Literature Review

Table of Contents

A literature review is an organised and comprehensive summary of existing research on a particular topic. The purpose of a literature review is to provide an overview of the existing research on a topic, identify any gaps in the current research, and draw conclusions and implications for future research. It is a critical process that helps synthesise existing research and identify any potential flaws or limitations in the research. A literature review is essential in any research project, as it helps to provide context, identify potential research gaps, and inform the overall research project.

A literature review requires a critical evaluation of the material; this is why it is called a literature review rather than a literature report. It is a process of reviewing the literature, as well as a form of writing.

To illustrate the difference between reporting and reviewing, think about television or film review articles. These articles include content such as a brief synopsis of the key points of the film or programme plus the critic’s own evaluation. Similarly, the two main objectives of a literature review are firstly the content covering existing research, theories and evidence, and secondly your own critical evaluation and discussion of this content.

Usually, a literature review forms a section or part of a dissertation, research project or long essay. However, it can also be set and assessed as a standalone piece of work.

Definition:

To Review has been defined as: “To View, inspect, or examine a second time or again”.

It is a crucial stage in the research process to establish what is already known about the topic so that unintentional replication can be avoided.

Why do we need to write a literature review?

There are several reasons to write a literature review, depending on your research plans. Some reasons include:

  • To find out what's already known about your topic. It helps readers understand the background of your study.
  • To show readers the size and depth of the topic you're studying.
  • To spot gaps in the research, where more study is needed. This helps you refine your research question and focus on a specific part of the topic.
  • To explain why your study is important.
  • To learn from past studies' methods and approaches, both successful and unsuccessful.
  • To analyse and judge the quality and relevance of the studies you're reviewing. This helps you refine your research methods and questions.
  • Literature reviews help you create a theoretical framework for your research, giving it a conceptual foundation.
  • To avoid doing research that's already been done. This way, you build on existing knowledge instead of repeating it.

Type of Literature Review

There are various types of literature reviews and these include:

Literature reviews or narrative reviews

Literature, or narrative, reviews provide an overview of what is known about a particular topic. They evaluate the material, rather than simply restating it, but the methods used to do this are not usually prespecified and they are not described in detail in the review. The search might be comprehensive but it does not aim to be exhaustive. Literature reviews are often topic-based and can take the form of a discussion. Literature reviews lack precision and replicability and can present their findings in the context of what has come before. Often, this sort of synthesis does not attempt to control for the author’s own bias. The results or conclusions of a literature review are likely to be presented in a narrative format rather than statistical methods.

Critical review

A critical review (sometimes called a critique, critical commentary, critical appraisal, critical analysis) is a detailed commentary on and critical evaluation of a text. The aim of the critical review is to demonstrate that the reviewer has a commanding understanding of the literature to the point where they can extrapolate hypotheses on the topic of review. This type of review goes beyond the level of detailed description of the existing literature.

While conducting a critical review, the reviewer identifies the most significant research in the field and evaluates the literature based on its contribution to the field (as opposed to a formal quality assessment). This review type is usually narrative or conceptual.

Scoping review

Scoping reviews are exploratory and typically address a broad question, compared to a systematic review that typically has a more targeted question. Researchers conduct scoping reviews to assess the extent of the available evidence, to organize it into groups and to highlight gaps. If a scoping review finds no studies, this might help researchers to decide that a systematic review is likely to be of limited value and that resources could be better directed elsewhere.

Rapid Review

Rapid reviews aim to produce a rigorous synthesis quickly (due to time constraints/urgency), based on a pre-defined research question. The review process for rapid reviews is the same as for a more traditional systematic review: the emphasis is on a replicable pre-specified search, and screening methods that minimize the risk of bias, although potentially isn’t as stringent as a formal systematic review. The process operates within pre-specified limits (for example, by restricting searches to articles published during a specific timeframe) and is usually run by a multidisciplinary team with expertise in systematic review methods.

