, 2022 from https://connect.ebsco.com/s/?language=en_US
EBSCO Connect [Discover and Search]. (2022). Searching with wildcards and truncation symbols. Retrieved May 3, 2022; https://connect.ebsco.com/s/?language=en_US
Machi, L.A. & McEvoy, B.T. (2009). The literature review . Thousand Oaks, CA: Corwin Press:
Reitz, J.M. (2014). Online dictionary for library and information science. ABC-CLIO, Libraries Unlimited . Retrieved from https://www.abc-clio.com/ODLIS/odlis_A.aspx
Ridley, D. (2008). The literature review: A step-by-step guide for students . Thousand Oaks, CA: Sage Publications, Inc.
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Marco pautasso.
1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France
2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France
Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .
When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.
Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.
How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:
Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).
After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:
The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,
The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .
When searching the literature for pertinent papers and reviews, the usual rules apply:
If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.
Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.
After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.
There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .
Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.
While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.
Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:
It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.
Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .
How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .
Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.
Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .
In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.
In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.
Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.
Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.
Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.
This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.
Literature review.
A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research. The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research. It should give a theoretical base for the research and help you (the author) determine the nature of your research. The literature review acknowledges the work of previous researchers, and in so doing, assures the reader that your work has been well conceived. It is assumed that by mentioning a previous work in the field of study, that the author has read, evaluated, and assimiliated that work into the work at hand.
A literature review creates a "landscape" for the reader, giving her or him a full understanding of the developments in the field. This landscape informs the reader that the author has indeed assimilated all (or the vast majority of) previous, significant works in the field into her or his research.
"In writing the literature review, the purpose is to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. The literature review must be defined by a guiding concept (eg. your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries.( http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review )
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The purpose of an academic research paper is to express and document an original idea. Literature Review is one part of that process of writing a research paper. In a research paper, you use the literature as a starting point, a building block and as evidence of a new insight. The goal of the literature review is only to summarize and synthesize the arguments and ideas of others. You should not present your original idea.
The reading that you do as part of a literature review will answer one of two questions:
“What do we know about the subject of our study?” “Based on what we know, what conclusions can we draw about the research question?”
Notice that the conclusions to be drawn are about the research question , as opposed to a novel theory.
The types of conclusions about your research question that you want to discover are: ❖ gaps in the knowledge on a subject area ❖ questions about your topic that remain unanswered ❖ areas of disagreement in your subject area that need to be settled.
There are a number of differing descriptions of the purpose of a literature review. Primarily it is a tool for
❖ researching the history of scholarly publication on a topic
❖ becoming aware of the scholarly debate within a topic
❖ a summary or restatement of conclusions from research which has been published
❖ synthesis or recombining, comparing and contrasting, the ideas of others.
❖ evaluate sources
❖ search for gaps
A literature review provides a comprehensive overview of a topic , supporting the fundamental purpose of a research paper, which is to present a new point of view or insight on a topic. The literature review supports the new insight. It does not present or argue for it.
There are various ways of organizing the literature review process- if one of these seems closer to your purpose, try it out.
What is the purpose of a literature review.
There are several reasons to conduct a literature review at the beginning of a research project:
Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.
A rhetorical tautology is the repetition of an idea of concept using different words.
Rhetorical tautologies occur when additional words are used to convey a meaning that has already been expressed or implied. For example, the phrase “armed gunman” is a tautology because a “gunman” is by definition “armed.”
A logical tautology is a statement that is always true because it includes all logical possibilities.
Logical tautologies often take the form of “either/or” statements (e.g., “It will rain, or it will not rain”) or employ circular reasoning (e.g., “she is untrustworthy because she can’t be trusted”).
You may have seen both “appendices” or “appendixes” as pluralizations of “ appendix .” Either spelling can be used, but “appendices” is more common (including in APA Style ). Consistency is key here: make sure you use the same spelling throughout your paper.
The purpose of a lab report is to demonstrate your understanding of the scientific method with a hands-on lab experiment. Course instructors will often provide you with an experimental design and procedure. Your task is to write up how you actually performed the experiment and evaluate the outcome.
In contrast, a research paper requires you to independently develop an original argument. It involves more in-depth research and interpretation of sources and data.
A lab report is usually shorter than a research paper.
The sections of a lab report can vary between scientific fields and course requirements, but it usually contains the following:
A lab report conveys the aim, methods, results, and conclusions of a scientific experiment . Lab reports are commonly assigned in science, technology, engineering, and mathematics (STEM) fields.
The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .
If you’ve gone over the word limit set for your assignment, shorten your sentences and cut repetition and redundancy during the editing process. If you use a lot of long quotes , consider shortening them to just the essentials.
If you need to remove a lot of words, you may have to cut certain passages. Remember that everything in the text should be there to support your argument; look for any information that’s not essential to your point and remove it.
To make this process easier and faster, you can use a paraphrasing tool . With this tool, you can rewrite your text to make it simpler and shorter. If that’s not enough, you can copy-paste your paraphrased text into the summarizer . This tool will distill your text to its core message.
Revising, proofreading, and editing are different stages of the writing process .
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 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.
Avoid citing sources in your abstract . There are two reasons for this:
There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.
An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:
Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.
In a scientific paper, the methodology always comes after the introduction and before the results , discussion and conclusion . The same basic structure also applies to a thesis, dissertation , or research proposal .
Depending on the length and type of document, you might also include a literature review or theoretical framework before the methodology.
Whether you’re publishing a blog, submitting a research paper , or even just writing an important email, there are a few techniques you can use to make sure it’s error-free:
If you want to be confident that an important text is error-free, it might be worth choosing a professional proofreading service instead.
Editing and proofreading are different steps in the process of revising a text.
Editing comes first, and can involve major changes to content, structure and language. The first stages of editing are often done by authors themselves, while a professional editor makes the final improvements to grammar and style (for example, by improving sentence structure and word choice ).
Proofreading is the final stage of checking a text before it is published or shared. It focuses on correcting minor errors and inconsistencies (for example, in punctuation and capitalization ). Proofreaders often also check for formatting issues, especially in print publishing.
The cost of proofreading depends on the type and length of text, the turnaround time, and the level of services required. Most proofreading companies charge per word or page, while freelancers sometimes charge an hourly rate.
For proofreading alone, which involves only basic corrections of typos and formatting mistakes, you might pay as little as $0.01 per word, but in many cases, your text will also require some level of editing , which costs slightly more.
It’s often possible to purchase combined proofreading and editing services and calculate the price in advance based on your requirements.
There are many different routes to becoming a professional proofreader or editor. The necessary qualifications depend on the field – to be an academic or scientific proofreader, for example, you will need at least a university degree in a relevant subject.
For most proofreading jobs, experience and demonstrated skills are more important than specific qualifications. Often your skills will be tested as part of the application process.
To learn practical proofreading skills, you can choose to take a course with a professional organization such as the Society for Editors and Proofreaders . Alternatively, you can apply to companies that offer specialized on-the-job training programmes, such as the Scribbr Academy .
Want to contact us directly? No problem. We are always here for you.
Our team helps students graduate by offering:
Scribbr specializes in editing study-related documents . We proofread:
Scribbr’s Plagiarism Checker is powered by elements of Turnitin’s Similarity Checker , namely the plagiarism detection software and the Internet Archive and Premium Scholarly Publications content databases .
The add-on AI detector is powered by Scribbr’s proprietary software.
The Scribbr Citation Generator is developed using the open-source Citation Style Language (CSL) project and Frank Bennett’s citeproc-js . It’s the same technology used by dozens of other popular citation tools, including Mendeley and Zotero.
You can find all the citation styles and locales used in the Scribbr Citation Generator in our publicly accessible repository on Github .
A literature review is not:
So, what is it then?
A literature review :
"A literature review is an account of what has been published on a topic by accredited scholars and researchers. Occasionally, you will be asked to write one as a separate assignment, ..., but more often, it is part of the introduction to an essay, research report, or thesis. In writing the literature review, you aim to convey to your reader what knowledge and ideas have been established on a topic and their strengths and weaknesses. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries."
A literature review is an integrated analysis-- not just a summary-- of scholarly writings that are related directly to your research question. That is, it represents the literature that provides background information on your topic and shows a correspondence between those writings and your research question.
A literature review may be a stand-alone work or the introduction to a more extensive research paper, depending on the assignment. Rely heavily on the guidelines your instructor has given you.
Why is it important?
A literature review is important because it:
The Literature Review portion of a scholarly article is usually close to the beginning. It often follows the introduction , or may be combined with the introduction. The writer may discuss his or her research question first, or may choose to explain it while surveying previous literature.
If you are lucky, there will be a section heading that includes " literature review ". If not, look for the section of the article with the most citations or footnotes .
Resources on the web.
An official website of the United States government
The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.
The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Email citation, add to collections.
Your saved search, create a file for external citation management software, your rss feed.
Affiliations.
Some patients with interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis exhibit a progressive clinical phenotype. These chronic progressive fibrosing ILDs have a variety of underlying diseases, and their prevalence is currently unknown. Here we carry out the first systematic review of literature on the prevalence of fibrosing ILDs and progressive fibrosing ILDs using data from physician surveys to estimate frequency of progression among different ILDs. We searched MEDLINE and Embase for studies assessing prevalence of ILD, individual ILDs associated with fibrosis and progressive fibrosing ILDs. These were combined with data from previously published physician surveys to obtain prevalence estimates of each chronic fibrosing ILD with a progressive phenotype and of progressive fibrosing ILDs overall. We identified 16 publications, including five reporting overall ILD prevalence, estimated at 6.3-76.0 per 100,000 people in Europe (four studies) and 74.3 per 100,000 in the USA (one study). In total, 13-40% of ILDs were estimated to develop a progressive fibrosing phenotype, with overall prevalence estimates for progressive fibrosing ILDs of 2.2-20.0 per 100,000 in Europe and 28.0 per 100,000 in the USA. Prevalence estimates for individual progressive fibrosing ILDs varied up to 16.7 per 100,000 people. These conditions represent a sizeable fraction of chronic respiratory disorders and have a high unmet need.
Keywords: Epidemiology; Fibrosis; Interstitial lung disease; Prevalence; Progressive.
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Crowd management has become an integral part of urban planning in abnormality in the crowd and predict its future issues. Big data in social media is a rich source for researchers in crowd data analysis. In this systematic literature review (SLR), modern societies. It can organize the flow of the crowd, perform counting, recognize the related works are analyzed, which includes crowd management from both global and local sides (Hajj events—Saudi Arabia) based on deep learning (DL) methods. This survey concerns crowd management research published from 2010 to 2023. It has specified 45 primary studies that accomplish the objectives of the research questions (RQs), namely, investigation of the taxonomies, approaches, and comprehensive studies of crowd management both globally and locally and focusing on the most commonly used techniques of DL. We found both supervised and unsupervised DL techniques have achieved high accuracy, with different strengths and weaknesses for each approach. A lot of these studies discuss aspects of scene analysis of crowds, that are captured by installed cameras in the place. However, there is a dilemma regarding exploiting data provided on social media to use in the crowd analysis domain. Which we believe that the analysis of big data may raise crowd management to the upper level of enhancement. To this end, motivated by the findings of this SLR. The primary purpose of this review is strived to illustrate obstacles and dilemmas in crowd analysis fields to provide a road map for future researchers. Furthermore, it aims to find research gaps existing to focus on it in the future studies. The results indicate that the lack of Hajj research, especially in sentiment analysis and the study of the pilgrims' behavior.
Avoid common mistakes on your manuscript.
A crowd is defined as a gathering of humans in the same area. If the number of individuals exceeds normal conditions, congestion becomes a concern regarding safety, health, or what may affect human choices due to herd culture. The concept of congestion differs depending on the culture of communities.
For example, gathering over 100 people in India is considered normal, while in other countries like Canada it may be considered a crowd [ 1 ]. Analysis, detection, management, and monitoring of crowds are a growing trend in computer sciences to study the behavior of human crowds in any event. Human gatherings may happen due to religious rituals (such as Hajj for Muslims at Makkah, Saudi Arabia, and Kumbh Mela for Hindus at Haridwar, India), sporting events (such as FIFA World Cup and Olympic Games), concerts, or annual carnivals (such as Carnival Parade and Riyadh Season [ 2 ]). Moreover, demonstrations, popular protests, and political or social riots (such as a political rally in Los Angeles [ 3 ]) are considered gatherings that may impact a crowd risk index and bring many unexpected reactions. Each type of human gathering has its own features: purposes of the individuals, behavior, place, and time. To avoid accidents, the organizers must perform prior analyses and studies for the mass gatherings.
Crowd analysis is one of the most crucial tools for crowd management [ 4 ]. Hence, crowd management requires profound and comprehensive plans in advance and flexible and agile strategies to take vigorous and accurate action if unexpected incidents occur.
Examples of common general issues in crowd management in the context of urban planning for smart cities are traffic, crowded pedestrians, pollution, energy consumption, etc. In urban planning for smart cities, it can be possible to predict crowd behavior abnormalities and the future evolution of these situations in order to prevent them and do the best decision-making and planning. In addition, the capacity to monitor, control, and predict the behavior of crowds is a fundamental enabling driver. Where predicting such notifications can be of effective help in a large variety of situations, such as organizing events, organizing pedestrians, managing situations of emergency, or even tracking how the pandemic spread through the urban areas. A violation of crowd management will lead to several consequences that may result in a loss of lives or property, besides the loss of people's confidence in the organization responsible for organizing the event in the future.
Billions of people around the world now have accounts on social media platforms to freely express their beliefs, opinions, or impressions about some things. This huge streamed data gives an opportunity for researchers in the data analysis domain to explore about behavior of people through their text content [ 5 ]. We believe big data may open other horizons in crowd management. Abnormal behavior detection or crowd-counting is now possible through these data. However, a lot of works of crowd management lack to attention the textual data analysis aspect of social media, especially in local crowd management works.
This review has conducted extensive examinations in this area, however, a lot of works for crowd management still have limited in using one particular data namely visual data. The main drawbacks and limitations faced by current crowd management are discussed as follows:
Existing works for crowd management are currently recurrent, meaning they do not take into account the collected data sources changes about the people during the behavior detection. Hence, current models may not fully apply on the multi-dataset, limiting their effectiveness with similar scenarios.
Collecting the datasets for existing models requires consideration of equipment or hardware such as installed cameras, live streaming channels, etc., that increases the cost of running the processes and maintenance besides the computational cost of the models.
Most of the existing research uses the same video dataset to study the behavior detection of crowds. Therefore, limiting their model's effectiveness with learning new patterns.
There is no dependency on data of social networks as one of the sources of data collection.
For these reasons, the objectives of this SLR are an overall survey of the concept of crowd management from two perspectives, crowd management in various world events and Hajj events especially. The authors endeavor through this work to make it a great reference point for other researchers in the crowd management domain. This systematic review provides a theoretical understanding of deep-learning techniques used in the various branches of crowd management. The review will also highlight factors that impact crowd modeling works such as limited patterns of datasets, applications generalizability, and evaluation metrics. Moreover, the review highlights the importance of urban planning integration, which leads to improving the quality of life for individuals and society. This work emphasizes is also necessary to draw attention to exploiting the various big data in social media as an important tributary of building novel datasets with a diversity of knowledge and patterns. The main contribution of the paper is to examine and summarize the state-of-art technologies and methodologies in the behavior detection of a crowd to apply them in Hajj research to improve the experience of pilgrims and provided services. Hence, the review scope determines three main points as follows: First, our survey summarizes the various technologies, approaches, and models that have been utilized to design and execute solutions to detect behaviors that control and monitor the crowds during any world events. Next, the survey summarizes and review the methods used for Hajj issues. Last, our survey covers shortcomings or defects in previous Hajj studies and how other research related to various crowd management may help improve the management, monitoring, and control of crowds during the Hajj season.
