literature review in research definition

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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

• October 26, 2022 recording
• Last Updated: Aug 13, 2024 1:52 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

Libraries | Research Guides

Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

• Next: Planning the Review >>
• Last Updated: Jul 8, 2024 11:22 AM
• URL: https://libguides.northwestern.edu/literaturereviews

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Methodology

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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See an example

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Reference management. Clean and simple.

What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

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

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Introduction to Literature Reviews

Introduction.

• Step One: Define
• Step Two: Research
• Step Three: Write
• Suggested Readings

A literature review is a written work that :

• Compiles significant research published on a topic by accredited scholars and researchers;
• —Surveys scholarly articles, books, dissertations, conference proceedings, and other sources;
• —Examines contrasting perspectives, theoretical approaches, methodologies, findings, results, conclusions.
• —Reviews critically, analyzes, and synthesizes existing research on a topic; and,
• Performs a thorough “re” view, “overview”, or “look again” of past and current works on a subject, issue, or theory.

From these analyses, the writer then offers an overview of the current status of a particular area of knowledge from both a practical and theoretical perspective.

Literature reviews are important because they are usually a  required  step in a thesis proposal (Master's or PhD). The proposal will not be well-supported without a literature review. Also, literature reviews are important because they help you learn important authors and ideas in your field. This is useful for your coursework and your writing. Knowing key authors also helps you become acquainted with other researchers in your field.

Look at this diagram and imagine that your research is the "something new." This shows how your research should relate to major works and other sources.

Olivia Whitfield | Graduate Reference Assistant | 2012-2015

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Literature Review - what is a Literature Review, why it is important and how it is done

What are literature reviews, goals of literature reviews, types of literature reviews, about this guide/licence.

• Strategies to Find Sources
• Evaluating Literature Reviews and Sources
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 What is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries. " - Quote from Taylor, D. (n.d) "The literature review: A few tips on conducting it"

Source NC State University Libraries. This video is published under a Creative Commons 3.0 BY-NC-SA US license.

What are the goals of creating a Literature Review?

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

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

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what have been written about your research topic and to point out how your own research will shed a new light into these body of scholarship.

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature reviews look at a topic from a historical perspective to see how the understanding of the topic have change through time.

What kinds of literature reviews are written?

• Narrative Review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : This is a type of review that focus on a small set of research books on a particular topic " to locate these books within current scholarship, critical methodologies, and approaches" in the field. - LARR
• Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L.K. (2013). Research in Communication Sciences and Disorders . San Diego, CA: Plural Publishing.
• Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M.C. & Ilardi, S.S. (2003). Handbook of Research Methods in Clinical Psychology . Malden, MA: Blackwell Pub.
• Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). "Qualitative meta-synthesis: A question of dialoguing with texts," Journal of Advanced Nursing , 53(3), 311-318.

Guide adapted from "Literature Review" , a guide developed by Marisol Ramos used under CC BY 4.0 /modified from original.

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How to Write a Literature Review

What's a literature review.

• Literature Reviews: A Recap
• Reading Journal Articles
• Does it Describe a Literature Review?
• 1. Identify the Question
• 2. Review Discipline Styles
• Searching Article Databases
• Finding Full-Text of an Article
• Citation Chaining
• When to Stop Searching
• 4. Manage Your References
• 5. Critically Analyze and Evaluate
• 6. Synthesize
• 7. Write a Literature Review

What's a Literature Review? 

A literature review (or "lit review," for short) is an in-depth critical analysis of published scholarly research related to a specific topic. Published scholarly research (aka, "the literature") may include journal articles, books, book chapters, dissertations and thesis, or conference proceedings. 

A solid lit review must:

• be organized around and related directly to the thesis or research question you're developing
• synthesize results into a summary of what is and is not known
• identify areas of controversy in the literature
• formulate questions that need further research

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What Is A Literature Review?

A plain-language explainer (with examples).

By:  Derek Jansen (MBA) & Kerryn Warren (PhD) | June 2020 (Updated May 2023)

If you’re faced with writing a dissertation or thesis, chances are you’ve encountered the term “literature review” . If you’re on this page, you’re probably not 100% what the literature review is all about. The good news is that you’ve come to the right place.

Literature Review 101

• What (exactly) is a literature review
• What’s the purpose of the literature review chapter
• How to find high-quality resources
• How to structure your literature review chapter
• Example of an actual literature review

What is a literature review?

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 research project. Let’s look at each of them:

Reviewing the literature

The first step of any literature review is to hunt down and  read through the existing research  that’s relevant to your research topic. To do this, you’ll use a combination of tools (we’ll discuss some of these later) to find journal articles, books, ebooks, research reports, dissertations, theses and any other credible sources of information that relate to your topic. You’ll then  summarise and catalogue these  for easy reference when you write up your literature review chapter. 

The literature review chapter

The second step of the literature review is to write the actual literature review chapter (this is usually the second chapter in a typical dissertation or thesis structure ). At the simplest level, the literature review chapter is an  overview of the key literature  that’s relevant to your research topic. This chapter should provide a smooth-flowing discussion of what research has already been done, what is known, what is unknown and what is contested in relation to your research topic. So, you can think of it as an  integrated review of the state of knowledge  around your research topic. 

What’s the purpose of a literature review?

The literature review chapter has a few important functions within your dissertation, thesis or research project. Let’s take a look at these:

Purpose #1 – Demonstrate your topic knowledge

The first function of the literature review chapter is, quite simply, to show the reader (or marker) that you  know what you’re talking about . In other words, a good literature review chapter demonstrates that you’ve read the relevant existing research and understand what’s going on – who’s said what, what’s agreed upon, disagreed upon and so on. This needs to be  more than just a summary  of who said what – it needs to integrate the existing research to  show how it all fits together  and what’s missing (which leads us to purpose #2, next). 

Purpose #2 – Reveal the research gap that you’ll fill

The second function of the literature review chapter is to  show what’s currently missing  from the existing research, to lay the foundation for your own research topic. In other words, your literature review chapter needs to show that there are currently “missing pieces” in terms of the bigger puzzle, and that  your study will fill one of those research gaps . By doing this, you are showing that your research topic is original and will help contribute to the body of knowledge. In other words, the literature review helps justify your research topic.  

Purpose #3 – Lay the foundation for your conceptual framework

The third function of the literature review is to form the  basis for a conceptual framework . Not every research topic will necessarily have a conceptual framework, but if your topic does require one, it needs to be rooted in your literature review. 

For example, let’s say your research aims to identify the drivers of a certain outcome – the factors which contribute to burnout in office workers. In this case, you’d likely develop a conceptual framework which details the potential factors (e.g. long hours, excessive stress, etc), as well as the outcome (burnout). Those factors would need to emerge from the literature review chapter – they can’t just come from your gut! 

So, in this case, the literature review chapter would uncover each of the potential factors (based on previous studies about burnout), which would then be modelled into a framework. 

Purpose #4 – To inform your methodology

The fourth function of the literature review is to  inform the choice of methodology  for your own research. As we’ve  discussed on the Grad Coach blog , your choice of methodology will be heavily influenced by your research aims, objectives and questions . Given that you’ll be reviewing studies covering a topic close to yours, it makes sense that you could learn a lot from their (well-considered) methodologies.

So, when you’re reviewing the literature, you’ll need to  pay close attention to the research design , methodology and methods used in similar studies, and use these to inform your methodology. Quite often, you’ll be able to  “borrow” from previous studies . This is especially true for quantitative studies , as you can use previously tried and tested measures and scales. 

How do I find articles for my literature review?

Finding quality journal articles is essential to crafting a rock-solid literature review. As you probably already know, not all research is created equally, and so you need to make sure that your literature review is  built on credible research . 

We could write an entire post on how to find quality literature (actually, we have ), but a good starting point is Google Scholar . Google Scholar is essentially the academic equivalent of Google, using Google’s powerful search capabilities to find relevant journal articles and reports. It certainly doesn’t cover every possible resource, but it’s a very useful way to get started on your literature review journey, as it will very quickly give you a good indication of what the  most popular pieces of research  are in your field.

One downside of Google Scholar is that it’s merely a search engine – that is, it lists the articles, but oftentimes  it doesn’t host the articles . So you’ll often hit a paywall when clicking through to journal websites. 

Thankfully, your university should provide you with access to their library, so you can find the article titles using Google Scholar and then search for them by name in your university’s online library. Your university may also provide you with access to  ResearchGate , which is another great source for existing research. 

Remember, the correct search keywords will be super important to get the right information from the start. So, pay close attention to the keywords used in the journal articles you read and use those keywords to search for more articles. If you can’t find a spoon in the kitchen, you haven’t looked in the right drawer. 

Need a helping hand?

How should I structure my literature review?

Unfortunately, there’s no generic universal answer for this one. The structure of your literature review will depend largely on your topic area and your research aims and objectives.

You could potentially structure your literature review chapter according to theme, group, variables , chronologically or per concepts in your field of research. We explain the main approaches to structuring your literature review here . You can also download a copy of our free literature review template to help you establish an initial structure.

In general, it’s also a good idea to start wide (i.e. the big-picture-level) and then narrow down, ending your literature review close to your research questions . However, there’s no universal one “right way” to structure your literature review. The most important thing is not to discuss your sources one after the other like a list – as we touched on earlier, your literature review needs to synthesise the research , not summarise it .

Ultimately, you need to craft your literature review so that it conveys the most important information effectively – it needs to tell a logical story in a digestible way. It’s no use starting off with highly technical terms and then only explaining what these terms mean later. Always assume your reader is not a subject matter expert and hold their hand through a journe y of the literature while keeping the functions of the literature review chapter (which we discussed earlier) front of mind.

Example of a literature review

In the video below, we walk you through a high-quality literature review from a dissertation that earned full distinction. This will give you a clearer view of what a strong literature review looks like in practice and hopefully provide some inspiration for your own. 

Wrapping Up

In this post, we’ve (hopefully) answered the question, “ what is a literature review? “. We’ve also considered the purpose and functions of the literature review, as well as how to find literature and how to structure the literature review chapter. If you’re keen to learn more, check out the literature review section of the Grad Coach blog , as well as our detailed video post covering how to write a literature review . 

Psst… there’s more!

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

16 Comments

Thanks for this review. It narrates what’s not been taught as tutors are always in a early to finish their classes.

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Literature Review: A Definition

What is a literature review, then.

A literature review discusses and analyses published information in a particular subject area.   Sometimes the information covers a certain time period.

A literature review is more than a summary of the sources, it has an organizational pattern that combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

While the main focus of an academic research paper is to support your own argument, the focus of a literature review is to summarize and synthesize the arguments and ideas of others. The academic research paper also covers a range of sources, but it is usually a select number of sources, because the emphasis is on the argument. Likewise, a literature review can also have an "argument," but it is not as important as covering a number of sources. In short, an academic research paper and a literature review contain some of the same elements. In fact, many academic research papers will contain a literature review section. What aspect of the study (either the argument or the sources) that is emphasized determines what type of document it is.

( "Literature Reviews" from The Writing Center, University of North Carolina at Chapel Hill )

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone.

For professionals, they are useful reports that keep them up to date with what is current in the field.

For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper's investigation.

Comprehensive knowledge of the literature of the field is essential to most research papers.