Systematic review

Systematic review attempts to collate all empirical evidence that fit pre-specified eligibility criteria in order to answer a specific clearly formulated research question. It uses explicit and reproducible systematic methods that are selected with a view to minimising bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.

The process starts with a research question and a protocol or research plan. A review team searches for studies to answer the question using a highly sensitive search strategy. The retrieved studies are then screened for eligibility using pre-specified inclusion and exclusion criteria (this is done by at least two people working independently). Next, the reviewers extract the relevant data and assess the quality of the included studies. Finally, the review team synthesises the extracted study data and presents the results.

A systematic review may contain meta-analyses (statistical analysis). A systematic review which is continually updated, incorporating relevant new evidence as it becomes available is often known as a living systematic review.

Meta-analysis

A meta-analysis is a systematic approach to combining the results of multiple studies. It is a statistical technique used to combine the results from multiple different studies in order to assess a single overall effect. Meta-analyses can be used to analyse data from randomized controlled trials, observational studies, or both. Meta-analyses are often used to assess the effectiveness of a certain treatment or intervention and can help provide better clarity on the effects of a particular intervention than individual studies alone.

Meta-ethnography

Meta-ethnography is a qualitative research methodology that is used to synthesize multiple qualitative studies. This methodology involves meta-analysis of qualitative data from multiple sources in order to compare, contrast, and integrate the data from the different sources. A meta-ethnography is typically used to look for patterns, relationships, and themes that span the different studies. It can also be used to identify gaps in the research, to highlight areas for further research, and to develop new theories.

Realist review

A realist review is an approach to the synthesis of qualitative and quantitative evidence. It is a type of review that focuses on understanding underlying mechanisms and processes that may explain why an intervention or policy works in certain contexts. The review helps to identify and explain the factors that are responsible for a particular outcome, as well as how different interventions might work in different contexts. Realist reviews can be used to identify strategies that have been successful in similar contexts in order to inform future interventions.

Review of reviews

A review of reviews is a systematic method of systematically summarizing the findings of existing reviews and synthesizing them into a single report. It is a form of evidence synthesis that can help to identify gaps in evidence, identify trends in the literature, and identify areas for further research. The review of reviews allows for a more comprehensive assessment of the existing evidence and can be used to inform future research.

Umbrella Reviews or Overview of Reviews

An umbrella review is a review of multiple systematic reviews. The process uses explicit and systematic methods to search for, and identify, systematic reviews on related research questions in the same topic area. The purpose of an umbrella review is to synthesize the results of the systematic reviews across important outcomes.

Click on the terms below to explore, understand and distinguish between various terms:

Description

Aims to demonstrate writer has extensively researched literature and critically evaluated its quality. Goes beyond mere description to include degree of analysis and conceptual innovation. Typically results in hypothesis or mode.

Search

Seeks to identify most significant items in the field.

Appraisal

No formal quality assessment. Attempts to evaluate according to contribution.

Synthesis

Typically narrative, perhaps conceptual or chronological.

Analysis

Significant component: seeks to identify conceptual contribution to embody existing or derive new theory.

Description

Generic term: published materials that provide examination of recent or current literature. Can cover wide range of subjects at various levels of completeness and comprehensiveness. May include research findings.

Search

May or may not include comprehensive searching.

Appraisal

May or may not include quality assessment.

Synthesis

Typically narrative.

Analysis

Analysis may be chronological, conceptual, thematic, etc.

Description

Map out and categorize existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature.

Search

Completeness of searching determined by time/scope constraint.

Appraisal

No formal quality assessment.

Synthesis

May be graphical and tabular.

Analysis

Characterizes quantity and quality of literature, perhaps by study design and other key features. May identify need for primary or secondary research.

Description

Technique that statistically combines the results of quantitative studies to provide a more precise effect of the results.

Search

Aims for exhaustive, comprehensive searching. May use funnel plot to assess completeness.

Appraisal

Quality assessment may determine inclusion/ exclusion and/or sensitivity analyses.

Synthesis

Graphical and tabular with narrative commentary.