This paper aims to highlight these three points through a comprehensive literature survey and focuses on crowd behavior detection for crowd surveillance and prediction. The purpose of RQs is to give a high level of precise topics which is extremely focused on examining the previous literature. The RQs have extreme significance in an SLR, due to controlling the distinguishing and identification of primary research needed to be involved in the review. Consequently, well-defined, logical, interesting, and relevant research questions should be articulated [ 6 ], at the discretion of the authors [ 7 ]. The review's contributions will answer the following research questions (RQs):
RQ1: What is the taxonomy of crowd analysis for Deep Learning-based works?
RQ1 aims to find the taxonomies of previous studies based on deep learning (DL) approaches. The answer is explained in Sect. 3 : “Related Work.”
RQ2: What are the approaches used in crowd management works?
RQ2 aims to identify the DL approaches used for crowd management at various places around the world. The answer is explained in Sect. 4 : “A Comprehensive Study of Crowd Management.”
RQ3: What are the approaches used in Hajj crowd management works?
RQ3 aims to identify the DL approaches used for crowd management during the Hajj season. The answer appears in Sect. 4.6 : “Crowd Management at Hajj Event.”
RQ4: What are the most commonly used techniques and algorithms in prior works? and the challenges faced them?
RQ4 aims to discover the most used techniques and algorithms of DL in prior works for crowd management at global around the world and local scope during the Hajj season. The answer is explained in Sect. 5 : “Analysis of Comprehensive Study of Crowd Management”.
In conclusion, a systematic review of the research studies in terms of global perspectives on crowd management can help provide insights into the scope and development of this field in Hajj events and establish a comprehensive conceptual framework, which can ultimately improve the pilgrims' experience and the religious rites practices comfortably. The rest of this paper is organized as follows. Section 2 explains the research methodology. Taxonomies of previous studies based on DL approaches appear in Sect. 3 . A summarization of the current methodologies of crowd management at various events appears in Sect. 4 . Section 5 summarizes the current approaches utilized during the Hajj events from 2010 until 2023. Section 5 displays analysis of comprehensive study of crowd management also analysis of crowd management at hajj event. The authors discuss gaps and directions in Hajj studies and compare them with state-of-the-art research on other events in Sect. 6 . Finally, Sect. 7 presents a conclusion of the survey and discuss future work approaches are presented.
This section offers the methodology followed to complete this research. The paper [ 8 ] has presented several steps for writing a systematic literature review (SLR). An SLR draws a thoughtful methodology to determine the mechanisms of exclusion and inclusion criteria for scientific papers articles. Moreover, the guidelines of SLR identify gaps in current research and extracts final results based on our RQs. This review was performed in four phases, and the following sections explain each phase. Figure 1 shows the review protocol that illustrates the plan to complete this paper.
Protocol of review to complete this paper
Initially, verification of previous related work. The authors checked that no SLR covers the topic of crowd management by the analysis of textual data of users. The enormous amount of data spread every second across various Social Media Platforms (SMP), such as Twitter, Facebook, Instagram, and many others, is adequate evidence that aspect extraction of textual data to study it has become urgent. Therefore, the authors use this review of the outputs from past related works to address their gaps and shortcomings.
Second, identification of relevant online databases. The authors selected the superior databases that are interested in computer science: SpringerLink, Science-Direct, IEEE Xplore Digital Library, ACM Digital Library, MDPI, Google Scholar and Web of Sciences. Next, the authors determined the starting and ending publishing dates for the articles in the review. This review selected 2010 as the starting date and 2023 as the ending date. This timeframe was chosen because it is the growth of AI research. In the early 2010s, researchers began to use neural networks for speech recognition and image processing, which has significantly improved performance and then spread neural networks widely in the commercial, healthcare, finance, transportation, and crowd control fields. In 2013, the field of computer vision began to transition using neural networks. The same transition occurred in natural language processing in 2016 until today [ 9 ]. In the future, similar revolutions will occur in visual robotics and many other AI fields. The searches were narrowed to journals published during the desired span. Table 1 presents the number of scientific paper articles obtained from each database and clarification for the initial and final results of the search.
Third, detection of keywords and their synonyms used in crowd management. Keywords of research that have been applied for finding articles in these databases are as follows: Crowd AND (“Management” OR “Analysis” OR “Tracking” OR “Monitoring” OR “Controlling” OR “Counting” OR “Density Estimation” OR “Abnormality Detection” OR “Behavior Analysis” OR “Crowd flow” OR “Mass Gathering” OR “Congestion Analysis Detection” OR “Predicting Human Behaviors” OR “Pedestrian”) AND (“Sentiment Analysis” OR “Opinion mining”) AND (“Deep Learning” OR “Machine Learning” OR “Convolutional Neural Network” OR “CNN”) AND (“Social Media” OR “Twitter”) AND (“Hajj” OR “Makkah” OR “Mecca”).
Criteria of inclusion and exclusion. We selected strict criteria to pick studies to be included in our review and those that must be excluded. The objective of inclusion criteria is to choose all papers describing the concept of opinions mining of crowds through DL techniques. Otherwise, it will be exclusion criteria of papers in order to limit the scope of the review and remain focused on the targeted RQs. Inclusion criteria are as follows:
Papers that were published from the year 2010 to 2023.
Papers written in the English language.
Papers selected for publication in a journal.
In terms of exclusion criteria are as follows:
Papers that are from a conference or a book.
Papers that do not extract specific databases.
Duplicate papers.
Papers that contain irrelevant keywords.
Figure 2 illustrates the criteria of exclusion and inclusion followed for this review.
Criteria of exclusion and inclusion for this review
Quality assessment (QA) of selected studies is a critical strategy for data synthesis and analysis to avoid bias and increase the selection of literature. The QA questions estimate the relevance, truthfulness, and rigorousness of the selected studies. Every one of the questions has only three optional answers derived from the study in [ 10 ], where “YES” = 1, “NO” = 0, and “Partly” = 0.5. as shown in Table 2 . Besides the QA questions, it has placed other criteria to prevent potential biases. For instance, clarification of studies included and excluded accurately. Comprehensive examination during the selection and publication stages several times. Formulating review protocols according to the sober methodology [ 8 ]. The assessment selection was from one of the researchers of this paper. The researchers have followed the mentioned standards rigorously to avoid the dominance of individual personal opinions and potentially biased decisions. The included papers should be achieved at least 2 of QA, otherwise, it will be overridden, as shown in Table 3 .
Transparency during the assessment process is conceived as a non-functional quality of the stakeholders of projects. Transparency is an essential factor that can be performed to ensure the stakeholder's satisfaction with the quality of assessment [ 11 ]. Therefore, transparency requirements should be clarified regarding the inclusion and exclusion criteria that are used for selecting the primary studies, which have to fulfill them to sustainability for quality and transparency of research. Consequently, our methodology identified 45 studies that we applied to the assessment of objectives of this paper. Figure 3 illustrates the peak appearance of research in the publication year 2021. Whereas Fig. 4 displays the percentage of papers obtained from each database.
Distribution of the papers from 2010 to 2023
Percentage of papers obtained from each database
According to our criteria of exclusion and inclusion papers, as shown in the Figs. 3 and 4 , the papers started spread from 2014 to 2023, the researchers note that the publication was at the highest levels in 2019, 2020, and 2021 years. In addition, the SpringerLink database was achieved highest published, whereas ACM database was got the lowest published than other databases. Finally, after applying the above filters of standards did not obtain unique papers in both Google Scholar and Web of Science. Most of the existing papers were duplicates of papers in another publishing database or did not meet our requirements and standards.
Since the last decade, the preceding reviews have illustrated that crowd analysis is studied from several different aspects. For instance, there are computer science [ 12 ], sociology-based [ 13 ], biology-based [ 14 ], and physics-based [ 15 ] approaches. Some of these works concentrate on the research axis, and others concentrate on various sides of the research axes as subtopics. In terms of computer science, there are two main types: traditional approaches from the period of pre-DL methods and DL methods [ 16 ]. DL techniques are a valuable addition to constructing the ideal models in many fields like Defect Prediction in Software (DeP) [ 17 ], improving Search-Based Software Testing (SBST) [ 18 ], improving the mechanisms of Detection of DDoS Attack[ 19 ], remotely imagery classification for unmanned aerial vehicles (UAV) [ 20 ]. Generally, achieving high-level intelligence, high robustness, high accuracy, big data, and low power consumption for artificial intelligence approaches are considered the critical challenges that faces the researchers. The authors in [ 21 , 22 , 23 , 24 ] have sought to address these issues. In this section, our review discusses the most other important reviews. Those that focus on the DL side and large datasets. DL algorithms are more properly suited and effective to address concerns related to the variety, volume, and accuracy of big data analytics. Furthermore, DL algorithms inherently exploit the availability of enormous amounts of data to explore and understand the higher-level complexities of various data patterns. Thus, minimizing the need for human experts to extract features from data [ 25 ].
The reviews aim to offer a panoramic vision of crowd analysis in the deep learning domain. Each previous survey was studied and organized into subsections to classify its authors.
Grant and Flynn [ 26 ] divided crowd analysis into two wide classes, crowd behavior analysis and crowd counting, which include several subsections. Crowd behavior analysis has four subsections: abnormal behavior analysis, dominant motion extraction, crowd analysis and tracking, and group behavior analysis. It focuses on behavior detection of individual scenes at first. Then, it describes group behavior within a crowd, crowd motion, and detection of an abnormal event. On the other hand, crowd counting contains six subsections: density mapping, joint detection and counting, line counting, texture-level analysis, object-level analysis, and pixel-level analysis. It focuses on behavior detection of individual scenes at first. Then, it describes group behavior within a crowd, crowd motion, and detection of an abnormal event. On the other hand, crowd counting contains six subsections: density mapping, joint detection and counting, line counting, texture-level analysis, object-level analysis, and pixel-level analysis.
It discussed the metrics used to estimate the density of a crowd, the Level of Service (LoS), and traffic flow. Moreover, they displayed datasets available according to crowd activity video research. Datasets fell into five categories: crowd counting (UCF_CC_50 dataset [ 69 ], UCSD dataset [ 70 ], and WorldExpo’10 Dataset [ 71 ]), group detection (Collective Motion dataset, The Museum Visitors dataset, student003 dataset, The Mall dataset [ 72 ], and the Grand Central Station dataset), behavior understanding (PETS2009 dataset [ 73 ], Collective Activity dataset, and The Unusual Crowd Activity dataset), holistic crowd movement (Chinese University of Hong Kong dataset (CUHK) [ 74 , 75 ], The Meta-Tracking dataset, Data-Driven Crowd Analysis dataset, and Crowd Segmentation dataset), and synthetic (The Agoraset dataset, Seven Environments/scenes).
Tripathi et al. [ 1 ] concentrated on studies that included Convolutional Neural Networks (CNNs). The authors have divided the previous studies into four classes: The first class summarizes influential portions of the CNN for handling crowd behavior analysis. The second class summarizes the primary studies proposed that focus on CNNs. The third summarizes studies that use CNNs incorporated with other architectures from deep learning. It includes four types, crowd counting, crowd density estimation, crowded abnormality analysis, and crowded scene analysis. The fourth summarizes studies that use CNNs to extract features and classifiers. Moreover, the authors highlighted opportunities, features, and challenges for future research in the crowd analysis domain. Furthermore, the authors displayed some of the datasets used in CNN-based crowd analysis: WorldEx po10, PETS2009 [ 73 ], WorldExpo’10 [ 71 ], Pedestrian dataset, UCLA, Dyntex++, DynTex, (WWW) crowd dataset, BEHAVE, NUS-HGA, UCF_CC_50 [ 69 ], ShanghaiTech [ 76 ], UMN [ 77 ], Mall [ 72 ], Rare Events Dataset (RED) [ 78 ], and City Dataset [ 79 ].
Li et al. [ 80 ] summarized the main concepts of crowd behavior analysis in terms of the Crowd Dynamics concept. It considers a crowd as either a set of individuals such as the Social Force Model or a fluid such as concepts of thermodynamics and statistical mechanics by computer vision. The survey divided the reviewed studies into three classes, anomaly detection, motion pattern segmentation, and behavior recognition. First, crowd motion pattern segmentation analyzes motion patterns in areas of crowded scenes. Several methods have been proposed based on the cluster of the motions or segment principle. For instance, flow-based segmentation, similarity-based clustering, and probability-model-based clustering. Next, crowded anomaly detection has been classified into two sections, global anomaly detection and local anomaly detection, i.e., where does the anomaly occur? Does the scene include an anomaly case or not? Lastly, crowd behavior recognition is classified into object and holistic-based.
Kiran et al. [ 81 ] discussed the detection and prediction of anomalies by defining rare events and detecting unseen objects. Furthermore, the authors present the related works that used DL, unsupervised and semi-supervised methods for anomaly detection in video scenes. They classified their survey according to detection criteria and types of models (deep generative models, predictive models, and reconstruction learning models). Each of these types has several subtypes. Representation learning for reconstruction uses models and methods of normal behavior in surveillance videos to represent deviations in poorly reconstructed anomalies. Examples include principal component analysis, autoencoders, convolutional autoencoders (CAEs), CAEs for video anomaly detection, contractive autoencoders, and other deep models (like stacked DAEs (SDAEs), de-noising autoencoders (DAE), and deep belief networks (DBNs)). Predictive modeling contains four subsections, composite model, convolutional Long Short-Term Memory (LSTM), 3D-autoencoder and predictor, and slow feature analysis (SFA). SFA is used to view video frames as time series or temporal patterns to predict the existing frame or its encoded representation utilizing the previous frames. Lastly, Deep generative models consist of eight subsections: Generative vs. Discriminative, Variational Autoencoders (VAEs), Anomaly Detection Using VAE, Generative Adversarial Networks (GANs), GANs for Anomaly Detection in Images, Adversarial Discriminators Using Cross-Channel Prediction, Adversarial Autoencoders (AAEs), and Controlling Reconstruction for Anomaly Detection. They are employed to model the probability of samples of normal video in a deep learning framework.
Bendali-Braham et al. [ 16 ] proposed a novel taxonomy for crowd analysis that includes two branches, crowd behavior analysis and crowd statistics. Crowd statistics determine the number of people currently in a scene. It includes two subbranches, crowd counting and density estimation. Crowded scene analysis is divided into crowd behavior recognition, motion tracking and prediction, and group behavior recognition for human behavior analysis in a crowded scene. Furthermore, crowd activities and motion patterns are described in video scenes and when crowd statistics determine the LoS. Al-Shaery et al. [ 82 ] tackled an inclusive review of crowd management, from the discovery of crowded places to crowd monitoring and management. They focus attention on systems of crowd management that require a well-designed decision support system (DSS), as well as the systems that have early warning capabilities to realize the primary goal of gatherings which is crowd safety. They divided their taxonomy into two branches: crowd detection and crowd monitoring and tracking analysis. The last section includes the crowd management and control stage that leads to the crowd DSS stage. They considered the crowd management stage as the intermediate between monitoring and the Crowd DSS stage. Ebrahimpour et al. [ 62 ] reviewed the studies of crowd analysis based on various data sources. They divided their taxonomy into three classes, crowd social media analysis, crowd spatiotemporal analysis, and crowd video analysis with some subsections. Crowd spatiotemporal analysis uses a data source generated by transportation that is monitored with Global Positioning System (GPS), such as shared bikes or buses. In terms of crowd social media analysis, it exploits check-in data that have been taken from geo-tagged social microblogs for crowd analysis. The data analysis process contains four steps, discovery, gathering, preparation, and analysis. Finally, crowd video analysis includes two sections with subsections inside them: crowd video behavior analysis (microscopic modeling and macroscopic modeling) for generating trustworthy trajectories for pedestrians as well as crowd video action recognition (single person action recognition and group activity recognition) for single or group activity surveillance, tracking people, objects, sports video analysis, and action recognition.
