literature review is important because

Harvey Cushing/John Hay Whitney Medical Library

• Collections
• Research Help

YSN Doctoral Programs: Steps in Conducting a Literature Review

• Biomedical Databases
• Global (Public Health) Databases
• Soc. Sci., History, and Law Databases
• Grey Literature
• Trials Registers
• Data and Statistics
• Public Policy
• Google Tips
• Recommended Books
• Steps in Conducting a Literature Review

What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
• << Previous: Recommended Books
• Last Updated: Jun 20, 2024 9:08 AM
• URL: https://guides.library.yale.edu/YSNDoctoral

• 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

• Library Homepage

Literature Review: The What, Why and How-to Guide: Literature Reviews?

• Literature Reviews?
• Strategies to Finding Sources
• Keeping up with Research!
• Evaluating Sources & Literature Reviews
• Organizing for Writing
• Writing Literature Review
• Other Academic Writings

What is a Literature Review?

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." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that 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 : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

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 has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
• << Previous: Overview
• Next: Strategies to Finding Sources >>
• Last Updated: Mar 5, 2024 11:44 AM
• URL: https://guides.library.ucsb.edu/litreview

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
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings
• Useful Resources

Help is Just a Click Away

Search our FAQ Knowledge base, ask a question, chat, send comments...

Go to LibAnswers

 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.

• Next: Strategies to Find Sources >>
• Last Updated: Jul 3, 2024 10:56 AM
• URL: https://lit.libguides.com/Literature-Review

The Library, Technological University of the Shannon: Midwest

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

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.

Instantly correct all language mistakes in your text

Upload your document to correct all your mistakes in minutes

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.

Prevent plagiarism. Run a free check.

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.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

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.

Open Google Slides Download PowerPoint

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 .  

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved July 30, 2024, from https://www.scribbr.com/dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, what is a theoretical framework | guide to organizing, what is a research methodology | steps & tips, how to write a research proposal | examples & templates, "i thought ai proofreading was useless but..".

I've been using Scribbr for years now and I know it's a service that won't disappoint. It does a good job spotting mistakes”

• Maps & Floorplans
• Libraries A-Z

• Ellis Library (main)
• Engineering Library
• Geological Sciences
• Journalism Library
• Law Library
• Mathematical Sciences
• MU Digital Collections
• Veterinary Medical
• More Libraries...
• Instructional Services
• Course Reserves
• Course Guides
• Schedule a Library Class
• Class Assessment Forms
• Recordings & Tutorials
• Research & Writing Help
• More class resources
• Places to Study
• Borrow, Request & Renew
• Call Numbers
• Computers, Printers, Scanners & Software
• Digital Media Lab
• Equipment Lending: Laptops, cameras, etc.
• Subject Librarians
• Writing Tutors
• More In the Library...
• Undergraduate Students
• Graduate Students
• Faculty & Staff
• Researcher Support
• Distance Learners
• International Students
• More Services for...
• View my MU Libraries Account (login & click on My Library Account)
• View my MOBIUS Checkouts
• Renew my Books (login & click on My Loans)
• Place a Hold on a Book
• Request Books from Depository
• View my ILL@MU Account
• Set Up Alerts in Databases
• More Account Information...

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

• Next: Step One: Define >>
• Last Updated: Jul 9, 2024 9:53 AM
• URL: https://libraryguides.missouri.edu/literaturereview

Research Methods

• Getting Started
• Literature Review Research
• Research Design
• Research Design By Discipline
• SAGE Research Methods
• Teaching with SAGE Research Methods

Literature Review

• What is a Literature Review?
• What is NOT a Literature Review?
• Purposes of a Literature Review
• Types of Literature Reviews
• Literature Reviews vs. Systematic Reviews
• Systematic vs. Meta-Analysis

Literature Review  is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.

Also, we can define a literature review as the collected body of scholarly works related to a topic:

• Summarizes and analyzes previous research relevant to a topic
• Includes scholarly books and articles published in academic journals
• Can be an specific scholarly paper or a section in a research paper

The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic

• Help gather ideas or information
• Keep up to date in current trends and findings
• Help develop new questions

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Helps focus your own research questions or problems
• Discovers relationships between research studies/ideas.
• Suggests unexplored ideas or populations
• Identifies major themes, concepts, and researchers on a topic.
• Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
• Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
• Indicates potential directions for future research.

All content in this section is from Literature Review Research from Old Dominion University 

Keep in mind the following, a literature review is NOT:

Not an essay 

Not an annotated bibliography  in which you summarize each article that you have reviewed.  A literature review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.

Not a research paper   where you select resources to support one side of an issue versus another.  A lit review should explain and consider all sides of an argument in order to avoid bias, and areas of agreement and disagreement should be highlighted.

A literature review serves several purposes. For example, it

• provides thorough knowledge of previous studies; introduces seminal works.
• helps focus one’s own research topic.
• identifies a conceptual framework for one’s own research questions or problems; indicates potential directions for future research.
• suggests previously unused or underused methodologies, designs, quantitative and qualitative strategies.
• identifies gaps in previous studies; identifies flawed methodologies and/or theoretical approaches; avoids replication of mistakes.
• helps the researcher avoid repetition of earlier research.
• suggests unexplored populations.
• determines whether past studies agree or disagree; identifies controversy in the literature.
• tests assumptions; may help counter preconceived ideas and remove unconscious bias.

As Kennedy (2007) notes*, it is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the original studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally that become part of the lore of field. In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews.

Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are several approaches to how they can be done, depending upon the type of analysis underpinning your study. Listed below are definitions of types of literature reviews:

Argumentative Review      This form examines literature selectively in order to support or refute an argument, deeply imbedded assumption, or philosophical problem already established in the literature. The purpose is to develop a body of literature that establishes a contrarian viewpoint. Given the value-laden nature of some social science research [e.g., educational reform; immigration control], argumentative approaches to analyzing the literature can be a legitimate and important form of discourse. However, note that they can also introduce problems of bias when they are used to to make summary claims of the sort found in systematic reviews.

Integrative Review      Considered a form of research that reviews, critiques, and synthesizes representative literature on a topic in an integrated way such that new frameworks and perspectives on the topic are generated. The body of literature includes all studies that address related or identical hypotheses. A well-done integrative review meets the same standards as primary research in regard to clarity, rigor, and replication.

Historical Review      Few things rest in isolation from historical precedent. Historical reviews are focused on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.

Methodological Review      A review does not always focus on what someone said [content], but how they said it [method of analysis]. This approach provides a framework of understanding at different levels (i.e. those of theory, substantive fields, research approaches and data collection and analysis techniques), enables researchers to draw on a wide variety of knowledge ranging from the conceptual level to practical documents for use in fieldwork in the areas of ontological and epistemological consideration, quantitative and qualitative integration, sampling, interviewing, data collection and data analysis, and helps highlight many ethical issues which we should be aware of and consider as we go through our study.

Systematic Review      This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyse data from the studies that are included in the review. Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?"

Theoretical Review      The purpose of this form is to concretely examine the corpus of theory that has accumulated in regard to an issue, concept, theory, phenomena. The theoretical literature review help establish what theories already exist, the relationships between them, to what degree the existing theories have been investigated, and to develop new hypotheses to be tested. Often this form is used to help establish a lack of appropriate theories or reveal that current theories are inadequate for explaining new or emerging research problems. The unit of analysis can focus on a theoretical concept or a whole theory or framework.

* Kennedy, Mary M. "Defining a Literature."  Educational Researcher  36 (April 2007): 139-147.

All content in this section is from The Literature Review created by Dr. Robert Larabee USC

Robinson, P. and Lowe, J. (2015),  Literature reviews vs systematic reviews.  Australian and New Zealand Journal of Public Health, 39: 103-103. doi: 10.1111/1753-6405.12393

What's in the name? The difference between a Systematic Review and a Literature Review, and why it matters . By Lynn Kysh from University of Southern California

Systematic review or meta-analysis?

A  systematic review  answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.

A  meta-analysis  is the use of statistical methods to summarize the results of these studies.

Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:

• clearly stated objectives with pre-defined eligibility criteria for studies
• explicit, reproducible methodology
• a systematic search that attempts to identify all studies
• assessment of the validity of the findings of the included studies (e.g. risk of bias)
• systematic presentation, and synthesis, of the characteristics and findings of the included studies

Not all systematic reviews contain meta-analysis. 

Meta-analysis is the use of statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review.  More information on meta-analyses can be found in  Cochrane Handbook, Chapter 9 .

A meta-analysis goes beyond critique and integration and conducts secondary statistical analysis on the outcomes of similar studies.  It is a systematic review that uses quantitative methods to synthesize and summarize the results.

An advantage of a meta-analysis is the ability to be completely objective in evaluating research findings.  Not all topics, however, have sufficient research evidence to allow a meta-analysis to be conducted.  In that case, an integrative review is an appropriate strategy. 

Some of the content in this section is from Systematic reviews and meta-analyses: step by step guide created by Kate McAllister.

• << Previous: Getting Started
• Next: Research Design >>
• Last Updated: Jul 15, 2024 10:34 AM
• URL: https://guides.lib.udel.edu/researchmethods

• UWF Libraries

Literature Review: Conducting & Writing

What is a literature review, what is a literature review: a tutorial, literature reviews: an overview for graduate students.

• Steps for Conducting a Lit Review
• Finding "The Literature"
• Organizing/Writing
• APA Style This link opens in a new window
• Chicago: Notes Bibliography This link opens in a new window
• MLA Style This link opens in a new window
• Sample Literature Reviews

A Literature Review Is Not:

• just a summary of sources
• a grouping of broad, unrelated sources
• a compilation of everything that has been written on a particular topic
• literature criticism (think English) or a book review

So, what is it then?

A literature review is an integrated analysis-- not just a summary-- of scholarly writings that are related directly to your research question.  That is, it represents the literature that provides background information on your topic and shows a correspondence between those writings and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

Literature Reviews: An Overview for Graduate Students (by North Caroline State University Libraries)

• Next: Steps for Conducting a Lit Review >>
• Last Updated: Mar 22, 2024 9:37 AM
• URL: https://libguides.uwf.edu/litreview

University Libraries

Literature review.

• What is a Literature Review?
• What is Its Purpose?
• 1. Select a Topic
• 2. Set the Topic in Context
• 3. Types of Information Sources
• 4. Use Information Sources
• 5. Get the Information
• 6. Organize / Manage the Information
• 7. Position the Literature Review
• 8. Write the Literature Review

A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research.  The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research.  It should give a theoretical base for the research and help you (the author) determine the nature of your research.  The literature review acknowledges the work of previous researchers, and in so doing, assures the reader that your work has been well conceived.  It is assumed that by mentioning a previous work in the field of study, that the author has read, evaluated, and assimiliated that work into the work at hand.

A literature review creates a "landscape" for the reader, giving her or him a full understanding of the developments in the field.  This landscape informs the reader that the author has indeed assimilated all (or the vast majority of) previous, significant works in the field into her or his research. 

 "In writing the literature review, the purpose is to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. The literature review must be defined by a guiding concept (eg. your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries.( http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review )

Recommended Reading

• Next: What is Its Purpose? >>
• Last Updated: Oct 2, 2023 12:34 PM

Literature Review: Purpose of a Literature Review

• Literature Review
• Purpose of a Literature Review
• Work in Progress
• Compiling & Writing
• Books, Articles, & Web Pages
• Types of Literature Reviews
• Departmental Differences
• Citation Styles & Plagiarism
• Know the Difference! Systematic Review vs. Literature Review

The purpose of a literature review is to:

• Provide a foundation of knowledge on a topic
• Identify areas of prior scholarship to prevent duplication and give credit to other researchers
• Identify inconstancies: gaps in research, conflicts in previous studies, open questions left from other research
• Identify the need for additional research (justifying your research)
• Identify the relationship of works in the context of their contribution to the topic and other works
• Place your own research within the context of existing literature, making a case for why further study is needed.

Videos & Tutorials

VIDEO: What is the role of a literature review in research? What's it mean to "review" the literature? Get the big picture of what to expect as part of the process. This video is published under a Creative Commons 3.0 BY-NC-SA US license. License, credits, and contact information can be found here: https://www.lib.ncsu.edu/tutorials/litreview/

Elements in a Literature Review

• Elements in a Literature Review txt of infographic
• << Previous: Literature Review
• Next: Searching >>
• Last Updated: Oct 19, 2023 12:07 PM
• URL: https://uscupstate.libguides.com/Literature_Review

Why is it important to do a literature review in research?

The importance of scientific communication in the healthcare industry

The Importance and Role of Biostatistics in Clinical Research

 “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research”. Boote and Baile 2005

Authors of manuscripts treat writing a literature review as a routine work or a mere formality. But a seasoned one knows the purpose and importance of a well-written literature review.  Since it is one of the basic needs for researches at any level, they have to be done vigilantly. Only then the reader will know that the basics of research have not been neglected.

The aim of any literature review is to summarize and synthesize the arguments and ideas of existing knowledge in a particular field without adding any new contributions.   Being built on existing knowledge they help the researcher to even turn the wheels of the topic of research.  It is possible only with profound knowledge of what is wrong in the existing findings in detail to overpower them.  For other researches, the literature review gives the direction to be headed for its success. 