Analysis

Numerical analysis of measures of effect assuming absence of heterogeneity.

Description

Refers to any combination of methods where one significant component is a literature review (usually systematic). Within a review context it refers to a combination of review approaches for example combining quantitative with qualitative research or outcome with process studies.

Search

Requires either very sensitive search to retrieve all studies or separately conceived quantitative and qualitative strategies.

Appraisal

Requires either a generic appraisal instrument or separate appraisal processes with corresponding checklists.

Synthesis

Typically both components will be presented as narrative and in tables. May also employ graphical means of integrating quantitative and qualitative studies.

Analysis

Analysis may characterise both literatures and look for correlations between characteristics or use gap analysis to identify aspects absent in one literature but missing in the other.

Description

Generic term: summary of the [medical] literature that attempts to survey the literature and describe its characteristics.

Search

May or may not include comprehensive searching (depends whether systematic overview or not).

Appraisal

May or may not include quality assessment (depends whether systematic overview or not).

Synthesis

Synthesis depends on whether systematic or not. Typically narrative but may include tabular features.

Analysis

Analysis may be chronological, conceptual, thematic, etc.

Description

Method for integrating or comparing the findings from qualitative studies. It looks for 'themes' or 'constructs' that lie in or across individual qualitative studies.

Search

May employ selective or purposive sampling.

Appraisal

Quality assessment typically used to mediate messages not for inclusion/exclusion.

Synthesis

Qualitative, narrative synthesis.

Analysis

Thematic analysis, may include conceptual models.

Description

Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research.

Search

Completeness of searching determined by time constraints.

Appraisal

Time-limited formal quality assessment.

Synthesis

Typically narrative and tabular.

Analysis

Quantities of literature and overall quality/direction of effect of literature.

Description

Preliminary assessment of potential size and scope of available research literature. Aims to identify nature and extent of research evidence (usually including ongoing research).

Search

Completeness of searching determined by time/scope constraints. May include research in progress.

Appraisal

No formal quality assessment.

Synthesis

Typically tabular with some narrative commentary.

Analysis

Characterizes quantity and quality of literature, perhaps by study design and other key features. Attempts to specify a viable review.

Description

Tend to address more current matters in contrast to other combined retrospective and current approaches. May offer new perspectives.

Search

Aims for comprehensive searching of current literature.

Appraisal

No formal quality assessment.

Synthesis

Typically narrative, may have tabular accompaniment.

Analysis

Current state of knowledge and priorities for future investigation and research.

Description

Seeks to systematically search for, appraise and synthesis research evidence, often adhering to guidelines on the conduct of a review.

Search

Aims for exhaustive, comprehensive searching.

Appraisal

Quality assessment may determine inclusion/exclusion.

Synthesis

Typically narrative with tabular accompaniment.

Analysis

What is known; recommendations for practice. What remains unknown; uncertainty around findings, recommendations for future research.

Description

Combines strengths of critical review with a comprehensive search process. Typically addresses broad questions to produce 'best evidence synthesis'.

Search

Aims for exhaustive, comprehensive searching.

Appraisal

May or may not include quality assessment.

Synthesis

Minimal narrative, tabular summary of studies.

Analysis

What is known; recommendations for practice. Limitations.

Description

Attempt to include elements of systematic review process while stopping short of systematic review. Typically conducted as postgraduate student assignment.

Search

May or may not include comprehensive searching.

Appraisal

May or may not include quality assessment.

Synthesis

Typically narrative with tabular accompaniment.

Analysis

What is known; uncertainty around findings; limitations of methodology.

Description

Specifically refers to review compiling evidence from multiple reviews into one accessible and usable document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address these interventions and their results.

Search

Identification of component reviews, but no search for primary studies.

Appraisal

Quality assessment of studies within component reviews and/or of reviews themselves.

Synthesis

Graphical and tabular with narrative commentary.

Analysis

What is known; recommendations for practice. What remains unknown; recommendations for future research.