Journal Articles on Writing Literature Reviews

• Research Methods for Comprehensive Science Literature Reviews Author: Brown,Barry N. Journal: Issues in Science & Technology Librarianship Date: Spring2009 Issue: 57 Page: 1 more... less... Finding some information on most topics is easy. There are abundant sources of information readily available. However, completing a comprehensive literature review on a particular topic is often difficult, laborious, and time intensive; the project requires organization, persistence, and an understanding of the scholarly communication and publishing process. This paper briefly outlines methods of conducting a comprehensive literature review for science topics. [ABSTRACT FROM AUTHOR];
• Research: Considerations in Writing a Literature Review Authors: Black,K. Journal: The New Social Worker Date: 01/01; 2007 Volume: 14 Issue: 2 Page: 12 more... less... Literature reviews are ubiquitous in academic journals, scholarly reports, and social work education. Conducting and writing a good literature review is both personally and professionally satisfying. (Journal abstract).
• How to do (or not to do) A Critical Literature Review Authors: Jesson,Jill; Lacey,Fiona Journal: Pharmacy Education Pub Date: 2006 Volume: 6 Issue: 2 Pages:139 - 148 more... less... More and more students are required to perform a critical literature review as part of their undergraduate or postgraduate studies. Whilst most of the latest research methods textbooks advise how to do a literature search, very few cover the literature review. This paper covers two types of review: a critical literature review and a systematic review. [ABSTRACT FROM AUTHOR]
• Conducting a Literature Review Authors: Rowley,Jennifer; Slack,Frances Journal: Management Research News Pub Date: 2004 Volume: 27 Issue: 6 Pages:31-39 more... less... Abstract: This article offers support and guidance for students undertaking a literature review as part of their dissertation during an undergraduate or Masters course. A literature review is a summary of a subject field that supports the identification of specific research questions. A literature review needs to draw on and evaluate a range of different types of sources including academic and professional journal articles, books, and web-based resources. The literature search helps in the identification and location of relevant documents and other sources. Search engines can be used to search web resources and bibliographic databases. Conceptual frameworks can be a useful tool in developing an understanding of a subject area. Creating the literature review involves the stages of: scanning, making notes, structuring the literature review, writing the literature review, and building a bibliography.

Some Books from the WU Catalog

• The SAGE handbook of visual research methods [electronic resource] by Edited by Luc Pauwels and Dawn Mannay. ISBN: 9781526417015 Publication Date: SAGE Publications, Inc., 2020.

Helpful Websites

• "How to do a Literature Review" from Ferdinand D. Bluford Library
• "The Literature Review: A Few Tips on Conducting It." from the University of Toronto
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What is a literature review?

A literature review is a critical analysis of the literature related to your research topic. It evaluates and critiques the literature to establish a theoretical framework for your research topic and/or identify a gap in the existing research that your research will address.

A literature review is not a summary of the literature. You need to engage deeply and critically with the literature. Your literature review should show your understanding of the literature related to your research topic and lead to presenting a rationale for your research.

A literature review focuses on:

• the context of the topic
• key concepts, ideas, theories and methodologies
• key researchers, texts and seminal works
• major issues and debates
• identifying conflicting evidence
• the main questions that have been asked around the topic
• the organisation of knowledge on the topic
• definitions, particularly those that are contested
• showing how your research will advance scholarly knowledge (generally referred to as identifying the ‘gap’).

This module will guide you through the functions of a literature review; the typical process of conducting a literature review (including searching for literature and taking notes); structuring your literature review within your thesis and organising its internal ideas; and styling the language of your literature review.

The purposes of a literature review

A literature review serves two main purposes:

1) To show awareness of the present state of knowledge in a particular field, including:

• seminal authors
• the main empirical research
• theoretical positions
• controversies
• breakthroughs as well as links to other related areas of knowledge.

2) To provide a foundation for the author’s research. To do that, the literature review needs to:

• help the researcher define a hypothesis or a research question, and how answering the question will contribute to the body of knowledge;
• provide a rationale for investigating the problem and the selected methodology;
• provide a particular theoretical lens, support the argument, or identify gaps.

Before you engage further with this module, try the quiz below to see how much you already know about literature reviews.

Research and Writing Skills for Academic and Graduate Researchers Copyright © 2022 by RMIT University is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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

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

Table of Contents

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

How to write a good literature review 

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

What is a literature review?

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

What is the purpose of literature review?

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

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

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

Find academic papers related to your research topic faster. Try Research on Paperpal  

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

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

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

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

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

Strengthen your literature review with factual insights. Try Research on Paperpal for free!    

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

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

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

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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Literature Reviews and Annotated Bibliographies

Initial databases for a literature review.

What is a Literature Review?

• How to Write a Literature Review?
• Graduate Research and the Literature Review
• What is an Annotated Bibliography?
• How to Evaluate Sources?
• Citation & Avoiding Plagiarism

The databases listed here are interdisciplinary and suitable for most disciplines. For databases specific to your discipline see our Research Guides  

Academic Search Ultimate  Includes some full text

A great place to start to search for magazine and journal articles on almost all topics. Tip : Check "peer reviewed" box to limit your search to scholarly journals.

Dissertations and Theses   (1861+) Indexes dissertations accepted for doctoral degrees by accredited North American educational institutions and over 200 other institutions. Also covers masters theses since 1962. Starting in the early to mid-1900's, the full text is included for an increasingly comprehensive number of dissertations and theses. 

Google Scholar   Enables you to search specifically for scholarly literature, including peer-reviewed papers, theses, books, preprints, abstracts and technical reports from all broad areas of research. Use Google Scholar to find articles from a widevariety of academic publishers, professional societies, preprint repositories and universities, as well as scholarly articles available across the web

Humanities and Social Science Retrospective   Bibliographic database that provides citations to articles in a wide range of English language journals in the humanities and social sciences for the period 1907-1984.

  JSTOR Includes full text Includes long runs of backfiles of scholarly journals. Subjects covered include Anthropology, Asian Studies, Ecology, Economics, Education, Finance, History, Mathematics, Philosophy, Political Science, Population Studies, and Sociology.

Periodical Archives Online- (1770-1995) Includes full text; Full text archive of hundreds of periodicals in the humanities and social sciences from their first issues to 1995 Allows date-limited searching. Periodical Index Online, 1665 - 1995

"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, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries."

--Written by Dena Taylor, Health Sciences Writing Centre and available at http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review (Accessed August 8th, 2011)

Writing the Literature Review sites :

  Literature Reviews: UNC - Chapel Hill

Write a Literature Review: UC-Santa Cruz  

Writing a Literature Review: Perdue OWL

Methods Map: Literature Review

What are the goals of creating a Literature Review?

• To develop a new theory
• To evaluate a theory or theories
• To survey what’s known about a topic
• Identify a problem in a field of research 
• Provide a historical overview of the development of a topic

Type of Literature Reviews:

• Mature and/or established topic: Topic is well-known and the purpose of this type of review is to analyze and synthesize this accumulated body of research.
• Emerging Topic: The purpose of this type of review to identify understudy or new emerging research area.
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• Last updated: Jan 8, 2024 2:52 PM
• URL: https://libguides.asu.edu/LiteratureReviews

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• J Grad Med Educ
• v.8(3); 2016 Jul

The Literature Review: A Foundation for High-Quality Medical Education Research

a  These are subscription resources. Researchers should check with their librarian to determine their access rights.

Despite a surge in published scholarship in medical education 1 and rapid growth in journals that publish educational research, manuscript acceptance rates continue to fall. 2 Failure to conduct a thorough, accurate, and up-to-date literature review identifying an important problem and placing the study in context is consistently identified as one of the top reasons for rejection. 3 , 4 The purpose of this editorial is to provide a road map and practical recommendations for planning a literature review. By understanding the goals of a literature review and following a few basic processes, authors can enhance both the quality of their educational research and the likelihood of publication in the Journal of Graduate Medical Education ( JGME ) and in other journals.

The Literature Review Defined

In medical education, no organization has articulated a formal definition of a literature review for a research paper; thus, a literature review can take a number of forms. Depending on the type of article, target journal, and specific topic, these forms will vary in methodology, rigor, and depth. Several organizations have published guidelines for conducting an intensive literature search intended for formal systematic reviews, both broadly (eg, PRISMA) 5 and within medical education, 6 and there are excellent commentaries to guide authors of systematic reviews. 7 , 8

• A literature review forms the basis for high-quality medical education research and helps maximize relevance, originality, generalizability, and impact.
• A literature review provides context, informs methodology, maximizes innovation, avoids duplicative research, and ensures that professional standards are met.
• Literature reviews take time, are iterative, and should continue throughout the research process.
• Researchers should maximize the use of human resources (librarians, colleagues), search tools (databases/search engines), and existing literature (related articles).
• Keeping organized is critical.

Such work is outside the scope of this article, which focuses on literature reviews to inform reports of original medical education research. We define such a literature review as a synthetic review and summary of what is known and unknown regarding the topic of a scholarly body of work, including the current work's place within the existing knowledge . While this type of literature review may not require the intensive search processes mandated by systematic reviews, it merits a thoughtful and rigorous approach.

Purpose and Importance of the Literature Review

An understanding of the current literature is critical for all phases of a research study. Lingard 9 recently invoked the “journal-as-conversation” metaphor as a way of understanding how one's research fits into the larger medical education conversation. As she described it: “Imagine yourself joining a conversation at a social event. After you hang about eavesdropping to get the drift of what's being said (the conversational equivalent of the literature review), you join the conversation with a contribution that signals your shared interest in the topic, your knowledge of what's already been said, and your intention.” 9

The literature review helps any researcher “join the conversation” by providing context, informing methodology, identifying innovation, minimizing duplicative research, and ensuring that professional standards are met. Understanding the current literature also promotes scholarship, as proposed by Boyer, 10 by contributing to 5 of the 6 standards by which scholarly work should be evaluated. 11 Specifically, the review helps the researcher (1) articulate clear goals, (2) show evidence of adequate preparation, (3) select appropriate methods, (4) communicate relevant results, and (5) engage in reflective critique.

Failure to conduct a high-quality literature review is associated with several problems identified in the medical education literature, including studies that are repetitive, not grounded in theory, methodologically weak, and fail to expand knowledge beyond a single setting. 12 Indeed, medical education scholars complain that many studies repeat work already published and contribute little new knowledge—a likely cause of which is failure to conduct a proper literature review. 3 , 4

Likewise, studies that lack theoretical grounding or a conceptual framework make study design and interpretation difficult. 13 When theory is used in medical education studies, it is often invoked at a superficial level. As Norman 14 noted, when theory is used appropriately, it helps articulate variables that might be linked together and why, and it allows the researcher to make hypotheses and define a study's context and scope. Ultimately, a proper literature review is a first critical step toward identifying relevant conceptual frameworks.

Another problem is that many medical education studies are methodologically weak. 12 Good research requires trained investigators who can articulate relevant research questions, operationally define variables of interest, and choose the best method for specific research questions. Conducting a proper literature review helps both novice and experienced researchers select rigorous research methodologies.

Finally, many studies in medical education are “one-offs,” that is, single studies undertaken because the opportunity presented itself locally. Such studies frequently are not oriented toward progressive knowledge building and generalization to other settings. A firm grasp of the literature can encourage a programmatic approach to research.

Approaching the Literature Review

Considering these issues, journals have a responsibility to demand from authors a thoughtful synthesis of their study's position within the field, and it is the authors' responsibility to provide such a synthesis, based on a literature review. The aforementioned purposes of the literature review mandate that the review occurs throughout all phases of a study, from conception and design, to implementation and analysis, to manuscript preparation and submission.

