literature review method of research

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.

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

Prevent plagiarism. Run a free check.

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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 June 18, 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”

Methodological Approaches to Literature Review

• Living reference work entry
• First Online: 09 May 2023
• Cite this living reference work entry

• Dennis Thomas 2 ,
• Elida Zairina 3 &
• Johnson George 4  

589 Accesses

1 Citations

The literature review can serve various functions in the contexts of education and research. It aids in identifying knowledge gaps, informing research methodology, and developing a theoretical framework during the planning stages of a research study or project, as well as reporting of review findings in the context of the existing literature. This chapter discusses the methodological approaches to conducting a literature review and offers an overview of different types of reviews. There are various types of reviews, including narrative reviews, scoping reviews, and systematic reviews with reporting strategies such as meta-analysis and meta-synthesis. Review authors should consider the scope of the literature review when selecting a type and method. Being focused is essential for a successful review; however, this must be balanced against the relevance of the review to a broad audience.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Similar content being viewed by others

Reviewing Literature for and as Research

Discussion and Conclusion

Systematic Reviews in Educational Research: Methodology, Perspectives and Application

Akobeng AK. Principles of evidence based medicine. Arch Dis Child. 2005;90(8):837–40.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Alharbi A, Stevenson M. Refining Boolean queries to identify relevant studies for systematic review updates. J Am Med Inform Assoc. 2020;27(11):1658–66.

Article   PubMed   PubMed Central   Google Scholar  

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

Article   Google Scholar  

Aromataris E MZE. JBI manual for evidence synthesis. 2020.

Google Scholar  

Aromataris E, Pearson A. The systematic review: an overview. Am J Nurs. 2014;114(3):53–8.

Article   PubMed   Google Scholar  

Aromataris E, Riitano D. Constructing a search strategy and searching for evidence. A guide to the literature search for a systematic review. Am J Nurs. 2014;114(5):49–56.

Babineau J. Product review: covidence (systematic review software). J Canad Health Libr Assoc Canada. 2014;35(2):68–71.

Baker JD. The purpose, process, and methods of writing a literature review. AORN J. 2016;103(3):265–9.

Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010;7(9):e1000326.

Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):1–12.

Brown D. A review of the PubMed PICO tool: using evidence-based practice in health education. Health Promot Pract. 2020;21(4):496–8.

Cargo M, Harris J, Pantoja T, et al. Cochrane qualitative and implementation methods group guidance series – paper 4: methods for assessing evidence on intervention implementation. J Clin Epidemiol. 2018;97:59–69.

Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med. 1997;126(5):376–80.

Article   CAS   PubMed   Google Scholar  

Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med. 1997;127(5):380–7.

Cummings SR, Browner WS, Hulley SB. Conceiving the research question and developing the study plan. In: Cummings SR, Browner WS, Hulley SB, editors. Designing Clinical Research: An Epidemiological Approach. 4th ed. Philadelphia (PA): P Lippincott Williams & Wilkins; 2007. p. 14–22.

Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. JMLA. 2018;106(4):420.

Ferrari R. Writing narrative style literature reviews. Medical Writing. 2015;24(4):230–5.

Flemming K, Booth A, Hannes K, Cargo M, Noyes J. Cochrane qualitative and implementation methods group guidance series – paper 6: reporting guidelines for qualitative, implementation, and process evaluation evidence syntheses. J Clin Epidemiol. 2018;97:79–85.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J. 2009;26(2):91–108.

Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med. 2006;5(3):101–17.

Gregory AT, Denniss AR. An introduction to writing narrative and systematic reviews; tasks, tips and traps for aspiring authors. Heart Lung Circ. 2018;27(7):893–8.

Harden A, Thomas J, Cargo M, et al. Cochrane qualitative and implementation methods group guidance series – paper 5: methods for integrating qualitative and implementation evidence within intervention effectiveness reviews. J Clin Epidemiol. 2018;97:70–8.

Harris JL, Booth A, Cargo M, et al. Cochrane qualitative and implementation methods group guidance series – paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis. J Clin Epidemiol. 2018;97:39–48.

Higgins J, Thomas J. In: Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.3, updated February 2022). Available from www.training.cochrane.org/handbook.: Cochrane; 2022.

International prospective register of systematic reviews (PROSPERO). Available from https://www.crd.york.ac.uk/prospero/ .

Khan KS, Kunz R, Kleijnen J, Antes G. Five steps to conducting a systematic review. J R Soc Med. 2003;96(3):118–21.

Landhuis E. Scientific literature: information overload. Nature. 2016;535(7612):457–8.