Process of Literature Review

This diagram provides a visual representation of the sequential steps involved in conducting a literature review. It serves as a useful reference for anyone engaged in the literature review process.

flowchart of the process of a literature review
  1. Select Topic: Choose a research topic relevant to your field of study or practice. Conduct a comprehensive search of relevant literature using databases, journals, and other sources.
  2. Apply Criteria: Define inclusion and exclusion criteria to select the most relevant sources.
  3. Review and Analyze Literature: Read and critically assess the selected literature to understand the key findings and methodologies.
  4. Synthesise Findings: Identify common themes, trends, and patterns in the literature.
  5. Evaluate and Appraise Literature: Assess the quality and reliability of the studies and acknowledge strengths and weaknesses.
  6. Organise and Write Review: Structure your review with clear headings, and write a comprehensive, organised document.
  7. Conclude: Summarise the key takeaways and implications of the literature review.

Stages in Literature Searching

Developing Review Question

Developing a research question for a literature review is a crucial step in the process. A well-crafted question guides your literature search and shapes the focus of your review. Here's how to develop a research question and an overview of different types of question development frameworks:

Steps to Develop a Research Question

  1. Choose a Broad Topic: Start with a general topic that interests you or is relevant to your field. It should be broad enough to provide a range of literature but not too broad to be unmanageable.
  2. Review Existing Literature: Before finalising your question, conduct some preliminary research to familiarise yourself with the existing literature. This will help you identify gaps and refine your focus.
  3. Determine the Key Elements: Identify the key elements or concepts within your topic. What are the essential components of the subject you want to explore?
  4. Formulate the Question: Your research question should be clear, concise, and specific. It should focus on a particular aspect of the topic. Consider using question words like "what," "how," "why," "to what extent," or "in what way."
  5. Consider the Scope: Ensure that your question isn't too broad or too narrow. It should be manageable within the scope of your literature review.
  6. Evaluate the Relevance: Ask yourself whether the question is relevant to your field and research goals. It should contribute to the existing body of knowledge.
  7. Test the Feasibility: Make sure that you can find enough literature to answer your question. If you can't locate relevant sources, consider revising your question.
  8. Refine and Revise: It's common to refine and revise your question as you progress in your literature review. Don't be afraid to adapt it based on your findings and emerging insights.

Question Development Framework

Asking a specific and focused question is a challenging task and to make this easy there are various frameworks that have been proposed to help practitioners develop a specific, focused and answerable question. The most widely used framework, in this respect, is PICO. This framework is commonly used in healthcare and clinical research. It stands for Patient/Population, Intervention, Comparison, and Outcome.

PICOT: It is a similar framework but with an added dimension of Time; It stands for Patient/Population, Intervention, Comparison, Outcome, and Time. It helps structure questions related to healthcare interventions, treatments, and outcomes.

PICO - To guide the development of your research question

  Term Description Example
P Population or Problem Identifying if research has a focused question.

E.g., Disease status, or current medication. Who is the patient? What is the problem?

People with Back Pain
I Intervention or Issue Stating clearly management strategy.

E.g., treatment, What is the intervention being considered?

Analgesic and Exercise
C Comparison or Context What are other alternatives/controls? Bed rest
O Outcome The desired outcome or patient consequence.

E.g., eliminating symptoms. What will you get (outcome) after the intervention?

No back pain

There are other frameworks that can be used to help formulate research questions. The important point to remember is that these frameworks are only a guide - they can help the researcher shape the question but will not provide ideas in justification for a good review question. The other two commonly used question development frameworks are SPIDER and SPICE.

SPIDER: This framework is often used in healthcare research and social sciences to develop well-structured and focused research questions for systematic reviews, scoping reviews, or other types of research. It stands for Sample of Setting, Phenomenon of Interest (research problem), Design, Evaluation, and Research type.

SPICE: This framework is useful in social science research. It stands for Setting, Perspective, Intervention, Comparison, and Evaluation. It's particularly helpful when exploring complex social issues and policies.

These are exemplified below.