Planning the literature review requires understanding of journal requirements, which vary greatly by journal ( table 1 ). Authors are advised to take note of common problems with reporting results of the literature review. Table 2 lists the most common problems that we have encountered as authors, reviewers, and editors.

Sample of Journals' Author Instructions for Literature Reviews Conducted as Part of Original Research Article a

Common Problem Areas for Reporting Literature Reviews in the Context of Scholarly Articles

Locating and Organizing the Literature

Three resources may facilitate identifying relevant literature: human resources, search tools, and related literature. As the process requires time, it is important to begin searching for literature early in the process (ie, the study design phase). Identifying and understanding relevant studies will increase the likelihood of designing a relevant, adaptable, generalizable, and novel study that is based on educational or learning theory and can maximize impact.

Human Resources

A medical librarian can help translate research interests into an effective search strategy, familiarize researchers with available information resources, provide information on organizing information, and introduce strategies for keeping current with emerging research. Often, librarians are also aware of research across their institutions and may be able to connect researchers with similar interests. Reaching out to colleagues for suggestions may help researchers quickly locate resources that would not otherwise be on their radar.

During this process, researchers will likely identify other researchers writing on aspects of their topic. Researchers should consider searching for the publications of these relevant researchers (see table 3 for search strategies). Additionally, institutional websites may include curriculum vitae of such relevant faculty with access to their entire publication record, including difficult to locate publications, such as book chapters, dissertations, and technical reports.

Strategies for Finding Related Researcher Publications in Databases and Search Engines

Search Tools and Related Literature

Researchers will locate the majority of needed information using databases and search engines. Excellent resources are available to guide researchers in the mechanics of literature searches. 15 , 16

Because medical education research draws on a variety of disciplines, researchers should include search tools with coverage beyond medicine (eg, psychology, nursing, education, and anthropology) and that cover several publication types, such as reports, standards, conference abstracts, and book chapters (see the box for several information resources). Many search tools include options for viewing citations of selected articles. Examining cited references provides additional articles for review and a sense of the influence of the selected article on its field.

Box Information Resources

• Web of Science a
• Education Resource Information Center (ERIC)
• Cumulative Index of Nursing & Allied Health (CINAHL) a
• Google Scholar

Once relevant articles are located, it is useful to mine those articles for additional citations. One strategy is to examine references of key articles, especially review articles, for relevant citations.

Getting Organized

As the aforementioned resources will likely provide a tremendous amount of information, organization is crucial. Researchers should determine which details are most important to their study (eg, participants, setting, methods, and outcomes) and generate a strategy for keeping those details organized and accessible. Increasingly, researchers utilize digital tools, such as Evernote, to capture such information, which enables accessibility across digital workspaces and search capabilities. Use of citation managers can also be helpful as they store citations and, in some cases, can generate bibliographies ( table 4 ).

Citation Managers

Knowing When to Say When

Researchers often ask how to know when they have located enough citations. Unfortunately, there is no magic or ideal number of citations to collect. One strategy for checking coverage of the literature is to inspect references of relevant articles. As researchers review references they will start noticing a repetition of the same articles with few new articles appearing. This can indicate that the researcher has covered the literature base on a particular topic.

Putting It All Together

In preparing to write a research paper, it is important to consider which citations to include and how they will inform the introduction and discussion sections. The “Instructions to Authors” for the targeted journal will often provide guidance on structuring the literature review (or introduction) and the number of total citations permitted for each article category. Reviewing articles of similar type published in the targeted journal can also provide guidance regarding structure and average lengths of the introduction and discussion sections.

When selecting references for the introduction consider those that illustrate core background theoretical and methodological concepts, as well as recent relevant studies. The introduction should be brief and present references not as a laundry list or narrative of available literature, but rather as a synthesized summary to provide context for the current study and to identify the gap in the literature that the study intends to fill. For the discussion, citations should be thoughtfully selected to compare and contrast the present study's findings with the current literature and to indicate how the present study moves the field forward.

To facilitate writing a literature review, journals are increasingly providing helpful features to guide authors. For example, the resources available through JGME include several articles on writing. 17 The journal Perspectives on Medical Education recently launched “The Writer's Craft,” which is intended to help medical educators improve their writing. Additionally, many institutions have writing centers that provide web-based materials on writing a literature review, and some even have writing coaches.

The literature review is a vital part of medical education research and should occur throughout the research process to help researchers design a strong study and effectively communicate study results and importance. To achieve these goals, researchers are advised to plan and execute the literature review carefully. The guidance in this editorial provides considerations and recommendations that may improve the quality of literature reviews.

• Open access
• Published: 07 August 2024

Relationship between patient safety culture and patient experience in hospital settings: a scoping review

• Adel Alabdaly   ORCID: orcid.org/0000-0003-0914-5225 1 , 2 ,
• Reece Hinchcliff   ORCID: orcid.org/0000-0001-9920-4211 3 , 4 ,
• Deborah Debono   ORCID: orcid.org/0000-0003-2095-156X 5 &
• Su-Yin Hor   ORCID: orcid.org/0000-0002-6498-9722 5  

BMC Health Services Research volume  24 , Article number:  906 ( 2024 ) Cite this article

174 Accesses

Metrics details

Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings.

This study was performed using the five stages of Arksey and O’Malley’s Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria.

4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients’ and families’ perspectives.

The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.

Peer Review reports

Introduction

Patient safety is a pressing challenge for health systems, globally. The importance of promoting and sustaining a robust safety culture is widely recognised [ 1 ]. The importance of the patient’s role in supporting patient safety is also increasingly recognised [ 2 ]. Despite the prominence of the concepts of patient safety culture and patient experience in academia and industry, the relationship between them remains underexplored and diffuse.

The concept of patient safety culture was defined as a collective of beliefs, attitudes, values, and norms that influence behaviours and attitudes, concerning patient safety [ 3 ]. Patient perspectives are often neglected when measuring safety culture [ 4 ]. Patient experience has been defined as patients’ perspectives of services, recognising that patients are the most valuable sources of information about their experiences [ 5 ].

It is essential to put the patient at the centre of healthcare services [ 6 ], and to do this requires nurturing caring cultures through the assurance that health professionals feel esteemed, involved and supported [ 7 ]. Patients pay attention to staff performance and other issues and can identify safety problems that hospital staff may miss, such as problems entering and exiting the healthcare system, systemic (multiple and distributed) problems that are cumulative, and errors of omission, especially the failure to attend to patients’ concerns [ 2 , 8 , 9 , 10 ]. A cultural change from the conventional approach that considered patients as care recipients, to seeing patients as partners in their care, is essential to provide patient-centred care that is informed by patient experience.

There has been considerable knowledge gained about patient safety, but it persists as a worldwide challenge in healthcare [ 11 ], with serious incidents and iatrogenic harm continuing to occur across health care settings, including within hospital settings. There has been a focus on reducing iatrogenic harm by enhancing safety culture in hospitals.

Understanding patient safety from the staff perspective alone is not enough. It is essential to also understand what factors might link safety culture and patient experience, as concepts often measured separately, but both important indicators of safety and quality. In examining this link, we hope to better understand what facets of care might contribute to both safety culture, as experienced by staff, and the safety and quality of care, as experienced by patients. The aim of this review is to explore and synthesise existing research literature to find out what is known regarding the relationship between patient safety culture and patient experience (of safety and quality) in hospital settings. We sought to achieve this aim through the following objectives: (a) to identify how these concepts have been defined or described in the literature; (b) to identify how these concepts are measured; and (c) to identify the links between the concepts.

This study followed a published protocol [ 12 ]. The methodology of this scoping review was developed using the Arksey and O’Malley [ 13 ] framework for a scoping review (Arksey & O’Malley, 2005), refined by the Joanna Briggs Institute [ 14 ]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) [ 15 ] guidelines were followed. The study does not critically appraise the included papers’ quality and risk of bias. The aim in our scoping review is not to evaluate the quality of the evidence found, but rather to explore what research has been done in this field, and what approaches were undertaken.

The processes of searching, applying inclusion and exclusion criteria, screening, data extraction, and reporting of the findings followed a published protocol for this study [ 12 ]. The search terms and strategies appear in the protocol, and searches were completed on 18 June 2022.

The inclusion and exclusion criteria

This review followed the Population, Concept and Context (PCC) framework for the inclusion criteria recommended by the Joanna Briggs Institute for scoping reviews [ 14 ]. In addition to the PCC criteria noted in Table  1 , included studies must have been conducted in the hospital context and reported in English or Arabic languages.

We searched journals from seven electronic databases relevant to the scope of the study (CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus); web search engine Google Scholar (first 30 results); and four organisations in Australia and globally: the Agency for Healthcare Research and Quality (AHRQ), the Australian Commission for Safety and Quality in Healthcare (ACSQHC), the Agency for Clinical Innovation (ACI), and National Institutes of Health (NIH). We supplemented these searches with hand-searching the reference lists of the final included papers for additional studies of relevance.

Study selection

As indicated in the protocol for this study [ 12 ], retrieved papers were screened and selected in two phases. In the first phase, one reviewer (AA) evaluated all titles and abstracts to determine whether each paper met the eligibility criteria, including categorising screened studies as ‘included’, ‘excluded’ or ‘not sure’. All papers screened as ‘included’ and ‘not sure’ in the first phase were considered for full-text review by the reviewer (AA). In the second phase, three reviewers (RH, DD, SH) screened ten per cent of titles and abstracts of studies screened as ‘included’, ‘excluded’ or ‘not sure’ against selection criteria. All authors (AA, RH, DD, SH) independently reviewed the full text of the included studies. The authors discussed the included papers in a meeting and reached a consensus on the included papers, with no disagreement between the authors.

Charting the data

One reviewer (AA) extracted relevant data from the included studies to address the scoping review question using the template provided in the published protocol [ 12 ]. Three reviewers (RH, DD and SH) verified the accuracy of the data extraction exercise. The data extracted included the following:

Aims/objective(s).

Methodology/methods.

Inclusion/exclusion criteria (e.g., PCC).

Types of intervention (if applicable).

Measurement of outcomes (if applicable).

Key results that relate to the review question.

Reporting the findings

Other concepts related to patient safety culture and patient experience, such as safety climate and patient satisfaction, were used in literature that measured safety culture or patient experience. The nuances of these terms were illustrated in the published protocol. The decision was taken to incorporate findings about safety climate alongside those about patient safety culture, and to incorporate findings about both patient satisfaction and patient experience. We noticed that the ‘patient experience’ and ‘patient satisfaction’ terms are often used interchangeably. For example, a study conducted by Mazurenko et al. [ 16 ] used the term ‘patient satisfaction’ in the paper title but measured patient satisfaction using the HCAHPS tool, which is a well-known tool for measuring ‘patient experience’. In fact, the terms, as operationalised in the instruments, overlap more than they should.

According to Bull [ 17 ], ‘patient satisfaction’ involves an evaluation and hence is subjective, suggesting that ‘patient experience’ is the more objective measure. However, considering the questions in the HCAHPS tool (commonly used for measuring ‘patient experience’ as mentioned above), we see that several questions involve an element of subjectivity and evaluation from the patient’s perspective. For instance, questions like: “During this hospital stay, how often did nurses treat you with courtesy and respect?” or “How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?”. The point made by Bull [ 17 ] reflects a tension between the recognised importance of finding out what care is like, from patients’ perspectives (which is subjective and evaluative), and the desire for objective measurements of care delivery for the purposes of comparison and evaluation of health services [ 18 ]. Due to these concepts being so intertwined in how they are understood and measured, and not wanting to limit the understanding of the patient experience only to objective measures devoid of patients’ subjective judgements, papers on patient satisfaction from the review were included, based on the inclusion criteria.