Lockwood C, Porritt K, Munn Z, Rittenmeyer L, Salmond S, Bjerrum M, Loveday H, Carrier J, Stannard D. Chapter 2: Systematic reviews of qualitative evidence. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. Available from https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-03 .

Chapter   Google Scholar  

Lorenzetti DL, Topfer L-A, Dennett L, Clement F. Value of databases other than medline for rapid health technology assessments. Int J Technol Assess Health Care. 2014;30(2):173–8.

Moher D, Liberati A, Tetzlaff J, Altman DG, the PRISMA Group. Preferred reporting items for (SR) and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;6:264–9.

Mulrow CD. Systematic reviews: rationale for systematic reviews. BMJ. 1994;309(6954):597–9.

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(1):143.

Munthe-Kaas HM, Glenton C, Booth A, Noyes J, Lewin S. Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool. BMC Med Res Methodol. 2019;19(1):1–13.

Murphy CM. Writing an effective review article. J Med Toxicol. 2012;8(2):89–90.

NHMRC. Guidelines for guidelines: assessing risk of bias. Available at https://nhmrc.gov.au/guidelinesforguidelines/develop/assessing-risk-bias . Last published 29 August 2019. Accessed 29 Aug 2022.

Noyes J, Booth A, Cargo M, et al. Cochrane qualitative and implementation methods group guidance series – paper 1: introduction. J Clin Epidemiol. 2018b;97:35–8.

Noyes J, Booth A, Flemming K, et al. Cochrane qualitative and implementation methods group guidance series – paper 3: methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings. J Clin Epidemiol. 2018a;97:49–58.

Noyes J, Booth A, Moore G, Flemming K, Tunçalp Ö, Shakibazadeh E. Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods. BMJ Glob Health. 2019;4(Suppl 1):e000893.

Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Healthcare. 2015;13(3):141–6.

Polanin JR, Pigott TD, Espelage DL, Grotpeter JK. Best practice guidelines for abstract screening large-evidence systematic reviews and meta-analyses. Res Synth Methods. 2019;10(3):330–42.

Article   PubMed Central   Google Scholar  

Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7(1):1–7.

Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. Brit Med J. 2017;358

Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Br Med J. 2016;355

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008–12.

Tawfik GM, Dila KAS, Mohamed MYF, et al. A step by step guide for conducting a systematic review and meta-analysis with simulation data. Trop Med Health. 2019;47(1):1–9.

The Critical Appraisal Program. Critical appraisal skills program. Available at https://casp-uk.net/ . 2022. Accessed 29 Aug 2022.

The University of Melbourne. Writing a literature review in Research Techniques 2022. Available at https://students.unimelb.edu.au/academic-skills/explore-our-resources/research-techniques/reviewing-the-literature . Accessed 29 Aug 2022.

The Writing Center University of Winconsin-Madison. Learn how to write a literature review in The Writer’s Handbook – Academic Professional Writing. 2022. Available at https://writing.wisc.edu/handbook/assignments/reviewofliterature/ . Accessed 29 Aug 2022.

Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med. 1999;18(20):2693–708.

Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16(1):15.

Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.

Yoneoka D, Henmi M. Clinical heterogeneity in random-effect meta-analysis: between-study boundary estimate problem. Stat Med. 2019;38(21):4131–45.

Yuan Y, Hunt RH. Systematic reviews: the good, the bad, and the ugly. Am J Gastroenterol. 2009;104(5):1086–92.

Download references

Author information

Authors and affiliations.

Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW, Australia

Dennis Thomas

Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia

Elida Zairina

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia

Johnson George

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Johnson George .

Section Editor information

College of Pharmacy, Qatar University, Doha, Qatar

Derek Charles Stewart

Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom

Zaheer-Ud-Din Babar

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Cite this entry.

Thomas, D., Zairina, E., George, J. (2023). Methodological Approaches to Literature Review. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_57-1

Download citation

DOI : https://doi.org/10.1007/978-3-030-50247-8_57-1

Received : 22 February 2023

Accepted : 22 February 2023

Published : 09 May 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-030-50247-8

Online ISBN : 978-3-030-50247-8

eBook Packages : Springer Reference Biomedicine and Life Sciences Reference Module Biomedical and Life Sciences

• Publish with us

Policies and ethics

• Find a journal
• Track your research

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: Aug 21, 2023 4:07 PM
• URL: https://guides.lib.udel.edu/researchmethods

Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

Libraries | Research Guides

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

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

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

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

• Next: Planning the Review >>
• Last Updated: May 2, 2024 10:39 AM
• URL: https://libguides.northwestern.edu/literaturereviews

• 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

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

How-to conduct a systematic literature review: A quick guide for computer science research

Angela carrera-rivera.

a Faculty of Engineering, Mondragon University

William Ochoa

Felix larrinaga.

b Design Innovation Center(DBZ), Mondragon University

Associated Data

• No data was used for the research described in the article.