Quantitative/Qualitative

SPIDER PICOS Example
S Sample P Population Overweight children
P + I Phenomenon of Interest I Intervention Diet
D Design C Comparison Exercise
E Evaluation O Outcome Lower BMI
R Research Type S Study Type Qualitative or Quantitative
Does the dietary intake of overweight children when compared to their level of physical exercise, have a significant impact on reducing their Body Mass Index (BMI)?

Mainly Qualitative

SPICE  
S Settings Hospitals
P Perspective cancer patients
I Intervention/ Interest/ Exposure dog therapy
C Comparison music therapy
E Evaluation feeling of stress and loneliness
"Among cancer patients in a hospital, does dog therapy or music therapy have a greater impact in reducing feelings of stress and loneliness?

Another model is called ECLIPSE that is mainly used to develop questions related to health policy and management. The framework refers to Expectation, Client group, Location, Impact/ Intervention, Professional, Service/ Study Design and Evaluation.

Try and use these frameworks to develop your review question. Find a template here to use

As already suggested, before starting a search of the literature, you need to determine what you are trying to find out about and what level of information is needed.

Search for Literature

Once you have developed a specific and answerable question, the next step is to find appropriate evidence to answer that question. Finding appropriate evidence can become a very complicated and a cumbersome task if you do not follow a systematic process. A process with smaller steps to enable you to identify the appropriate number of articles/ research studies that you can evaluate. To do this, you need to follow a few steps and these include:

  1. Develop a search strategy: This means identifying various search terms that you think will help you find appropriate evidence. It is about thinking about alternative spellings and synonyms for each component of your PICO to ensure maximum search results.

  2. Use Boolean Operators: When searching in databases or search engines, employ Boolean operators like "AND," "OR," and "NOT" to combine or exclude keywords. This can help you refine your search.

  3. Utilise Filters and Advanced Search Options: Many databases provide advanced search options and filters. You can use these to narrow down your results by date, type of publication, language, and more.

  4. Identify Appropriate Databases: Databases are structured collections of information, and they are often the first place to start your search. These can be subject-specific databases, such as PubMed for medical research, IEEE Xplore for engineering, or PsycINFO for psychology. General databases like Google Scholar, JSTOR, or Scopus are also commonly used for broader searches. You use these databases to input search terms, keywords, or phrases related to your research topic.

Boolean operator Search examples How it works Results
AND Obesity and exercise AND Searches for two terms and hence narrows the search. When you use AND - It will retrieve results that have both words. Venn diagram of obesity AND exercise
OR Hospital OR Healthcare OR Searches for two or more terms and hence expands the search. When you use OR - It will retrieve results that have either word. It is useful for capturing synonymous. Venn diagram of Hostpital OR Healthcare
NOT NOT Excludes a term or terms from search and hence narrows the search. When you use NOT - it will only retrieve result of primary term (s). venn diagram of Practitioners NOT Doctors

Sources of literature

Four common approaches to finding evidence that fits with your inclusion criteria:

Searching approaches Search examples
Electronic Searching This involves using databases, search engines, and online resources to find academic articles, papers, and research on a specific topic.

Internet-accessible online bibliographical databases are valuable sources of general references

Reference List This involves Checking the citations within relevant articles to discover other studies and sources related to your research
Hand Searching relevant literature This involves physically going through printed journals, books, and documents in libraries or archives to find relevant literature
Author Searching This inovolves seeking out authors who have a substantial publication record in the area of your interest

Apply Inclusion and exclusion Criteria

  1. Develop Inclusion criteria: These are the characteristics or attributes that a study or source must possess to be considered for inclusion in your review. These criteria are typically aligned with your research question and are used to select studies that are directly relevant to your topic. Inclusion criteria can include elements such as study design (e.g., randomised controlled trials, cohort studies), population characteristics (e.g., age, gender, specific health condition), intervention or exposure of interest, outcomes, and publication types (e.g., peer-reviewed articles, conference abstracts).For example, if you are conducting a review on the effectiveness of a specific medication in treating a particular medical condition, your inclusion criteria might specify that you will include only randomised controlled trials (study design), involving adult patients (population), receiving the specific medication as an intervention, and reporting relevant clinical outcomes.