The common perception of literature review and reality:

As per the common belief, literature reviews are only a summary of the sources related to the research. And many authors of scientific manuscripts believe that they are only surveys of what are the researches are done on the chosen topic.  But on the contrary, it uses published information from pertinent and relevant sources like

• Scholarly books
• Scientific papers
• Latest studies in the field
• Established school of thoughts
• Relevant articles from renowned scientific journals

and many more for a field of study or theory or a particular problem to do the following:

• Summarize into a brief account of all information
• Synthesize the information by restructuring and reorganizing
• Critical evaluation of a concept or a school of thought or ideas
• Familiarize the authors to the extent of knowledge in the particular field
• Encapsulate
• Compare & contrast

By doing the above on the relevant information, it provides the reader of the scientific manuscript with the following for a better understanding of it:

• It establishes the authors’  in-depth understanding and knowledge of their field subject
• It gives the background of the research
• Portrays the scientific manuscript plan of examining the research result
• Illuminates on how the knowledge has changed within the field
• Highlights what has already been done in a particular field
• Information of the generally accepted facts, emerging and current state of the topic of research
• Identifies the research gap that is still unexplored or under-researched fields
• Demonstrates how the research fits within a larger field of study
• Provides an overview of the sources explored during the research of a particular topic

Importance of literature review in research:

The importance of literature review in scientific manuscripts can be condensed into an analytical feature to enable the multifold reach of its significance.  It adds value to the legitimacy of the research in many ways:

• Provides the interpretation of existing literature in light of updated developments in the field to help in establishing the consistency in knowledge and relevancy of existing materials
• It helps in calculating the impact of the latest information in the field by mapping their progress of knowledge.
• It brings out the dialects of contradictions between various thoughts within the field to establish facts
• The research gaps scrutinized initially are further explored to establish the latest facts of theories to add value to the field
• Indicates the current research place in the schema of a particular field
• Provides information for relevancy and coherency to check the research
• Apart from elucidating the continuance of knowledge, it also points out areas that require further investigation and thus aid as a starting point of any future research
• Justifies the research and sets up the research question
• Sets up a theoretical framework comprising the concepts and theories of the research upon which its success can be judged
• Helps to adopt a more appropriate methodology for the research by examining the strengths and weaknesses of existing research in the same field
• Increases the significance of the results by comparing it with the existing literature
• Provides a point of reference by writing the findings in the scientific manuscript
• Helps to get the due credit from the audience for having done the fact-finding and fact-checking mission in the scientific manuscripts
• The more the reference of relevant sources of it could increase more of its trustworthiness with the readers
• Helps to prevent plagiarism by tailoring and uniquely tweaking the scientific manuscript not to repeat other’s original idea
• By preventing plagiarism , it saves the scientific manuscript from rejection and thus also saves a lot of time and money
• Helps to evaluate, condense and synthesize gist in the author’s own words to sharpen the research focus
• Helps to compare and contrast to  show the originality and uniqueness of the research than that of the existing other researches
• Rationalizes the need for conducting the particular research in a specified field
• Helps to collect data accurately for allowing any new methodology of research than the existing ones
• Enables the readers of the manuscript to answer the following questions of its readers for its better chances for publication
• What do the researchers know?
• What do they not know?
• Is the scientific manuscript reliable and trustworthy?
• What are the knowledge gaps of the researcher?

22. It helps the readers to identify the following for further reading of the scientific manuscript:

• What has been already established, discredited and accepted in the particular field of research
• Areas of controversy and conflicts among different schools of thought
• Unsolved problems and issues in the connected field of research
• The emerging trends and approaches
• How the research extends, builds upon and leaves behind from the previous research

A profound literature review with many relevant sources of reference will enhance the chances of the scientific manuscript publication in renowned and reputed scientific journals .

References:

http://www.math.montana.edu/jobo/phdprep/phd6.pdf

journal Publishing services  |  Scientific Editing Services  |  Medical Writing Services  |  scientific research writing service  |  Scientific communication services

Related Topics:

Meta Analysis

Scientific Research Paper Writing

Medical Research Paper Writing

Scientific Communication in healthcare

pubrica academy

Related posts.

Statistical analyses of case-control studies

Selecting material (e.g. excipient, active pharmaceutical ingredient, packaging material) for drug development

Health economics in clinical trials

Comments are closed.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• PLoS Comput Biol
• v.9(7); 2013 Jul

Ten Simple Rules for Writing a Literature Review

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

• interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
• an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
• a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

• keep track of the search items you use (so that your search can be replicated [10] ),
• keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
• use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
• define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
• do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

• discussing in your review the approaches, limitations, and conclusions of past reviews,
• trying to find a new angle that has not been covered adequately in the previous reviews, and
• incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

• be thorough,
• use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
• look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

• the major achievements in the reviewed field,
• the main areas of debate, and
• the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

• Link to facebook
• Link to linkedin
• Link to twitter
• Link to youtube
• Writing Tips

5 Reasons the Literature Review Is Crucial to Your Paper

• 3-minute read
• 8th November 2016

People often treat writing the literature review in an academic paper as a formality. Usually, this means simply listing various studies vaguely related to their work and leaving it at that.

But this overlooks how important the literature review is to a well-written experimental report or research paper. As such, we thought we’d take a moment to go over what a literature review should do and why you should give it the attention it deserves.

What Is a Literature Review?

Common in the social and physical sciences, but also sometimes required in the humanities, a literature review is a summary of past research in your subject area.

Sometimes this is a standalone investigation of how an idea or field of inquiry has developed over time. However, more usually it’s the part of an academic paper, thesis or dissertation that sets out the background against which a study takes place.

There are several reasons why we do this.

Reason #1: To Demonstrate Understanding

In a college paper, you can use a literature review to demonstrate your understanding of the subject matter. This means identifying, summarizing and critically assessing past research that is relevant to your own work.

Reason #2: To Justify Your Research

The literature review also plays a big role in justifying your study and setting your research question . This is because examining past research allows you to identify gaps in the literature, which you can then attempt to fill or address with your own work.

Find this useful?

Subscribe to our newsletter and get writing tips from our editors straight to your inbox.

Reason #3: Setting a Theoretical Framework

It can help to think of the literature review as the foundations for your study, since the rest of your work will build upon the ideas and existing research you discuss therein.

A crucial part of this is formulating a theoretical framework , which comprises the concepts and theories that your work is based upon and against which its success will be judged.

Reason #4: Developing a Methodology

Conducting a literature review before beginning research also lets you see how similar studies have been conducted in the past. By examining the strengths and weaknesses of existing research, you can thus make sure you adopt the most appropriate methods, data sources and analytical techniques for your own work.

Reason #5: To Support Your Own Findings

The significance of any results you achieve will depend to some extent on how they compare to those reported in the existing literature. When you come to write up your findings, your literature review will therefore provide a crucial point of reference.

If your results replicate past research, for instance, you can say that your work supports existing theories. If your results are different, though, you’ll need to discuss why and whether the difference is important.

Share this article:

Post A New Comment

Got content that needs a quick turnaround? Let us polish your work. Explore our editorial business services.

6-minute read

How to Write a Nonprofit Grant Proposal

If you’re seeking funding to support your charitable endeavors as a nonprofit organization, you’ll need...

9-minute read

How to Use Infographics to Boost Your Presentation

Is your content getting noticed? Capturing and maintaining an audience’s attention is a challenge when...

8-minute read

Why Interactive PDFs Are Better for Engagement

Are you looking to enhance engagement and captivate your audience through your professional documents? Interactive...

7-minute read

Seven Key Strategies for Voice Search Optimization

Voice search optimization is rapidly shaping the digital landscape, requiring content professionals to adapt their...

4-minute read

Five Creative Ways to Showcase Your Digital Portfolio

Are you a creative freelancer looking to make a lasting impression on potential clients or...

How to Ace Slack Messaging for Contractors and Freelancers

Effective professional communication is an important skill for contractors and freelancers navigating remote work environments....

Make sure your writing is the best it can be with our expert English proofreading and editing.

• Franklin University |
• Help & Support |
• Locations & Maps |

• | Research Guides

To access Safari eBooks,

• Select not listed in the Select Your Institution drop down menu.
• Enter your Franklin email address and click Go
• click "Already a user? Click here" link
• Enter your Franklin email and the password you used to create your Safari account.

Continue Close

Public Administration

• Franklin University Resources
• Recommended Resources
• Scholarly Resources vs. Not Scholarly Resources

What is a Literature Review?

Literature review process.

• Career/Employment Information

What is APA Style?

APA Style is a standardized writing format, established by the American Psychological Association, which you may need to follow when submitting projects or papers. If you have questions about APA formatting, look at our APA Style Guide .

RefWorks   is a powerful online research management tool designed to help you easily gather, organize, store and share your research and to instantly generate citations and bibliographies. See our RefWorks research guide  for information about using refworks. 

A Literature Review is NOT:

• just a summary of sources
• a grouping of broad, unrelated sources
• a list of anything and everything that has been written on a specific topic
• literature criticism (think back to high school English classes) or a book review

So, what is it?

• a summary of each resource (but not just a summary!)
• an analyzation and interpretation of each resource
• a critical evaluation of each resource

A literature review is when you , the researcher, collect the Top Resources that you consider to be directly related to your research question. You will then take those resources and discuss how each of them supports (or does not support!) your research question, AND each other. 

For example, pretend your research question is "Does My Little Pony: Friendship is Magic teach kids positive, helping behavior?" You have three resources: Resource A, Resource B, and Resource C. Let's say that Resource A and Resource C agree that the My Little Pony show teaches kids positive social behaviors, like sharing. But maybe Resource B disagrees slightly, and says that there are some areas of the show that could use improvement. Your literature review should point out what all three resources agree on, and where they disagree (or differ). 

You are NOT adding your own opinion! That belongs to a different type of assignment. You're simply summarizing and combining (sometimes called synthesizing) the main points from each resource. 

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic
• Demonstrates why a topic is significant to a subject area
• Discovers relationships between research studies/ideas
• Identifies major themes, concepts, and researchers on a topic
• Identifies critical gaps and points of disagreement
• Points the way in fulfilling a need for additional research
• Discusses further research questions that logically come out of the previous studies

The analytical features of a literature review might:

• Give a new interpretation of old material or combine new with old interpretations
• Trace the intellectual progression of the field, including major debates
• Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant
• Identify where gaps exist in how a problem has been researched to date

Be sure to check out the Literature Review Template linked below to help you construct and organize your review! 

• Literature Review Template (pdf) from Thompson Rivers University

Development of the Literature Review

Four stages:.

• Introduce the reader to the importance of the topic being studied . The reader is oriented to the significance of the study and the research questions or hypotheses to follow.
• Places the problem into a particular context  that defines the parameters of what is to be investigated.
• Provides the framework for reporting the results  and indicates what is probably necessary to conduct the study and explain how the findings will present this information.
• Literature search -- finding materials relevant to the subject being explored.
• Evaluation of resources  -- determining which literature makes a significant contribution to the understanding of the topic.
• Analysis and interpretation -- discussing the findings and conclusions of pertinent literature.

Consider the following issues before writing the literature review:

Sources and expectations.  if your assignment is not very specific about what form your literature review should take, seek clarification from your professor by asking these questions:.

• Roughly how many sources should I include?
• What types of sources should I review (books, journal articles, websites)?
• Should I summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should I evaluate the sources?
• Should I provide subheadings and other background information, such as definitions and/or a history?

Find Models.   When reviewing the current literature, examine how authors in your discipline or area of interest have organized their literature reviews. Read not only for information, but also to get a sense of the types of themes you might want to look for in your own research review.

Narrow the topic.  the narrower your topic, the easier it will be to limit the number of sources you need to read in order to obtain a good survey of relevant resources., consider whether your sources are current and applicable.  s ome disciplines require that you use information that is as current as possible. this is very common in the sciences where research conducted only two years ago could be obsolete. however, when writing a review in the social sciences, a survey of the history of the literature may be what is needed because what is important is how perspectives have changed over the years or within a certain time period. try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. you can also use this method to consider what is consider by scholars to be a "hot topic" and what is not., follow the bread crumb trail.  the bibliography or reference section of sources you read are excellent entry points for further exploration. you might find resourced listed in a bibliography that points you in the direction you wish to take your own research., ways to organize your literature review, chronologically:  .

If your review follows the chronological method, you could write about the materials according to when they were published or the time period they cover.

By Publication:  

Order your sources chronologically by publication date, only if the order demonstrates a more important trend. For instance, you could order a review of literature on environmental studies of brown fields if the progression revealed, for example, a change in the soil collection practices of the researchers who wrote and/or conducted the studies.

Conceptual Categories:

The literature review is organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For example, a review of the Internet’s impact on American presidential politics could focus on the development of online political satire. While the study focuses on one topic, the Internet’s impact on American presidential politics, it will still be organized chronologically reflecting technological developments in media. The only difference here between a "chronological" and a "thematic" approach is what is emphasized the most.

Methodological:  

A methodological approach focuses on the methods utilized by the researcher.  A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Sections of Your Literature Review:  

Once you've decided on the organizational method for your literature review, the sections you need to include should be easy to figure out because they arise from your organizational strategy.

Here are examples of other sections you may need to include depending on the type of review you write:

• Current Situation : information necessary to understand the topic or focus of the literature review.
• History : the chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Selection Methods : the criteria you used to select (and perhaps exclude) sources in your literature review. For instance, you might explain that your review includes only peer-reviewed articles and journals.
• Standards : the way in which you present your information.
• Questions for Further Research : What questions about the field has the review sparked? How will you further your research as a result of the review?

Writing Your Literature Review

Once you've settled on how to organize your literature review, you're ready to write each section. When writing your review, keep in mind these issues.

Use Evidence:

A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be Selective:  

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the research problem, whether it is thematic, methodological, or chronological.

Use Quotes Sparingly:  

Some short quotes are okay if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Sometimes you may need to quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. Do not use extensive quotes as a substitute your own summary and interpretation of the literature.

Summarize and Synthesize:  

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. Recapitulate important features of a research study, but then synthesize it by rephrasing the study's significance and relating it to their own work.

Keep Your Own Voice:  

While the literature review presents others' ideas, your voice (the writer's) should remain front and center. For example, weave references to other sources into what you are writing but maintain your own voice by starting and ending the paragraph with your own ideas and wording.