Performing a literature review is a critical first step in research to understanding the state-of-the-art and identifying gaps and challenges in the field. A systematic literature review is a method which sets out a series of steps to methodically organize the review. In this paper, we present a guide designed for researchers and in particular early-stage researchers in the computer-science field. The contribution of the article is the following:

• • Clearly defined strategies to follow for a systematic literature review in computer science research, and
• • Algorithmic method to tackle a systematic literature review.

Graphical abstract

Specifications table

Method details

A Systematic Literature Review (SLR) is a research methodology to collect, identify, and critically analyze the available research studies (e.g., articles, conference proceedings, books, dissertations) through a systematic procedure [12] . An SLR updates the reader with current literature about a subject [6] . The goal is to review critical points of current knowledge on a topic about research questions to suggest areas for further examination [5] . Defining an “Initial Idea” or interest in a subject to be studied is the first step before starting the SLR. An early search of the relevant literature can help determine whether the topic is too broad to adequately cover in the time frame and whether it is necessary to narrow the focus. Reading some articles can assist in setting the direction for a formal review., and formulating a potential research question (e.g., how is semantics involved in Industry 4.0?) can further facilitate this process. Once the focus has been established, an SLR can be undertaken to find more specific studies related to the variables in this question. Although there are multiple approaches for performing an SLR ( [5] , [26] , [27] ), this work aims to provide a step-by-step and practical guide while citing useful examples for computer-science research. The methodology presented in this paper comprises two main phases: “Planning” described in section 2, and “Conducting” described in section 3, following the depiction of the graphical abstract.

Defining the protocol is the first step of an SLR since it describes the procedures involved in the review and acts as a log of the activities to be performed. Obtaining opinions from peers while developing the protocol, is encouraged to ensure the review's consistency and validity, and helps identify when modifications are necessary [20] . One final goal of the protocol is to ensure the replicability of the review.

Define PICOC and synonyms

The PICOC (Population, Intervention, Comparison, Outcome, and Context) criteria break down the SLR's objectives into searchable keywords and help formulate research questions [ 27 ]. PICOC is widely used in the medical and social sciences fields to encourage researchers to consider the components of the research questions [14] . Kitchenham & Charters [6] compiled the list of PICOC elements and their corresponding terms in computer science, as presented in Table 1 , which includes keywords derived from the PICOC elements. From that point on, it is essential to think of synonyms or “alike” terms that later can be used for building queries in the selected digital libraries. For instance, the keyword “context awareness” can also be linked to “context-aware”.

Planning Step 1 “Defining PICOC keywords and synonyms”.

Formulate research questions

Clearly defined research question(s) are the key elements which set the focus for study identification and data extraction [21] . These questions are formulated based on the PICOC criteria as presented in the example in Table 2 (PICOC keywords are underlined).

Research questions examples.

Select digital library sources

The validity of a study will depend on the proper selection of a database since it must adequately cover the area under investigation [19] . The Web of Science (WoS) is an international and multidisciplinary tool for accessing literature in science, technology, biomedicine, and other disciplines. Scopus is a database that today indexes 40,562 peer-reviewed journals, compared to 24,831 for WoS. Thus, Scopus is currently the largest existing multidisciplinary database. However, it may also be necessary to include sources relevant to computer science, such as EI Compendex, IEEE Xplore, and ACM. Table 3 compares the area of expertise of a selection of databases.

Planning Step 3 “Select digital libraries”. Description of digital libraries in computer science and software engineering.

Define inclusion and exclusion criteria

Authors should define the inclusion and exclusion criteria before conducting the review to prevent bias, although these can be adjusted later, if necessary. The selection of primary studies will depend on these criteria. Articles are included or excluded in this first selection based on abstract and primary bibliographic data. When unsure, the article is skimmed to further decide the relevance for the review. Table 4 sets out some criteria types with descriptions and examples.

Planning Step 4 “Define inclusion and exclusion criteria”. Examples of criteria type.