  2. Develop Exclusion Criteria: Exclusion criteria outline the characteristics or attributes that disqualify a study or source from being included in your review. These criteria help you filter out studies that do not meet your research objectives or may introduce bias. Exclusion criteria can include the opposite of your inclusion criteria. For example, you may exclude studies with certain study designs (e.g., case reports, editorials), populations (e.g., paediatric patients for an adult-focused study), interventions (e.g., studies involving different medications), or outcomes (e.g., studies not reporting relevant data).

Summary of Inclusion and exclusion Criteria

Inclusion criteria Exclusion Criteria
  • Primary research relating to xyz
  • English and Spanish languages only
  • Published including grey literature
  • Between 2010 and 2020
  • Primary research..
  • Non-English/Spanish
  • Unpublished, papers under review or proposals
  • Published pre 2010 and after 2020

Conducting a comprehensive search is a critical foundation for a literature review or any research study, as it ensures that you are aware of the existing body of knowledge and can build on previous research. It's a systematic and methodical process that demands patience, critical thinking, and attention to detail. There are some important points that you should keep in mind throughout the process and these are:

  • Keep Records: As you find relevant sources, make sure to keep records of them. This might involve creating a bibliography, using citation management software, or simply keeping a detailed list of the sources you've found.

  • Review and Refine Search: Periodically review your search results and refine your search strategy as needed. You may discover additional keywords or subject headings as you delve deeper into the literature.

  • Search Iteratively: Conduct multiple searches with different combinations of keywords and databases. This iterative process helps ensure that you locate a comprehensive set of relevant literature.

What is Primsa flow Chart?

"PRISMA helps researchers ensure that they report all their search and paper selection details transparently in various types of reviews. The Prisma flow chart provides a visual summary of the steps reviewers took to find and decide whether to include published data in the review."

diagram of the Prisma Chart
Prisma Chart

Review and Analyze Literature

Up until now you have learned to develop a specific research question and then to identify relevant research studies. Now you have got a pile of research articles on the table in front of you. But do you actually know how to read a research article? Is it the same as a magazine article? What are the various components of a research article? How to make sense of it. All of these questions are very important. If you don’t know the components of a research article, you will not be able to appraise that article effectively.

Usual component of a research article/ Format of a research article

Research articles in the healthcare field typically consist of several key components. These components are structured to provide a clear and comprehensive understanding of the research, its methods, results, and implications. The specific format can vary slightly between different journals, but the core components often include:

  • Title: The title should be concise and clearly reflect the main topic of the research.

  • Abstract: A brief summary of the research, including the research question, methods, key findings, and conclusions. It provides a quick overview of the article.

  • Introduction: This section sets the stage for the research by providing background information, context, and a clear statement of the research question or hypothesis.

  • Literature Review: A review of relevant literature that provides the theoretical and empirical basis for the research. It identifies gaps in existing knowledge.

  • Methods: A detailed description of the research methods, including study design, data collection procedures, study participants, and statistical or analytical methods used.

  • Results: Presentation of the research findings, often through text, tables, figures, or graphs. This section should be clear and organised, allowing readers to understand the results easily.

  • Discussion: An interpretation of the results, including their significance and relevance. This section also addresses limitations and suggests areas for further research.

  • Conclusion: A concise summary of the key findings and their implications for the healthcare field.

  • Recommendations: If applicable, suggestions for practical applications or policy recommendations based on the research.A section where authors can acknowledge individuals or organizations that contributed to the research.

  • References: A comprehensive list of all sources cited in the article, following a specific citation style (e.g., APA, MLA, Chicago).

  • Appendices: Supplementary materials that provide additional details on methods, data, or analysis. These are often included if they would be too extensive to include in the main body of the article.

Additionally, some articles may include other components like a "Methods" section that is divided into subsections (e.g., participants, data collection, data analysis) or a "Conflict of Interest" statement to disclose any potential conflicts.