The study sought to review a wide range of literature in relation to the study aim and inclusion criteria. Rather than being a systematic review or meta-analysis, the study aims to offer the reader an overview of the research carried out regarding the relationship between safety culture and patient experience. The characteristics and findings of the included papers were analysed initially by (AA), performing a content analysis, using a framework of categories aligned with the research questions. Within these categories, study features and findings were discussed among all the authors (AA, RH, DD, SH), and descriptively summarised. All authors agreed upon the findings and categories. This descriptive content analysis was found to be sufficient to address the study objectives. Thus, deviating from the published protocol [ 12 ], no further thematic analysis was conducted. The results are presented according to the categories as follows:

Conceptualisations of patient safety culture and patient experience.

Measurement of patient safety culture and patient experience.

Relationship between patient safety culture and patient experience.

As depicted in Fig.  1 , the initial search yielded 4512 articles. After removing duplicates, 3833 articles remained, and 3793 were excluded at the first stage of screening (title and abstract). Following full-text screening, 15 articles remained that met the inclusion criteria. The included studies were conducted in different countries, including Australia (one study) [ 19 ], Canada (two studies) [ 8 , 20 ], Germany (one study) [ 4 ], Indonesia (one study) [ 21 ], Iran (one study) [ 22 ], Israel (two studies) [ 10 , 23 ], Nigeria (one study) [ 24 ], United Kingdom (one study) [ 2 ] and United States (five studies) [ 16 , 25 , 26 , 27 , 28 ]. A summary of the characteristics of the included studies is presented in Table  2 .

PRISMA flowchart of search process and results

Conceptualisations of patient safety culture and patient experience

Patient safety culture.

In the studies reviewed, patient safety culture was commonly conceptualised as relating to the attitudes, beliefs, perceptions, norms and values that workers share about safety [ 8 , 10 , 24 , 27 ]. These shared characteristics shape healthcare professionals’ understandings of what is essential in a healthcare institution, how they should act, what attitudes or actions are acceptable, and what approaches are rewarded or punished concerning patient safety [ 8 , 10 , 27 ]. Patient safety culture has been identified within the included studies as being central to the behaviour of the individuals, and influences staff proficiency, attitudes and behaviours concerning their safety performance [ 8 , 10 , 27 ].

The reviewed literature also identified patient safety culture as one element of a broader organisational culture, related to preventing and detecting shortfalls in patient safety, and managing patient safety in healthcare settings [ 16 , 20 , 21 ]. The concept of ‘safety climate’ was also prevalent in the literature, and was often used in studies that also described ‘safety culture’ [ 10 , 16 , 19 , 26 , 27 ] without distinguishing between the two concepts.

• Patient experience

From our review of the studies, the concept of patient satisfaction was more commonly used than patient experience, and defined as a subjective assessment of the ways those receiving healthcare react to particular relevant elements of treatment, including the process, environment, and outcomes, and this was quantified as representing the degree to which patients believe that their requirements and aspirations were fulfilled by their experiences [ 24 , 26 ]. Although the research that examined patient experience, did not offer specific definitions of the concept, patient experience was conceptualised as a resource for understanding patients’ perceptions, which helps promote the quality and safety of healthcare services [ 2 , 8 , 25 , 27 , 28 ].

The reviewed research frequently refered to the concept of patient satisfaction and ways of measuring it, regarding patient satisfaction as indicative of the effectiveness of organisational performance with regard to patient safety [ 2 , 8 , 25 , 26 , 27 ]. Review of the included studies identified another related concept, customer satisfaction, which is defined as how the individual feels when making a comparison between what they expected and how they regarded what they received; this is regarded as a high-performance target for the delivery of public services [ 21 ]. The variation in the concepts also reflected variation in the measurement tools currently used.

Measuring patient safety culture and patient experience

In the research reviewed, patient safety culture was most commonly measured by the deployment of questionnaires. Included studies also presented assessments of the validity of deployed instruments. The most common patient safety culture tool used in the reviewed studies was the Hospital Survey on Patient Safety Culture (HSOPS) [ 2 , 16 , 20 , 22 , 24 , 25 , 27 , 28 ]. The next most common tool used was the Safety Attitudes Questionnaire (SAQ) [ 19 , 26 ]. The SAQ was also combined with the Leadership Effectiveness Survey (LES) to construct a new tool named the Safety Culture and Leadership Questionnaire to assess clinician perceptions of safety, teamwork and leadership [ 19 ].

The HSOPS tool developed by the Agency of Healthcare Research and Quality was employed in included studies to assess clinician and staff perceptions of the culture of safety at the hospital’s macro level [ 16 , 22 , 27 , 28 ]. HSOPS is also used in individual departments within a hospital [ 2 , 20 , 24 , 25 ], and regarded as a reliable and valid tool. The SAQ is another reliable and valid tool employed for the evaluation of patient safety culture [ 26 ]. The safety culture domains in HSOPS and SAQ tools are different but overlapping (Table  3 ).

The use of HSOPS and SAQ tools reflected the overlap in use of the concepts of safety culture and safety climate. For example, HSOPS includes more dimensions of patient safety culture than the SAQ, and both tools were employed to measure ‘patient safety culture’ [ 2 , 16 , 20 , 21 , 24 , 25 , 26 , 27 , 28 ], although the HSOPS was also employed for the measurement of ‘safety climate’ [ 16 ]. In addition, the SAQ includes two dimensions referring to climate: teamwork climate and safety climate [ 29 ]. Importantly however, both the HSOPS and SAQ offer a quantitative measure of patient safety culture from the point of view of staff alone [ 2 , 16 , 20 , 24 , 25 , 26 , 27 , 28 ].

Patient-reported measures of safety were limited and mentioned more frequently in more recent literature. The Patient Measure of Safety (PMOS), Patients’ Perceptions of Safety Culture (PaPSC) and narratives were used in the research reviewed to identify safety concerns from the patient’s perspective and provide data regarding safety matters, including patient safety culture [ 2 , 4 , 8 , 19 ]. Lawton et al. [ 2 ] noted that the PMOS has undergone considerable testing and is generally recognised as having both validity and reliability; it is also popular with patients and allows researchers to assess how patients perceive the ways in which organisational elements influence patient safety within a hospital by collecting patient feedback about contributing factors to safety incidents [ 2 ].

With regard to measuring patient experience, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was the most frequently used tool in studies reviewed, and is regarded as a valid and reliable instrument for measuring the ways in which patients perceive their interactions with the hospital, and can be used by government as a tool for assessing hospital funding [ 16 , 25 , 26 , 28 ]. HCAHPS (also referred to as Hospital CAHPS) asks the patient to report on their recent experiences with inpatient care [ 16 , 25 , 26 , 28 ]. The HCAHPS tool measures the following domains: nurse communication, doctor communication, pain management, staff responsiveness, hospital environment, communication about medicine, discharge information, and overall patient perception [ 16 , 25 , 26 , 28 ]. Similarly to the overlapping concepts described with the safety culture surveys earlier, the HCAHPS has been employed for the measurement of both patient satisfaction [ 16 , 26 ] and patient experience [ 25 , 28 ]. Other feedback tools such as the Patient Satisfaction Questionnaire Short Form (PSQ) [ 24 ], the Friends and Family Test (FFT) [ 2 ] and Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU-24) [ 20 ] were used for measuring patient feedback and perception of care in our reviewed studies.

Finally, only one study in our review used a qualitative method to examine patient experience; drawing on pre-recorded video narratives published on the Canadian Patient Safety Institute website [ 2 ].

Relationship between patient safety culture and patient experience

In the research reviewed, the relationship between patient safety culture and patient experience was generally identified and presented as a statistical correlation [ 2 , 16 , 24 , 25 , 26 , 27 , 28 ]. Positive correlations were found between some domains of patient safety culture and patient experience (Table  4 ) [ 2 , 8 , 20 , 21 , 23 , 25 , 28 ]. The teamwork and communication domains seem to be central to positive correlations between patient safety culture and patient experience [ 8 , 16 , 25 , 26 , 27 ]. Other studies reviewed demonstrated no correlation between patient safety culture and patient experience overall scores [ 2 , 24 , 26 ].

Staff responsibilities, including direct contact with patients, may affect the relationship between patient safety culture and patient experience. For instance, no significant correlation was found between patient satisfaction and safety climate when management alone had a highly positive view of the safety climate [ 16 ]. However, when management and clinicians both had a positive view of the safety climate, there was a positive correlation. The FFT tool that measured patient experience was correlated with the ways patients perceived safety issues but was not correlated with either the staff safety culture or publicly available safety data [ 2 ]. From the sole qualitative study, we find that structuring safety and quality based on teamwork among healthcare professionals, patients, and family members is a more effective approach than relying on the individual healthcare practitioner alone [ 8 ]. Also, patients’ and families’ involvement is essential for creating a trusting relationship, which helps create an inviting environment that facilitates and encourages open communication and coordination among staff and patients [ 8 ]. Finally, conversation between staff, patients and families is crucial to capture different views of safety and better understand safety culture, particularly from the patient’s perspective.

The research under review also frequently examined how patient safety culture and patient experience, either individually or in combination, were related to other quality measures such as hospital performance, however this is outside of the scope of our review.

Patient safety culture and patient experience overlapped with other concepts

The concepts “safety culture” and “safety climate” were used interchangeably in the reviewed literature, which reflects their overlap in the broader literature, although these concepts are also sometimes differentiated. Patient safety culture tends to refer more broadly to the complex set of shared perceptions about safety that form over time in an organisation, while safety climate is considered ‘a snapshot’ of these shared perceptions, that can be measured at a specific time point using survey studies [ 29 , 30 ].

In the reviewed studies, the use of the terms patient experience and patient satisfaction also significantly overlapped. The two terms are recognised quality indicators for assessing healthcare quality, and while both concepts are related, they have also been differentiated [ 31 ]. Although the reviewed studies did not offer specific definitions, patient experience has been described elsewhere as patient “perceptions of phenomena for which they are the best or only sources of information, such as personal comfort or effectiveness of discharge planning” [5 p1]. While patient experience is viewed as the sum of all interactions that influence patient perceptions over the entire experience [ 32 ], as noted earlier, patient satisfaction is more about whether patients’ expectations are met [ 33 ]. In this regard, patient satisfaction is viewed as evaluating the patient experience of health services. Therefore, patients’ perception of what they actually experienced in healthcare organisations (patient experience) has an influential impact on how they evaluate healthcare services (patient satisfaction).

Measuring the relationship between patient safety culture and patient experience

The relationship identified between patient safety culture and patient experience in the reviewed literature is mostly measured by quantitative approaches/surveys, and thus little is known about causality or the underlying reasons (or mechanisms) for any relationship identified between these concepts. The availability, validity and reliability of the surveys such as HSOPS and HCAHPS may facilitate and encourage the use of questionnaires in busy working environments such as hospitals. However, the significant differences and variations in methodologies/tools (including dimensions captured by the instruments) employed to measure safety culture and patient experience, makes it difficult to compare the different items of research, and results in variations in the findings.