In summary, the studies and surveys above used various taxonomy according to their perspectives. Most of these studies focused on crowd behavior and motion analysis based on the captured video scenes. One of them focused on crowd spatiotemporal analysis based on GPS data, owing to the ability to collect data automatically remotely by mobile sensing and mobile computing [ 83 ]. Obviously, there is no exploit on social media data, this paper investigates this scope with the best technologies. Our review is distinguished from others that we study general cases of crowd management and analysis, in addition to local studies in the Hajj season to discover the flaws and difficulties facing the Hajj authorities in order to avoid disasters and accidents among crowds.
Literature that discusses crowd management in various past universal events. Through a methodical literature review, they have classified crowd analysis into several types according to the purpose of the study. Crowd scene analysis, social media-based analysis, and crowd sound emotion recognition are the main types of crowd management. Each one has some subsections below, according to our taxonomy in Fig. 5 . Studies discussing the analysis of crowds with various purposes employ DL algorithms. Researchers seek to use the newest of these technologies to achieve the highest performance and accuracy possible. Table 4 illustrates the statistics for papers obtained from each subsection.
Taxonomy of crowd management
To avoid accidents, it is crucial to know when the people will gather. Then, the organizers must perform in-depth prior analyses and develop comprehensive plans for these mass gatherings. Crowd analysis is a vital tool for crowd management [ 4 ]. Ordinarily, there will be an advance notice for well-known human gatherings, either religious, sports, carnival events, or always-crowded places such as airports, train stations, stadiums, etc.
Every human gathering has special features regarding the purpose, location, and time as well as the behavior of the people, their beliefs, affiliations, and race. For instance, in 1987, a group of Iranian pilgrims rioted during the performance of the Hajj rituals at Makkah, Saudi Arabia, and, as a result, 402 people were killed and injured [ 61 ]. To give another example of religious events in India, Hindus gather to bathe at the Ganga River, Saraswati River, Kshipra River, and Godavari River, where heavy crowds are expected at specific times. On 31 December 2014, on Shanghai New Year’s Eve, there was a stampede, resulting in 36 individuals killed and 47 others injured [ 60 ]. Table 5 summarizes the tragedies that happened previously. Therefore, it is critical to adopt crowd management and propose rigorous and flexible strategies to prepare for unforeseen occurrences at any time. If crowd management fails, it will lead to a loss of lives or properties.
Crowd counting and density estimation are characteristic types of crowd analysis. Calculation of crowd counting, and density can be beneficial in planning crowd security and safety. If the crowd size can be estimated at crowded places, such as temples, stadiums, airports, or metro stations, in advance, it would be extremely beneficial for planning alternate strategies for crowd control.
Several methods have been developed for crowd counting, which include three classes under the methodologies of DL: (1) CNN-based methods [ 36 , 42 ]; (2) detection-based methods [ 87 ]; and (3) regression-based methods [ 88 , 89 ]. Briefly, detection-based methods utilize detection algorithms, which consider that a crowd consists of the sliding-window detector and individual entities to compute the number of object instances in the detected image [ 33 , 87 ].
Regression-based methods exist to solve the problem of occlusion. The main ideas of this method are learning a density map and extracting its features from an image to estimate crowd density [ 33 , 88 , 89 ].
Lastly, many works have been developed by CNN-based methods in the crowd counting field due to their successful applications in computer vision.
Kang et al. [ 27 ] proposed an adaptive convolutional neural network (ACNN)-based model for counting. It improves the counting precision compared to an ordinary CNN with a similar number of parameters.
Marsden et al. [ 28 ] had developed a previous model in [ 76 ] of convolutional crowd counting for the high-density crowd. They added several contributions, including a training set increase to minimize redundancy between samples of training to improve counting performance. They also use a single column, deep, fully convolutional network (FCN) for analyzing images with any aspect and resolution ratio.
Sheng et al. [ 54 ] proposed a framework based on locality-aware features (LAF) integrated with CNN features to capture more semantic spatial and attributes of the image. Furthermore, they used a vector of locally aggregated descriptors (VLAD) which consider the weights of the coefficients.
Hu et al. [ 47 ] used a convolutional neural network (convNet or CNN) structure to extract features of a crowd in a single image to estimate the crowd count. Their approach was based on CNN and appropriate for a mid-level or high-level crowd. Similarly, Kumagai [ 29 ] adopted CNNs with fixed weights to reduce the fault rate when counting a crowd.
Dai et al. [ 84 ] proposed improved approaches to crowd flow prediction, whose goal is to count the incoming and outgoing numbers of people in urban regions. The approaches were based on a spatiotemporal attention mechanism with a simplified deep spatiotemporal residual network. The first one captures information about the spatial correlations on crowd flows and finds the regions with positive impacts. The second one reduces training time and gives the best prediction performance compared with similar approaches.
Gong et al. [ 30 ] used existing images on social media to estimate the number of people in crowds at city events. This study is the first to count crowds from this side, unlike prior studies that used datasets from popular sources such as video surveillance data. They constructed a novel dataset of images collected from social media for diverse events and major activities in the city. Each image is annotated with its characteristics and the size of the crowd. They applied four methods of two types, direct methods (Faceplusplus and Darknet Yolo) and indirect methods (Cascaded method A and B), to crowd size estimation analysis. The results showed that direct methods achieve higher accuracy than indirect methods. Specifically, Darknet Yolo achieves the best accuracy in estimating the crowd size level (72.01%) and the number of people (38.09%). This study provides a novel method to count people via the advantage of their visual posts on social media.
Huang et al. [ 31 ] solved the problem of noise in the areas with different densities, which appeared in a previous study that used a multi-column convolutional neural network (MCNN) method. The authors proposed a novel method named a segmentation-aware prior network (SAPNet). Using a map of coarse head-segmentation, they produced a map of high-quality density without noise. SAPNet contains two networks, CR-CNN as the back end and FS-CNN as the front end. They are a crowd-regression convolutional neural network and a foreground-segmentation convolutional neural network, respectively. FS-CNN produces a map of coarse head-segmentation, then this map is inputted to CR-CNN to perform a highly accurate crowd counting to produce a high-quality density map. The four datasets that tested their approach were WorldExpo’10 [ 71 ], UCF-CC-50 [ 90 ], UCSD [ 70 ], and ShanghaiTech [ 76 ]. It has achieved high performances on the UCF-CC-50 and ShanghaiTech part B datasets. However, the WorldExpo’10 dataset [ 71 ] was unsuitable for their method because the raw images are of low precision. Furthermore, a poor Canny-edge map can lead to the generation of a faulty segmentation map. This study succeeds in an efficient solution to the problem of noise in areas with different densities. It will be very beneficial in high-congestion places such as train stations, stadiums, religious gathering.
In the same context, Jiang et al. [ 32 ] produced a novel PSDENet method, the people segmentation-based density estimation network. At first, the PSDENet model performs learning and pre-training on virtual synthetic data, then, it transfers these tests to real data. The proposed method has proven effective even though it uses two independent networks, PSDENet and people segmentation network (PSNet). It requires the consumption of much computation.
Zhang et al. [ 33 ] proposed a two-task convolutional neural network (T 2 CNN). It is a novel method for crowd counting that concomitantly learns two tasks, the density map estimation of images and the classification of the tasks of dense degree. Each image has different degrees of density, and local regions inside them have different degrees of density. Determining the density degrees of images helps the estimation of the density maps. For this purpose, researchers incorporate the module of T 2 CNN with dense degree classification (DDC). T 2 CNN takes the scale of the adaptive CNN as the density maps estimator, then classifies images into several categories based on degrees of density. Therefore, that model is an efficient way to treat the perspective and scale variations in crowd images, according to experimental results performed on common datasets: WorldExpo’10 [ 71 ], UCF_CC_50 [ 69 ], and ShanghaiTech [ 76 ].
Shang et al. [ 34 ] developed a new architecture to deal with the perspective variation problems for estimating the number of people in images on the web. The proposed approach has two-stage processing: policy network and count network. A policy network is an estimation of perspective by a regular CNN, while a counting network is a normalization of perspective for the input patches into a scale-specific CNN. Then, given the arranged inputs, they adjusted the scale-specific counting network and their approach to deal with a large perspective variation in web images. In this context, the evaluation metrics were used to verify the model of Xu et al. [ 91 ], which gives an average enhancement of 4.68% of Grid Average Mean Absolute Error (GAME), 6.7% of Mean Squared Error (MSE), and 3.68% of Mean Absolute Error (MAE). Also, their experiments were performed on datasets following UCF_CC_50 [ 69 ], UCF-QNRF [ 92 ], RGBT-CC [ 93 ], and ShanghaiTech [ 76 ].
Jiang and Jin [ 35 ] discussed estimating high-quality crowd density maps and counting crowds by revisiting the design of CNNs to get high-quality density maps as well as high resolution on datasets of crowd counting. For instance, these datasets include UCF_CC_50 [ 69 ], UCSD [ 70 ], and ShanghaiTech datasets [ 76 ]. Their proposed method, multilayer perception counting (MPC), realized high results in a high-quality density map, which is better than counting the crowd. Their method relies on diverse deep supervision (DDS) rather than general supervision, which uses all the intermediate layers or hierarchical in the network. Moreover, MPC is considered the ideal way for cases requiring prediction in real-time.
Khan and Basalamah [ 36 ] proposed a unified model to detect human heads in visual images for crowds using regression models with CNNs. The model is based on DenseNet, which contains 174 layers. It handles a wide range of scale differences by integrating scale-specific detectors within the network. Therefore, the network parameters are improved in an end-to-end fashion. The model was applied to difficult benchmark datasets, such as UCSD [ 70 ] and UCF-QNRF, and achieved the best results.
Liu et al. [ 52 ] proposed a global density feature to add to the multi-column convolution neural network (MCNN) to improve its performance using the cascaded learning method. This model differs from existing works because it concentrates on uneven crowd distribution. Furthermore, deconvolutional layers and the max pooling were utilized to generate a thorough density map and to restore the missing details of the accuracy of the density map during the down-sampling process. The results of experiments prove that this model has higher accuracy and stability when applied to ShanghaiTech [ 76 ] and UCF_CC_50 datasets [ 69 ].
Kizrak and Bolat [ 4 ] used video images or static images to estimate the number of people in a crowd by utilizing CNN with modules of capsule network-based attention. They have proposed a 75,442 VOLUME to crowd analysis using a CNN and two-column cascade and CapsNet as an attention module. The positive impact of the Capsule attention was proven to detect the number of people in images of a crowd. However, this method is still not effective in terms of computational complexity.
Elharrouss et al. [ 53 ] provided two contributions, a new method using CNN and the creation of a novel crowd counting dataset taken from the Football Supporters Crowd (FSC-Set). It contains 6000 annotated images of various scenes. FSC-Set can be used for other domains such as localization of individuals, image supporter recognition, and face recognition. The proposed method named FSCNet used several modules: channel-wise attention, spatial-wise attention, and context-aware attention for crowd counting. The results were satisfactory on all the datasets. This research provides a solution to counting people in crowded places based on several attributes. This method can be contributed to aid other studies of crowd counting.
Khan et al. [ 55 ] developed a framework using end-to-end semantic scene segmentation (SSS) based on CNN for counting people in a densely crowded image. The framework consists of three components: Density Estimation (DE), classification using optimized CNN, and SSS. Moreover, to solve the problem of scaling variations in images, they used four fields that had sixteen filters to feed output at every stage. Their method has validated four standard datasets such as Shanghai Tech, World Expo, NWPU_Crowd [ 94 ], and UCF_CC_50 [ 69 ]. Furthermore, they claimed that the crowd counting domain is still an immature research area due to limited data in deep learning.
Zou et al. [ 67 ] proposed a model to address ignoring the massive temporal information among consecutive frames when process each video frame independently. The model namely, temporal channel-aware (TCA), it realizes exploiting the temporal interdependencies between video sequences through fusion of 3D kernels of convolution in order to encode local spatio-temporal attributes.
Du et al. [ 68 ] redesigned a classical multi-scale neural network to treat challenging of crowd counting. The scheme merges multi-scale density maps. The network uses both the local counting map and the crowd density map to optimization. The experiments results proved that the novel scheme fulfills the state-of-the-art performance on five public datasets such as UCF_CC_50, JHU-CROWD++, ShanghaiTech, Trancos, and NWPU-Crowd.
At the end, Most of studies above developed their architectures based on CNN features to count crowd. Moreover, they used the famous benchmarks datasets such as Shanghai Tech, World Expo and others to perform experimentation on these architectures.
Density estimation of a crowd is an extended part of crowd counting. Density computation is important to support preset plans and strategies to avoid overcrowding. The authors of [ 51 ] discussed the flow patterns of a crowd. They used an unsupervised methodology to cluster people patterns in large public infrastructures. The proposed approach has been applied to an international airport. Their approach successfully summarized the representative patterns and provided the required data for airport management.
The work of [ 44 ] proposed a model to estimate crowd density via an optimized ConvNet. The model has two ConvNet classifiers to improve its speed and accuracy. In the same context, the work of [ 63 ] used LSTM-combined Node2Vec graph embedding to extract spatial features.
Crowd Scene Analysis is most important to study normal or abnormal human behavior. This aspect includes Crowd Motion Analysis and Tracking using the most common approach is video surveillance to detect alarms and anomalies.
[ 95 ] developed a new framework for an online gating neural network. It consists of two phases: the offline training phase and the online predicting phase. In the first phase, their training set is trained daily using a gated recurrent unit-based predictor of human mobility. In the second phase, they constructed an online adaptive predictor of human mobility. Moreover, it switched between offline pre-trained and online adaptive human predictors using a gating neural network. They have adopted a real-world GPS-log dataset for training Tokyo and Osaka cities, where this approach realized a higher prediction accuracy for this approach. This framework can be employed for several purposes, for instance, incorporating additional data such as event information or weather data to predict human mobility. The framework minimizes unnecessary information by performing more than one online training simultaneously. Moreover, the used dataset is considered a little representation of the real world. However, that system is unstable due to the sparse data.
Shi et al. [ 77 ] proposed a novel model for the trajectory prediction of pedestrians in highly crowded scenarios. The model relies on using LSTM and contains a trained decoder and encoder by truncated backpropagation. The experiments used data from the trajectory train station in Tokyo, Japan. This model has proven stable concerning predictions of varying lengths. In addition, it realized an average for both Evaluation Metrics Of The Prediction Errors (Average Displacement Error And Final Displacement Error) Of 21.0%.
In the same context, [ 57 ] studied the prediction of the trajectories of foreign tourists using lstm. Nevertheless, there is a difference. The first layer of lstm is fed with the input sequence, and every other layer of lstm is fed with the layer's output that precedes it. They claimed that the proposed method outperformed classical approaches.
Zhang et al. [ 79 ] studied monitoring passenger flow in a passenger metro by creating a cnn-based platform. The proposed method has three parts: the first is a cnn group used to extract features from images. Then, the second is a module of feature extraction utilized to enhance multiscale. Finally, transposed convolution is applied to the sample to create a high-quality density map.