Use Caution When Paraphrasing:  

When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. Even when paraphrasing an author’s work, you still must provide a citation to that work.

• << Previous: Scholarly Resources vs. Not Scholarly Resources
• Next: Career/Employment Information >>
• Last Updated: Nov 27, 2023 11:33 AM
• URL: https://guides.franklin.edu/PUAD

• Harvard Library
• Research Guides
• Faculty of Arts & Sciences Libraries

Finding and Reading Journal Articles

• Journal Articles: Why You Use Them

Why are articles so important to research?

• Subject Databases: Organizing Research Conversations
• Databases We Recommend For You
• Sources in the Disciplines
• Reading in the Disciplines

Journal articles are the academic's stock in trade, t he basic means of communicating research findings to an audience of one’s peers. That holds true across the disciplinary spectrum, so no matter where you land as a concentrator, you can expect to rely on them heavily. 

Regardless of the discipline, moreover,  journal articles perform an important knowledge-updating function .

Textbooks and handbooks and manuals will have a secondary function for chemists and physicists and biologists, of course. But in the sciences, articles are the standard and  preferred publication form. 

In the social sciences and humanities , where knowledge develops a little less rapidly or is driven less by issues of time-sensitivity , journal articles and books are more often used together.

Not all important and influential ideas warrant book-length studies, and some inquiry is just better suited to the size and scope and concentrated discussion that the article format offers.

Journal articles sometimes just present the most  appropriate  solution for communicating findings or making a convincing argument.  A 20-page article may perfectly fit a researcher's needs.  Sustaining that argument for 200 pages might be unnecessary -- or impossible.

The quality of a research article and the legitimacy of its findings are verified by other scholars, prior to publication, through a rigorous evaluation method called peer-review . This seal of approval by other scholars doesn't mean that an article is the best, or truest, or last word on a topic. If that were the case, research on lots of things would cease. Peer review simply means other experts believe the methods, the evidence, the conclusions of an article have met important standards of legitimacy, reliability, and intellectual honesty.

Searching the journal literature is part of being a responsible researcher at any level: professor, grad student, concentrator, first-year. Knowing why academic articles matter will help you make good decisions about what you find -- and what you choose to rely on in your work.

Think of journal articles as the way you tap into the ongoing scholarly conversation , as a way of testing the currency of  a finding, analysis, or argumentative position, and a way of bolstering the authority (or plausibility) of explanations you'll offer in the papers and projects you'll complete at Harvard. 

• Next: Subject Databases: Organizing Research Conversations >>

Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License , which allows anyone to share and adapt our material as long as proper attribution is given. For details and exceptions, see the Harvard Library Copyright Policy ©2021 Presidents and Fellows of Harvard College.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Open access
• Published: 30 July 2024

Patient adherence in orthodontics: a protocol for a scoping review

• R. M. van der Bie   ORCID: orcid.org/0000-0003-3880-3370 1 ,
• A. Bos   ORCID: orcid.org/0000-0003-2036-0233 1 ,
• J. J. M. Bruers   ORCID: orcid.org/0000-0002-3755-2947 2 &
• R. E. G. Jonkman   ORCID: orcid.org/0000-0002-5905-3639 1  

BDJ Open volume  10 , Article number:  62 ( 2024 ) Cite this article

15 Accesses

Metrics details

• Orthodontics

Patient adherence is a key factor in achieving orthodontic success. While in recent years there have been changes in orthodontic healthcare, no recent comprehensive reviews regarding adherence in orthodontics are available. Therefore, the aim of this planned scoping review is to systematically map the available literature regarding patient adherence in orthodontics to identify factors associated with patient adherence and to investigate if there are knowledge gaps in the available literature.

Methods/design

This protocol was drafted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) statement and the PRISMA extension for Scoping Reviews (PRISMA-ScR). For the methods Arksey and O’Malley’s framework and the Reviewer’s Manual of the Joanna Briggs Institute for conducting scoping reviews were consulted. The inclusion criteria for this scoping review are studies of all designs assessing any form of adherence in orthodontics, published in English from 2006 onwards. The exclusion criteria are studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist’s recommendations and advice, those with oral cleft and craniofacial conditions, and those solely treated for obstructive sleep apnoea. Case reports and studies published in non peer reviewed journals will also be excluded. The following electronic databases will be searched: Embase, PubMed, and Web of Science Core Collection. The following key terms will be used in the search strategies: ‘treatment adherence and compliance’, and ‘orthodontics’. Multiple reviewers will independently screen the results and perform the data charting process. A narrative description will be provided for the analysis of the included studies. The results will be categorized into multiple topics based on recommendations by previous studies into patient adherence. Identified knowledge gaps will be reported and recommendations for future research will be suggested.

No systematic review has previously assessed this exact topic. Because of the broad-spectrum research questions and the expected widely scattered literature a scoping review approach was chosen over a systematic review approach. The Academic Centre for Dentistry Amsterdam (ACTA) has been conducting research in patient adherence in orthodontics up to 2006 and therefore only studies published from 2006 onwards will be researched in this review. Identifying knowledge gaps and summarizing and disseminating research findings on this topic is important for every dental professional performing orthodontic treatment. This protocol is registered in the Open Science Framework: https://osf.io/ec6qd

Similar content being viewed by others

Patient adherence in orthodontics: a scoping review

Are orthodontic decisions consistent?

A scoping literature review on minimum intervention dentistry for children with dental caries

Introduction.

Patient adherence is regarded as a key factor in achieving orthodontic treatment success [ 1 , 2 , 3 ]. Poor adherence may result in less satisfactory treatment outcomes, deleterious effects, prolonged orthodontic treatment, and relapse after treatment [ 1 , 3 ]. The demand for orthodontic treatment is substantial and in recent years there have been changes in orthodontic healthcare. There has been an increase in the number of adult patients treated and a rise in demand for more aesthetic forms of orthodontic treatment has been reported [ 4 ]. Advances in techniques have let to innovations of orthodontic appliances, such as the development of clear aligner therapy, which has gained significant popularity [ 5 , 6 ]. Also the development of so called ‘non-compliance’ appliances as implant supported appliances [ 7 ] can be mentioned.

However, our initial searches did not identify any recent comprehensive reviews regarding patient adherence in orthodontics. Therefore, this manuscript presents the protocol of a planned scoping review. The aims are to systematically search, explore and map the available literature regarding multiple aspects of patient adherence in orthodontics, to identify factors associated with patient adherence, and to investigate if there are knowledge gaps in the available literature. We chose a scoping review approach over a systematic review approach because of the broad-spectrum topic and the expected widely scattered literature. This review explores the literature regarding patient adherence during both active orthodontic treatment as well as the retention phase. Regarding adherence in the active orthodontic treatment phase this study explores the literature of patient adherence in multiple treatment methods and during multiple phases of active orthodontic treatment. The results of this study may be used to conduct further research to explore the fields in which identified knowledge gaps exist.

While in healthcare patient adherence is usually defined as ‘the extent to which a person’s behaviour coincides with medical or health advice’[ 8 ], there is no precise definition of patient adherence in orthodontics. Since both the terms ‘adherence’ and ‘compliance’ are commonly used in dentistry [ 9 ] these terms will be used interchangeably in this review.

Based on the objective of this scoping review, we have formulated the following research questions:

How is patient adherence defined in the field of orthodontics?

What is known about the level of patient adherence in orthodontics?

How is this level assessed and what can be said about the validity and reliability of these methods?

What are the factors that influence patient adherence in orthodontics?

What is known about the promotion of patient adherence in orthodontics?

The Academic Centre for Dentistry Amsterdam (ACTA) has been conducting research in patient adherence in orthodontics up to 2006 [ 10 ] and therefore only studies published from 2006 onwards will be researched in this review.

Materials and methods

Reporting and conducting of the scoping review.

The protocol for this scoping review was drafted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) statement [ 11 , 12 ] (Additional file  1a ) and the PRISMA extension for Scoping Reviews (PRISMA-ScR) [ 13 ] (Additional file  1b ). For the methods of this review we consulted Arksey and O’Malley’s framework [ 14 ] and the Reviewer’s Manual of the Joanna Briggs Institute (JBI) for conducting scoping reviews [ 15 ] as well. We registered our protocol a priori in the registries of the Open Science Framework ( https://doi.org/10.17605/OSF.IO/EC6QD ). Ethical approval for this scoping review protocol was granted by the Ethical Committee of ACTA on 11 February 2022. Our planned and future research projects are reported in a flow diagram (Fig.  1 ).

Flow diagram of the current and future research projects.

Eligibility criteria

The following selection criteria will be applied:

Sources of evidence: studies of all designs with the primary aim of investigating any form of patient adherence in orthodontics will be included, with the exception of case reports and studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist’s recommendations and advice, those with oral cleft and craniofacial conditions, and those treated solely for obstructive sleep apnoea. Patients with oral cleft and craniofacial conditions are excluded because of the higher orthodontic burden for this group of patients [ 16 ]. Patients solely treated for obstructive sleep apnoea are excluded because of the difference in treatment need and used appliances for this group of patients. Research in adherence for these groups of patients should be reported in separate reviews.

Publication type: peer reviewed manuscripts only. No grey literature sources will be included.

Publication date: eligible studies published from 2006 onwards will be included. The ACTA has been exploring patient compliance in orthodontics up to 2006 [ 10 ].

Publication language restrictions: only eligible studies published in English will be included.

Information sources and search strategy

The information sources and key terms have been selected in consultation with a medical information specialist working at the Vrije Universiteit (VU) Amsterdam medical university library. The following electronic databases will be searched: Embase, PubMed, and Web of Science Core Collection. The following key terms, including synonyms and subheadings of the MeSH terms, will be used in the search strategies: ‘treatment adherence and compliance’ and ‘orthodontics’. Two reviewers (RB and RJ) pilot tested these strategies. A draft search strategy for PubMed is presented in Additional file  2 . The draft search resulted into 3201 results. Since our selection criteria require a publication date from 2006 onwards, we decided to apply this search restriction immediately to make the selection of eligible studies more convenient. The search will be performed by the medical information specialist. Citation tracking and searching of reference lists of included eligible studies will be performed to identify additional eligible relevant research.

Selection of sources of evidence

The results will be screened independently by multiple reviewers (RB and RJ) in two stages. In the first stage, results will be screened based on the studies’ title, abstract and keywords to identify eligible publications using a conducted first stage screening form (Additional file  3 ). Rayyan, a free web and mobile application will be used for this first stage. In the second stage, after identification of relevant studies, full-text articles will be obtained and a final selection of studies to be included in our scoping review will be made based on our eligibility criteria using a conducted second stage screening form (Additional file  4 ). EndNote will be used as the reference management software program. Two reviewers (RB and RJ) pilot tested the two screening stages using 50 randomly selected studies from the 3201 results of the draft search strategy and fine-tuned the screening forms. Potential disagreements between the two reviewers during the two-stage screening will be resolved by rereading of the pertinent studies. Persisting disagreements will be resolved by independent validation by a third reviewer (AB or JB) to either reach consensus or to cast a decisive vote for selection. All steps of the screening and selection process will be presented in a PRISMA flow diagram [ 11 ].

Data charting process

For data extraction, a data charting form (Additional file  5 ) was conducted using the data extraction template and guidance for scoping reviews of the Joanna Briggs Institute [ 15 ] and the checklists of the Enhancing the Quality and Transparency Of health Research Network (EQUATOR Network). Two reviewers (RB and RJ) pilot tested the data charting form. The data charting process will be performed by the two reviewers who selected the sources of evidence (RB and RJ). Potential disagreements between the two reviewers will be resolved by rereading of the pertinent studies. Persisting disagreements will be resolved by independent validation by a third reviewer (AB or JB) to reach consensus on the data to be extracted.

Quality assessment and risk of bias

Quality appraisals and risk of bias assessments are optional when conducting a scoping review [ 13 , 14 ] and are typically not performed. Due to the expectation that the eligible studies will include various study designs and will have a lack of reported quantitative outcome measures, we will not perform a quality appraisal or risk of bias assessment or perform any quantitative analyses of the results.

Synthesis of the results

A narrative description will be provided for the analysis of the included studies containing the year of publication, design of the study, objective of the study, methodology of the study, population and sample size of the study, outcome measures of the study (if described), and any key findings that relate to our research questions. Tables will be created to report the characteristics and results of the eligible studies. A draft table to summarize the characteristics and key findings of the included studies is presented in Fig.  2 .

Draft table to summarize the characteristics and key findings of the included studies.

The results will be categorized into the following topics, partially based on recommendations by previous research into compliance in orthodontics [ 2 ]:

What is known about the definition of patient adherence in orthodontics?

What is known about the effects of patient adherence on orthodontic treatment outcomes?

What is known about the methods of measuring patient adherence in orthodontics?

What is known about the degree of patient adherence during active orthodontic treatment, taking into account different types of appliances and different stages of treatment?

What is known about the degree of patient adherence during the orthodontic retention phase?

What is known about factors to influence patient adherence and methods to promote patient adherence in orthodontics?

Identified knowledge gaps will be reported and recommendations for future research will be suggested.

The proposed scoping review will systematically map the available literature regarding patient adherence in orthodontics. We will assess and synthesize the literature on this research topic, identify knowledge gaps within the available literature, consider the clinical implications, and provide recommendations for future research. The rationale for only including studies published from 2006 onwards is that the ACTA has been conducting research in patient adherence in orthodontics up to 2006 [ 10 ]. The rationale for excluding studies investigating patient adherence in orthodontics in patients with oral cleft and craniofacial conditions is that this patient group has a high orthodontic burden when compared to patients without these conditions. This patient group is generally treated in specialized teams and has a longer duration of treatment [ 16 , 17 ]. Research in adherence for this patient group should therefore be reported in a separate review. Any changes made to this protocol when conducting the scoping review will be reported in the final manuscript and in the Open Science Framework. We will present the type and timing of these changes as well as the rationale and the potential consequences of these modifications.