Patient involvement in the measurement of patient safety culture

Our review findings support research arguing that patients can provide useful feedback on safety [ 34 ]. Patient voice is increasingly included in other aspects of patient safety, but we need to include it more in the measurement of safety culture. In fact, some measures of patient experience pay attention to safety, for instance, in terms of physical comfort and a safe environment, which are also domains of patient safety culture. It was recognised in the included studies that instruments for assessing patient perceptions could be adapted to incorporate questions regarding patient safety, such as PMOS and PaPSC. This would enable patient perceptions and experience of safety to be assessed and the findings employed to effect enhancements in safety culture.

The PMOS and PaPSC scales were developed specifically to capture patients’ feedback on the safety of their care. The PMOS is based on the Yorkshire Contributory Factors Framework (YCFF) to capture patient feedback regarding the contributing factors to patient safety incidents [ 35 ]. However, the YCFF was developed based on input from healthcare professionals alone [ 36 ]. Likewise, the PaPSC scale was also initially developed based on staff perceptions. Although these scales are administered to patients, they may not fully reflect the patients’ perceptions of safety culture, if patients identify other aspects. In addition, the PMOS data was collected from one hospital in northern England; as such, the outcomes of the survey are not reflective of the perceptions of the general global population.

Another measurement approach for capturing patient perceptions of safety culture is to consider patients’ and families’ pre-recorded narratives as a qualitative assessment method [ 8 ]. This approach was limited in terms of inability to ask questions or follow-up with the participants, and the analysis was based on a revised or edited perspective that could carry certain biases. However, this study demonstrated the value of patient narratives and interviews in understanding the interrelationships between different aspects of patient safety culture. In contrast to surveys, qualitative interviews aim to understand participants’ attitudes, behaviours, experiences and perceptions. Qualitative research methods are common in healthcare research, but are largely missing in research into the association between safety culture and patient perceptions of safety culture.

No consensus exists as to the best method to be employed for the measurement of the concepts in question. Different measurements have been employed for each concept for various purposes, resulting in variations in data sources, and variations in results. Consequently, to create useful and usable data, there is a need to adopt measurement methods that are reliable, comparable and valid, for examining the relationship between patient safety culture and patient experience, such as the HSOPS and HCAHPS. It is also useful to consider qualitative investigation when exploring the relationship between these concepts.

Several relationships between patient experience and safety culture subdomains were identified in the included studies (Table  4 ). This suggests that staff and patient views on aspects of safety can be usefully incorporated and examined together. For example, the communication between staff and patients, and the coordination within and across hospital departments. According to Doyle, Lennox, and Bell [ 37 ], the smooth coordination (integration) of care is a key and valued aspect of the patient experience.

In this review, we found that the conceptual relationship between patient safety culture and the patient experience was not clearly described. The differences and overlaps between concepts, results, or measurement tools makes it difficult to understand the relationship between patient safety culture (among health professionals and managers) and patient experience. Future investigations may benefit from the development of a conceptual framework that allows researchers to test and develop their understandings of how patients’ experiences intersect with safety culture. We know that patient experience and safety culture are both valuable quality indicators. Better understanding how they are associated will enable healthcare staff to comprehend patient needs and create an effective strategy for enhancing patient safety culture that aligns with patients’ needs.

This scoping review has offered an overview of extant research regarding the association between patient experience and patient safety culture within the hospital context, and identified potential associations between the two concepts. However, the included studies have been conducted in limited countries, and generally assessed the relationship between these two concepts using quantitative methods. It may be the case that in other countries or cultures, the type of relationship could vary. Differences in ethnicity and national cultures could play an important role in patient experience. For instance, it was recognised in the reviewed literature, that Arab patients reported lower patient satisfaction levels compared with other ethnic groups within the same setting [ 10 ]. Therefore, it is important to consider other elements that may have an indirect effect on patient safety culture and patient experience, particularly in ethnic or national cultures where this relationship has not yet been investigated. Likewise, other factors related to the organisation could impact the relationship between the concepts. For example, the accreditation status of a facility has been shown to have a significant positive relationship with patient satisfaction [ 21 ].

It has been demonstrated that the terms “safety culture” and “safety climate,” as well as “patient experience” and “patient satisfaction” are not always consistently applied across research, with the concepts not often being clearly defined, lacking a theoretical basis for the relationship, not being widely investigated with qualitative methodologies and with considerable diversity in terms of the tools and methodologies employed. The outcomes of this review suggest that research into the association between patient safety culture and patient experience needs to be investigated by using a suitable theoretical framework, in combination with validated methods, and supported by qualitative inquiry, in order to investigate this relationship more comprehensively, particularly in contexts where such investigations have not taken place.

Limitations

While the literature search was conducted in major electronic databases without restrictions on date of publication or country of origin, additional relevant resources not in English or Arabic languages are likely to have been missed. This may lead to a language bias and limit the chance of capturing different perspectives from diverse communities to obtain a comprehensive understanding of the research phenomena, impacting the findings’ generalisability. Further, in accordance with the scoping review methodology of Arksey and O’Malley, a quality assessment was not conducted. Thus, it would be challenging to determine the validity of the reported findings due to the lack of quality assessment. These limitations are common in scoping reviews.

Data availability

Not applicable.

Abbreviations

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

Population, Concept and Context

The Agency for Healthcare Research and Quality

The Australian Commission for Safety and Quality in Healthcare

The Agency for Clinical Innovation

National Institutes of Health

The Hospital Survey on Patient Safety Culture

The Safety Attitudes Questionnaire

The Patient Measure of Safety

The Hospital Consumer Assessment of Healthcare Providers and Systems

The Patient Satisfaction Questionnaire Short Form

The Friends and Family Test

Family Satisfaction in the Intensive Care Unit questionnaire

The Yorkshire Contributory Factors Framework

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Acknowledgements

The authors wish to acknowledge the librarians at the University of Technology Sydney for providing support in developing the search strategy for this study. The authors acknowledge the Gadigal of the Eora Nation, the traditional custodians of the land on which this study was conducted, and pay our respects to the Elders both past and present.

The first author is funded for a PhD scholarship from Imam Abdulrahman Bin Faisal University, Saudi Arabia.

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A.A conceived and wrote the original manuscript. R.H, D.D and S.H reviewed and edited the manuscript. All authors read and approved the final manuscript.

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Alabdaly, A., Hinchcliff, R., Debono, D. et al. Relationship between patient safety culture and patient experience in hospital settings: a scoping review. BMC Health Serv Res 24 , 906 (2024). https://doi.org/10.1186/s12913-024-11329-w

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• Volume 11, Issue 1
• Definitions of pulmonary exacerbation in people with cystic fibrosis: a scoping review
• Article Text
• Article info
• Citation Tools
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• Article metrics

• Maryam Almulhem 1 , 2 ,
• http://orcid.org/0000-0002-6954-9611 Christopher Ward 1 ,
• Iram Haq 1 , 3 ,
• Robert D Gray 4 and
• http://orcid.org/0000-0003-4591-8299 Malcolm Brodlie 1 , 3
• 1 Translational and Clinical Research Institute , Newcastle University , Newcastle upon Tyne , UK
• 2 College of Applied Medical Sciences , King Faisal University , Al-Ahsa , Saudi Arabia
• 3 Paediatric Respiratory Medicine , Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
• 4 School of Infection and Immunity , University of Glasgow , Glasgow , UK
• Correspondence to Dr Malcolm Brodlie; Malcolm.Brodlie{at}newcastle.ac.uk

Background Pulmonary exacerbations (PExs) are clinically important in people with cystic fibrosis (CF). Multiple definitions have been used for PEx, and this scoping review aimed to identify the different definitions reported in the literature and to ascertain which signs and symptoms are commonly used to define them.

Methods A search was performed using Embase, MEDLINE, Cochrane Library, Scopus and CINAHL. All publications reporting clinical trials or prospective observational studies involving definitions of PEx in people with CF published in English from January 1990 to December 2022 were included. Data were then extracted for qualitative thematic analysis.

Results A total of 14 039 records were identified, with 7647 titles and abstracts screened once duplicates were removed, 898 reviewed as full text and 377 meeting the inclusion criteria. Pre-existing definitions were used in 148 publications. In 75% of papers, an objective definition was used, while 25% used a subjective definition, which subcategorised into treatment-based definitions (76%) and those involving clinician judgement (24%). Objective definitions were subcategorised into three groups: those based on a combination of signs and symptoms (50%), those based on a predefined combination of signs and symptoms plus the initiation of acute treatment (47%) and scores involving different clinical features each with a specific weighting (3%). The most common signs and symptoms reported in the definitions were, in order, sputum production, cough, lung function, weight/appetite, dyspnoea, chest X-ray changes, chest sounds, fever, fatigue or lethargy and haemoptysis.

Conclusion We have identified substantial variation in the definitions of PEx in people with CF reported in the literature. There is a requirement for the development of internationally agreed-upon, standardised and validated age-specific definitions. Such definitions would allow comparison between studies and effective meta-analysis to be performed and are especially important in the highly effective modulator therapy era in CF care.

• pulmonary exacerbation
• cystic fibrosis

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All data relevant to the study are included in the article or uploaded as supplementary information.

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Pulmonary exacerbations (PExs) are clinically important in cystic fibrosis (CF) and are frequently used as outcome measures in clinical research studies.

Multiple definitions of PEx exist.

WHAT THIS STUDY ADDS

Substantial variation in the types of definitions used for PEx in people with CF was identified in this scoping review.

Common themes in these definitions were identified, along with a lack of age-specific definitions.

This limits the comparison between studies and effective meta-analysis to be performed.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

There is a requirement for the development of internationally agreed-upon, standardised and validated definitions of PEx in CF that are age-specific.

This is especially pertinent in the era of highly effective CF transmembrane modulator therapies for many people with CF.

Introduction

Lung disease remains the major cause of morbidity and mortality in people with cystic fibrosis (CF). 1 This is characterised by intermittent episodes of increased symptoms known as pulmonary exacerbations (PExs). 2 PEx are typically managed with antibiotics and intensified chest physiotherapy. 3 4 If a PEx is severe, then hospitalisation may be required. 5 Multiple studies have demonstrated the clinical importance of PEx in people with CF. In around a quarter of patients, there is a failure to recover to baseline lung function after a PEx. 6 7 Furthermore, PEx frequency has been associated with the rate of lung function decline in both adults and children. 8 Ultimately, people who experience frequent PEx have reduced survival. 9 PEx also impact quality of life and are associated with a financial burden in terms of healthcare costs and time away from employment. 10 11

Due to the importance of PEx, they are frequently used as a primary or secondary outcome measure in clinical trials, 12 for example, trials of recombinant human DNase, 13 tobramycin, 14 hypertonic saline, 15 azithromycin 16 and CF transmembrane conductance regulator (CFTR) modulators. 17 18 Despite this, there is no agreed-upon uniform definition of PEx and a lack of age-specific criteria. 12 This heterogeneity makes it challenging to evaluate, meta-analyse or compare findings between studies and limits meaningful conclusions to impact clinical practice.

We performed a scoping review to summarise the definitions of PEx used in the CF research literature, the various criteria used and identify common themes. A scoping review was felt to be most appropriate to examine the extent, nature, range and variety of evidence on this extensive topic. 19 These findings will feed into the development of consensus-based age-specific definitions by the European Cystic Fibrosis Society Pulmonary Exacerbation Working Group.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used to report our findings. 20 The research question was developed using the ‘PICo tool,’ where P stands for population, I for interest and Co for context. 21 We formulated the following research question: ‘What definitions are reported for PEx in people of different age groups with CF in primary research studies?’. Alongside this, we also asked: ‘What are the most common signs and symptoms reported in definitions of PEx in people with CF?’.