Lastly, some of these works used cnns with lstm methods to extract images feature in order to examine and analyze crowd scene, they have accomplished high-quality. In every case, the integration of cnns with lstm is considered an effective method to produce a high-quality density map, and thus it can give good results.
Swathi et al. [ 37 ] developed a vigorous model, which integrates features of deep learning AlexNet (alippi, disabato and roveri, 2018) with high-dimensional features of the gray-level co-occurrence matrix (GLCM) that have hybrid deep statistical features. Moreover, it used a multi-feed forward neural network model (MFNN) to execute multi-category classification. AlexNet and GLCM provide a wealth of information on spatiotemporal features to make ideal classification decisions. The MFNN algorithm helps ideal multi-class classification. The model has achieved an accuracy rate of crowd behavior classification of 91.35%, 89.92% precision, 89.12% f-measure, and recall of 88.34%.
Zhang et al. [ 65 ] proposed a framework to predict crowd behavior in complex scenarios. The framework consists of three components: the module of scene feature extraction, the discriminator, and the generator. The first component captures the environment's visual signal, the spatial layout, and the interrelationship of pedestrians. The second component measures the similarities between the real trajectories and the generated ones. The third component consists of the encoder and the decoder parts that use lstm for inputting. Experiments are executed on the standard crowd benchmarks datasets, such as the chinese university of hong kong(cuhk) crowd (shao, change loy and wang, 2014; shao, loy and wang, 2016), the eth zurich university(eth) datasets [ 97 ], the crowd-flow, and the university of cyprus (ucy)datasets [ 98 ]. These experiments confirm that the proposed framework successfully predicts the behaviors of crowds in complex scenarios.
According to above, integration alexnet features with glcm have achieved a good accuracy rate for classification.
Abnormal behavior is an unusual event occurring in overcrowded scenes. Therefore, crowd abnormality detection in crowded areas plays a pivotal role in preventing any disasters due to riots. The domain of anomaly detection has gained the interest of researchers in computer science in recent years.
Video anomaly detection (VAD) uses algorithms of temporal video segmentation to detect shot boundaries in sequential frames of video [ 99 ]. VAD challenges relate to crowded and complex scenes, small anomaly datasets, and anomaly localization [ 49 ]. Moreover, the challenge of false-positive detection results is that the system incorrectly discovers normal events as abnormal ones [ 49 ]. For these reasons, deep learning methods are more suitable than traditional methods [ 69 , 95 , 100 ]. In particular, unsupervised deep learning methods are the best solution [ 49 ].
Ganokratanaa et al. [ 49 ] proposed a new unsupervised deep residual spatiotemporal translation network (named DR-STN). The proposed approach has embedded with DR-cGAN and OHNM, which refer to Deep Residual conditional Generative Adversarial Network and Online Hard Negative Mining, respectively. The authors claim that their approach reduces the detection of a false-positive anomaly. Furthermore, it increases anomaly localization accuracy with a rate of 96.73%.
Wang et al. [ 38 ] proposed a novel algorithm to solve the problem of visual abnormality detection in crowd scenes. The abnormal frame is called a global abnormal event (GAE). However, determining the abnormal area in one frame is called a local abnormal event (LAE). This process uses a feature descriptor extraction of MHOFO (motion descriptor, namely a multi-frame descriptor). The motion information is represented by this descriptor after capturing it as a multi-frame. After that, captured samples are trained via a cascade deep autoencoder (CDA) as a generative network to detect abnormal behavior. Their experiment was performed on three benchmark datasets, University of California, San Diego (UCSD) [ 70 ], PETS2009 [ 73 ], and UMN [ 77 ]. They have proven that their algorithm shows competitive results. Although their model is slower than the SCL method, it is better in terms of performance. The SCL is the fastest method in the published papers for anomaly detection.
Ammar and Cherif [ 39 ] proposed a model to treat the problem of panic behavior detection in abnormal situations, which is named DeepROD. This technique worked in real time, online, and offline. It relies on statistical characterization and LTMS neural networks to predict future values of features. They claimed that their model is proven by experiments on well-known datasets (both public databases and livestreaming sources). Specifically, online training has given a better performance than offline training for the crowded scenes. Furthermore, it provided good processing time and accuracy. Nevertheless, DeepROD has lower accuracy when tested on a livestreaming source, such as a festival video.
Khan et al. [ 59 ] proposed an AlexNet-based crowd anomaly detection model to detect the anomaly in the image frame. Their model was comprised of three fully connected layers, four convolution layers, with additional the rectified linear unit (ReLU) was used as an activation function. The experiment has been performed on a personal computer using fewer computational resources, it appeared that the proposed model outperformed other studies and fulfilled 98%.
Basalamah et al. [ 50 ] proposed a Bi-LSTM framework using motion information to detect congestion rather than count pedestrians.
Vahora et al. [ 45 ] proposed a novel model using a deep neural network for the recognition of group activity via video monitoring. The model has a multi-layer deep architecture, which integrates CNN with RNN. CNN model was used to capture information, feature, and level semantics from the scene for recognizing mysterious group activities. The RNN model used the LSTM model and gated recurrent unit (GRU) model to handle the problem of long-term dependency for the RNN model.
Over the last few years, several smartphone social network applications (apps) have come to market. These apps enable users to exchange their information, location, and temporal data, usually called check-in data. Day by day, social network apps have become more utilized by people. Especially popular are apps based on geotagged social microblogs and location-based social networks (LBSNs) such as Twitter, Facebook, Instagram, and LinkedIn. An advantage of social media (SM) is that users share their interests and purposes when, where, and why they go out. A result is an enormous source of data that may help researchers in different domains to perform crowd analysis, such as sports, religious, and carnival events, as well as in the marketing domain and trend detections. From another perspective, the data sources of SM open other horizons in the analysis domain, including counting people, computing individual tracks, and detecting normal and abnormal behavior in a crowd [ 101 ]. Moreover, they show how much impact these data have to create a crowd or influence their behavior [ 102 ]. Figure 6 illustrates trends of analysis via social media.
Analysis trends via Social Media
Öztürk and Ayvaz [ 46 ] collected all tweets in English and Turkish languages that discuss humanitarian issues concerning the Syrian refugee crisis to perform sentiment analysis on them. They used the twitter package to collect data from twitter. Then, they utilized the Rsentiment package. Both packages were developed in the r programming language. Rsentiment contains a comprehensive sentiment dictionary in English and provides a sentiment score. Whereas in the Turkish language, the authors have developed a sentiment lexicon of 5405 words. Finally, the results of these analytics, overall sentiments were positive about Syrian issues. While only 12% of the tweets in English were positive, the tweets in Turkish were equally distributed among neutral, negative, and positive sentiments. It is good to adopt this model to suit different languages.
In the same context, Malik et al. [ 64 ] created an alert system for Pakistan government authorities in order to determine the public emotions of people against upcoming anti-government.
Duan et al. [ 60 ] studied a stampede on shanghai new year’s eve in 2014. This study investigated the reasons for this crowd behavior through the viewpoint of social media data. The authors developed a framework using check-in data of the Weibo platform of three trends, the emotional fluctuations of citizens, the topic changes in posts, and the collection level of check-in data. The framework processes are executed as follows. At first, the location information of check-in data is taken from Weibo to analyze the spatial and temporal using Moran’s i index. Next, the textual data of Weibo is analyzed through topic modeling using the Latent Dirichlet Allocation (LDA) method. Finally, sentiment analysis is analyzed and divided into five groups to extract percentages of negative and positive sentiments. As a result of this study, the geographical features can directly reflect changes in crowd flow, as well as the psychological states of people before and after accidents. However, it still faced some challenges.
Redondo et al. [ 48 ] proposed a hybrid solution based on clustering techniques and entropy analysis to early detect unexpected behaviors in social media. Data is collected from Location-based Social Networks (LBSNs). The authors used the Instagram platform for this study because it is a good source for geo-located data. Moreover, the APIs of some social media platforms impose limitations on the access of visual data by developers.
Finally, previous works has studied crowd flow behavior by analyzing textual data. Thus, Duan et al. [ 18 ] claimed that prior knowledge of people's psychological and behavioral states may help in understanding crowd behavior.
Franzoni et al. [ 40 ] introduced the first model to study sound emotions for the crowd. The model integrates CNN and spectrogram-based techniques. According to their claims, they have not compared the results of their experiments with any prior study with a similar domain (crowd). However, they compared these results with studies focused on analyzing individual-speech emotions. The model has a 10% improvement in average accuracy. Their study proved that the AlexNet-CNN spectrogram-based method is appropriate to analyze the sound emotions of the crowds.
At the end of this section, this paper demonstrates the limitations of the above papers. There are some problems during the process of data extraction. The information inferred was insufficient due to a lack of data on procedure, methods, and performance, which may be reflected by the QA.
This part will display all studies that support Hajj research. Hajj ritual is the fifth pillar of Islamic, every Muslim should visit to the holy places in Makkah, Saudi Arabia once at least in his life. They should able financially and physically to perform worships of Hajj. The period of Hajj is between 8 and 12th of the 12th month every year, it is called (Dhulhijjah) in the Islamic (lunar) calendar. Hajj's crowd of up to three million people comprised of pilgrims from all over the world in one sacred spot. The geographic area of the holy sites for performing Hajj rituals is not exceeding 33 km 2 . This makes the Hajj authorities to face a great challenge to deal with the overcrowding of the Hajj in a specific period and place, firstly relating to the security and safety of pilgrims. The objective of our work is to discover the efficient practices of crowd management in the holy biggest event in Saudi Arabia, it is the Hajj ritual [ 103 , 104 ]. All methods currently applied in the field of Hajj crowd management are still lack of attention and development from researchers, especially in terms of exploiting of textual data to analysis of crowd's emotions, sentiments, or opinions. The two papers are picked below according to our criteria in this survey.
Farooq et al. [ 41 ] presented a novel method for abnormal behavior detection for crowds that may lead to dangerous disasters, such as a stampede. The model captures motion in the form of images, then classifies these images according to crowd divergence behavior using a CNN method, where the CNN has been trained on motion-shape images (MSIs). Moreover, the finite-time Lyapunov exponent (FTLE) domain is acquired when the optical flow (OPF) is computed first. LCS (Lagrangian coherent structure) in the FTLE domain represents dominant motion for the crowd. Finally, a scheme of ridge extraction transforms the LCS-to-grayscale MSIs. The model is tested on six real-world low and high-density datasets. They claimed that the experiments produced effective results for their method in terms of detecting divergence accurately, as well as detecting starting points of congestion at high and at low density. Furthermore, they presented two new datasets, including video scenes of normal and abnormal behaviors for a high-density crowd. In the Hajj case, the authors have applied their model to pilgrims’ crowds at Makkah, Saudi Arabia. It used recorded Video data (the PILGRIM dataset) taken from a live broadcast of the Makkah TV channel. They have generated three behavior videos from every single video. The proposed method also has outperformed this dataset.
Habib et al. [ 61 ] developed a novel framework to identify abnormal activity for pilgrims at Makkah. A lightweight CNN model was trained on the dataset of pilgrims. This dataset was captured from installed CCTV et al.-Haram. The images’ frames were passed to the proposed model for the extraction of spatial features. Then, an LSTM network was created for the extraction of temporal features. Lastly, the system will make an alarm when an emergency occurs, such as an accident or violent activity, to inform the authorities to take the appropriate action. They have performed experiments on two violent activity datasets: Hockey Fight and Surveillance Fight. The model achieved good accuracies of 98.00 and 81.05, respectively. However, this model suffers from the shortcoming of recognizing violent activity from one perspective only. And it is the best that recognizes violent activity from multiple perspectives to obtain insights into the activities.
Finally, the review concludes from Sects. 4 and 5 that most of these studies have been concerned with CNN methodology and integrated with other techniques to benefit further and improve the accuracy of model performance, Table 6 summarizes all studies that used CNN approach with their advantages and disadvantages. Table 7 displays that used the methodologies of RNN such as LSTM approach. While Table 8 illustrates studies that used different methodologies to create models.
According to our viewpoint, the models of crowd counting still need development for several problems as follows: Detecting large objects as people, but do not detect small objects. Most of models cannot be generalized on all datasets, where they give good results with some datasets and inefficient results with others. Classifying some objects as people by mistake. The accuracy of captured image/video varies according to the installed camera angles. Hence, the challenges can be minimized as possible, installing cameras at every angle in the place to ensure the monitoring of all people and improving the accuracy of image/video pixels for the extraction of features efficiently. At last, internet of things (IoT) devices can improve counting crowds besides DL models. In terms of analysis of social media, geographic locations feature should be exploited for processes analytic of crowds. Furthermore, the various languages should be supported just like the English language. Consideration of the backgrounds of psychological, social, and beliefs of people when studying their expression on social media.
In this study, the comprehensive study is divided into two domains. The first one is crowd management in various events in the world. The second one is crowd management in local area named Hajj event in Makkah, Saudia Arabia. All these studies focus on approaches that applied DL techniques. In terms of comprehensive study of crowd management in various events, the related works are divided into four sections, everyone has two or more subsections. The sections are crowd statistics, crowd scene analysis, social media-based analysis, and crowd sound emotion recognition.
Many new hybrid approaches have been developed by CNN-based methods to improve crowd counting and crowd density estimation fields. The outcomes of combining two or more methods have confirmed that hybrid techniques enhance performance, increase accuracy, and prevent many obstacles in computer vision projects. This has been displayed using the adaptive convolutional neural network (ACNN)-based model, locality-aware features (LAF) integrated with CNN features, multi-column convolutional neural network (MCNN) method, two-task convolutional neural network (T2CNN) with dense degree classification (DDC), and end-to-end semantic scene segmentation (SSS) based on CNN for calculation of crowd counting and density.
Many works have attempted to find the successful solutions for normal or abnormal human behavior analysis. Videos scene analysis for human behavior detection is faced many challenges relate to crowded and complex scenes, anomaly localization, small anomaly datasets, and false-positive detection [ 56 ]. To solve these reasons, DL techniques are more suitable and successful solutions than traditional methods to treat problems and challenges. The researches have been developed by CNN-based methods integrated with other techniques. The works of Shi et al. [ 50 ] and Crivellari and Beinat [ 51 ] have used backpropagation processing through the LSTM technique. LSTM in the first layer feeds subsequent layers and every other layer of LSTM is provided with the layer's output that precedes it. Furthermore, the model of Zhang et al. [ 54 ] used LSTM in third component for inputting stage to improve accuracy rate for classification. Moreover, Ammar and Cherif [ 61 ] have integrated LTMS neural networks and statistical characterization to predict future values of features. Vahora et al. [ 31 ] used LSTM beside GRU to handle the problem of long-term dependency, also used CNN to capture features from the scenes.
Finally, some of these works used CNNs with RNN methods such as LSTM and GRU to treat long-term dependency problems, increase improve extraction of scene features, and accomplish high-quality to anomaly behavior detection.
Some of the works focus on studying crowd management through text data analysis is less compared to analyzing image and video scenes. Due to of the difficulties associated with natural language processing that make it difficult to understand the intentions of people's feelings and emotions towards events and situations. Moreover, It would be excellent if there is prior knowledge of people's social, psychological and behavioral states in order to understand crowd behavior to prevent emergency cases proactively to ensure crowd safety [ 43 ].
There is one research that has presented to study emotion detection by sounds, where it used AlexNet-CNN spectrogram-based method to analyze the sound emotions of the crowds. Spectrogram-based method is appropriate for crowd sounds analysis.