The specific structure and requirements may vary from one journal to another. These components collectively serve to present the research in a clear, transparent, and structured manner, allowing readers to understand, assess, and potentially build upon the research findings.

It is also important to remember that research articles and their parts or components vary depending on the study reported in the article. For instance, an article reporting the findings of a qualitative study will be written in a different way than one reporting a quantitative study. An article reporting in a systematic review will be different from presenting information about screening tests.

Analytical/Critical reading triggers critical thinking

Analytical reading is an active cognitive process that involves developing the ability to think critically. It encompasses mental activities such as focusing, categorising, choosing, and assessing. Engaging in analytical reading not only leads to a deeper comprehension of the subject matter but also supports researchers in honing and retaining their analytical reading abilities.

The EEECA Model of Analytical reading

  • Examine the topic from more than one perspective
  • Evaluate: Critique the topic, thereby making a judgement about it
  • Establish relationships and show how they are related
  • Compare and contrast the ideas - similarities and differences
  • Argue for and against something to try to persuade the reader to agree

Critically Appraising Literature

Part 2. Appraising Literature

Critical appraisal means thoroughly and carefully evaluating research to figure out if it's trustworthy and how useful it is in a specific situation. It's like a detailed review of a research study to see what's good and not so good in the research paper.

So, now you have developed a research question, found the evidence and read the research article. Is that enough? Now you need to make sense of the research article. Not in terms of the components or parts of a research article, but to understand the findings of the study reported in the article. You need to be able to make a judgement about the quality of the study presented in the article. You need to decide if the findings are valid and reliable. You will be able to make these judgments only if you are able to critically appraise the article.

Why there is a need for critical appraisal?

  • Not all published research is scientifically sound. The majority of published articles are not of appropriate quality and therefore cannot be used to inform practice

  • To weigh up evidence to see how useful it is in decision making

  • To determine and balance benefits and strengths of research against its flaws and weaknesses

  • All health care professionals should have an ability and skill to critically appraise evidence-

  • It is important to remember that studies that do not state methods fully overstate the benefits of treatments. In addition, studies funded by a pharmaceutical company are more likely to give results that are favourable to the company than independent studies.

Principles of Critical Appraisal

There are some principles of appraising and these can be summarised as:

  • Read and critique the entire study
  • Examine the organisation and presentation of the research report
  • Examine the significance of the problem
  • Identify strengths and weaknesses of the study objectively and realistically
  • Provide specific examples of the strengths and weaknesses
  • Provide a rationale for your critique
  • Suggest modifications for future studies
  • Discuss feasibility of replication of the study
  • Discuss usefulness of findings for practice

Critical appraisal tools

There are many critical appraisal tools available that can be used to evaluate various types of research.

Using tools for critical appraisal, one can determine whether the evidence is derived from impartial, methodologically sound, and rigorous research.

Table 3.3 provides a list of some common critical appraisal tools used in health and social care research.

Table of Common Critical Appraisal Tools

Tool Description Sub-type
CASP (Critical Appraisal Skills Programme) The CASP (Critical Appraisal Skills Programme) checklist is a tool used in evidence-based medicine and research to assess the quality of studies, particularly in the fields of healthcare and social sciences.

  • CASP- Randomised Controlled Trial (RCT)
  • CASP - Qualitative Studies
  • CASP - Cohort studies

CEBM (Centre for Evidence Based Medicine) The Centre for Evidence-Based Medicine (CEBM) is an organization, typically associated with universities or healthcare institutions, that promotes and conducts research in the field of evidence-based medicine.

  • Systematic review
  • Randomised Controlled Trial (RCT)
  • Qualitative studies

JBI (Joanna Briggs Institute) The Joanna Briggs Institute (JBI) checklist is a tool developed and used by the Joanna Briggs Institute, an international research organization known for its work in evidence-based healthcare. The JBI checklist is designed to assist researchers and healthcare professionals in critically appraising and synthesizing research studies and evidence, particularly in the fields of healthcare and nursing.