Criteria for including publications

To get a comprehensive understanding of the definitions used in primary research studies, all clinical trials (randomised clinical trials (RCTs) and non-RCTs) and prospective observational studies that reported PEx as an outcome were included. Publications had to be available in English and clearly specify a PEx definition used in people with CF of any age group. Studies published in abstract form only were considered. Authors were contacted by email if publications were not accessible. Review articles, retrospective studies, case reports and in vitro and in vivo experimental studies were excluded.

Search strategy

Embase, MEDLINE, Cochrane Library, Scopus and CINAHL databases were searched between January 1990 and December 2022. A comprehensive search strategy was developed in consultation with a librarian specialising in health databases. Medical subject headings and keywords were used with ‘AND’ and ‘OR’ to narrow or broaden the search, depending on the search strategy for each database. Specific details outlining the search strategies for each database can be found in the online supplemental material . The following search terms were employed: ‘cystic fibrosis’ AND ‘pulmonary exacerbation’, limited to English language and 1990–2022. Several pilot searches were run in each database to ensure that key articles were identified. All the references were then imported into Endnote 20 reference management software (Clarivate, London, UK). Duplication was checked using different field settings, as suggested by Bramer et al . 22 After removing the duplicates, all results were exported to the Rayyan website 23 to screen the title and abstract.

Supplemental material

Study selection and data charting.

The titles and/or abstracts of studies retrieved were screened by the primary reviewer (MA). Decisions about the inclusion or exclusion of studies were made between two reviewers (MA and MB). Eligible studies were then retrieved and assessed in full by the primary reviewer (MA). A second reviewer (MB) screened 10% of the included articles to ensure accuracy and agreement. An electronic data recording form was designed for the specific methodology used in the review. The form was piloted on three articles and subsequently optimised.

Data synthesis

A thematic qualitative synthesis was used for this study 24 to facilitate the systematic identification of prominent themes and summarise definitions under these themes in a structured way. Thematic synthesis has three stages: the coding of text line by line, the development of descriptive themes and the generation of analytical themes. The charted data were pooled and then coded. Similarities and differences between codes were identified to begin grouping them. 25 Two main themes were developed from the coded data based on clinical presentation and treatment. For each theme, the frequencies of extracted definitions were reported along with the signs and symptoms used.

Patient and public involvement

There was no specific patient or public involvement in this scoping review.

Characteristics of articles identified by the search strategy

In total, 14 039 publications were identified by the search strategy across all databases. The PRISMA flow diagram for the study is shown in figure 1 . From these, 377 articles met the inclusion criteria for the scoping review and were included and analysed in the qualitative synthesis (the full list of included articles is provided in the online supplemental material ). These consisted of 272 observational studies and 105 experimental studies. Most studies were full articles, while 16 studies were available in abstract form only.

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Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram.PEx, pulmonary exacerbation.

Themes of definitions used for PEx

Two key themes were developed for PEx definitions used in the included articles. After manually coding the definitions, the definitions of PEx were categorised into two themes: those based on objective criteria and those using subjective criteria, as per figure 2 . The breakdown of studies: 94 (25%) studies used a subjective definition and 283 (75%) articles used an objective definition as shown in figure 3 . The duration of signs and symptoms or length of the treatment course, was included in 23 publications. The duration of signs and symptoms varied from 3 days (nine studies), 5 days (four studies) or 7 days (five studies). Others delineated a minimum course of treatment of 7 days to meet the criteria of PEx (three studies), whereas others required the administration of an antibiotic course for 21 days (two studies).

Pulmonary exacerbation definitions and themes.

Frequency of pulmonary exacerbation definitions and themes reported in studies.

Commonly used definitions

Out of the 377 articles reviewed, 148 studies used previously established definitions. There were six commonly used definitions that were identified from the analysis of the articles, as shown in table 1 . Full details of these definitions are included in the online supplemental material .

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Commonly used definitions for pulmonary exacerbation

Fuchs definition (1994)

The most commonly used definition was originally published by Fuchs et al 13 in a trial of nebulised recombinant human DNase. The Fuchs definition for PEx is based on a combination of signs and symptoms (at least 4 out of 12 possible) and the need for intravenous antibiotics in people with CF aged >5 years. Various modifications of the original Fuchs definition have been developed and used in studies. Typically, these involve an alteration of the criteria for intravenous treatment or variations in the signs and symptoms required.

These include:

The definition proposed by the EuroCareCF Working Group in 2011. 26

The ‘expanded Fuchs criteria/definition’ broadens the definition to any oral, inhaled and/or intravenous antibiotics prescribed in response to the presence of 4 out of the 12 Fuchs criteria. 18

The ‘modified Fuchs criteria’ involve only the presence of 4 out of 12 signs and symptoms without a specified requirement for treatment.

These subtly different definitions have led to some inconsistency in their use and meaning in the literature. For example, some studies use ‘modified Fuchs’ for the EuroCareCF Working Group definition, 26 while others use ‘modified Fuchs’ to mean the criteria described above, where there is no requirement for intravenous antibiotic treatment. 27 28 Another modified Fuchs definition excludes one of the original 12 signs/symptoms. 10 Due to this variation in terminology, some articles were excluded from this review if they did not specify clearly which Fuchs definition was used (original, modified or expanded). 29 30

US CF Foundation (CFF) definition

In 2005, the CFF Microbiology and Infectious Disease Consensus defined a PEx as 3 out of 11 signs or symptoms being present. There was no specification of the age of the patient in the original definition. Studies have used this definition in paediatric patients aged 2–12 years, 31 although it requires a measurement of forced expiratory volume in 1 s usually done for 6 years old and above only.

The Early Pseudomonas Infection Control (EPIC) definition

The EPIC definition published by Treggiari et al in 2009 is based on signs and symptoms and specifically applies to children with CF aged 1–12 years. 32 It divides signs and symptoms into four major and six minor criteria. A presentation involving one major and/or two of the minor criteria signs or symptoms for a specified duration fulfils the definition of a PEx. Some studies have also used the EPIC definition in adults and children aged over 12 years. 33 34 Another adjustment to the EPIC definition in some studies is to shorten the duration of symptoms for the minor criteria from 5 to 3 days. 35 36

Akron Pulmonary Exacerbation Score (PES) definition

An alternative method to objectively define a PEx is to use a scoring system where each sign or symptom has a specific weighting, with a total score greater than a predefined value being diagnostic of a PEx. The Akron PES 37 was designed for people with CF aged over 6 years. This score contains 14 elements that are divided into systemic, pulmonary signs and symptoms, and objective measurements. A score of 5 or greater is required to meet the criteria for a PEx. Although the original PES definition was developed for a population aged over 6 years, it has been used in studies for participants down to the age of 6 months, for example, by Hoen et al . 38

Rosenfeld definition

The Rosenfeld definition 39 is another example of a score-based method that involves two models. This score is designed for use in a population aged 6 years and above. It was used in four publications that we identified.

Definitions used in different age groups

Out of a total of 377 articles, only one of the included abstracts did not report participant age clearly. We subsequently divided these populations into three groups: adult (aged ≥18 years), paediatric (<18 years) and mixed for studies applying definitions to both age groups. We found that in the specific paediatric and adult groups, an objective definition, defining PEx based on signs and symptoms, was the most commonly used. However, a predefined combination of signs and symptoms and the initiation of an acute treatment definition were used most often in studies with a mixed age group ( figure 4 ). A breakdown of the definitions used in studies involving the different age groups is provided in table 2 .

Specific definitions used by studies involving different age groups

Types of definitions reported in paediatric and adult studies.

Commonly used signs and symptoms in PEx definitions

The second aim of this review was to examine the signs and symptoms used in the different definitions of PEx. Out of the 377 included publications, 288 defined PEx using signs and symptoms. The frequency of these different signs and symptoms is shown in figure 5 . Common signs and symptoms (in 75% of included studies) used in defining PEx were mainly respiratory signs and symptoms such as an increase in the amount of sputum, increased cough and a decline in lung function, followed by systemic features such as weight loss and decreased appetite.

Most common signs and symptoms used in pulmonary exacerbation definitions.

The results of this scoping review highlight large amounts of variation in definitions reported and used for PEx in CF primary research literature. Some studies proposed their own novel definition of a PEx, with the remainder instead using definitions or elements derived from previous studies. This heterogeneity and lack of an accepted and validated standardised definition make it challenging to design clinical trials with PEx as a clinical outcome and limit meta-analysis and comparison of studies. It may be argued that the lack of standardised definitions reduces the effectiveness and applicability of clinical research in CF at present.

Using a predefined combination of signs and symptoms is the most frequently used method to define PEx. This approach has some objectivity and depends on clinical presentation and parameters rather than clinical interventions. However, there may still be inconsistencies in the symptoms and their duration used to define PEx. Another factor that should be considered is the difference in clinical presentations between adults and children when determining which clinical characteristics best define a PEx. The difference in reported signs and symptoms in different age groups is illustrated by various studies in this review. 40–42 Arguably, there is no single definition that will fit all age groups, and criteria must be age specific to be truly clinically relevant. Adult and paediatric populations vary in their ability to perform spirometry reliably, typical presenting symptoms 40 41 and the preferred route of treatment. 43

The need for a change in treatment, most commonly prescribing antibiotics, is frequently part of the definitions used for PEx. 44 45 Few would disagree that this is a crucial intervention relevant to both patients and multidisciplinary clinical teams. However, there is variation in the threshold for recognising and treating PEx at multiple levels in reality. 46 Indications for oral, inhaled or intravenous antibiotics also vary between centres and individual clinicians. For these reasons, the use of treatment-based definitions was not recommended by the EuroCareCF Group 26 and CFF, 47 arguing that treatment as a definition of PEx in CF should not stand alone because of rapid changes in treatment modalities. As the rate of intravenous antibiotic administration at home has increased, using this definition will not capture such cases. 48 Despite this, predefined signs and symptoms and treatment are widely employed in the included articles (35%), while a definition based on treatment or hospitalisation is less prevalent (19%).

The least well-specified method to define a PEx is simply a subjective judgement made by the attending clinician. This method was used in nine publications included in this review. This type of definition is open to variability and bias depending on physicians’ preferences and backgrounds. Such a definition is ineffective as a clinical outcome in clinical trials. Two scoring systems to define PEx were found in the included literature. These scores were based on clinical assessment and were independent of treatment decisions. 37 39 The advantage of these scoring methods is that they do not rely on therapeutic decisions as recommended by the CFF Consensus Conference on Outcome Measures for Clinical Trials 47 and the EuroCareCF Group 26 because of rapid developments in treatment modalities.