In terms of crowd management at hajj event, the flow of data during a Hajj period is huge, whether it is visual, text, or audio data. This digital wealth must be greatly exploited by the Hajj authorities to reduce the terrible effects that may be when proactive solutions are not developed to control crowds. Like previous studies, CNN with LSTM have been used to effectively extract visual attributes to classify anomalous or anomalous crowd behavior, this achieved excellent accuracy results.
It is clear from the review of existing works that crowd management is plagued by drawbacks and challenges that have restricted its rapid improvement in recent years. Hence, we made several important considerations when building crowd models.
It can be noticed most of the works of literature is that they still remain density-dependent. It means their models developed for macro-analysis independently from micro-analysis, while applications of real-world require crowd analysis to be conducted starting at macro-level and branching down into the micro-level. Therefore, it is important in future works in terms of modelling surveillance, behavioral understanding of crowds, must concern on the enhancement at both macro-and micro-levels and integrated between them.
Furthermore, it can be observed that most of the literature based on computer vision is performed under strong and restrictive conditions, for example, the perspective of the installed camera in the place, surrounding environment, estimating density of crowds, noise, etc. It is vital to realize that these requirements are inherited from the computer vision field since they are viewed as extension techniques for crowd modeling. There is a common sense of acceptance of these challenges for researchers. Whereas in this work, we recommend the integration of some techniques that collect data about people to reduce absolute dependence on traditional equipment. We claim that utilizing various data on social media will make a vital source for video surveillance domain and counting crowd density, behavior, or abnormality crowd detection, which increases the cognitive diversity and learning new patterns for datasets. Hence, the crowd models will be generalizability on the different environments. It has increased the number of large-scale events in the world; thus, the organizers should benefit from the deepest insights about attendees’ characteristics besides events' characteristics. It becomes possible to describe the behavior of people during crowd events using social media data, this is paving the path for crowd monitoring and management by using real-time applications [ 105 ]. The work of [ 106 ] is a good example of exploiting the data in streaming channels and social media during the Hajj season. We believe that, in the future, social media data related to expressing people’s daily lives will become close to understanding the behavior of crowds during events.
The future research must be concerned with the complementarity of the models to solve challenges and drawbacks rather than with minor developments to increase the accuracy of the model only. For these reasons, it is important to understand the differences between the kinds of supervised and unsupervised DL techniques. Many of the relevant concepts may confused together when building large or complex models. Table 9 clears the most important strengths and weaknesses of ML and DL algorithms.
One of the main problems with the majority of local works during Hajj season is that most research is performed in isolation as urban planning for smart cities and the variety of needs regarding crowd management. Urban crowd management is an integral activity for any event, such as crowd flow, estimating density, monitoring street grid, movement of buses [ 107 ], crowd trajectory [ 108 ], impact of a pandemic on crowds [ 109 ], etc. Integration Urban provides good decision support for the development of the city in all respects. Big data and advanced intelligence computational techniques can help the planning, design, management, analysis, and simulation of smart cities. For instance, early planning of safety evacuations in the midst of a natural disaster incident based on location data of mobile phones leveraging both machine learning approaches [ 110 ]. Use crowd-harvested data to study the population's sentiments, traffic patterns, and perceptions of neighborhoods, in addition, to simulating the model urban systems more realistically, which is crowdsourcing effective the analyzing and modeling of urban morphology at much finer social scales, temporal, and spatial [ 111 ]. Hence, smart cities will be able to control and monitor dynamic changes as they happen inside the city during crowded events. For instance, using the FOPID controllers controls systems with nonlinear dynamics, also improves the complex systems performance in various applications [ 112 ], and using DETDO optimizer to solve real-world engineering design problems [ 113 ].
In this SLR, about 45 DL-based articles are reviewed. According to the detailed analysis of various crowd management approaches and their state-of-the-art performance in this survey, our survey forecasts that DL-based methods will predominate future research in the crowd analysis and management fields. It can be noticed that most methods have been integrated with other DL methods, such as CNN with LSTM, to increase the accuracy performance. Moreover, variations in types of input, layers, or fed to in the CNN. It utilizes popular datasets or creates a novel dataset for performing testing on proposed approaches.
Most of these papers focused on crowd scene analysis in the computer vision field. Therefore, the major challenge for crowd management is the lack of sentiment analysis of crowd-based big data on social media. There is also a lack of custom datasets to feed textual data analysis. Owing to the challenges related to natural language processing, it makes difficult to understand people's emotions towards events and situations by textual expression. Furthermore, studying of people's psychological and behavioral it may reduce the severity of these challenges. Furthermore, its open scope for a greater understanding of what is behind the meanings and words. Thus, investigation of the crowd’s behavior from all aspects is greatly crucial for crowd safety, also to prevent dangerous emergency situations before they happened [ 43 ].
This section discusses our vision of this study compared to previous state-of-the-art studies. The main objective of this survey is to spotlight the shortcomings or defects of previous papers. New approaches must provide effective solutions for crowd video analysis in real-time, while traditional approaches are not able to handle efficient solutions in a time-bounded manner. Traditional approaches are insufficient for crowd analysis cause the size of the crowd is huge and dynamic in real-world scenarios. In addition, the behavior and actions of individuals are difficult to identify. The shortcomings can be identified in existing approaches as follows: real-world dynamics, time complexity, bad weather conditions, overlapping of objects [ 119 ], and unexpected incidents. All existing approaches were handling the shortcomings independently. It can be observed that there seem to be almost no concerns about the lack of research in sentiment analysis of crowd-based big data on social media in the world, especially during Hajj events. It can be perceived as a missed chance to learn from different visions. Thus, this study seeks to change imbalance research by configuring new Integrative frameworks and methodologies and highlighting the prior good practices in this domain. It is significant that the researcher community realizes these gaps when constructing existing systems and continuing to monitor the development of integrated research in crowd management.
This paper aims to support Hajj research through the enhancement of the pilgrims' behavior analysis and work to cover the above aspects. Moreover, we will provide datasets of pilgrims taken from social media and will make them publicly available to be useful to other researchers. The authors are seeking “actionable SM-based crowd management”. In this sense, traditional crowd management needs a new multidimensional conception. To build a new robust infrastructure, it must be integrated as follows; “AI algorithm + computing power + big data = smart service” [ 120 ]. It is significant that utilize the best optimizers to improve the performance of complex systems such as FOPID [ 112 ], DETDO [ 113 ], Genghis Khan shark [ 121 ], Geyser Inspired Algorithm [ 122 ], Prairie Dog Optimization Algorithm [ 123 ], Dwarf Mongoose Optimization Algorithm [ 124 ], and Gazelle Optimization Algorithm [ 125 ].
The advantage of this work is the crowd management domain may rise to another sophisticated level if considering the attention on social media big data. Presenting a new taxonomy of crowd management based on deep learning algorithms, including all domains of analyzing data: visual, audio, and textual. Presenting the comprehensive examination of the global crowd management works in order to benefit Hajj authorities to apply the best practices locally. The following research [ 53 , 126 ] can be contributed to addressing weaknesses in Hajj research regarding counting crowds, where the model focuses on the attention of CNN channel-wise, spatial-wise attention, and context-aware. In addition, the model can be used for other purposes, such as image supporter recognition, localization of individuals, and face recognition. Furthermore in [ 46 ], the authors provide a good model for the analysis of textual data and understanding the emotions of users, but it needs some modifications to suit other languages like Arabic.
There are some lessons that can be learnt from this SLR. First, our practice of SLR has emphasized the lack of Hajj data analysis topics. SLR employment is valuable to stay informed about those topics to support the data or knowledge of Hajj. Second, this SLR discovered that the future direction of data analysis and prediction depends on the development of CNN models. Third, crowd analysis studies focus on the analysis aspect of video surveillance more than textual data.
Limitations of this SLR include intentionally ignoring conference papers because they contain incomplete models or studies. Thus, we limited our sources to academic articles only. During data extraction, we found insufficient information related to the environment, evaluation, accuracy, and procedure in some papers, which may be reflected by the QA. As a result, some inferred data may have inaccuracies due to unclear information in the papers. Table 10 shows the summarization of the learning lesson, limitations, and future research directions.
In this SLR, the researchers explored comprehensive crowd management from the aspect of DL methods. This survey has performed a wide investigation for relevant related works published in the interval 2010 to 2023. Moreover, the survey elicited pivotal information based on our research questions (RQs). The research goals have been fulfilled effectively through these RQs that were established to examine and analyze the scope of the research. Moreover, ensuring that the key findings and contributions have been performed usefulness for future researchers, also the gaps and obstacles that faced crowd management have been discussed in the Sects. 5.6 and 6 . The four RQs raised in this SLR, and their findings are as follows:
RQ1: Most previous works have been classified into two categories, crowd scene analysis and crowd statistics. However, these previous works omit the opinion mining of users on social media to predict future crowd actions.
RQ2: Supervised and unsupervised DL methods provide high accuracy in general, which supported computer vision in crowd analysis in many studies, especially in architectures based on the CNN model. Because of its high efficiency and accuracy, it has become the most reliability model for researchers.
RQ3: We observed there is the fewest number of studies regarding crowd management at Hajj. As well they focused on the detection of abnormalities in crowded scenes.
The primary aim of our review is to investigate crowd analysis fields in every gathering around the world. Furthermore, the local gathering, especially crowd analysis in a Hajj event for example. The paper aims to illustrate the dilemmas and obstacles that have been faced in every study. Moreover, it aims to find research gaps existing to focus on it in future studies. Finally, we observe that most studies were about crowd scene analysis via private/publicly available datasets or live-streaming surveillance, whether using supervised or unsupervised techniques. They ignored the behavior analytics and predicted it by textual data on social media. In addition, the literature indicates the lack of Hajj research, especially in sentiment analysis and the study of the pilgrims' behavior. Overall, the systematic literature review links the widespread knowledge transfer debate of crowd management in terms of the study behavior of entities via SM big data and predicting the actions. Thus, the current study enriches the research communities and academic discourse.
Availability upon request from the Corresponding author.
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Department of Computer Science and Artificial Intelligence, College of Computing, Umm Al-Qura University, 21955, Makkah, Saudi Arabia
Aisha M. Alasmari
College of Computing, Umm Al-Qura University, 21955, Makkah, Saudi Arabia
Norah S. Farooqi
Dar Al-Hekma University, Jeddah, Saudi Arabia
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Youseef A. Alotaibi
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Alasmari, A.M., Farooqi, N.S. & Alotaibi, Y.A. Recent trends in crowd management using deep learning techniques: a systematic literature review. J. Umm Al-Qura Univ. Eng.Archit. (2024). https://doi.org/10.1007/s43995-024-00071-3
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Although the COVID-19 pandemic claimed a great deal of lives, it is still unclear how it affected mortality in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality during the COVID-19 pandemic in LLMICs, including methods, sources of data, and potential contributing factors that might have influenced excess mortality.
We conducted a systematic review and meta-analysis on excess mortality during the COVID-19 pandemic in LLMICs in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines We searched PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus. We included studies published from 2019 onwards with a non-COVID-19 period of at least one year as a comparator. The meta-analysis included studies reporting data on population size, as well as observed and expected deaths. We used the Mantel–Haenszel method to estimate the pooled risk ratio with 95% confidence intervals. The protocol was registered in PROSPERO (ID: CRD42022378267).
The review covered 29 countries, with 10 countries included in the meta-analysis. The pooled meta-analysis included 1,405,128,717 individuals, for which 2,152,474 deaths were expected, and 3,555,880 deaths were reported. Calculated excess mortality was 100.3 deaths per 100,000 population per year, with an excess risk of death of 1.65 (95% CI: 1.649, 1.655, p < 0.001). The data sources used in the studies included civil registration systems, surveys, public cemeteries, funeral counts, obituary notifications, burial site imaging, and demographic surveillance systems. The primary techniques used to estimate excess mortality were statistical forecast modelling and geospatial analysis. One out of the 24 studies found higher excess mortality in urban settings.
Our findings demonstrate that excess mortality in LLMICs during the pandemic was substantial. However, estimates of excess mortality are uncertain due to relatively poor data. Understanding the drivers of excess mortality, will require more research using various techniques and data sources.
Peer Review reports
Only six viruses within the coronavirus family, namely 229E, NL63, OC43, HKU1, SARS-CoV, and MERS-CoV, have been known to cause respiratory tract infections in humans [ 1 ]. The SARS-CoV-2 virus, identified in 2019 as the cause of COVID-19, emerged in Wuhan, China [ 2 ]. Despite containment efforts, the virus spread globally, leading the World Health Organization (WHO) to declare it a pandemic in March 2020 [ 3 ]. To date, over 6.5 million deaths and 623 million infections have been reported worldwide, with Africa recording nearly 9 million cases and over 173,000 deaths [ 4 ].
Numerous non-pharmaceutical interventions were adopted globally to combat COVID-19, such as lockdowns and mask mandates [ 5 , 6 , 7 ]. While these measures aimed to reduce the transmission of the virus, [ 8 , 9 ] may have inadvertently increased mortality among chronically ill patients by hindering timely medical care access [ 10 , 11 ]. Additionally, the pandemic response contributed to higher fatalities from domestic violence, suicide, and mental health issues [ 9 , 12 , 13 ].
Confirmed COVID-19 deaths alone may not fully reflect the pandemic's impact [ 14 ]. Excess mortality offers a more comprehensive view, capturing both direct and indirect effects. As per the World Health Organization (WHO), excess mortality is the difference between actual deaths during a crisis and expected deaths without it [ 15 ], encompassing COVID-19-related deaths and those indirectly influenced by the pandemic, including socio-economic challenges like compromised food security, disruptions in supply chains, and limited access to healthcare [ 16 , 17 , 18 ].
Studies have shown that the pandemic exacerbated food insecurity due to lockdowns and economic downturns, which affected the nutritional status and health outcomes of vulnerable populations. Additionally, disruptions in healthcare services led to delays in treatment for chronic conditions and reduced access to essential medical care, further increasing mortality. Mental health issues and increased domestic violence during lockdowns also contributed to higher death rates indirectly associated with the pandemic. These multifaceted impacts highlight the necessity of assessing excess mortality to gain a full understanding of the pandemic's toll, particularly in low- and lower-middle-income countries (LLMICs), where healthcare systems and social safety nets are often less robust. The estimated excess mortality rate from COVID-19 could be 5 to 25-fold higher than reported COVID-19 mortality rates [ 14 ].
Understanding and accurately reporting mortality statistics is crucial for global health policy and resource allocation. In low- and lower-middle-income countries (LLMICs), mortality reporting remains a significant challenge. These countries often face systemic challenges, including incomplete civil registration systems, and under-resourced statistical offices, which contribute to incomplete or inaccurate mortality data. Hence knowledge on excess mortality during the COVID-19 pandemic in LLMICs remains limited [ 19 , 20 , 21 , 22 ]. Vital registration systems and other data sources are often incomplete or inaccurate, lacking routine mortality reporting [ 5 , 20 , 23 ]. To address these limitations, various methods like data interpolation and extrapolation have been proposed [ 24 ]. Innovative approaches such as using satellite imagery to track new graves and participatory epidemiology have also been employed to estimate excess mortality [ 25 , 26 , 27 ] and these unique circumstances and innovative solutions emerging from LLMICs require focused attention.