Strengths and limitations

No systematic review has previously assessed this exact topic. Because of the broad-spectrum research questions and the expected widely scattered literature a scoping review approach was chosen over a systematic review approach. The strengths of this scoping review include the broad spectrum of information sources, a research team consisting of topic experts and information scientists, pilot-tested research methods, and peer reviewed search strategies. Scoping reviews have some limitations compared to systematic reviews, for example registration of the review protocol is not possible in PROSPERO, there is no mandatory risk of bias assessment, quality assessment or critical appraisal, and no quantitative synthesis [ 18 ]. We addressed some of these limitations by registering our protocol a priori in the Open Science Framework.

Importance and beneficiaries

Conducting of a scoping review is important to identify the need to conduct research in a field when little or no primary studies are identified. Identifying knowledge gaps and summarizing and disseminating research findings on this topic is important for every dental professional performing orthodontic treatment. We will disseminate our findings to a sample of orthodontists in The Netherlands to identify patient-important and therapist-important outcomes and to prioritize new research questions for future research.

Data availability

All data generated or analysed for this research study are reported in this manuscript and the supplementary files.

Al-Moghrabi D, Salazar FC, Pandis N, Fleming PS. Compliance with removable orthodontic appliances and adjuncts: A systematic review and meta-analysis. Am J Orthod Dentofac Orthop. 2017;152:17–32.

Article   Google Scholar  

Bos A, Hoogstraten J, Prahl-Andersen B. Towards a comprehensive model for the study of compliance in orthodontics. Eur J Orthod. 2005;27:296–301.

Article   PubMed   Google Scholar  

Fleming PS, Scott P, DiBiase AT. Compliance: getting the most from your orthodontic patients. Dent Update. 2007;34:565–6.

Rosvall MD, Fields HW, Ziuchkovski J, Rosenstiel SF, Johnston WM. Attractiveness, acceptability, and value of orthodontic appliances. Am J Orthod Dentofac Orthop. 2009;135:276.e1–12.

Alansari RA, Faydhi DA, Ashour BS, Alsaggaf DH, Shuman MT, Ghoneim SH, et al. Adult Perceptions of Different Orthodontic Appliances. Patient Prefer Adherence. 2019;13:2119–28.

Article   PubMed   PubMed Central   Google Scholar  

Robertson L, Kaur H, Fagundes NCF, Romanyk D, Major P, Flores Mir C. Effectiveness of clear aligner therapy for orthodontic treatment: A systematic review. Orthod Craniofac Res. 2020;23:133–42.

Bellini-Pereira SA, Pupulim DC, Aliaga-Del Castillo A, Henriques JFC, Janson G. Time of maxillary molar distalization with non-compliance intraoral distalizing appliances: a meta-analysis. Eur J Orthod. 2019;41:652–60.

Haynes RB, Dantes R. Patient compliance and the conduct and interpretation of therapeutic trials. Control Clin Trials. 1987;8:12–9.

Article   CAS   PubMed   Google Scholar  

Asimakopoulou K, Daly B. Adherence in dental settings. Dent Update. 2009;36:626–30.

Bos, A Compliance in Orthodontics . (2006) [Thesis, fully internal, Universiteit van Amsterdam].

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–73.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.

Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H Chapter 11: Scoping Reviews (2020 version). Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis . JBI; 2020. Available from https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-12 (date last accessed 19 March 2024).

Roguzińska S, Pelc A, Mikulewicz M. Orthodontic-care burden for patients with unilateral and bilateral cleft lip and palate. Dent Med Probl. 2020;57:411–6.

Hameed O, Amin N, Haria P, Patel B, Hay N. Orthodontic burden of care for patients with a cleft lip and/or palate. J Orthod. 2019;46:63–7.

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:143.

Download references

Author information

Authors and affiliations.

Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands

R. M. van der Bie, A. Bos & R. E. G. Jonkman

Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands

J. J. M. Bruers

You can also search for this author in PubMed   Google Scholar

Contributions

All authors contributed equally to the design and development of this protocol.

Corresponding author

Correspondence to R. M. van der Bie .

Ethics declarations

Competing interests.

The authors declare no competing interests

Ethical approval

Ethical approval for this scoping review protocol was granted by the Ethical Committee of ACTA on 11 February 2022.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Additional file 1a, additional file 1b, additional file 2, additional file 3, additional file 4, additional file 5, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

van der Bie, R.M., Bos, A., Bruers, J.J.M. et al. Patient adherence in orthodontics: a protocol for a scoping review. BDJ Open 10 , 62 (2024). https://doi.org/10.1038/s41405-024-00249-w

Download citation

Received : 05 June 2024

Revised : 26 June 2024

Accepted : 28 June 2024

Published : 30 July 2024

DOI : https://doi.org/10.1038/s41405-024-00249-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• DOI: 10.2478/rjr-2024-0021
• Corpus ID: 271469598

Sinonasal angiosarcoma: case report and literature review

• Andreea Milea , Alex Milea , C. Sarafoleanu
• Published in Romanian Journal of Rhinology 1 July 2024

23 References

Angiosarcoma of the nasal cavity and paranasal sinuses: a rare case report, angiosarcoma of the nasal cavity: a case report, a case of angiosarcoma of the nasal cavity successfully treated with recombinant interleukin-2, paranasal sinus angiosarcoma with facial paralysis as a novel manifestation: a case report and literature review, a case of an angiosarcoma arising from a hemangioma located in the nasal cavity., angiosarcoma of maxillary sinus: a case report, the role of differential diagnosis in intravascular papillary endothelial hyperplasia of the sinonasal cavity mimicking angiosarcoma: a case report., sinonasal tract angiosarcoma: a clinicopathologic and immunophenotypic study of 10 cases with a review of the literature, sinonasal angiosarcoma., nasopharyngeal angiofibroma: a clinical, histopathological and immunohistochemical study of 42 cases with emphasis on stromal features, related papers.

Showing 1 through 3 of 0 Related Papers

Sustainability certification of bio-based products: Systematic literature review of socio-economic impacts along the supply chain

• Rossi, Costanza
• Junginger, Martin
• Wicke, Birka

Voluntary certification schemes and labels are used as a means to improve the sustainability of biomass feedstock production and biobased products. To ensure the viability of certification, it is important to understand its socioeconomic implications for certificate holders. Existing literature focuses on the economic impacts of certification within specific contexts (e.g., specific feedstock, regions, supply chain elements), and rarely addresses the social impacts. The present systematic literature review analyses the findings of 75 scientific articles covering the socioeconomic impacts of certification on producers of biobased feedstock (i.e. palm oil, maize, natural rubber, soybean, sugar cane, wood, and raw cotton) and related supply chains. The socioeconomic impacts are aggregated into 7 economic outcome categories (direct costs, indirect costs, revenues, income, productivity, price premiums, market access) and 5 social ones (health, education, poverty reduction, labour conditions, well-being). The results show that the economic impacts of certification are generally positive, with economic benefits compensating for the increased costs faced by companies after certification. Smallholders and companies located in low-income countries are more likely to experience negative economic impacts after certification because they have less access to resources for financing high upfront costs or legal documents on certification requirements, and face proportionally higher certification costs. The social impacts have been less investigated than the economic ones, and the results showed more mixed findings, although still mostly positive. Looking across the supply chain, both economic and social impacts were found to be investigated more for feedstock producers compared to other actors in the supply chains. New policy should focus on mitigating the negative impacts on vulnerable groups to improve their participation in certification programmes.

• Sustainability certification;
• Biobased supply chain;
• Socioeconomic impacts certification;
• Smallholder certification;
• Low-income countries certification;
• Biobased ecolabels

This paper is in the following e-collection/theme issue:

Published on 1.8.2024 in Vol 26 (2024)

Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income Countries: Scoping Review

Authors of this article:

• Sarah Bostan 1, 2, 3 , PhD   ; 
• Owen A Johnson 3   ; 
• Lena J Jaspersen 1 , PhD   ; 
• Rebecca Randell 4, 5 , PhD  

1 Leeds University Business School, University of Leeds, Leeds, United Kingdom

2 School of Healthcare, University of Leeds, Leeds, United Kingdom

3 School of Computing, University of Leeds, Leeds, United Kingdom

4 Faculty of Health Studies, University of Bradford, Bradford, United Kingdom

5 Wolfson Centre for Applied Health Research, Bradford, United Kingdom

Corresponding Author:

Sarah Bostan, PhD

Leeds University Business School

University of Leeds

Maurice Keyworth Building

Leeds, LS2 9JT

United Kingdom

Email: [email protected]

Background: Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation.

Objective: This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research.

Methods: We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach.

Results: This review included 13 studies that examined open-source EHRs’ adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes.

Conclusions: While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers’ experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.

Introduction

Low- and lower-middle-income countries (LMICs) are challenging contexts that lack robust infrastructure, technical expertise, and other key resources [ 1 - 3 ]. In most LMICs, there is limited access to information about the health of individuals considered vulnerable, making it difficult to improve health care systems because these settings often require additional funding and maintenance support [ 4 , 5 ]. Furthermore, individuals considered vulnerable seldom have a platform to express their views on health care development and implementation strategies within their communities [ 6 - 8 ]. The resource-scarce settings of LMICs account for a higher percentage of global epidemics and chronic diseases in comparison to the Global North because of limited access to health care, particularly for individuals considered vulnerable [ 9 - 11 ]. This persistent problem of limited access to health care exacerbates inequalities in LMIC settings [ 12 , 13 ], and this calls for innovative and sustainable interventions.

Open-source electronic health records (EHRs) can enhance health care delivery in LMICs by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. Open source is broadly defined as free software that includes a flexible source code [ 14 - 16 ] that can be modified for various settings [ 17 ]. An EHR system is a computerized version of a patient’s (longitudinal) medical records maintained by a given health care provider [ 18 - 20 ]. There is demand for open-source EHR systems in LMICs because they provide implementers with the flexibility to customize the system to meet context-specific needs [ 21 ]. An implementer is a member of a local implementing organization who understands the technology, context, and end users. An implementing organization can be a social enterprise or a nongovernment organization that is concerned with the implementation of software. Local implementers and software developers implement open-source EHRs to enhance the delivery of health care for local health facilities [ 22 - 25 ].

The process of implementing open-source EHRs often requires implementing organizations to systematize and conduct an initial analysis of the context, reinvent the software to meet local requirements, lead configuration and installation, and provide user training [ 4 , 18 , 22 ]. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in LMICs. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. This scoping review provides an overview of barriers impacting the implementation of open-source EHR systems in LMICs, identifies gaps in the existing literature, and points to opportunities for future research.

Digital Transformation of Global Health Care

The transformation and innovation of technology over the last few decades have shaped how the global health care industry operates [ 26 ]. The demand for universal access to quality health care is rising, putting pressure on governments to develop sustainable solutions for the effective delivery of health care [ 27 ]. While digital technologies have the potential to enable equal delivery of better health care [ 28 ], they also raise important questions about ethics and data protection [ 9 , 29 - 31 ], particularly in settings characterized by stark power imbalances. A focus on the development of better technical solutions can distract from the underlying values and ethical concerns associated with health care technologies.

Goal 3 of the United Nations sustainable development goals, “good health and wellbeing,” highlights the importance of improving access to quality health care and managing global health risks [ 32 ]. The World Health Organization advocates the use of electronic health tools [ 33 ] to enhance the monitoring of patient care [ 34 , 35 ]. An EHR is “a computer based patient records system designed mainly for the use of doctors [or other clinicians that have direct contact with the patient]” [ 19 ]. EHR systems can help ease the burden of existing paper record processes and provide better management of patient care electronically [ 24 ]. The sustainable development and implementation of EHR systems is a challenge in the contemporary environment [ 21 , 36 ], specifically from political, economic, social, technological, and ethical perspectives [ 19 , 37 ]. Data ownership, informed consent, data protection, and confidentiality are concerns that influence the implementation of many health technologies, including EHR systems [ 31 , 38 ]. Evans [ 39 ] and Manders-Huits [ 40 ] assert the importance of acknowledging and integrating human values responsibly in health care technology. Therefore, if the context of implementing EHR systems is better understood, it could help address key challenges and barriers from a comprehensive perspective.

Evolution of Open-Source EHR Systems

There has been a rapid growth of open-source software, notably in the health care sector [ 18 , 41 ]. The phrase “open-source software” was coined in 1998 [ 17 ]. Open-source software includes an adaptable source code; when the source code is made publicly accessible under a free license [ 42 ], it can be customized by health care providers to meet context-specific requirements [ 14 , 15 , 43 , 44 ]. There are various open-source software solutions used for distinct purposes in LMIC settings [ 45 , 46 ], such as the Open Enterprise-level Laboratory Information System (OpenELIS Foundation); District Health Information Software 2 (HISP Centre at the University of Oslo), a web-based platform communicating health data across several levels of a given health care system; and GNU Health, a hospital information system [ 24 , 47 - 49 ].

An open-source EHR system provides an adaptable and digitalized version of a patient’s medical history, a record that comprises identifiable and personal health information such as demographics, allergies, medication, medical episodes, and health facility visits [ 18 - 20 ]. Open-source EHR systems can enhance health care delivery, inform the development and delivery of health care at the policy level, and lower costs for LMIC settings [ 21 - 23 , 50 , 51 ]. A good example of an open-source EHR system, adopted primarily for LMIC settings, is the Open Medical Record System (OpenMRS; OpenMRS Inc) platform [ 52 - 55 ]. The OpenMRS platform is perceived as a collaborative project [ 25 , 56 - 58 ] aiming to serve a moral purpose by “bringing people together to write code and save lives” [ 59 ].