Rather than definitions based on clinical presentation and/or treatment, patient-reported indicators of PEx have been suggested to help recognise PEx at an earlier stage and facilitate prompt intervention. 40 41 Abbott and colleagues 40 interviewed adults with CF who experienced exacerbations. They asked them to report symptoms experienced during PEx and how they consequently recognised when these had resolved. 40 For many patients, the onset of an exacerbation was recognised by fatigue and alterations in sleep, cough, sputum, appetite, mood and daily activities. When describing the improvement, they reported enhancement mainly in the activity level, ability to sleep, cough and less sputum production. Abbott and partners extended their work to include children, using the same method. 41 They found that, in general, the most frequently reported symptoms for the onset of exacerbations were tiredness and increased cough and ‘cold’ symptoms, while in moderate or severe disease, activity-induced breathlessness, sleep disturbances and mood fluctuations were most common. 41 Those with severe disease also reported increases in sputum production and lack of appetite. 41 The child-reported indicators of PEx tended to map onto those reported by adults, with some exceptions. 41 Although these findings support the concept that there are similarities between reported indicators of PEx across the CF lifespan, developing tools to monitor the progression of the disease, requisite intervention and progression of treatment that are applicable to all ages is likely to be challenging. 49

This scoping review’s strengths involve the comprehensive search strategy of five large and reliable databases (Embase, MEDLINE, Cochrane Library, Scopus and CINAHL) and seek to summarise the entire range of PEx definitions reported in the primary research CF literature. The review covers a long period from 1990 to 2022, and we performed an extensive review of the reference lists from relevant studies to avoid missing other potentially important papers. However, the review was limited to studies in English only, potentially missing some relevant non-English papers.

Conclusions

This scoping review affirms that there is no single unified definition of PEx in people with CF used in the research literature. Rather, several unvalidated definitions are commonly used, with considerable variation between the different definitions. This inconsistency in defining a PEx is almost certainly detrimental to clinical research by making comparisons of studies challenging and limiting meta-analysis. There is a need for internationally agreed-upon and age-specific definitions of PEx that include specific signs and symptoms and the need for treatment. Moving forward, definitions should reflect the impact of highly effective CFTR modulators on the clinical characteristics of PEx in people with CF who are eligible. 50 We suggest that consensus-based definitions for PEx could be reached by integrating the criteria of the PEx definitions found in this review together with the opinion of multidisciplinary experts, practising healthcare professionals and people with CF themselves.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Acknowledgments.

We acknowledge support from the European Cystic Fibrosis Society Working Group on Pulmonary Exacerbation. MA acknowledges funding received as a scholarship from King Faisal University, Saudi Arabia.

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X @malc_brod

Contributors Conception and design: MB, CW and RDG. Acquisition of data: MA and MB. Analysis and interpretation of data: MA and MB. Manuscript preparation: MA, IH, RDG, CW and MB. MB is the guarantor.

Funding This work was supported by a scholarship from King Faisal University, Saudi Arabia. MB was supported by a Medical Research Council (MRC) Clinician Scientist Fellowship (MR/M008797/1).

Competing interests MB: Not related to this study, has been CI on investigator-led research grants from Pfizer and Roche Diagnostics; speaker fees paid to Newcastle University from Novartis, Roche Diagnostics, TEVA and Vertex Pharmaceuticals; travel expenses to educational meetings from Boehringer Ingelheim and Vertex Pharmaceuticals.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Published: 14 August 2024

Mapping ultra-processed foods (UPFs) in India: a formative research study

• Suparna Ghosh-Jerath   ORCID: orcid.org/0000-0002-2229-4455 1   na1 ,
• Neha Khandpur 2   na1 ,
• Gaurika Kumar 3 ,
• Sahiba Kohli 1 ,
• Meenu Singh 3 ,
• Inderdeep Kaur Bhamra 3 ,
• Fernanda H Marrocos-Leite 4 &
• K Srinath Reddy 3  

BMC Public Health volume  24 , Article number:  2212 ( 2024 ) Cite this article

Metrics details

Increased consumption of ultra-processed foods (UPFs) which have additives such as artificial colours, flavours and are usually high in salt, sugar, fats and specific preservatives, are associated with diet-related non-communicable diseases (NCDs). In India, there are no standard criteria for identifying UPFs using a classification system based on extent and purpose of industrial processing. Scientific literature on dietary intake of foods among Indian consumers classifies foods as unhealthy based on presence of excessive amounts of specific nutrients which makes it difficult to distinguish UPFs from other commercially available processed foods.

A literature review followed by an online grocery retailer scan for food label reading was conducted to map the types of UPFs in Indian food market and scrutinize their ingredient list for the presence of ultra-processed ingredients. All UPFs identified were randomly listed and then grouped into categories, followed by saliency analysis to understand preferred UPFs by consumers. Indian UPF categories were then finalized to inform a UPF screener.

A lack of application of a uniform definition for UPFs in India was observed; hence descriptors such as junk-foods , fast-foods , ready-to-eat foods , instant-foods , processed-foods , packaged-foods , high-fat-sugar-and-salt foods were used for denoting UPFs. After initial scanning of such foods reported in literature based on standard definition of UPFs, an online grocery retailer scan of food labels for 375 brands (atleast 3 brands for each food item) confirmed 81 food items as UPFs. A range of packaged traditional recipes were also found to have UPF ingredients. Twenty three categories of UPFs were then developed and subjected to saliency analysis. Breads, chips and sugar-sweetened beverages (e.g. sodas and cold-drinks) were the most preferred UPFs while frozen ready-to-eat/cook foods (e.g. chicken nuggets and frozen kebabs) were least preferred.

India needs to systematically apply a food classification system and define Indian food categories based on the level of industrial processing. Mapping of UPFs is the first step towards development of a quick screener that would generate UPF consumption data to inform clear policy guidelines and regulations around UPFs and address their impact on NCDs.

Peer Review reports

Non-communicable diseases (NCDs) are one of the leading causes of premature morbidity and mortality resulting in over 7 out of 10 deaths worldwide [ 1 ]. Mortality due to NCDs has been on the rise in India, increasing from 37.9% of all deaths in 1990 to 61.8% in 2016 [ 2 , 3 ]. Overweight/obesity have been identified as a contributing factor [ 4 ]. The recent national-level data shows an increase of 25% in the prevalence of overweight and obesity among Indian men and women over 14–15 years and 3% among children under five years [ 5 , 6 ]. Due to their thin fat phenotype, Indian infants and children, who comprise almost one quarter of the total population, are predisposed to obesity [ 7 , 8 ]. These risk factors are further amplified by changing food environments and behavioural variables such as tobacco, alcohol, drug use and low physical activity [ 9 ]. Exposure to unhealthy food environments in genetically predisposed children, along with other behavioural risk factors, increases their risk of developing obesity and diet-related non-communicable diseases (DR-NCDs) in the long term [ 10 ].

The rapidly changing food environment is characterized by diets transitioning from minimally-processed staple foods (such as pulses and whole cereals) high in vitamins, minerals and fibre to refined, processed and ultra-processed foods (UPFs) [ 11 ]. The Indian population is exposed to a wide variety of UPFs which are hyper-palatable, packaged, convenient, affordable and have a long shelf life, such as sugar-sweetened beverages, chips, biscuits and bread, and ready-to-eat/ ready-to-cook (RTC) meals [ 12 ]. The sales data of UPFs in India demonstrates an exponential increase, from USD 0.9 billion in 2006 to USD 37.9 billion in 2019 [ 13 ]. This growth indicates a notable expansion of these food products in the market, coupled with widespread advertising efforts that specifically target vulnerable populations, including children and youth [ 14 , 15 , 16 , 17 , 18 ]. Consumer demand for UPFs has increased due to higher disposable incomes, nuclear families, single-member households, and less availability of time for housework [ 19 , 20 ]. UPFs have penetrated the rural boundaries of the country and are likely making their way into households of diverse geographic and socio-economic attributes [ 21 , 22 ].

The Nova food classification system categorizes foods based on the purpose and the level of processing and includes four categories: (i) unprocessed/ minimally processed foods, (ii) processed culinary ingredients, (iii) processed foods, and (iv) ultra-processed foods [ 23 , 24 , 25 , 26 ]. UPFs are a category of food that undergo a series of industrial processes like extrusion and moulding, and have presence of classes of additives whose function is to make the final product palatable or more appealing, such as flavours, flavour enhancers, colours, emulsifiers, thickeners, sweeteners, etc. Although not unique to UPF, they also include additives that prolong the product duration and protect original properties or prevent proliferation of microorganisms [ 23 , 24 , 25 , 26 ]. In addition to this, several of these products are high in saturated fats or trans-fats, added sugars, and salt and low in dietary fibre, various micronutrients and other bioactive compounds [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].

Overconsumption of UPFs has been associated with higher body mass index (BMI), obesity, type-2 diabetes, hypertension, cardiovascular diseases, and certain types of cancers [ 36 , 37 , 38 ]. Given the diversity in UPFs, there is a need to systematically map the range of UPFs accessed by the Indian population. This is an important first step to understanding their potential role in contributing to the NCD burden in India and in developing strategies to encourage the substitution of the most frequently consumed UPFs to healthier alternatives. Identifying specific UPF categories could also help inform the development of dietary assessment instruments like food frequency questionnaires (FFQ) and screeners.

The present study aimed at: (i) mapping the specific categories of UPFs accessed and consumed in India, (ii) assessing the ingredient composition of these products, (iii) ranking the UPFs by consumer preference, and (iv) developing a list of categories of UPFs commonly consumed in India. For this, a secondary review of available literature complemented by an online grocery retailer scan and a saliency analysis were conducted between April 2021 and February 2022 (Fig.  1 ).

Flow chart briefly explaining the 3 steps of methodology

Step 1. The literature review was conducted to map and identify the various types of UPFs accessed, consumed, preferred and/ or purchased (as reported behaviours) in India. This review included published cross-sectional and observational research studies that used surveys, focus group discussions and interviews to elicit reported behaviours across different population groups and regions in India. International and national survey reports on UPF food intake and purchase among Indian population were also included in the review. Articles for review were identified from two electronic databases (NLM NCBI and Google Scholar). To ensure the search captured the diversity of UPFs, search terms included proxy descriptors identified in Indian policy documents [ 39 , 40 , 41 , 42 , 43 , 44 ], including: junk food* , fast food* , modern food* , westernized food* , ultra-processed food* , UPF* , convenience food* , ready-to-eat food* , ready-to-eat snack* , ready-to-cook food* , instant food* , frozen food* , canned food* , tinned food* , processed food* , packaged food* , high fat , sugar and salt food* and HFSS*. The literature search and data extraction was conducted by two authors (MS and GK).

To be eligible for the review, studies needed to: (i) include UPFs or their proxy descriptors, with examples of products, (ii) be conducted in either rural and/or urban areas of India, (iii) be published in the English language, between January 2012 and December 2022. This time frame was chosen to capture the high growth in UPFs sales during this decade [ 45 , 46 ]. Review articles, and publications that did not define the food category studied or did not cite any examples of foods were excluded.

Data from eligible articles were extracted in MS-Excel to record key variables on UPFs or their proxy descriptors with examples, location of the study (national/specific state), geographical area (urban/rural), sample size, sampling method, study participants’ age (years) and dietary data collection tools such as 24 h dietary recalls, FFQ, interviews and structured questionnaires (Additional file 1 ). A free list of UPF foods and beverages identified from the reviewed studies, was developed.