In addition, to estimating excess mortality using available data, Shang et al. observed a higher pooled excess mortality in developing countries compared to developed ones but did not delve into specific LLMIC results or assess methodologies and data in these contexts [ 28 ]. This systematic review and meta-analysis presents a focused and current summary of excess mortality literature in LLMICs. This study helps to fill a critical gap in the literature by systematically reviewing and analyzing excess mortality in LLMICs during the COVID-19 pandemic. This will not only enhance our understanding of the pandemic's true impact but also support the development of more effective public health responses in these vulnerable regions.The objectives included summarizing existing studies on excess mortality during the COVID-19 pandemic, describing estimation methods and data sources, and identifying drivers of excess mortality in these settings.
This systematic review and meta-analysis focused on studies from low- and lower-middle-income countries.
This review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 29 ], focused on estimating excess mortality levels, examining the methodologies and data used for estimation, and identifying factors influencing excess mortality in LLMICs. Quantitative methods were utilized to conduct a meta-analysis, providing a summary estimate of the excess mortality.
The protocol for conducting this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42022378267).
We conducted searches in electronic bibliographic databases including PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus. Additionally, we reviewed the reference lists of included studies and relevant publications. The search strategy comprised terms related to key review concepts: COVID-19 and/or SARS-CoV-2, excess mortality, and low- and lower-middle-income countries. Each term was operationalized with various synonyms and tailored for specific databases. The search strategy used Medical Subject Headings (MeSH) terms and involved key terms with the appropriate Boolean operators (AND, OR) to ensure comprehensive coverage.
No language restrictions were applied, and the searches were restricted to studies published between 2019 and the date of the searches. In September 2023, the searches were rerun before the final analyses, resulting in additional studies for inclusion.
The inclusion and exclusion criteria were defined based on the Participants, Intervention/Exposure, Comparator, and Outcome (PICO) framework, as detailed below:
The review included population-level or cohort studies from LLMICs, independent of the administrative level (district, region, nation). Facility-based studies were considered to examine covariates and the methods used, but disease-specific studies were excluded.
The exposure of interest was the COVID-19 pandemic. This referred to the period from when the WHO declared COVID-19 a pandemic on March 11, 2020, to the most current wave of COVID-19 infection that was reported in the population under review.
The comparator in the estimation of the excess mortality was all-cause mortality in the non-COVID-19 period (registered or estimated). This comparator period included data from at least one year before March 2020.
The main review outcome was excess mortality in the population under investigation.
Additional outcomes included the methods and data sources used in estimating excess mortality and factors that influenced excess mortality in LLMICs.
Articles that reported on excess mortality with the COVID-19 pandemic as the exposure of interest
Articles conducted in Low and Lower-Middle Income Countries as defined by the World Bank
Studies published between the years 2019 and to date
Population-level, cohort studies or facility-based studies, independent of the administrative level (district, region, nation)
Studies with a comparator of all-cause mortality in the non-COVID-19 period being at least one year before March 2020
Two independent investigators (JMG and OL) used the eligibility criteria to select studies for inclusion in the review. Any disagreement was resolved by discussion and/or a third reviewer (WQ) was consulted for a consensus to be reached. A meta-analysis was conducted for a subset of the included studies in the review. Studies were included in the meta-analysis only if they provided the following information: a clearly defined estimate for excess mortality, a documented method for estimating excess mortality, a specified population size for the study, as well as an observed, and expected death count for the period reported.
We extracted the following data: author (s), publication year, study country, study period, World Bank income level, estimated excess mortality, disaggregated results for differences in socio-economic groups, estimated and registered COVID-19 mortality, mortality data sources, methods used to estimate excess mortality, identified drivers of excess mortality, type of population (geographical region, cohort), and population baseline characteristics. Mendeley Desktop Version 1.19.8 was used to identify duplicate records.
The review’s primary outcome was estimated excess mortality as reported in primary studies. Studies that did not indicate the expected (i.e. baseline) deaths and the observed/estimated deaths were not included in the meta-analysis. Secondary outcomes included methods for estimating excess mortality, disaggregated measures of excess mortality (e.g. mortality by socio-economic status) and factors influencing excess mortality.
Reported estimates of excess mortality were summarized in tabular format and synthesized narratively. The methods and data that were used for estimating excess mortality and identifying factors that influenced excess mortality, and the socioeconomic disparities in the estimates of excess mortality were summarized and synthesized into thematic narratives.
A meta-analysis was conducted to estimate the rate of excess mortality in LLMICs. Data analysis was conducted using StataSE 16 statistical software from StataCorp, College Station, Texas, USA.. Mortality rates estimated before and during the pandemic were calculated and summarized. The Mantel–Haenszel random-effects method was adopted to estimate the pooled risk ratio at 95% confidence intervals (CIs) and heterogeneity among the studies was estimated using I 2 values. The I 2 quantified the degree of heterogeneity in the meta-analysis.
Sensitivity analyses were carried out to investigate how non-eligible research may have an impact on risk differences. This was accomplished by running the data through a meta-analysis twice. For studies that did not have full details based on the eligibility criteria, first, we included all studies and second, only included those that were known to be eligible. Only studies that were known to be eligible were included in the final meta-analysis.
The quality of the included studies was assessed using appropriate tools. Quality assessment was performed by two independent reviewers based on the Newcastle- Ottawa Scale (NOS) score and any disparity was solved by discussion and/or consulting a third reviewer (Appendix 1). In this assessment, all studies included in the review and meta-analysis were at minimal risk of bias. In addition to the NOS score, we also considered the methodological rigor of each study, including factors such as study design, sample size, and data collection methods. This comprehensive assessment ensured a thorough evaluation of the quality of the included studies and provided confidence in the robustness of our findings.
Figure 1 summarizes the results of the study search and selection process. A total of 10,196 studies were identified in the databases after removal of duplicates. During title and abstract screening, 10,068 were excluded, leaving 129 studies for full-text review, of which, 24 studies were included in the systematic review and 6 in the meta-analysis.
Flow diagram of the study selection procedure
The main reasons for exclusion in the review were (1) Reports outside the study scope, (2) Studies not related to review objectives, (3) estimation of excess mortality among patients with a specific disease instead of a population and/or cohort, and (4) the use of a comparator which was less than 1 year in the estimation of the expected number of deaths in the calculation of excess mortality. The main reasons for exclusion from the meta-analysis were that studies did not specify the population size, the number of expected deaths (all-cause mortality), the number of observed deaths, or the methods for estimating excess mortality.
The characteristics of the 24 included studies are summarized in Table 1 . Studies were published between 2020 and 2023 but most were published in 2021 (13 studies). Five studies were conducted in low-income countries and 19 in lower-middle-income countries (Fig. 2 ). Most of the studies were conducted in Asia, including Iran (7). India (4), Bangladesh (2), and Indonesia (2). There were 6 studies from Africa and none from Latin America or the Caribbean. Sanmarchi et al. [ 30 ] reported estimates from 5 countries, making it a total of 29 countries in the review (Fig. 3 ).
Number of studies classified by World Bank income level
Countries and their represented number of included number of studies
For the meta-analysis, 10 countries were included from 6 studies. In 7 countries, the observed deaths were higher than expected ([India (2), Iran (1), Kyrgyzstan (1), Uzbekistan (1), Tunisia(1), and Bolivia (1)]. In three countries (Indonesia, Kenya and Mongolia), negative excess mortality was recorded, thus the observed deaths were lower than the number expected in the absence of the pandemic.
Table 2 provides an overview of population and mortality data reported by the studies included in the meta-analysis. During the COVID-19 pandemic, of the total 1,398,858,717 individuals/populations, 3,555,880 all-cause deaths were reported, while 2,152,474 deaths were expected from the eleven countries. The pooled excess mortality was 100.3 deaths per 100,000 population. The excess risk of death was 1.65 (95% CI: 1.649, 1.655 p < 0.001). There was a high heterogeneity as indicated by the I 2 of 100% among the studies (Fig. 4 ).
Adjusted Pooled estimate of excess mortality
In 7 countries, the observed deaths were higher than expected, whilst, in three countries, negative excess mortality was recorded, thus the observed deaths were lower than the number expected in the absence of the pandemic.
The 24 articles used four distinct methods/study designs to determine excess mortality. The largest group of studies (15 articles) used retrospective data of already existing mortality datasets [Bangladesh (1), Iran (5), India (4), Kenya(1); Syria(1), Madagascar(1), Indonesia(1), Uganda(1)] to estimate excess mortality. Two studies used quantification of burial sites by observing the increase in the number of burial grounds to estimate excess mortality [Yemen(1), Somalia(1)]. One study used a cross-sectional survey through a household census (Bangladesh) and another used grey literature (use of already published figures from journalists and organizations) (India) to estimate excess mortality.
Concerning the source of data, four studies used more than one data source to estimate excess mortality. This included burials in public cemeteries + civil death registration + health authority death registration (Indonesia), daily mortality/incidence data from the Syrian Ministry of Health + Excess all-cause mortality data from a statement by the Damascus governorate + obituary notification data from Facebook page (Syria), National survey data + health facility deaths Jha et al. [ 49 ] (India) and figures published by regional governments and Indian journalists + government hospital data + funeral counts + handwritten death registers (India).
All other studies relied on only one data source. Five studies used National Civil Registration Data (4 studies from Iran and 1 India). Two studies each used the Health and Demographic Surveillance System (Kenya and Bangladesh), death registers (India and Madagascar) and imaging of burial sites/grounds (a study each from Yemen and Somalia). One study (in Bangladesh) used only primary data (census/survey) data and another study (in Iran and Indonesis) used Bureau of Vital Statistics data to estimate excess mortality.
Studies used several different methods to determine the expected deaths that were used to calculate excess mortality. Twelve studies used modelling techniques to estimate excess mortality. Of these, five studies used linear regression [India(2), Indonesia(1); Iran(2)], two studies used auto-regression modelling techniques. Two other studies (In Madagascar and Iran) used geospatial analysis which involves identifying new grave plots and measuring changes in burial surface area over a period ( In Yemen and Somalia) and two studies used estimation of death counts (In Uganda and Indonesia). Other modelling techniques used included Cox proportional hazard models, Auto-Regressive Integrated Moving Average, model fit, multilevel regression model (full bayesian model).
In assessing the factors that might have influenced excess mortality, of the 24 studies, only one (in India) reported differences in mortality between rural and urban areas. They found that excess deaths in the first wave of the pandemic were concentrated in urban areas, while deaths in the second wave affected both urban and rural areas. Other studies speculated what could have caused excess morality without empirical evidence in their data. No study reported disaggregated information by socio-economic status.
This is the first systematic review and meta-analysis of studies estimating excess mortality during the COVID-19 pandemic in low- and lower-middle-income countries (LLMICs), exploring methods in estimating excess mortality and the factors that might have influenced excess morality in LLMICs.
The results of the meta-analysis indicate that excess mortality in LLMICs was substantial. There were an estimated 1,403,406 excess deaths in the 10 countries covered by the included studies, representing 100.3 excess deaths per 100,000 population or a 1.65 excess risk of death (95% CI: 1.649, 1.655 p < 0.001) during the pandemic. Expected deaths were mostly estimated based on secondary data analysis. Other studies quantified an increase in burial grounds and other household surveys. This review identified only one study that assessed factors associated with excess mortality. According to that study, excess deaths were concentrated in urban areas during the first wave of the pandemic but affected both urban and rural areas in the second wave [ 49 ].
A previous review and meta-analysis of global excess mortality reported a slightly higher estimate of excess mortality for lower-middle-income countries [133.45 (95% CI: 75.10–189.38) per 100,000]. Also, according to the COVID-19 Excess Mortality Collaborators, globally, the number of excess deaths due to the COVID-19 pandemic was largest in the regions of South Asia, north Africa the Middle East, and Eastern Europe. India (4·07 million [3·71–4·36]), the USA (1·13 million [1·08–1·18]), Russia (1·07 million [1·06–1·08]), Mexico (798,000 [741000–867000]), Brazil (792,000 [730000–847000]), Indonesia (736,000 [594000–955000]), and Pakistan (664,000 [498000–847000]) were estimated to have the highest cumulative excess deaths due to COVID-19 at the national level. They highlighted that across countries, the ratios showed significant variation, with New Zealand having the lowest at -17.10 (-26.06 to -8.84) and the Central African Republic the highest at 139.24 (88.86–213.67). South Africa, the only sub-Saharan African nation with available direct estimates of excess mortality from vital registration data, had a ratio of 3.31 (3.15–3.64). In South Asia, national-level ratios ranged from 8.33 (7.58–8.92) in India to 36.06 (15.14–53.25) in Bhutan. Within India and Pakistan, the most extreme ratios were observed at the state and province level, spanning from 0.96 (0.44–1.41) in Goa, India to 49.64 (28.94–72.74) in Balochistan, Pakistan [ 50 ].
By examining the methods employed in estimating excess mortality, we provide valuable insights into the diverse approaches used in LLMIC contexts. Notably, innovative techniques such as quantifying burial sites and utilizing geospatial analysis emerged during the pandemic, offering alternative means of mortality surveillance in resource-constrained settings. The methods of studies included in this review align with the methods of other studies conducted in high-income countries. 50− Retrospective data analysis, while essential for calculating excess mortality, can be limited by delays in death registration, leading to potential underestimation at the time of analysis. This design was however suitable at the time of the pandemic and further corresponded to WHO recommendations. 53 Estimating excess mortality requires an estimate of a certain level of baseline mortality to enable computation of excess mortality. Quantification of burial sites using geospatial analysis is a new method that emerged during the pandemic and was found to have considerable advantages for rapidly monitoring population mortality in settings without effective vital registrations [ 25 ]. However, this method could result in underestimation due to moderate precision because of missing grave counts in satellite images [ 26 ].
A few studies used burial site expansion before and after the pandemic to quantify excess mortality.
Some studies from the review used a combination of two or more methods, ranging from death registries, burial ground quantifications, journal reports and demographic survey data. The use of multiple methods is not new. It has been used in other studies [ 32 , 51 ]. In this current review, linear regression models were widely used to estimate the number of deaths that would have occurred in the absence of the pandemic. This aligns with other estimation methods proven to be statistically efficient in estimating excess mortality [ 34 ].
There is relatively limited information on factors that influence excess mortality in LLMICs. Only one study included in our review [ 52 ] reported that excess mortality was associated with sociodemographic and clinical characteristics. [ 34 ], whereas in several high-income countries, socioeconomic disparity in excess mortality has been studied extensively. In England for example, it was observed that excess mortality was consistently higher for essential workers throughout 2020, particularly for healthcare workers [ 39 ]. In Korea, the pandemic has disproportionately affected those of lower socioeconomic status and has exacerbated inequalities in mortality [ 37 ]. Unfortunately, similar evidence is unavailable for LLMICs.
In this study, it is evident that the overall estimate is greatly influenced by the data from India due to its significant population size, constituting 65% of the weight. Consequently, the observed excess mortality rates in other countries appear considerably lower. This substantial variance could potentially be attributed to this influential factor for the high rates of excess mortality in LLMICs. It is plausible to speculate that excess mortality has been impacted by a wide range of factors, including limited health sector capacities to detect and treat COVID-19, more constrained resources to take care of other diseases, and fewer resources to cushion the negative social consequences of the pandemic [ 14 ].
The findings of this review reconfirm that the true impact of the pandemic is considerably higher than the reported number of COVID-19 deaths, which have been estimated at 100.3 /100,000 for the 10 LLMICs covered by studies included in our meta-analysis. Overall, our review shows the importance of addressing excess mortality in LLMICs and provides a foundation for ongoing research and policy initiatives aimed at improving pandemic preparedness and response strategies in these settings.