Two early examples of open-source EHRs were the Computer Stored Ambulatory Record and the Veterans Health Information Systems and Technology Architecture, both developed nearly 5 decades ago in a high-income country (the United States) [ 20 , 41 , 60 , 61 ]. Since then, there has been an increasing interest in developing and using open-source EHR solutions [ 17 , 18 , 24 ]. Today, open-source EHR systems are used in many countries, but predominantly in LMICs, where they are seen as helping to address the high cost and inflexibility associated with proprietary EHR systems [ 4 , 23 , 62 - 65 ]. Open-source EHR systems can, however, introduce different tensions when implemented in LMIC settings [ 15 , 18 ]. Despite the promises of open-source EHR systems, they are not proliferating as expected. It remains unclear what barriers inhibit their implementation, whether these barriers vary according to different contexts, and how they can be addressed.

Open-Source Software Versus Proprietary Software

Open-source software offers publicly available source code that can be modified and distributed without incurring licensing fees [ 14 , 42 , 66 ]. By contrast, proprietary software has copyright restrictions on source code that is not publicly available [ 16 ]. Proprietary software such as Microsoft Windows or Office can be perceived as an out-of-the-box solution, and any adaptations required must be completed by the proprietor of the software, resulting in additional fees [ 17 ]. Open-source software can be tailored to the specifics of a given context, but this often requires technical expertise and adequate funding for implementation [ 29 , 67 - 69 ]. Moreover, Reynolds and Wyatt [ 15 ] contend that opening the source code compels developers to carefully examine and craft the quality of their code, making bug patching easier, which strengthens the security aspect of open-source systems [ 41 , 43 ]. Proprietary software can be more costly to develop in comparison to open-source software [ 51 ], where the source code can be adapted and shared, particularly if there is a need to customize certain system aspects or add additional system features [ 44 , 70 ].

Open-source software does not miraculously address the inadequacies of existing health care systems [ 17 , 66 , 68 , 71 - 73 ]. It still requires a level of expertise and human competence for software design and developing effective systems for end users [ 74 ]. Nevertheless, open-source software offers the potential for communities to collaborate effectively, build stronger networks, develop new skills, and transform policy and practice where required [ 75 , 76 ]. Therefore, there are several benefits of using open-source software for health care in LMIC settings [ 22 , 51 , 77 ].

Open-source EHR systems provide implementers with greater flexibility in building customized systems for a given context and can ease suffering from vendor lock-in often found with proprietary EHR systems [ 16 , 44 , 65 , 69 , 77 ]. For example, vendors of proprietary EHR systems are restrictive in what they share with users, adopt surveillance measures, and impose upgrades [ 14 , 15 ], thus inhibiting freedom and flexibility for end users [ 18 , 61 ]. Conversely, a perceived challenge with open-source EHR systems is that they require specialized skills for implementation and maintenance support [ 4 , 17 ]. Nevertheless, open-source EHR systems allow implementers to adapt a given system to meet context-specific needs [ 51 , 70 , 78 ].

Context-Specific Barriers

For LMIC settings, the adoption of open-source EHR systems requires context-specific adaptations [ 4 ].

Context can be defined as “the place where an intervention is delivered...or unique factors surrounding an implementation effort.” [ 79 ]. There is extensive literature on EHR implementations [ 4 , 24 , 28 ]; however, existing research has focused on technical perspectives [ 30 , 31 , 40 ] and factors such as technology infrastructure, power supply, and backups as well as a lack of financial resources [ 22 , 65 , 70 , 80 , 81 ]. However, local and regional context-specific barriers inhibiting the adaptation and implementation of open-source EHRs and issues inhibiting implementing organizations from adopting such technology in LMICs have not yet been researched.

IT implementation requires diverse stakeholders “taking a design and translating it into a working system” [ 19 ]. The process of implementing an open-source EHR system involves different stakeholders conducting initial analysis and adapting the software to local requirements, software development, configuration, and installation, as well as providing user training and support [ 22 , 82 , 83 ]. Open-source EHR implementation requires stakeholder engagement and participation to cocreate a solution that results in a change that generates true value for a given context [ 79 ]. Consequently, there is a need for various stakeholders, such as local software developers, implementers, IT providers, and health care practitioners, to work collaboratively when designing and adopting open-source EHR systems for LMIC settings [ 21 , 39 , 84 ].

Therefore, this scoping review provides an overview of the context-specific barriers and facilitators impacting the adaptation and implementation of open-source EHR systems in LMIC settings. No previous scoping review has explored the perceived contextual barriers impacting the adaptation and implementation of open-source EHRs for LMICs.

This scoping review aims to provide an overview of the contextual barriers impacting the adaptation and implementation of open-source EHR systems in LMIC settings and outline opportunities for future research. A scoping review methodology was chosen because it provides an understanding of the potential breadth of literature available, lends itself to the identification of relevant concepts and research gaps, and enables the researcher to assess whether a full systematic review is needed or indeed possible [ 85 , 86 ]. The following subsections describe the methodological framework and approach used to undertake the scoping review.

Stage 1: Identifying the Research Question

To address the interdisciplinary nature and scope of the gap in our understanding, a broad review question was chosen to map the breadth of literature available and identify key concepts and related themes for further exploration. The following research question was formulated: “What are the perceived key contextual barriers impacting the adaptation and implementation of open-source EHRs in LMICs?”

This review follows the 5 stages of the systematic methodological framework for conducting scoping studies by Arksey and O’Malley [ 87 ] and follows relevant guidance from the JBI [ 88 ], Levac et al [ 89 ], and Davis et al [ 90 ].

Stage 2: Identifying Relevant Studies

The 7 most relevant electronic databases were searched from January 1960 to September 2021 ( Textbox 1 ), as EHR developments initially started in the early 1960s [ 20 ]. The first reviewer (SB) performed a comprehensive search, which was supported using a population, intervention, and outcome framework [ 91 ] that identified four key terms: (1) LMIC, (2) open source, (3) EHR, and (4) adaptation and implementation. The key terms and synonyms are detailed in Multimedia Appendix 1 . The selection of databases covered literature from medicine and health sciences, computing, and social sciences. In addition, Open Grey was used to identify relevant gray literature using the key terms, but no results were retrieved. A backward and forward citation search was performed using Google Scholar from reference lists of selected papers to ensure potentially relevant articles were not overlooked [ 91 ]. The searches concluded on September 27, 2021. The searches for MEDLINE and MEDLINE In-Process, CINAHL, and Web of Science are included in Multimedia Appendix 2 .

Electronic databases

• MEDLINE and MEDLINE In-Process
• EBSCO Business Source Premier
• Web of Science
• Cochrane Library
• IEEE Xplore

Stage 3: Study Selection

Studies were included in the review if they were published in English, presented empirical data (including systematic reviews), or nonempirical accounts of experiences and system descriptions on the adaptation and implementation of open-source EHRs in all variations (associated synonyms and phrases) in LMICs. No restrictions were placed on the study design or the format of the publication, and both published and unpublished (gray) literature were included. Papers were reviewed at the title, abstract, and full-text level to exclude articles that did not address the adaptation and implementation of open-source EHRs or were not concerned with LMICs. No other criteria were applied; this was to maximize the search results for an initial inquiry. Multimedia Appendix 3 [ 3 ] shows the list of LMICs used for the inclusion criteria.

The following terms were used in the search for relevant material: LMIC, open source, EHR, adaptation, and implementation. These were defined before the search to ensure consistency across the range of databases. The definitions of these key terms can vary; however, for this review, the following definitions were adopted: the World Bank’s definition of LMICs was used [ 3 ]; an EHR system is a computerized version of a patient’s (longitudinal) medical records, specifically designed for clinicians who have direct contact with patients [ 19 , 20 ]; open-source software includes publicly available source code that can be adapted to meet context-specific requirements without incurring any license fees [ 14 - 17 , 42 , 43 ]; implementation is a complex process that requires organized and deliberated effort to put a given innovation or intervention into practice in such a way that it results in better outcomes for an identified context [ 79 , 92 ]; and adaptation is an element of the implementation process. It is the construction of different processes (eg, analysis, customization, installation and configuration, training, and support) that support a given innovation or intervention [ 93 ].

Overall, the search yielded 3504 articles, which were exported into EndNote X9 reference software (Clarivate). After removing 893 (25.49%) duplicates from the 3504 articles, the first reviewer (SB) screened articles via a 2-level process: 2611 (74.51%) titles and abstracts were screened for relevance. Thus, of the 2611 studies, 170 (6.51%) full-text articles were included for review. In addition, a team of 3 reviewers (RR, LJ, and OJ) independently screened 10% (17/170) of the articles to ensure consistency using the inclusion and exclusion algorithm for screening titles and abstracts and then full-text reviews ( Multimedia Appendix 4 ). Any disagreements were discussed and resolved among the reviewers. Finally, 12 studies met all criteria of the inclusion and exclusion algorithm. An additional article was discovered through the forward and backward reference list checks. In total, 13 studies were found to satisfy the inclusion and exclusion criteria and were included in the review. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) [ 94 ] flow diagram was used to report the results of the study selection process ( Figure 1 ).

Stage 4: Charting the Data

A standard data extraction form was used to obtain an overview of the 13 selected studies. For each study, the following information was extracted: authors publication year, country of origin (where the study was conducted), aims or purpose, study design, study population and sample size (if applicable), methods, intervention type (open-source EHRs), and key findings that relate to the scoping review question. Any inconsistencies were discussed and resolved among the reviewers.

Stage 5: Collating, Summarizing, and Reporting the Results

After charting the key data from the 13 studies, a qualitative thematic analysis [ 95 , 96 ] and a synthesis approach was adopted [ 89 ]. The first reviewer coded, categorized, and grouped the results into key themes to address the scoping review question and identify the implications for future research. The thematic analysis was inspired by existing frameworks presented by Jawhari et al [ 84 ] and Muinga et al [ 21 ], who synthesized key findings using relevant categories to illustrate the advantages and barriers to implementing electronic medical record systems in a given geographically bounded space. However, this scoping review focused on the global level, examining contextual barriers impacting the adaptation and implementation of open-source EHR systems for LMIC settings (local and regional). Therefore, the categories and key themes identified in this review were generated from the analysis of the 13 studies.

Quality Assessment

The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were adopted to assess the quality, where relevant, of the included studies, as the review comprises a broad range of study designs and methodologies [ 97 - 99 ].

Characteristics of Studies

Table 1 briefly summarizes the characteristics of the included studies. All studies were published between 2002 and 2021. Of the 13 studies included in this review, geographically, 9 (69%) report research conducted in Sub-Saharan Africa, Uganda, Ethiopia, Kenya, Ghana, and Sierra Leone [ 9 , 21 , 24 , 28 , 44 , 84 , 100 - 102 ]. A total of 2 studies were conducted in South Asia: India and Nepal [ 103 , 104 ]. The type of research varied across the spectrum, with the most common following a qualitative design, with the use of interviews, surveys including qualitative questions, participatory techniques and observations used to address the design, and barriers and facilitators with implementing open-source EHRs [ 9 , 21 , 84 , 101 ].

Of the 2 quantitative studies, one used controlled observations of clinicians and patients before implementation and postimplementation and the other used a survey with standardized measures [ 28 , 102 ]. One study adopted a mixed methods design inclusive of quantitative and qualitative aspects [ 83 ]. The systematic reviews looked at various open-source EHRs in LMICs and the challenges inhibiting implementation [ 24 , 44 ]. Other studies were more accounts of experiences and system descriptions [ 68 , 100 , 103 , 104 ]. Most of the studies (10/13, 77%) addressed rural areas [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 100 , 103 , 104 ], and other studies (3/13, 23%) addressed urban settings [ 84 , 101 , 102 ]. Multimedia Appendix 5 [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 104 ] illustrates the detailed characteristics of each included study.

The Mixed Methods Appraisal Tool checklist was used for 7 studies [ 9 , 21 , 28 , 83 , 84 , 101 , 102 ], and the Critical Appraisal Skills Programme Systematic Review checklist was used for 2 systematic reviews [ 24 , 44 ]. A total of 4 studies [ 68 , 100 , 103 , 104 ] were nonempirical accounts of experiences and system descriptions of open-source EHR implementations, which provided interesting insights but were not suitable for quality assessment. In total, 2 qualitative studies in this review were of moderate quality, as it is unclear what data were included in the analysis [ 9 ], and there is no information about the analysis [ 21 ]. A total of 5 studies were assessed as good quality: 2 qualitative [ 84 , 101 ], 2 quantitative [ 28 , 102 ], and the mixed methods study [ 83 ]. Moreover, 2 systematic reviews were assessed as moderate quality [ 24 , 44 ] with less scientific rigor, as there was no information about the quality of the included studies. The data table reporting the quality assessments is included in Multimedia Appendix 6 [ 9 , 21 , 24 , 28 , 44 , 83 , 84 , 101 , 102 ].

Contextual Barriers Impacting Open-Source EHR Implementations

The 13 included studies provide a broad overview of the perceived contextual barriers impacting the adaptation and implementation of open-source EHRs in LMICs. Three distinct but interrelated perspectives emerged from the thematic review: (1) socioenvironmental barriers draw attention to issues surrounding the relationship between humans in a given society and their external environments, such as social capital, social cohesion, infrastructure (local and regional), culture, values, languages, institutions, and stakeholders; (2) technological barriers emphasize the issues surrounding the software and hardware used in open-source EHR implementations; and (3) organizational barriers draw attention to the operational practices in organizational structures of open-source EHR implementations. In Textbox 2 , we organize our findings around these 3 themes. While some issues can be assigned to one thematic barrier, others are cross-cutting barriers, as summarized in Textbox 2 . Some subcategories are addressed within >1 barrier, where they are interpreted through different lenses. For example, issues such as infrastructure, ethical practices, or finance are not only of importance from a socioenvironmental perspective but are also raised, albeit in different ways, by researchers who adopt a technological or organizational perspective.