Step 2. An online grocery retailer scan for extracting detailed information on the UPFs identified in Step 1, was also conducted. The objective was to review and scrutinize the ingredient list provided in the food labels and to confirm that the food item qualified as UPFs. For this online scan, three researchers (GK, IKB, MS) reviewed the online grocery websites of the largest grocery retailers in India - Big Basket, Grofers, and Amazon [ 47 ]. Individual foods and beverages from Step 1, were checked for their ingredient composition and the presence of additives. This activity was guided by the FAO document ‘Ultra-processed foods, diet quality, and health using the Nova classification system’ [ 23 , 24 , 25 , 26 ] and the expertise of the co-authors (NK and FHML). Food items were specifically scrutinized for the use of additives (flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, artificial sweeteners, thickeners, foaming, anti-foaming, bulking, carbonating, gelling and glazing agents), specific ingredients such as industrially derived sugars (fructose, invert sugar, maltodextrin, dextrose, lactose, high fructose corn syrup, fruit juice concentrates), modified oils (hydrogenated fats, interesterified fats), extracted proteins (hydrolysed proteins, soy protein isolate, gluten, casein, whey protein, mechanically separated meat) [ 23 , 24 , 25 , 26 , 48 ]. All food items were assessed for at least three different brands and if a majority of the items (2 out of 3) qualified as UPFs, the product category was confirmed as UPF. The free-list of UPFs identified from the literature and confirmed through label reading using the online grocery retailer scan were then categorized on the basis of the primary ingredient of their composition and/or functionality of the product. A 23 category UPF list was developed at the end of Step 2.

Step 3. The confirmed UPF categories (23 categories), were then subjected to a saliency analysis, conducted by two authors (GK, MS). Saliency is a statistical accounting of items for rank and frequency of mention, across all respondents within a given domain. For example, the colour chosen most often from a free list of ten colours by a study population is referred to as the most salient [ 49 ]. The saliency test indicators included the commonly accessed, consumed, preferred and/or purchased (collectively referred to as ‘preferred’ in this paper to identify the common UPF categories accessed by the Indian consumers). These categories were limited to the food items that were confirmed as UPFs in Step 2. For example, if a study used “junk food” as a descriptor of UPFs and included freshly prepared savouries like “samosa/kachori” along with chips and soft drinks, we included data for only chips and soft drinks for the purpose of saliency analysis. The UPFs were then sorted from the most to the least preferred UPFs (Additional file 2 ). The steps and formulas [ 49 ] used to calculate composite salience scores for each UPF category have been illustrated in Fig.  2 . The UPF categories were classified per consumer preference, to the composite salience score cut-offs, defined after dividing the distribution of the composite salience scores obtained into tertiles as follows: (i) ≥ 0.61 as frequently preferred, (ii) 0.61 − 0.51 as infrequently preferred, and (iii) < 0.51 as rarely preferred UPFs.

Saliency analysis method for free-listed UPF categories

The literature search and study selection process of Step 1 is illustrated in Fig.  3 . A total of 23 research articles that matched the inclusion criteria were included in the final review. An overview of the extracted variables is provided in Additional File 1 . These studies were conducted in both rural (5 out of 23) and urban areas (17 out of 23), in different regions of the country, among a diverse population aged between 9 and 69 years (Table  1 ). Table  2 provides the outcome of the literature review with proxy descriptors along with the food items listed under them. These foods were verified as UPFs and non-UPFs.

Flow diagram reporting the screening and selection of studies reporting consumption and availability of UPFs in India

The online grocery retailer scan, label readings of 375 packaged foods were completed (atleast 3 brands per product) and 81 of those food products qualified as UPFs. Several of the packaged Indian traditional foods and snacks such as bottled and packaged pickles, namkeens (cereal and pulse-based extruded snacks), papads , frozen non-vegetarian meals and snacks, and frozen RTE meals (like rajmah curry and rice, biryani , dal makhni , etc.) had UPF ingredients and additives in their formulation that qualified them as UPFs (Table  3 ). Food products such as RTE breakfast cereals (e.g. poha , upma , etc.), RTE Indian curries (e.g. paneer makhani , butter chicken, etc.), Indian RTE bread (e.g. thepla , paratha , etc.), RTC mixes (e.g. idli mix, dal vada mix, etc.) also qualified as UPFs. However, some RTE traditional meals such as RTE biryani , RTE rajmah curry with rice, RTE kadhi pakoda with rice were not categorized as UPFs as these did not include UPF ingredients.

Consumer preferences for the confirmed UPF food categories identified above, were assessed using saliency scores. Table  4 lists these categories and shows the order of preference based on the saliency scores. The last column in the table indicates ‘frequently’, ‘infrequently’ or ‘rarely’ preferred UPFs by consumers in India. The frequently preferred UPFs were breads, chips and other extruded snacks (such as potato chips, cheese balls, puff corns, etc.) and sugar-sweetened beverages (such as cold drinks, diet coke, sodas, and energy drinks. The three rarely preferred UPFs were margarine and frozen/ packaged vegetarian and non-vegetarian snacks and meals (such as stuffed/plain parantha , naan , palak paneer , rajma , cutlets, fish/seafood snacks, salami, and sausages).

The present study aimed to identify the specific categories of UPFs accessed in India and rank them by consumer preference using a literature review, an online grocery retailer scan and saliency analysis. We found 23 categories of UPFs accessed by Indian consumers. After analysing the ingredient list of UPFs, we found that product formulation of several traditional Indian foods has transitioned from being processed to ultra-processed category with the use of industrially processed ingredients and presence of additives such as artificial colours, flavour enhancers, anti-caking agents. These ultra-processed versions of traditional foods even though have similar nutrient composition to home-prepared meals, are increasingly consumed, displacing home-cooked meals, and substituting staples. While the health effects of this displacement from minimally processed food ingredients to UPFs is an area of on-going research, we have growing evidence that UPF dietary patterns are linked to poor health outcomes [ 23 , 69 ]. It is crucial to track reformulation of traditional recipes to ultra-processed convenience foods especially since traditional meals are thought to be healthier [ 70 ]. The increasing market of ultra-processed traditional Indian recipes with poor nutritional profile needs more scrutiny and research.

Saliency analysis identified the preferred UPFs among the Indian population with breads, chips and sugar-sweetened beverages being the most preferred UPFs and frozen non-vegetarian snacks being the least preferred. This finding is consistent with the sales trends reported by Euromonitor International in 2020, which has also highlighted a substantial contribution of similar categories of packaged foods, such as bakery items, biscuits, packaged dairy products, savory snacks, and sauces and condiments [ 46 ]. Further, saliency analysis also indicates the preference of Indian consumers towards UPFs such as fruit-based preserves, cookies and biscuits, Indian sweet mixes, sauces and pickles, instant noodles/soups/ pasta and savoury puff rolls. Studies from other low and middle-income countries (LMICs) demonstrates similar trends in preference (consumption of UPFs and contribution to percentage of total calories) towards packaged confectioneries, savoury snacks, deep-fried foods, biscuits, candy/ chocolate, savoury snacks, canned red and luncheon meats, pre-fried French fries, mayonnaise, ketchup, fast-food such as sandwiches and pizzas, chips and salty snacks (including tortillas and pretzels), sweets and sweetened beverages and sausages (including canned) [ 71 , 72 ].

Our results also suggest a benefit of utilizing a classification system based on processing. Currently several UPFs are being captured by proxy descriptors like junk foods, fast foods, convenience foods, instant foods, packaged foods, etc. This limits comparability with other studies, monitoring the preference for and consumption of these products by the population, developing targeted interventions, tracking product reformulation and other regulatory measures to control exposure of these foods to vulnerable age groups through food advertising, etc. [ 73 ]. Using UPFs more consistently in studies reporting unhealthy food consumption pattern in India will help with global comparisons and in also elucidating the health effects of these foods. Additionally, as per the packaged food sales data from 2015-19, the Indian UPF market is slowly expanding with increasing sales of RTE meals, savoury snacks, processed fruits, vegetables, meats and other packaged foods [ 46 ]. The Nova food classification system can serve this purpose and may be explored as an option for categorization of foods by regulatory authorities. This classification system is used to assess dietary patterns in several high and middle-income countries [ 23 , 70 ]. Food based dietary guidelines of several countries such as Brazil, Uruguay, Ecuador, Peru and Israel have utilized Nova classification system to inform their dietary recommendations [ 74 , 75 , 76 , 77 , 78 ].

The present paper identified only a limited number of Indian studies which were primarily reported from 2 geographical regions. More such surveys on the consumption of UPFs are desirable to identify common regional UPFs. In the Indian context, several UPFs are indigenously produced by local retailers apart from the huge market share of nationally known branded UPFs [ 79 ]. These locally accessible UPFs have greater penetration into the local markets.

The categories of UPFs in India developed in the present study after due validation can be developed into a UPF consumption screener. This tool can be used for monitoring the UPF consumption in India and can address critical gap in scientific literature. This information on quantitative estimate of UPF consumption among Indian population can be useful for assessing impact of UPF consumption on increasing burden of NCDs in India.

This study is one of the first attempts to explore the types of UPFs in the Indian food market, identify the types of packaged traditional recipes that have been converted to UPFs, and map their saliency.

Study limitations

Studies reviewed were majorly from South India and largely represented the urban population, hence the results cannot be extended to the rural population. The study could only conduct saliency mapping of preferred foods without quantity of intake of UPFs and their contribution to total day’s energy intake. We could not explore traditional variants of UPFs that may be sold in the local unregulated markets.

Conclusions

India needs to develop a food classification system while systematically defining food categories based on level of processing. This should be followed by an assessment of the extent of UPFs consumption in India. The mapping of the UPFs in India reported in this paper provides the first step in developing a quick screener that systematically lists all the UPF categories. The data generated on consumption of UPFs using the screener is likely to inform policies on regulating the Indian UPFs market, undertake consumer education initiatives and create nutrition literacy around UPFs and thus contain their indiscriminate consumption. This may address the impact of UPF consumption on increasing burden of NCDs in India. There is an urgent need for strengthening the food regulatory environment to check the infiltration of several unhealthy UPFs in the Indian food market.

Data availability

No new data was created or analyzed under the literature review part of the study. The datasets used as part of a particular component is available from the corresponding author on reasonable request.

Abbreviations

• Ultra-processed foods

Non-communicable diseases

Diet-related non-communicable diseases

Food frequency questionnaires

High fat sugar salt

Low and middle-income countries

Ready-to-eat

Ready-to-cook

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Acknowledgements

We would like to appreciate the contribution of Dr. Shukrani Shinde for supporting the study team during the literature search and online grocery retailer scan.

This work is funded through the Innovative Methods and Metrics for Agriculture and Nutrition Action (IMMANA) programme (Grant IMMANA 3.06), led by the London School of Hygiene & Tropical Medicine (LSHTM). IMMANA is co-funded with UK Aid from the UK government and by the Bill & Melinda Gates Foundation. This work was supported, in part, by the Bill & Melinda Gates Foundation [INV-002962 / OPP1211308]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.

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Suparna Ghosh-Jerath and Neha Khandpur contributed equally to this work.

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The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, Delhi, 110025, India

Suparna Ghosh-Jerath & Sahiba Kohli

Wageningen University, Wageningen, The Netherlands

Neha Khandpur

Public Health Foundation of India, New Delhi, India

Gaurika Kumar, Meenu Singh, Inderdeep Kaur Bhamra & K Srinath Reddy

Center for Epidemiological Research in Nutrition and Health, Faculty of Public Health, University of Sao Paulo, Sao Paulo, Brazil

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The study was conceptualized by KSR, SGJ, NK and FHML. The literature review and online grocery retailer scan were conducted by MS, GK, IKB. The first draft of the manuscript was prepared by MS, GK, IKB, SK and SGJ. The manuscript was critiqued and edited by SGJ, NK, FHML and KSR. SGJ had primary responsibility for final content; and all authors read and approved the final manuscript.

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Ghosh-Jerath, S., Khandpur, N., Kumar, G. et al. Mapping ultra-processed foods (UPFs) in India: a formative research study. BMC Public Health 24 , 2212 (2024). https://doi.org/10.1186/s12889-024-19624-1

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