Our review has some limitations. First, a low number of primary studies met the criteria for inclusion and large variation in methods of included studies limited our ability to include studies in the meta-analysis. Second, our results are not representative of all LLMICs given insufficient numbers of studies from some parts of the world. Nevertheless, the results of this study provide a better understanding of the effect of the pandemic on mortality in LLMICs and may inform future analyses of excess mortality. The need to enhance death registration systems in LLMICs is essential for better pandemic monitoring.
Our review shows that excess mortality during the COVID-19 pandemic was substantial in LLMICs. It was above excess mortality levels reported for HIC and much higher than reported COVID-19 deaths in LLMIC. Most studies used retrospective and linear regression models to estimate excess mortality. More research and better data are needed to identify the drivers of excess mortality in LLMICs.
No datasets were generated or analysed during the current study.
All-Cause Mortality
Berlin University Alliance
Coronavirus Disease 2019
German-West African Centre for Global Health and Pandemic Prevention
High-Income Countries
Low-Income Countries
Lower-Middle-Income Countries
Low- and Lower-Middle-Income Countries
Newcastle–Ottawa Scale
Preferred Reporting Items for Systematic Review and Meta-Analysis
Participants, Intervention, Comparator, and Outcome
World Health Organization
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A big thank you to the management of the German-West African Centre for Global Health and Pandemic Prevention (G-WAC) / Berlin University Alliance (BUA) for their financial and technical support. I extend my sincere thanks to the leadership of the Global Health and Infectious Diseases Research Group at the Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana for their understanding in excusing the Principal Investigator (JMG) to carry out this study.
The work has been made possible by the German-West African Centre for Global Health and Pandemic Prevention (G-WAC) scholarship of the German Academic Exchange Service (DAAD) as part of the Global Centres Programme funded by the German Federal Foreign Office. Additional financial support for supervision was made available by the Flattening the Curve Project of the Berlin University Alliance (BUA).
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JMG, JHA, WQ, AJ and VB made substantial contributions to the conception and design of this systematic review and meta-analysis. JMG performed the screening, study selection and data extraction from all studies using the eligibility criteria. OL independently screened the titles and abstracts of the identified studies. All authors approved the final version of this manuscript.
Correspondence to Jonathan Mawutor Gmanyami .
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Gmanyami, J.M., Quentin, W., Lambert, O. et al. Excess mortality during the COVID-19 pandemic in low-and lower-middle-income countries: a systematic review and meta-analysis. BMC Public Health 24 , 1643 (2024). https://doi.org/10.1186/s12889-024-19154-w
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Informal care is an essential part of support provided in the homecare setting. To ensure effective healthcare provision, good communication and collaboration between informal and formal care providers are crucial. To achieve this aim, it is necessary to have a clear understanding of the perspectives of all stakeholders. In the scientific literature, limited knowledge is available regarding family members’ opinions about their involvement in care. To date, no instruments have been developed that accurately measure these opinions. This study aims to elucidate the opinions of family members about their involvement in nursing care.
A cross-sectional survey approach was employed. The methodological steps in this study were (1) convert the Families’ Importance in Nursing Care–Nurses’ Attitudes (FINC-NA) from a nurses’ perspective to a family perspective and thus develop the Families’ Importance in Nursing Care–Families’ Opinions (FINC-FO) and (2) measure families’ opinions regarding their involvement in home nursing care. The questionnaire was sent to 3,800 patients with activated patient portals, which accounts for about 17% of the total patient base. Responses were received from 1,339 family members, a response rate of 35%.
The developed FINC-FO questionnaire showed homogeneity and internal consistency. The results of the questionnaire indicate that family members consider it important to be involved in care and that they wish to be acknowledged as participants in discussions about care (planning) but are less inclined to actively participate in the provision of care by nurses. Family members expressed less explicit opinions about their own support needs. Factors such as level of education, type of partnership, and amount of care provided are seemingly associated with these opinions.
Family members in the homecare setting wish to be involved in discussions about care (planning). The transition in care from primarily formal to more informal care necessitates an awareness and clear definition—on part of both healthcare professionals and families—of their respective roles in the provision of care. Communication about wishes, expectations, and the need for support in care is essential to ensure quality of care and that the family can sustain caregiving.
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• Limited knowledge is available regarding family members’ opinions about their involvement in care, and to date, no instruments have been developed that accurately measure these opinions. |
• The developed FINC-FO seems to be a feasible questionnaire to measure families’ opinions about their involvement in nursing care in the home setting. |
• This study offers insight into family members’ opinions on their involvement in caregiving and the influencing factors. It underscores the importance for both healthcare professionals and families to cultivate awareness and establish clear definitions of their respective roles in providing care. |
Informal family care is an essential aspect of healthcare that involves the provision of support to family members who are ill, disabled, or vulnerable [ 1 ]. Family caregivers (e.g., partner, child, neighbor, friend) are vital for patients’ support and informal care [ 2 , 3 ]. In recent years, the need for support from family caregivers at home has increased due to societal changes, such as the aging population and the decreasing availability of institutionalized professional care for daily support. As a result, vulnerable, dependent elderly people continue to live at home for longer periods but are less able to rely on professional care. These societal changes necessitate an appropriate transition from primarily formal to more informal care. Informal care provided by family benefits patients’ wellbeing; however, it is also associated with a range of practical, physical, and emotional challenges for family members [ 4 , 5 ].
To make this transition of care successful, a need exists for targeted, effective communication that facilitates collaboration between healthcare professionals and informal family caregivers. Healthcare professionals should view family caregivers as partners in the care process to meet patient and family needs [ 6 ]. Earlier research indicates that preparedness for caregiving depends on the support that families receive from healthcare professionals [ 7 ]. To achieve good communication and collaboration between healthcare professionals and family caregivers, it is important to know both families’ and healthcare professionals’ opinions regarding the role of family members in caring for patients. Earlier research further indicates that nurses who generally have positive attitudes toward involving families as partners in patient care are more likely to communicate and collaborate with families [ 8 ]. With the increasing importance of family caregivers at home, it is implicitly expected that in general, family members wish to be involved in care. However, limited research has been conducted on families’ opinions regarding their involvement in direct nursing care and, subsequently, how they prefer to communicate and collaborate with nurses [ 9 ]. Involvement in the care for a family member is likely to be imagined differently by and between family members, which may differ from what is expected by nurses [ 10 , 11 ]. It is thus crucial to understand the opinions of family members regarding their involvement in nursing care and determine whether families’ wishes and expectations align with the principles of care envisioned by nurses. As such, this study aims to explore family members’ opinions regarding their involvement in nursing care for relatives in a homecare setting.
Instruments exploring family members’ opinions regarding their involvement in nursing care are currently lacking. As such, we have adapted the widely used Families’ Importance in Nursing Care–Nurses’ Attitudes (FINC-NA) from a nursing to a family perspective.
The methodological steps employed in this study were to (1) convert FINC-NA from a nursing to a family perspective and thus develop the Families’ Importance in Nursing Care–Families’ Opinions (FINC-FO) and (2) measure families’ opinions regarding their involvement in nursing care at home. A cross-sectional survey approach adhering to the “Strengthening the Reporting of Observational Studies in Epidemiology” guidelines for articles reporting cross-sectional studies was employed [ 12 ].
FINC-NA, a widely used instrument to measure nurses’ attitudes toward the importance of involving families in nursing care [ 13 , 14 ], is based on family systems nursing theory and has been validated in different healthcare settings and countries [ 15 , 16 ]. The study of Hagedoorn et al. (2018) provides an overview of countries that have validated the FINC-NA. Examples of nurses and care settings described in this study are registered nurses in Sweden, psychiatric nurses in Iceland and Taiwan, primary healthcare nurses in Portugal and hospital nurses in Portugal and Australia [ 16 ]. In educational attainment, there are slight variations, but al nurses maintain an educational level comparable to registered nurses.
The FINC-NA comprises four subscales: family as a resource in nursing care , referring to a positive attitude toward families’ presence in nursing care; family as a conversational partner , referring to the acknowledgment of patients’ families as conversational partners; family as a burden , referring to statements of experiencing family as a burden; and family as its own resource , referring to families’ own resources for coping [ 17 ]. Other instruments exist that measure families’ perspectives toward family involvement, but these typically involve a specific context and focus on families’ experiences with care, rather than their opinions about how they want to be involved. As such, we have adapted FINC-NA from a nursing to a family perspective.
The FINC-NA questionnaire has undergone translation into Dutch and subsequent psychometric testing. Hagedoorn et al. (2018) details this linguistic validation process, which involved translating the original Swedish questionnaire to Dutch [ 16 ]. This Dutch version of FINC-NA, comprising 26 statements utilizing a 5-point Likert scale, was converted from a nursing to a family perspective, resulting in the Dutch FINC-FO. To remain as close as possible to the original statements of the validated list, initially, only the concept of “nurse” was converted to that of “family” (or vice versa). The statements were subsequently evaluated and adjusted by two researchers (MLL and LD) with expertise in family care, who aimed to maintain the intention of the statements while ensuring that they were also easily understandable and applicable from a family perspective. Most of the adjustments involved the addition of the words “I consider it important…”. Only one item from FINC-NA, on the subscale family as resource in nursing care (“The presence of families gives me a feeling of security”), could not be transferred to a family perspective. As this statement relates to nurses’ emotions and perceptions, it was not considered something that the family could express an opinion on.
The content validity of the FINC-FO items was established by homecare patients and experienced informal caregivers (4 in total) who were members of an official customer council within a homecare organization. The FINC-FO was sent to the council by e-mail. Members of the council were asked to review all 26 statements for clarity and relevance and provided written feedback to the research team. Some statements were assessed as unclear, which could subsequently be resolved by changes in word-order or word-choice. All experts agreed that the statements in the final version of FINC-FO were clear and relevant to examine families’ opinions about their involvement in care at home.
The converted questionnaire resulted in an FINC-FO list comprising 25 statements exploring the four subscales using a 5-point Likert scale (1 = strongly disagree–5 = strongly agree) aligning with the original FINC-NA. Items were presented per subscale, starting with family as a resource in nursing care , with nine items, followed by family as a conversational partner , with eight items, then family as a burden , with four items, and finally family as its own resource , also comprising four items [ 12 ].
An item-total correlation correcting for overlap was conducted to evaluate the homogeneity and discrimination ability of the items. This correlation should be higher than 0.30 [ 18 ]. Cronbach’s alpha was used as a measure of the internal consistency or reliability of FINC-FO and its subscales. An alpha value of 0.70 or higher is generally considered acceptable, while values of 0.80 or higher are considered excellent [ 18 ]. To analyze the questionnaire’s construct validity, a confirmatory factor analysis was used. Since FINC-FO is based on the theory of FINC-NA, a deductive theory-based approach with the original, pre-specified factor structure of the four constructs was tested. A one-factor analysis per subscale was used to investigate the size of loadings (i.e., the items’ degree of association with the latent factor). Stevens (2002) recommends interpreting factor loadings with absolute values above 0.40 as sufficient [ 19 ].
FINC-FO was distributed among the family members of patients receiving care from three home healthcare organizations in the northern region of the Netherlands. In the Dutch research context, homecare institutions are defined as organizations that deliver varying levels of care within individuals’ homes, serving to different levels of complexity. These organizations match the complexity of care required with the training and competency level of the healthcare professional, typically categorized by nursing levels. This coordination is facilitated through a nursing assessment performed by registered nurses. This model of healthcare organization is generally analogous to home healthcare organization in other European countries and North America.
As the FINC-FO questionnaire was made available exclusively through the electronic health record system’s patient portal (Caren-Nedap), only family members admitted to the patient portal were able to participate. The questionnaire was sent to 3,800 patients with activated patient portals, which accounts for about 17% of the total patient base. Responses were received from 1,339 family members, a response rate of 35%.
In April 2022, FINC-FO was administered to family caregivers through the patients’ electronic health record system. The questionnaire was accessible via a link within the patient’s care file, visible to both patients and their families. Demographic characteristics such as age, gender, level of education, type of relationship with the patient, number of hours of caregiving, and working status were subsequently collected. The entire data collection process took 4 weeks.
Only completed questionnaires were included in the data analysis. Of the 1,339 questionnaires, 64 were excluded due to incomplete responses, resulting in 1,275 questionnaires for data analysis. As in FINC-NA, items on the subscale family as a burden were reverse scored, so the scores on this scale were recoded before analysis. Education level was categorized as high (tertiary education), middle (secondary education), or low (primary education), and the categories of relationship to the patient were merged into three: spouse, parent/child, and other. Data were analyzed using SPSS for Windows (release 28.0.1.1), and descriptive statistics were used to describe the study population and the responses to the FINC-FO questionnaire on item levels. Higher scores indicate more positive opinions. An independent t-test and an ANOVA were used to compare differences in attitudes related to background variables. For these analyses, the continuous variables age and caregiving hours were dichotomized. Mean or median was used as the cut-off point for the distribution. Multivariable linear regression analyses were performed to determine the individual contribution of each background variable to the FINC-FO and subscale scores. The significance level was set at p ≤ 0.05.
The questionnaire was completed by 1,275 respondents. Table 1 illustrates the subscales, with the associated FINC-FO items. Subscales and items are shown in the same order as they appear in the questionnaire. All items on the subscales have been translated from Dutch to English by a certified translation agency with the original English FINC-NA terminology serving as a reference. They are expressed in truncated sentences to save space. Table 1 shows the homogeneity of the total FINC-FO scale with item-total correlations, internal consistency with the Cronbach’s alpha, and factor loadings per subscale.
The total FINC-FO questionnaire and the subscales family as a resource in nursing care , family as a conversation partner , and family as its own resource demonstrated strong internal consistency, with Cronbach’s alpha scores exceeding 0.80 across these scales. Most item-total correlations surpassed 0.40, with the exception of two items (RCN-1 and CP-5), which exhibited lower correlations. These two items also displayed inadequate factor loadings, below 0.40. Excluding them resulted in a slight improved Cronbach’s alpha. The Cronbach’s alpha for the subscale family as a burden was moderate, with one item showing a negative item-total correlation and the remaining items falling below 0.30.
Additionally, these FINC-FO score seem comparable to the Dutch FINC-NA questionnaire [ 16 ] which demonstrated similar reliability, with Cronbach’s alpha of 0.88 and 0.82 for the total score of the FINC-NA and subscale family as a resource in nursing care , respectively. However, the subscales family as a conversational partner and family as its own resource exhibited slightly lower Cronbach’s alpha values (0.74 and 0.73, respectively) compared to their counterparts in the FINC-FO. Conversely, the subscale family as a burden demonstrated slightly higher Cronbach’s alpha in the FINC-NA compared to the FINC-FO [ 16 ].
Study population.
Table 2 illustrates the characteristics of the 1,275 respondents who completed the questionnaire. The average age of respondents was 60.7 years, and over 90% were between 40 and 80 years old. Over 70% were female, and more than half (57%) reported having paid employment. On average, these respondents worked 28 h a week, with 30% working 32 h a week or more. More than half of the respondents (59%) spent 8 h or less on caregiving tasks (ranging from 0 to 168 h), with 11.5% reporting spending at least 35 h on caregiving and 6.5% providing caregiving tasks 24 h a day.
The total score of 92.3 (SD 11.5; range 25–125), as well as the scores on the subscales of the FINC-FO questionnaire, represented approximately 70% of the maximum possible score (see Table 3). Table 1 illustrates the response percentages per category.