Socioenvironmental barriers

• Lack of social cohesion: voice and trust [ 9 , 21 , 24 , 28 , 44 , 84 , 100 , 102 - 104 ]
• Require stakeholder engagement and participation as well as political support [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 104 ]
• Sustainability: co-design and collaboration [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 104 ]
• Social capital and lack of funding [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 104 ]
• Language barriers: reliance on the local language [ 44 , 68 ]
• Epidemic diseases (health emergencies) [ 9 , 21 , 28 , 44 , 68 , 84 , 100 , 103 , 104 ]
• Environment—lack of resources (poverty) [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 104 ]
• Infrastructure: access to electricity, local network coverage, medical facilities, and rural and urban health [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 104 ]

Technological barriers

• Infrastructure (power, network, and technology) [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 , 101 , 104 ]
• Data security, privacy and confidentiality, storage, quality, and ethics [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 102 , 104 ]
• Software and hardware suitability (context specific) [ 9 , 21 , 28 , 44 , 68 , 84 , 100 - 102 , 104 ]
• Interoperability [ 21 , 24 , 28 , 68 , 84 , 100 ]
• Sustainability of systems [ 9 , 21 , 28 , 44 , 68 , 83 , 84 , 100 - 102 , 104 ]
• User interface: not supporting different clinical roles [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 , 101 ]
• Patient-centered design (lack of end user [clinicians, health facility administrators, and patients] involvement) [ 9 , 21 , 28 , 68 , 83 , 84 , 100 , 103 , 104 ]

Organizational barriers

• Finance and benefactors (costs for context-specific implementations and maintenance) [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 , 101 , 103 , 104 ]
• Human resource development (training, IT skills or expertise, support, and staff shortage) [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 - 102 , 104 ]
• Resistance to change [ 21 , 28 , 44 , 68 , 83 , 84 , 100 , 101 ]
• Organizational culture and change management [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 , 101 ]
• Strategic, agile planning (context specific) [ 9 , 21 , 24 , 28 , 68 , 84 , 100 , 101 , 104 ]
• Lack of leadership [ 21 , 24 , 28 , 44 , 68 , 83 , 84 , 101 , 104 ]
• Documentation and resources [ 9 , 24 , 28 , 68 , 83 , 84 , 100 , 101 , 104 ]
• Self-sufficiency [ 9 , 21 , 68 , 84 , 101 ]
• Communication and transparency [ 9 , 21 , 24 , 28 , 83 , 84 , 100 , 101 , 103 ]
• Trust, social cohesion, and ownership [ 9 , 21 , 68 , 83 , 84 , 101 , 104 ]
• Workflow pressure, staff morale, and ethical practices [ 9 , 21 , 24 , 28 , 44 , 84 , 100 - 102 , 104 ]
• More reactive than proactive [ 9 , 21 , 28 , 44 , 68 , 84 , 101 , 103 ]
• Deep-rooted habits (relative to culture or specific context) [ 28 , 44 , 68 , 83 , 84 , 100 , 101 ]

Adaptation of open-source EHR software is needed because of contextual factors such as limited resources, infrastructure, organizational setup, and workflows. LMIC settings have unique requirements. There are different user realities to consider, and specific issues seem to determine the success or failure of open-source EHR implementations [ 105 ]. These contextual barriers have been found to include political, economic, social, and technological issues [ 31 , 106 ]. To better understand these barriers to implementing open-source EHRs in LMICs, one has to first acknowledge the given setting, understand end-user realities, and consider the availability of resources [ 107 ].

Socioenvironmental Barriers Impacting Open-Source EHR Adaptation and Implementation

The socioenvironmental barriers include diverse issues: resource scarcity, limited political support, and socioeconomic difficulties. These issues impact open-source EHR adaptation and implementation in LMICs. Nearly all studies [ 9 , 21 , 24 , 28 , 44 , 68 , 83 , 84 , 100 , 102 - 104 ] show that a lack of resources, such as technical expertise, power and connectivity, investment, workstations, human resource, and support, impedes successful adaptations and implementations.

The lack of effective stakeholder engagement and participation may impact long-term sustainability and health care delivery in LMICs [ 102 ]. Anantraman et al [ 103 ] state that the adaptation and implementation of open-source EHRs are best supported through the effective involvement of various stakeholders, such as end users, IT providers, clinicians, and developers [ 21 ]. Moreover, Akanbi et al [ 44 ], Syzdykova et al [ 24 ], and Muinga et al [ 21 ] highlighted the importance of government intervention in supporting open-source EHR projects, both before implementation and postimplementation. This is confirmed by Raut et al [ 104 ]. They describe the success of 2 open-source EHR implementations in rural Nepal, primarily because of the commitment, cohesion, and support provided by the government of Nepal (at the local and regional level) as a key stakeholder.

Jawhari et al [ 84 ] reported the importance of addressing social challenges and health inequalities within communities considered marginalized in urban-poor contexts as a key issue, but it is one that is often overlooked in adaptation and implementation. Moreover, how implementers enact the implementation process and how they respond to the perceived challenges in local settings remain unclear. An important finding by Jawhari et al [ 84 ] illustrates that socially constructed stigmas associated culturally with certain diseases can impact the acceptance and effective use of open-source EHRs in slums and other urban-poor settings, where some patients use multiple identities or show resistance to their data being recorded electronically. Resistance from patients may be related to “general mistrust of systems that might track identities” [ 84 ], as often these individuals reside in insecure tenures and lack rights and legal status. These issues are perceived to be influenced simultaneously by the technological barriers , such as poor patient-centered design and data privacy and confidentiality issues, and organizational barriers , such as lack of trust, communication issues, limited funds for context-specific implementations, and maintenance support [ 68 ].

Technological Barriers Impacting Open-Source EHR Adaptation and Implementation

Our review suggests that technological barriers include power outages, network failure, interoperability, hardware suitability, data privacy, and system sustainability [ 9 , 68 , 83 , 100 ]. Data security, privacy, and confidentiality issues emerged as a critical need in terms of addressing adequate security features before adaptation and implementation, with concerns that patient data are too broadly accessible to health care professionals not directly involved in a patient’s care [ 21 , 84 , 101 ].

Several studies [ 9 , 21 , 24 , 28 , 44 , 84 , 100 , 101 , 103 , 104 ] reported on the limited interoperability of their open-source EHRs with legacy health systems and how that can hinder successful adaptations and implementations. These are additionally influenced by socioenvironmental (lack of resources and stakeholder intervention) and organizational (lack of expertise and finance) barriers [ 68 ]. Unreliable infrastructure at local and regional levels is perceived to be a major challenge encountered in urban and rural settings, often because of limited funding, poor stakeholder intervention, and limitations of key resources [ 83 , 101 ], issues that are perceived to be influenced by socioenvironmental and organizational barriers. Moreover, there is little information on how implementers address the identified challenges responsively.

Organizational Barriers Impacting Open-Source EHR Adaptation and Implementation

There are broad issues, particularly relating to the management of organizations and human resources, that are categorized within the organizational barriers theme. For example, finance, human resource development, strategic planning, change management, data ownership, social cohesion, trust, and ethical practice influence open-source EHR adaptation and implementation in LMICs. The ethical issues intersect across multiple perspectives. From an organizational perspective, ethical issues comprise ownership, trust, management, and organizational culture [ 9 , 21 , 101 ]. From a technological perspective, ethical issues raise concerns for data privacy and confidentiality, protection, and infrastructure [ 24 , 100 ]. From a socioenvironmental perspective, the ethical issues emphasize sustainability and context, stakeholder intervention, and socioeconomic factors [ 68 , 84 ].

Several studies identified hybrid interventions where open-source EHR systems were used alongside paper processes and described how this approach appeared to impede successful adaptations and implementations [ 28 , 44 , 84 , 100 ]. This may be interpreted in terms of inadequate stakeholder intervention, unreliable local and regional infrastructure, lack of proficiency and training, and inherent habits impeding open-source EHR adaptation and implementation [ 68 , 84 , 104 ]. The practice of such hybrid interventions lowers the true value of open-source EHR success and constructs a dysfunctional organizational environment in LMIC settings, overburdening staff, increasing workload pressure, hindering morale, and influencing resistance to change [ 28 , 83 , 100 ]. Furthermore, there is limited information on how exactly open-source EHR systems are adapted and implemented in LMICs and the roles of implementers in the implementation process.

From a socioenvironmental and technological perspective, finance can be seen as an important factor for resources and sustainability. However, from an organizational perspective, finance is perceived to be a major challenge that impacts the adaptation and implementation of open-source EHR systems in LMICs. This can be observed in terms of the inability to source proficient software developers and IT providers, inadequate staff training and support, limited funding from potential stakeholders, and overreliance on funders [ 9 , 44 , 101 ]. The lack of adequate training and support from stakeholders, such as implementers, developers, IT providers, funders, and government, can adversely influence open-source EHR ownership [ 21 , 83 ]. This is understood in terms of inefficient organizational responsibility of system management, quality data, and conflicting stakeholder relations: the lack of leadership, inability to take responsibility, risking patient data, raising confidentiality concerns, poor communication, and trust leading to an insecure organizational environment [ 28 , 68 , 84 , 100 ]. End users report a lack of leadership, motivation, and communication and suggest the need for a reliable organizational culture and human resources that provide adequate support and training [ 101 ].

Principal Findings

This scoping review revealed thematic sets of socioenvironmental, technological, and organizational barriers to the adaptation and implementation of open-source EHR systems in LMICs. Specific issues, which were mentioned often, include organizational and management, limited funding, local and regional infrastructure, data privacy, confidentiality and protection, ownership, and sustainability, which appear to influence the adaptation and implementation of open-source EHRs in LMICs [ 9 , 21 , 83 , 101 ]. From an organizational and management perspective, data protection and confidentiality, ownership, and ethics emerge as important issues that are context dependent. The process of implementation is a key topic to explore because it is an issue often overshadowed by technical processes, with less emphasis on the social perspective [ 30 , 31 , 40 , 68 ], which requires the application of a relational lens to gain an in-depth understanding [ 108 ]. There is a need for a holistic understanding to explore how implementing organizations in LMIC settings addresses socioenvironmental, technical, and organizational barriers.

This scoping review shows that shortfalls in funding, leadership, and organizational and human resources also give rise to serious data protection and confidentiality issues [ 44 , 68 , 84 , 101 ]. It has been argued that there is a need for implementing organizations to develop self-sufficiency and take responsibility for data protection and ownership, establish local support and training initiatives, and build relations with key stakeholders for long-term sustainability [ 102 , 104 ]. This notion shows that implementing organizations could better engage with key stakeholders and develop better ethical practices in terms of taking responsibility, managing organizational culture, and implementing change responsibly. Furthermore, the adaptation and implementation of open-source EHR systems can be supported through collaborative actions such as ensuring local sites are sufficiently equipped with access to power, considering data protection and confidentiality, ensuring that networks and workstations are integrated efficiently, and considering alternative measures in case of emergencies [ 21 , 28 , 84 ]. Nevertheless, strategic and agile organizational planning are also perceived as essential for successful implementations in LMICs.

There is a need to examine the given context; encourage meaningful change; involve end users such as clinicians, health facility administrators, and patients in implementation design; and collaborate with a diverse range of stakeholders cohesively for successful implementations [ 21 , 68 , 84 , 101 ]. Key stakeholders, particularly government, need to collaborate, support, and develop sustainable context-specific open-source EHR implementations that offer robust functionality. Unreliable technical infrastructure at the local and regional levels can have negative implications for open-source EHR adaptations and implementations in LMICs. Open-source EHR systems can enable better health care access, have a positive impact on medical record quality, and enhance the potential of patient care [ 23 , 77 ]. However, the challenge with adapting and implementing open-source EHR systems is finding local expertise, technical skills, and sophisticated support for implementation and maintenance, which are key ingredients needed to make it work meaningfully in LMIC settings [ 4 , 15 , 17 , 83 ]. Therefore, there is a disconnect between the understanding of the context-specific barriers, the implementation process, and stakeholder relations.

These findings show that, depending on the thematic perspective adopted, different issues stand out. Each of the 3 perspectives brings into view some issues and obscures others. Hence, a holistic view, inclusive of all 3 perspectives, is needed to better understand the implementation process and how challenges are addressed locally. Context-specific barriers and issues in open-source EHR implementations can be better understood through the voices of key stakeholders (implementers and end users) on the ground [ 21 , 68 , 83 , 101 , 106 ].

Some challenges need to be addressed systematically, such as considering the socioenvironmental and organizational perspectives, understanding change from a reflexive perspective, conducting responsible operations, integrating values, and including stakeholders in design before adapting and implementing open-source EHR systems in LMICs [ 84 , 103 ]. For example, Oza et al [ 28 ] highlight that adapting and implementing an open-source EHR system during a health emergency, the Ebola outbreak, was a major problem as the outbreak (fortunately) started to decline, which limited the usefulness of the system (postimplementation) in a resource-scarce environment. Furthermore, designing open-source EHR systems while epidemic cases are increasing is not a sustainable action; intervention needs to be planned earlier and in retrospect to address the true value of what open-source EHR systems can offer in health emergencies [ 28 ]. This perception shows that different socioenvironmental barriers to adaptation and implementation can arise, depending on the situation. The findings indicate that understanding and collectively addressing the perceived contextual barriers in LMICs before implementation is of paramount importance. There is a gap in our understanding of how open-source EHR systems are implemented and the importance of implementers in the implementation process.