  • Economic Evaluations
  • Prevalence Studies
  • Qualitative studies

PEDro The PEDro (Physiotherapy Evidence Database) critical appraisal checklist is a widely used tool designed to assess the quality and methodological rigor of clinical research studies in the field of physiotherapy and related healthcare disciplines.

PEDro Scale

MMAT (Mixed Methods Appraisal Tool) Mixed methods research involves the integration of both qualitative and quantitative research approaches within a single study to provide a comprehensive understanding of a research question or issue.

MMAT Tool

Part 3 Synthesising literature

The literature synthesis stage of a literature review is where you make sense of all the articles and studies you've gathered. It's like putting together pieces of a puzzle to create a clear picture of what's known about your topic. As nurses and healthcare professionals, this step is crucial for understanding the latest research and its practical applications in your field. Here's how to do it:

Organise Your Sources: Start by organising the articles and studies you've found. You can use software or tools like reference managers to help with this. Create categories or themes that relate to your topic, making it easier to group similar findings together.

Read Carefully: Read each article carefully and take notes. Highlight key findings, important statistics, and the author's conclusions. Note any differences or contradictions in the studies.

Identify Patterns: Look for patterns or trends in the literature. Do multiple studies support similar conclusions, or are there mixed findings? Identify any gaps in the research where more investigation is needed.

Compare and Contrast: Compare and contrast the studies and analyse the methodology used in each research piece. Are there differences in sample size, demographics, or methods that could explain variations in the results?

Extract Key Insights: Extract key insights from the literature. These are the main takeaways that are relevant to your research question or topic. Think about how these insights might be applied in your healthcare practice.

Synthesise Information: Write a summary of the literature, combining the key findings and insights from various sources. This should provide a clear, comprehensive view of the current state of knowledge in your area of interest.

Discuss Implications: Consider the practical implications of the research for your nursing or healthcare practice. How can the findings be applied to patient care, policies, or procedures? What questions or issues still need further exploration?

Identify Future Directions: Highlight areas where more research is needed or suggest potential future studies that could address existing gaps in the literature.

Write Your Review: Finally, write your literature review, structuring it with an introduction, a discussion of the reviewed literature, and a conclusion that summarizes the key findings and their relevance to your field.

Remember, the literature synthesis stage is all about connecting the dots and creating a clear, evidence-based understanding of your topic. This knowledge will not only benefit your own practice but can also contribute to the advancement of healthcare as a whole,

Part 4. Reporting Literature

The literature reporting stage in a literature review is where you share your findings with your fellow nurses and healthcare professionals. Here's how to effectively report your literature review:

Introduction: Start with an engaging introduction that explains the purpose of your review and why it's important for healthcare professionals.

Methods: Briefly describe the methods you used for your literature review, such as search criteria, databases, and inclusion/exclusion criteria.

Review Structure: Clearly outline the structure of your review, mentioning how you've organised the literature (e.g., by themes, chronology, or other categories).

Key Findings: Present the key findings and insights from the literature. Summarise what the existing research says about your topic.

Implications for Practice: Discuss the practical implications of the literature for healthcare professionals. How can this information be applied to improve patient care, policies, or healthcare practices?

Challenges and Gaps: Mention any challenges or limitations you encountered during your review. Highlight gaps in the research where further investigation is needed.

Recommendations: Provide recommendations for healthcare professionals based on the literature. What actions or changes in practice should be considered?

Conclusion: Summarise the main takeaways from your literature review and emphasise, the relevance of this knowledge for nurses and healthcare professionals.

References: List all the sources you've reviewed in a proper format, such as APA or MLA, so that your peers can access the original studies.

Appendices (if necessary): Include any supplementary materials, like tables or charts, that can help illustrate your findings.

Remember, the goal of the literature reporting stage is to communicate the valuable insights you've gathered from the research to your healthcare colleagues in a clear and concise manner. This information can be a valuable resource for evidence-based practice and decision-making in healthcare.