Family as a resource in nursing care
Almost all respondents indicated that a good relationship with nurses gives them a positive feeling (95%), and most (75%) indicated having valuable knowledge that can be useful in caring for the patient or their family members. About half of the respondents indicated that their presence in care at home was meaningful (54%), made the work of a nurse easier (43%), and gave them a sense of purpose (52%). Family members also considered it important to actively participate in discussions about care (planning) and for nurses to allocate time for them. Fewer family members (19%) found it important to be present during actual care moments.
Family as a conversational partner
Of the family members, 87% found it important that nurses identify those who belong to the family, while less than half (43%) indicated that this had occurred in their situation. Most respondents (86%) considered it important to be invited for a conversation at the start of care provision, and 72% of respondents believed that this would save time. They also wished to be engaged in conversation at the end of care provision (77%), during changes (95%), or to regularly discuss progress (68%). Less than half (42%) found it important to be actively invited to participate in care provision.
Family as a burden
Most respondents (86%) did not believe that they hindered nurses in their work. Additionally, 67% did not feel that nurses found it difficult when family was present during care provision. Approximately 10% felt that they needed to monitor care provision to ensure that everything went well.
Nearly two-thirds (64%) of the respondents considered it important for nurses to view them as collaborative partners, while 10% did not find this important. Almost half of the respondents (46%) found it important to be asked how they could be supported, while 51% wanted support from nurses in coping with the situation. One-third (36%) found it important to be encouraged to cope with the situation as best as possible, while 19% did not find it important, and 45% had no opinion.
Table 4 shows the scores for both the total FINC-FO questionnaire and the subscales related to the background variables.
A significant difference was found in the scores between the age groups. Older (> 60 years) family members scored higher compared to younger family members on the overall FINC-FO and on the three subscales family as a resource in nursing care , family as a burden , and family as its own resource ( p ≤ 0.005).
Gender showed no significant difference in scores, except on the subscale family as a resource in nursing care. On this subscale, male family members scored higher than female family members ( p = 0.03).
Family members with low education levels showed a significant higher score on the overall FINC-FO compared to middle and high education levels ( p < 0.001). This difference was also observed on the subscale family as its own resource . The subscale family as a resource in nursing care showed a statistically significant difference among family members of all education levels ( p < 0.001).
Spouses of patients scored significantly higher compared to other relationships on the total FINC-FO and on the three subscales family as a resource in nursing care , family as a burden , and family as its own resource ( p < 0.001).
Family members who had paid employment scored significantly lower than family members who were unemployed or doing volunteer work on the total score of FINC-FO ( p < 0.001) as well as on the three subscales family as a resource in nursing care , family as a burden , and family as its own resource ( p ≤ 0.03).
The more care hours were provided by family members, the higher the scores on FINC-FO. Significant higher scores were seen in the total score of FINC-FO and on the subscales family as a resource in nursing care , family as a conversational partner , and family as its own resource ( p < 0.001).
To determine the unique contribution of each background variable (see Table 4), multivariable linear regression models were performed for the FINC-FO questionnaire and its subscales (see Table 5). The number of caregiving hours made the greatest contribution for all subscales except family as a burden , and more caregiving hours resulted in a higher total FINC-FO score (β = 0.18; p < 0.001). The family relationship of spouses made the same contribution as caregiving hours on the subscale family as a resource in nursing care (β = 0.15; p < 0.001). Spouses made a significant contribution to the overall FINC-FO score (β = 0.09; p = 0.03), and on all subscales except family as a conversational partner . Low education level also contributed to the total FINC-FO score (β = 0.06; p = 0.04), as well as the subscales family as a resource in nursing care (β = 0.07; p = 0.02) and family as its own resource (β = 0.08; p = 0.02). Families with low education levels scored higher than those with middle education levels. For the subscale family as a burden , age made the greatest contribution (β = 0.10; p = 0.01).
Table 5 shows that only 2–9% is explained by the selected background variables.
In this study, we gained insight into families’ opinions regarding their involvement in nursing care at home using the developed FINC-FO questionnaire. The results specifically reveal that family members consider it important to be acknowledged as participants in discussions about care and care planning and that they wish for their knowledge and input to be appreciated. Family members seem less inclined to actively participate in care and express less explicit opinions about their own support needs. Overall, FINC-FO seems to be a feasible questionnaire to capture families’ opinions regarding their involvement in nursing care in the home setting.
Our study indicates that primarily, level of education, type of relationship, and amount of care provided are associated with opinions regarding involvement in care. In particular, spouses, family caregivers with a relative low level of education compared to middle and high level educated family members, and family caregivers providing more than eight hours of care express the wish to be involved in care for their relatives. As demonstrated in previous studies, the influences of these background characteristics often interconnect [ 20 ]. It seems obvious that spouses, who spend more time with patients, have the opportunity to provide more informal care. Also, people with lower resources in terms of education and income more often provide informal care because they are less inclined to utilize professional care and often have smaller social networks to assist with caregiving, and as a result, bear the burden of care themselves [ 21 , 22 , 23 , 24 ]. Healthcare professionals must be aware of these associations and the impact of these variables, as the desire for a high involvement in care and the inability to mobilize other resources to organize care might eventually contribute to the overloading of family members, which often happens gradually and when it becomes apparent it will become a crisis [ 25 ]. Prevention necessitates an approach that considers the entire care situation. Regular communication between patients, families, and healthcare professionals about collaborative caregiving and the division of roles and tasks is essential to ensure quality care in the long term and the sustainability of family caregiving.
Background variables discussed above explain only up to 9% of the variance regarding family involvement in care. This suggests that several other unidentified factors influence family members’ opinions and highlights the need for further research on this topic.
Although family members express a desire to be acknowledged as participants in discussions about care and care planning, they seem less inclined to be actively involved in actual care provision by nurses. Before healthcare professionals become involved, family members frequently perform myriad caregiving tasks. However, these responsibilities seem to shift when healthcare professionals become involved and take over the provision of care [ 26 ]. With the need for a transition from primarily formal care to a higher level of involvement of informal care, healthcare professionals should consider what care is already being provided by a family and discuss which additional aspects of care the family is willing and able to deliver by discussing the possibilities, wishes, and expectations in the provision of care with the family. This necessitates an awareness—on the part of both healthcare professionals and family members—of their respective roles and tasks in the provision of care [ 8 ]. In addition, it seems desirable that healthcare professionals and family members harmonize their principles, values, and mutual expectations regarding the provision of care for the patient. Such conversations will promote better collaboration and coordination based on mutual understanding.
Family members responded more neutrally on the subscale family as its own resource , which suggests that family members are focused primarily on the patient and less on themselves and their needs as family caregivers. Family members may be unaware of their need for support or expect nurses to be primarily dedicated to the patient, not to family members. However, from the perspective of family systems nursing, the focus of nurses should not be solely on the patient but on the care situation as a whole and the family as the unit of care [ 27 ]. Considering the transition from formal to more informal care, the awareness that families may need support seems relevant among healthcare professionals, and among the patients and families themselves [ 28 ].
The FINC-FO questionnaire was distributed via an electronic health record system, so it reached not the entire population of family members within the organization but only those who utilized the electronic patient portal. As a result, a possibility of bias in the results exists; family members who use the electronic patient portal may be more closely involved than those who do not. The sample size of 1275 allowed us to perform psychometric testing of the FINC-FO, indicating that the FINC-FO seems to be a feasible questionnaire to capture families’ opinions regarding their involvement in nursing care in the home setting. However, with a final response rate representing 35% of the total population, only cautious conclusions can be drawn about the population of family members of patients receiving homecare using the electronic patient portal. Further research is needed, employing alternative strategies to engage more respondents, in order to be able to generalize findings to a broader family population.
In this study, a questionnaire that has not yet demonstrated validity was employed. Nevertheless, the FINC-FO offer a sufficiently reliable and differentiated picture of family members’ opinions regarding their involvement in nursing care in the home setting, which suggests that this instrument can be recommend for use in future studies. However, it should be noted that the psychometric test conducted in this study indicates that the subscale family as a burden had moderate internal consistency as a subscale and a low item-total correlation with the total questionnaire. Depending on the primary questions in such studies, consideration may be given to adjusting or removing the subscale family as a burden ; this domain seems to answer a nurse related topic as it concerns the perception of families toward nurses and is not related to family involvement. Therefore this subscale seems not to contribute meaningfully to the research question we posed as the starting point in our study. The internal consistency of the three other subscales had good reliability but could potentially be improved by removing two specific items (RNC-1: Having a good relationship with nurses gives me a good feeling ; CP-5: The nurses found out who the family members are ). These items also had the lowest factor loadings of the subscales, so removing or reformulating these items should be considered. RNC-1 seems to be more associated with generating positive emotions than functioning as a resource, while C-5 is not an opinion item. It asks about specific experiences, which does not fit in this questionnaire.
Further research will be needed to examine the performance of the FINC-FO questionnaire following further psychometric refinement and suitability in different (institutional) healthcare settings.
While many studies have investigated the perspective of nurses with regarding the role of family members in patient care, this study investigated how family members perceive their own role in patient care. Exploring how family members experience the involvement of nurses in the care for their loved-one, could also be an interesting lens to study in future research since nurses, at some point, enter the existing family system that initially takes up the care of the patient.
Despite the limit sample size in this study, it is vital to prioritize policy implications surrounding awareness among healthcare professionals and families regarding their caregiving roles. Interventions should be developed and implemented to enhance communication and fostering collaboration between healthcare providers and families. Healthcare education should emphasize the important of communication and implementation regarding the division of roles between nurses and family members in caregiving.
In general, the family members of homecare patients want to be involved in nursing care. They wish to be acknowledged in discussions about care and care planning as participants with valuable knowledge. Family members are less inclined to actively participate in the care provided by nurses and are less explicit in their opinions about their own support needs.
The transition from primarily formal to more informal care necessitates an awareness on the part of both healthcare professionals and families of their respective roles in the provision of care. Communication about wishes, expectations, and the need for support in care is essential to ensuring quality care and that family members can sustain caregiving. With some suggestions for adjustment and improvement, FINC-FO is a feasible questionnaire to capture families’ opinions about their involvement in care.
The FINC-FO questionnaire, meta data and The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines used to support the findings of this study has been deposited in the Dataverse repository. Available at : https://doi.org/10.34894/OYDOU4.
Families’ Importance in Nursing Care–Nurses’ Attitudes
Families’ Importance in Nursing Care–Families’ Opinions
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The authors would like to thank Sabine van der Ham, library specialist, for supporting in data storage and nursing students Anna van der Heide and Lisa Oolders for their contribution in data collection.
No funding was received for conducting this study.
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Research Group Nursing Diagnostics, Family Care & Family Nursing, School of Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, 9714 CA, The Netherlands
Josien M. Woldring, Wolter Paans & Marie Louise Luttik
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
Josien M. Woldring & Reinold Gans
Department of Critical Care, University Medical Centre Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands
Wolter Paans
Merkbaar Beter, PO Box 102, Espria, Beilen, 9410 AC, the Netherlands
Laura Dorland
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Conceptualization, Methodology, Validation: All authors; Formal analysis: JW, WP, MLL and LD; Investigation: JW and LD; Resources: JW, MLL and LD; Data curation, Writing original draft, Supervision and project administration : JW Writing-reviewing and editing: WP, RG, MLL and LD.
Correspondence to Josien M. Woldring .
Ethics approval and consent to participate.
The study was approved by the ethical committee of Hanze University Groningen (heac.T2023.028). Patients and family members were informed about the aim of the study, and the participation of family members was voluntary. Family members were asked for informed consent before beginning the online FINC-FO questionnaire. The researchers received anonymized responses, and answers could not be tracked to individuals.
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The authors declare no competing interests.
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Woldring, J.M., Paans, W., Gans, R. et al. Families’ importance in nursing care–families’ opinions: a cross-sectional survey study in the homecare setting. Arch Public Health 82 , 87 (2024). https://doi.org/10.1186/s13690-024-01314-4
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Published : 17 June 2024
DOI : https://doi.org/10.1186/s13690-024-01314-4
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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 .
A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated.
A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research. There are five key steps to writing a literature review: Search for relevant literature. Evaluate sources. Identify themes, debates and gaps.
Writing a Literature Review. A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels ...
A literature review is a survey of published work relevant to a particular issue, field of research, topic or theory. It will never be about everything and should have clearly defined limits. This survey will certainly provide short descriptions of the sources being reviewed, but much more importantly it will also provide the reader with a
Example: Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework: 10.1177/08948453211037398 ; Systematic review: "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139).
A literature review is a surveys scholarly articles, books and other sources relevant to a particular. issue, area of research, or theory, and by so doing, providing a description, summary, and ...
A literature review is a collation of survey, research, critical evaluation, and assessment of the existing literature in a preferred domain. Eminent researcher and academic Arlene Fink, in her book Conducting Research Literature Reviews, defines it as the following:
The word "literature review" can refer to two related things that are part of the broader literature review process. The first is the task of reviewing the literature - i.e. sourcing and reading through the existing research relating to your research topic. The second is the actual chapter that you write up in your dissertation, thesis or ...
As mentioned above, writing your literature review is a process, which I'll break down into three steps: Finding the most suitable literature. Understanding, distilling and organising the literature. Planning and writing up your literature review chapter. Importantly, you must complete steps one and two before you start writing up your chapter.
The results of the literature survey can contribute to the body of knowledge when peer-reviewed and published as survey articles. Literature Review: Is the process of technically and critically reviewing published papers to extract technical and scientific metadata from the presented contents. The metadata are usually used during literature ...
Literature Review A literature review is a survey of scholarly sources that provides an overview of a particular topic. Literature reviews are a collection of the most relevant and significant publications regarding that topic in order to provide a comprehensive look at what has been said on the topic and by whom.
A literature review is an integrated analysis-- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.
A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing ...
Literature Review is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.. Also, we can define a literature review as the collected body of scholarly works related to a topic:
A literature review is "a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works" (Reitz, 2014).
Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications .For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively .Given such mountains of papers, scientists cannot be expected to examine in detail every ...
A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research. The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research. It should give a theoretical base for the ...
As mentioned previously, there are a number of existing guidelines for literature reviews. Depending on the methodology needed to achieve the purpose of the review, all types can be helpful and appropriate to reach a specific goal (for examples, please see Table 1).These approaches can be qualitative, quantitative, or have a mixed design depending on the phase of the review.
Literature Review is one part of that process of writing a research paper. In a research paper, you use the literature as a starting point, a building block and as evidence of a new insight. The goal of the literature review is only to summarize and synthesize the arguments and ideas of others. You should not present your original idea.
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.
A literature review: Surveys all of the scholarship that has been written about a particular topic (your research question). Provides a description, summary, and evaluation of each scholarly work. Synthesizes and organizes the previous research by comparing and contrasting the findings or methodology of those previous writings.
A literature review surveys books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to
A literature review is a survey of scholarly sources that provides an overview of a particular topic. Literature reviews are a collection of the most relevant and significant publications regarding that topic in order to provide a comprehensive look at what has been said on the topic and by whom.
Determinants of social desirability bias in sensitive surveys: A literature review. Quality & Quantity, 47 (2013), pp. 2025-2047. CrossRef View in ... in tertiary education is more substantial than the literature on the same association in secondary education so that a literature review focussing on tertiary education is more appropriate than ...
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Informal care is an essential part of support provided in the homecare setting. To ensure effective healthcare provision, good communication and collaboration between informal and formal care providers are crucial. To achieve this aim, it is necessary to have a clear understanding of the perspectives of all stakeholders. In the scientific literature, limited knowledge is available regarding ...