Literature, which was not included in the study selection but was considered useful, provided supplementary information. For example, it indicates the presence of a wider discourse on how stakeholders need to reflect on ownership, data confidentiality, protection of information, patient dignity, and addressing unethical operations [ 15 , 30 , 37 , 39 , 63 ]. Were and Meslin [ 31 ] contend that many ethical frameworks exist (relating to issues of research ethics); however, there are no such frameworks that evaluate how well open-source EHR implementations address ethical issues in LMIC settings. While the level of discussion in high-income countries focuses on “privacy, confidentiality, data security, informed consent, data ownership, and secondary use of data” [ 31 ], little research has been conducted to address similar ethical issues existing with open-source EHR implementations in LMICs. Therefore, if the open-source EHR implementation process is better understood, it could help implementers address implementation readiness issues effectively and improve outcomes for LMICs.

There is also the issue of being responsible and accountable for data quality and negotiating during implementation. This points to the broader issue of whether responsibility is socially assumed or coconstructed. Manders-Huits [ 40 ] highlights that “[health] technologies can promote or undermine specific human values...technology shapes our practices and institutions in important ways.” This shows that developers and implementers, as key stakeholders, have a level of responsibility in acting purposefully in a role to embed human values and ethical considerations within open-source EHR system adaptations and implementations. There is potential for research to explore the roles of local implementing organizations that play a fundamental role in adopting open-source EHRs on the ground.

The findings in this review highlight that more funding is required to achieve better EHR implementation readiness in LMIC settings [ 9 , 68 , 84 , 101 ]. There are several eHealth readiness assessment (eHRA) frameworks and related tools within the existing literature that have identified 8 readiness types: organizational, technology and infrastructure, health care providers, engagement, social, core, government, and public or patient [ 109 - 111 ]. The 3 thematic barriers and the subcategories identified in Textbox 2 resonate with some aspects of the 8 eHRA types. However, existing eHRA frameworks are found to be inadequate to support implementation readiness in the context of LMIC settings [ 112 - 114 ]. It is key to better understand the implementation process from a holistic perspective. There are limitations when one looks at adaptation and implementation from one of the 3 perspectives (socioenvironmental, technological, and organizational barriers). Hence, implementation needs to be clearly understood holistically, through implementers’ perspectives, to better navigate barriers encountered in LMICs.

Strengths and Limitations

The results of this review may be limited because only studies published in English were included, and hence, they are subject to cultural selection bias. Nevertheless, no other restrictions were placed on the study design or the publication format to maximize the search results. The identified key search terms, LMIC, open source, EHR, and adaptation and implementation, were defined before the search to ensure consistency across the range of databases. In addition, using an inclusion and exclusion algorithm to screen titles, abstracts, and full-text reviews helped to ensure consistency. This scoping review identified a small number of helpful studies exploring the contextual barriers impacting open-source EHR implementations in LMICs. However, existing research does not examine how implementers understand and navigate the implementation process more closely and how they respond to barriers in a given context. Therefore, the identified opportunity in the literature highlights a need to conduct further research in this area.

We acknowledge that the use of picture archiving and communication systems in LMIC settings could be a useful area for future research. Furthermore, research opportunities could explore the acceptability of international standards and compare alternatives such as Health Level Seven, Fast Health care Interoperability Resources, and Digital Imaging and Communications in Medicine in LMIC settings. The comparison of open-source EHRs with web applications and mobile apps or focusing evaluation research is also a useful direction for future research.

Conclusions

Open-source EHRs have the potential to facilitate enhanced health care and encourage sustainable development in LMICs, where designed effectively and responsibly within country-specific requirements. This scoping review provides an overview of the contextual barriers impacting the adaptation and implementation of open-source EHR systems in LMIC settings. It shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. Each of the 3 perspectives (socioenvironmental, technological, and organizational) draws attention to key implementation issues and highlights the important role implementers may play in addressing these issues. However, by itself, none of these 3 perspectives enable us to appreciate more fully the many interlocking challenges associated with implementing open-source EHRs in LMIC settings.

It is vital to consider the more specific context in which open-source EHRs are to be adopted and to address the need for effective implementation through a better understanding and collaboration with all stakeholders. A lack of empirical evidence limits our understanding of how exactly open-source EHR systems are adapted and implemented. Research is required to explore the roles of local implementing organizations in addressing implementation barriers in LMIC settings. A holistic understanding of implementers’ experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline. We hope that the review results will inform areas for future research and enhance implementation.

Acknowledgments

The authors acknowledge and appreciate the support from the OpenMRS community and Dr Hamish Fraser, who provided an opportunity to present and discuss the preliminary findings of this review at the 2019 OpenMRS Implementers’ Conference (December 6, 2019) in Maputo, Mozambique.

Data Availability

All data generated or analyzed during this study are included in this published article.

Conflicts of Interest

None declared.

Identification of the key terms and synonyms using the population, intervention, and outcome framework.

Search terms and search strategy for the scoping review.

List of low- and lower middle–income countries.

The inclusion and exclusion algorithm for screening articles.

Characteristics of the included studies.

Quality assessment tools table.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

• Puchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, et al. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol. Aug 2016;76:229-237. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Shuvo T, Islam R, Hossain S, Evans JL, Khatun F, Ahmed T, et al. eHealth innovations in LMICs of Africa and Asia: a literature review exploring factors affecting implementation, scale-up, and sustainability. Innov Entrep Health. Oct 2015;2:95-106. [ FREE Full text ] [ CrossRef ]
• World Bank country and lending groups. World Bank. URL: https:/​/datahelpdesk.​worldbank.org/​knowledgebase/​articles/​906519-world-bank-country-and-lending-groups [accessed 2021-09-01]
• Jawhari B, Ludwick D, Keenan L, Zakus D, Hayward R. Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review. BMC Med Inform Decis Mak. Sep 06, 2016;16(1):116. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mbuthia D, Molyneux S, Njue M, Mwalukore S, Marsh V. Kenyan health stakeholder views on individual consent, general notification and governance processes for the re-use of hospital inpatient data to support learning on healthcare systems. BMC Med Ethics. Jan 08, 2019;20(1):3. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Indicators of urban poor communities and their accessibility. The United Nations Human Settlements Programme (UN-Habitat). 2015. URL: https://unhabitat.org/indicators-of-urban-poor-communities-and-their-accessibility [accessed 2024-04-29]
• Mahabir R, Crooks A, Croitoru A, Agouris P. The study of slums as social and physical constructs: challenges and emerging research opportunities. Reg Stud Reg Sci. Sep 22, 2016;3(1):399-419. [ CrossRef ]
• Lilford RJ, Oyebode O, Satterthwaite D, Melendez-Torres GJ, Chen YF, Mberu B, et al. Improving the health and welfare of people who live in slums. Lancet. Feb 04, 2017;389(10068):559-570. [ CrossRef ] [ Medline ]
• Mohammed-Rajput NA, Smith DC, Mamlin B, Biondich P, Doebbeling BN, Open MRS Collaborative Investigators. OpenMRS, a global medical records system collaborative: factors influencing successful implementation. AMIA Annu Symp Proc. 2011;2011:960-968. [ FREE Full text ] [ Medline ]
• Ellis JA. Leveraging mobile phones for monitoring risks for noncommunicable diseases in the future. J Med Internet Res. May 05, 2017;19(5):e137. [ FREE Full text ] [ CrossRef ] [ Medline ]
• McMaster D, Clare G. Designing a mobile eye hospital to support health systems in resource-scarce environments. Disaster Med Public Health Prep. Aug 14, 2022;16(4):1618-1622. [ CrossRef ] [ Medline ]
• Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH. Poverty and access to health care in developing countries. Ann N Y Acad Sci. 2008;1136:161-171. [ CrossRef ] [ Medline ]
• Gibson DG, Pariyo GW, Wosu AC, Greenleaf AR, Ali J, Ahmed S, et al. Evaluation of mechanisms to improve performance of mobile phone surveys in low- and middle-income countries: research protocol. JMIR Res Protoc. May 05, 2017;6(5):e81. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Stallman R. ViewpointWhy "open source" misses the point of free software. Commun ACM. Jun 2009;52(6):31-33. [ CrossRef ]
• Reynolds CJ, Wyatt JC. Open source, open standards, and health care information systems. J Med Internet Res. Feb 17, 2011;13(1):e24. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Dhir S, Dhir S. Adoption of open‐source software versus proprietary software: an exploratory study. Strateg Change. Jul 24, 2017;26(4):363-371. [ CrossRef ]
• Blaya J, Otzoy D. Buy, build, or adapt – how to decide? A guide to open source electronic health records (EHRs). Inter-American Development Bank. 2019. URL: https://socialdigital.iadb.org/en/sph/resources/research-publications/838 [accessed 2024-04-29]
• Maglogiannis I. Towards the adoption of open source and open access electronic health record systems. J Healthc Eng. Jan 2000;3(1):141-161. [ CrossRef ]
• Coiera E. Guide to Health Informatics, 3rd Edition. Boca Raton, FL. CRC Press; 2015.
• Atherton J. Development of the electronic health record. Virtual Mentor. Mar 01, 2011;13(3):186-189. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Muinga N, Magare S, Monda J, Kamau O, Houston S, Fraser HS, et al. Implementing an open source electronic health record system in Kenyan health care facilities: case study. JMIR Med Inform. Apr 18, 2018;6(2):e22. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Fraser HS, Blaya J. Implementing medical information systems in developing countries, what works and what doesn't. AMIA Annu Symp Proc. Nov 13, 2010;2010:232-236. [ FREE Full text ] [ Medline ]
• Blaya JA, Fraser HS, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). Feb 2010;29(2):244-251. [ CrossRef ] [ Medline ]
• Syzdykova A, Malta A, Zolfo M, Diro E, Oliveira JL. Open-source electronic health record systems for low-resource settings: systematic review. JMIR Med Inform. Nov 13, 2017;5(4):e44. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mamlin BW, Biondich PG, Wolfe BA, Fraser HS, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2006;2006:529-533. [ FREE Full text ] [ Medline ]
• Dinesen B, Nonnecke B, Lindeman D, Toft E, Kidholm K, Jethwani K, et al. Personalized telehealth in the future: a global research agenda. J Med Internet Res. Mar 01, 2016;18(3):e53. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Williams F, Boren SA. The role of electronic medical record in care delivery in developing countries. Int J Inf Manage. Dec 2008;28(6):503-507. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Oza S, Jazayeri D, Teich JM, Ball E, Nankubuge PA, Rwebembera J, et al. Development and deployment of the OpenMRS-Ebola electronic health record system for an Ebola treatment center in Sierra Leone. J Med Internet Res. Aug 21, 2017;19(8):e294. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Grodzinsky FS, Miller K, Wolf MJ. Ethical issues in open source software. J Inf Commun Ethics Soc. 2003;1(4):193-205. [ CrossRef ]
• Spriggs M, Arnold MV, Pearce CM, Fry C. Ethical questions must be considered for electronic health records. J Med Ethics. Sep 2012;38(9):535-539. [ CrossRef ] [ Medline ]
• Were MC, Meslin EM. Ethics of implementing electronic health records in developing countries: points to consider. AMIA Annu Symp Proc. 2011;2011:1499-1505. [ FREE Full text ] [ Medline ]
• About the sustainable development goals. United Nations. 2019. URL: https://www.un.org/sustainabledevelopment/sustainable-development-goals/ [accessed 2024-04-29]
• National eHealth strategy toolkit. World Health Organization and International Telecommunication Union. 2012. URL: https://apps.who.int/iris/bitstream/handle/10665/75211/9789241548465_eng.pdf?sequence=1&isAllowed=y [accessed 2024-04-29]
• Patient engagement: technical series on safer primary care. World Health Organization. 2016. URL: https://www.who.int/publications/i/item/9789241511629 [accessed 2024-04-29]
• Electronic health records: manual for developing countries. World Health Organization. 2006. URL: https://apps.who.int/iris/bitstream/handle/10665/207504/9290612177_eng.pdf?sequence=1&isAllowed=y [accessed 2024-04-29]
• Ross J, Stevenson F, Lau R, Murray E. Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update). Implement Sci. Oct 26, 2016;11(1):146. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Barrows RC, Clayton PD. Privacy, confidentiality, and electronic medical records. J Am Med Inform Assoc. Mar 01, 1996;3(2):139-148. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Amato F, Mazzocca N, De Pietro G, Esposito M. A system for semantic-based access control. In: Proceedings of the 2013 Eighth International Conference on P2P, Parallel, Grid, Cloud and Internet Computing. 2013. Presented at: 3PGCIC '13; October 28-30, 2013:442-446; Compiegne, France. URL: https://ieeexplore.ieee.org/document/6681268 [ CrossRef ]
• Evans RS. Electronic health records: then, now, and in the future. Yearb Med Inform. Mar 06, 2018;25(S 01):S48-S61. [ CrossRef ]
• Manders-Huits N. What values in design? The challenge of incorporating moral values into design. Sci Eng Ethics. Jun 12, 2011;17(2):271-287. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Webster PC. The rise of open-source electronic health records. Lancet. May 14, 2011;377(9778):1641-1642. [ CrossRef ] [ Medline ]
• The open source definition (annotated). Opensource. 2007. URL: https://opensource.org/osd.html [accessed 2021-09-10]
• Cowan C. Software security for open-source systems. IEEE Secur Privacy. Jan 2003;1(1):38-45. [ CrossRef ]
• Akanbi MO, Ocheke AN, Agaba PA, Daniyam CA, Agaba EI, Okeke EN, et al. Use of electronic health records in sub-Saharan Africa: progress and challenges. J Med Trop. 2012;14(1):1-6. [ FREE Full text ] [ Medline ]
• Curto-Millet D, Shaikh M. The emergence of openness in open-source projects: the case of OpenEhR. J Inf Technol. Dec 01, 2017;32(4):361-379. [ CrossRef ]
• Raymond E. The cathedral and the bazaar. Knowl Technol Policy. Sep 1999;12(3):23-49. [ CrossRef ]
• What is OpenELIS global? OpenELIS. 2021. URL: https://openelis-global.org/about/ [accessed 2021-10-22]
• About DHIS2. DHIS2. URL: https://dhis2.org/about/ [accessed 2021-10-22]
• Welcome to GNU health! GNU Health. 2020. URL: https://www.gnuhealth.org/about-us.html [accessed 2021-10-22]
• OpenMRS releases 2015 annual report. OpenMRS Inc. 2015. URL: https://openmrs.org/openmrs-releases-2015-annual-report/ [accessed 2024-04-29]
• Seebregts CJ, Mamlin BW, Biondich PG, Fraser HS, Wolfe BA, Jazayeri D, et al. OpenMRS Implementers Network. The OpenMRS implementers network. Int J Med Inform. Nov 2009;78(11):711-720. [ CrossRef ] [ Medline ]
• Open medical record system. OpenMRS Inc. URL: https://openmrs.org [accessed 2021-08-20]
• Introduction to OpenMRS. OpenMRS Wiki. 2021. URL: https://wiki.openmrs.org/display/docs/Introduction+to+OpenMRS [accessed 2024-04-29]
• Atlas. Where we are: OpenMRS Atlas. OpenMRS Inc. 2022. URL: https://atlas.openmrs.org/ [accessed 2022-01-21]
• Introduction: what is OpenMRS 3? OpenMRS Wiki. URL: https:/​/wiki.​openmrs.org/​display/​projects/​Designer+Onboarding+to+OpenMRS+3#DesignerOnboardingtoOpenMRS3-VisualHistoryoftheOpenMRSFrontend [accessed 2022-04-18]
• Who we are: OpenMRS community. OpenMRS Inc. URL: https://openmrs.org/who-we-are/ [accessed 2022-01-21]
• OpenMRS community. OpenMRS Inc. 2022. URL: https://wiki.openmrs.org/display/RES/OpenMRS+Community [accessed 2024-04-29]
• Guide for the new and curious. OpenMRS Inc. URL: https://wiki.openmrs.org/display/docs/Guide+for+the+New+and+Curious [accessed 2022-04-22]
• Thengo L. “write code! save lives!”. Medium. URL: https://medium.com/amplify/write-code-save-lives-784a3a6abd09 [accessed 2024-04-29]
• McDonald CJ, Schadow G, Barnes M, Dexter P, Overhage JM, Mamlin B, et al. Open source software in medical informatics--why, how and what. Int J Med Inform. Mar 2003;69(2-3):175-184. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Alsaffar M, Yellowlees P, Odor A, Hogarth M. The state of open source electronic health record projects: a software anthropology study. JMIR Med Inform. Feb 24, 2017;5(1):e6. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bagayoko CO, Dufour JC, Chaacho S, Bouhaddou O, Fieschi M. Open source challenges for hospital information system (HIS) in developing countries: a pilot project in Mali. BMC Med Inform Decis Mak. Apr 16, 2010;10(1):22. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Flores Zuniga AE, Win KT, Susilo W. Functionalities of free and open electronic health record systems. Int J Technol Assess Health Care. Oct 2010;26(4):382-389. [ CrossRef ] [ Medline ]
• Fraser HS, Thomas D, Tomaylla J, Garcia N, Lecca L, Murray M, et al. Adaptation of a web-based, open source electronic medical record system platform to support a large study of tuberculosis epidemiology. BMC Med Inform Decis Mak. Nov 07, 2012;12(1):125. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Millard PS, Bru J, Berger CA. Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys. BMJ Open. 2012;2(4):e000690. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Singh A, Bansal R, Jha N. Open source software vs proprietary software. Int J Comput Appl. Mar 18, 2015;114(18):26-31. [ CrossRef ]
• Gropper A. Open-source health care software. Virtual Mentor. Sep 01, 2011;13(9):632-636. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Fish KE, Guha GS. Towards an electronic medical record system for a rural Haitian medical clinic. J Strateg Innov Sustain. Aug 11, 2020;15(4):15-20. [ CrossRef ]
• Boulanger A. Open-source versus proprietary software: is one more reliable and secure than the other? IBM Syst J. 2005;44(2):239-248. [ CrossRef ]
• Aminpour F, Sadoughi F, Ahamdi M. Utilization of open source electronic health record around the world: a systematic review. J Res Med Sci. Jan 2014;19(1):57-64. [ FREE Full text ] [ Medline ]
• Holck J, Larsen MH, Pedersen MK. Managerial and technical barriers to the adoption of open source software. In: Proceedings of the 4th International Conference on COTS-Based Software Systems. 2005. Presented at: ICCBSS '05; February 7-11, 200:289-300; Bilbao, Spain. URL: https://link.springer.com/chapter/10.1007/978-3-540-30587-3_38 [ CrossRef ]
• Brown AW, Booch G. Reusing open-source software and practices: the impact of open-source on commercial vendors. In: Proceedings of the 7th International Conference on Software Reuse: Methods, Techniques, and Tools. 2002. Presented at: ICSR '02; April 15-19, 2002:123-136; Austin, TX. URL: https://link.springer.com/chapter/10.1007/3-540-46020-9_9 [ CrossRef ]
• Canonical and Ubuntu. Ubuntu. 2021. URL: https://ubuntu.com/community/canonical [accessed 2021-09-10]
• Shaw N, Pepper D, Cook T, Houwink P, Jain N, Bainbridge M. Open source and international health informatics: placebo or panacea? J Innov Health Inform. 2002;10(1):39-43. [ CrossRef ]
• Edwards K. Epistemic communities, situated learning and open source software development. In: Proceedings from the 2001 Conference on Epistemic Cultures and the Practice of Interdisciplinarity. 2001. Presented at: ECPI '01; January 1-4, 2001:1-33; Trondheim, Norway. URL: https://backend.orbit.dtu.dk/ws/portalfiles/portal/2976336/Epistemic_com_Sit_Learn+and+OSS+v074.pdf
• Jin L, Robey D, Boudreau MC. Beyond development: a research agenda for investigating open source software user communities. Inf Resour Manag J. 2007;20(1):68-80. [ CrossRef ]
• Purkayastha S, Allam R, Maity P, Gichoya JW. Comparison of open-source electronic health record systems based on functional and user performance criteria. Healthc Inform Res. Apr 2019;25(2):89-98. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Allen C, Jazayeri D, Miranda J, Biondich PG, Mamlin BW, Wolfe BA, et al. Experience in implementing the OpenMRS medical record system to support HIV treatment in Rwanda. Stud Health Technol Inform. 2007;129(Pt 1):382-386. [ Medline ]
• Pfadenhauer LM, Mozygemba K, Gerhardus A, Hofmann B, Booth A, Lysdahl KB, et al. Context and implementation: a concept analysis towards conceptual maturity. Z Evid Fortbild Qual Gesundhwes. 2015;109(2):103-114. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Zaidan AA, Zaidan BB, Al-Haiqi A, Kiah ML, Hussain M, Abdulnabi M. Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS. J Biomed Inform. Feb 2015;53:390-404. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Akhlaq A, McKinstry B, Muhammad KB, Sheikh A. Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review. Health Policy Plan. Nov 16, 2016;31(9):1310-1325. [ CrossRef ] [ Medline ]
• Implementer documentation. OpenMRS Inc. 2017. URL: https://wiki.openmrs.org/display/docs/Implementer+Documentation#ImplementerDocumentation-Overview [accessed 2019-07-25]
• Verma N, Mamlin B, Flowers J, Acharya S, Labrique A, Cullen T. OpenMRS as a global good: impact, opportunities, challenges, and lessons learned from fifteen years of implementation. Int J Med Inform. May 2021;149:104405. [ CrossRef ] [ Medline ]
• Jawhari B, Keenan L, Zakus D, Ludwick D, Isaac A, Saleh A, et al. Barriers and facilitators to electronic medical record (EMR) use in an urban slum. Int J Med Inform. Oct 2016;94:246-254. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. Jun 27, 2009;26(2):91-108. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Peterson J, Pearce PF, Ferguson LA, Langford CA. Understanding scoping reviews: definition, purpose, and process. J Am Assoc Nurse Pract. Jan 2017;29(1):12-16. [ CrossRef ] [ Medline ]
• Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. Feb 2005;8(1):19-32. [ CrossRef ]
• Peters M, Mcinerney P, Godfrey CM, Soares CB. Methodology for JBI scoping reviews. In: Micah P, Christina D, Patricia M, Cassia S, Hanan K, Deborah P, editors. The Joanna Briggs Institute Reviewers' Manual 2015: Methodology for JBI Scoping Reviews. Adelaide, Australia. The Joanna Briggs Institute; 2016.
• Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. Sep 20, 2010;5(1):69. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Davis K, Drey N, Gould D. What are scoping studies? A review of the nursing literature. Int J Nurs Stud. Oct 2009;46(10):1386-1400. [ CrossRef ] [ Medline ]
• Gough D, Oliver S, Thomas J. An Introduction to Systematic Reviews. 2nd edition. Thousand Oaks, CA. Sage Publications; 2017.
• Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, et al. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci. Mar 09, 2013;8(1):28. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. Aug 07, 2009;4(1):50. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. Oct 02, 2018;169(7):467-473. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Saldaña J. The Coding Manual for Qualitative Researchers. Thousand Oaks, CA. Sage Publications; 2015.
• Castleberry A, Nolen A. Thematic analysis of qualitative research data: is it as easy as it sounds? Curr Pharm Teach Learn. Jun 2018;10(6):807-815. [ CrossRef ] [ Medline ]
• Pluye P, Hong QN. Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews. Annu Rev Public Health. 2014;35:29-45. [ CrossRef ] [ Medline ]
• Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Department of Family Medicine. Aug 01, 2018. URL: http:/​/mixedmethodsappraisaltoolpublic.​pbworks.com/​w/​file/​fetch/​127916259/​MMAT_2018_criteria-manual_2018-08-01_ENG.​pdf [accessed 2024-04-29]
• Systematic review checklist. Critical Appraisal Skills Programme. 2018. URL: https://casp-uk.b-cdn.net/wp-content/uploads/2018/01/CASP-Systematic-Review-Checklist_2018.pdf [accessed 2021-04-05]
• Gainer A, Roth M, Strong P, Davis J. A standards-based open source application to gather health assessment data in developing countries. In: Proceedings of the 2012 IEEE Global Humanitarian Technology Conference. 2012. Presented at: GHTC '12; October 21-24, 2012:293-298; Seattle, WA. URL: https://ieeexplore.ieee.org/document/6387064 [ CrossRef ]
• Gyamfi A, Mensah KA, Oduro G, Donkor P, Mock CN. Barriers and facilitators to electronic medical records usage in the emergency centre at Komfo anokye teaching hospital, Kumasi-Ghana. Afr J Emerg Med. Dec 2017;7(4):177-182. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Were MC, Emenyonu N, Achieng M, Shen C, Ssali J, Masaba JP, et al. Evaluating a scalable model for implementing electronic health records in resource-limited settings. J Am Med Inform Assoc. 2010;17(3):237-244. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Anantraman V, Mikkelsen T, Khilnani R, Kumar VS, Pentland A, Ohno-Machado L. Open source handheld-based EMR for paramedics working in rural areas. Proc AMIA Symp. 2002:12-16. [ FREE Full text ] [ Medline ]
• Raut A, Yarbrough C, Singh V, Gauchan B, Citrin D, Verma V, et al. Design and implementation of an affordable, public sector electronic medical record in rural Nepal. J Innov Health Inform. Jun 23, 2017;24(2):862. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hawari AA, Heeks R. Explaining ERP failure in a developing country: a Jordanian case study. J Enterp Inf Manag. 2010;23(2):135-160. [ FREE Full text ] [ CrossRef ]
• Odekunle FF, Odekunle RO, Shankar S. Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. Int J Health Sci (Qassim). 2017;11(4):59-64. [ FREE Full text ] [ Medline ]
• Heeks R. Health information systems: failure, success and improvisation. Int J Med Inform. Feb 2006;75(2):125-137. [ CrossRef ] [ Medline ]
• Dépelteau F. The Palgrave Handbook of Relational Sociology. Cham, Switzerland. Springer; 2018.
• Khoja S, Scott RE, Casebeer AL, Mohsin M, Ishaq AF, Gilani S. e-Health readiness assessment tools for healthcare institutions in developing countries. Telemed J E Health. Aug 2007;13(4):425-431. [ CrossRef ] [ Medline ]
• Rezai-Rad M, Vaezi R, Nattagh F. E-health readiness assessment framework in iran. Iran J Public Health. 2012;41(10):43-51. [ FREE Full text ] [ Medline ]
• Mauco KL, Scott RE, Mars M. Critical analysis of e-health readiness assessment frameworks: suitability for application in developing countries. J Telemed Telecare. Feb 2018;24(2):110-117. [ CrossRef ] [ Medline ]
• Oliver DR, Demiris G. An assessment of the readiness of hospice organizations to accept technological innovation. J Telemed Telecare. 2004;10(3):170-174. [ CrossRef ] [ Medline ]
• Yusif S, Hafeez-Baig A, Soar J. e-Health readiness assessment factors and measuring tools: a systematic review. Int J Med Inform. Nov 2017;107:56-64. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mauco KL, Scott RE, Mars M. Development of an eHealth readiness assessment framework for Botswana and other developing countries: interview study. JMIR Med Inform. Aug 22, 2019;7(3):e12949. [ FREE Full text ] [ CrossRef ] [ Medline ]

Abbreviations

Edited by A Mavragani; submitted 21.12.22; peer-reviewed by Y Chu, M Mars, I Mircheva; comments to author 06.03.23; revised version received 29.09.23; accepted 09.02.24; published 01.08.24.

©Sarah Bostan, Owen A Johnson, Lena J Jaspersen, Rebecca Randell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.08.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.