Define the Quality Assessment (QA) checklist

Assessing the quality of an article requires an artifact which describes how to perform a detailed assessment. A typical quality assessment is a checklist that contains multiple factors to evaluate. A numerical scale is used to assess the criteria and quantify the QA [22] . Zhou et al. [25] presented a detailed description of assessment criteria in software engineering, classified into four main aspects of study quality: Reporting, Rigor, Credibility, and Relevance. Each of these criteria can be evaluated using, for instance, a Likert-type scale [17] , as shown in Table 5 . It is essential to select the same scale for all criteria established on the quality assessment.

Planning Step 5 “Define QA assessment checklist”. Examples of QA scales and questions.

Define the “Data Extraction” form

The data extraction form represents the information necessary to answer the research questions established for the review. Synthesizing the articles is a crucial step when conducting research. Ramesh et al. [15] presented a classification scheme for computer science research, based on topics, research methods, and levels of analysis that can be used to categorize the articles selected. Classification methods and fields to consider when conducting a review are presented in Table 6 .

Planning Step 6 “Define data extraction form”. Examples of fields.

The data extraction must be relevant to the research questions, and the relationship to each of the questions should be included in the form. Kitchenham & Charters [6] presented more pertinent data that can be captured, such as conclusions, recommendations, strengths, and weaknesses. Although the data extraction form can be updated if more information is needed, this should be treated with caution since it can be time-consuming. It can therefore be helpful to first have a general background in the research topic to determine better data extraction criteria.

After defining the protocol, conducting the review requires following each of the steps previously described. Using tools can help simplify the performance of this task. Standard tools such as Excel or Google sheets allow multiple researchers to work collaboratively. Another online tool specifically designed for performing SLRs is Parsif.al 1 . This tool allows researchers, especially in the context of software engineering, to define goals and objectives, import articles using BibTeX files, eliminate duplicates, define selection criteria, and generate reports.

Build digital library search strings

Search strings are built considering the PICOC elements and synonyms to execute the search in each database library. A search string should separate the synonyms with the boolean operator OR. In comparison, the PICOC elements are separated with parentheses and the boolean operator AND. An example is presented next:

(“Smart Manufacturing” OR “Digital Manufacturing” OR “Smart Factory”) AND (“Business Process Management” OR “BPEL” OR “BPM” OR “BPMN”) AND (“Semantic Web” OR “Ontology” OR “Semantic” OR “Semantic Web Service”) AND (“Framework” OR “Extension” OR “Plugin” OR “Tool”

Gather studies

Databases that feature advanced searches enable researchers to perform search queries based on titles, abstracts, and keywords, as well as for years or areas of research. Fig. 1 presents the example of an advanced search in Scopus, using titles, abstracts, and keywords (TITLE-ABS-KEY). Most of the databases allow the use of logical operators (i.e., AND, OR). In the example, the search is for “BIG DATA” and “USER EXPERIENCE” or “UX” as a synonym.

Example of Advanced search on Scopus.

In general, bibliometric data of articles can be exported from the databases as a comma-separated-value file (CSV) or BibTeX file, which is helpful for data extraction and quantitative and qualitative analysis. In addition, researchers should take advantage of reference-management software such as Zotero, Mendeley, Endnote, or Jabref, which import bibliographic information onto the software easily.

Study Selection and Refinement

The first step in this stage is to identify any duplicates that appear in the different searches in the selected databases. Some automatic procedures, tools like Excel formulas, or programming languages (i.e., Python) can be convenient here.

In the second step, articles are included or excluded according to the selection criteria, mainly by reading titles and abstracts. Finally, the quality is assessed using the predefined scale. Fig. 2 shows an example of an article QA evaluation in Parsif.al, using a simple scale. In this scenario, the scoring procedure is the following YES= 1, PARTIALLY= 0.5, and NO or UNKNOWN = 0 . A cut-off score should be defined to filter those articles that do not pass the QA. The QA will require a light review of the full text of the article.

Performing quality assessment (QA) in Parsif.al.

Data extraction

Those articles that pass the study selection are then thoroughly and critically read. Next, the researcher completes the information required using the “data extraction” form, as illustrated in Fig. 3 , in this scenario using Parsif.al tool.

Example of data extraction form using Parsif.al.

The information required (study characteristics and findings) from each included study must be acquired and documented through careful reading. Data extraction is valuable, especially if the data requires manipulation or assumptions and inferences. Thus, information can be synthesized from the extracted data for qualitative or quantitative analysis [16] . This documentation supports clarity, precise reporting, and the ability to scrutinize and replicate the examination.

Analysis and Report

The analysis phase examines the synthesized data and extracts meaningful information from the selected articles [10] . There are two main goals in this phase.

The first goal is to analyze the literature in terms of leading authors, journals, countries, and organizations. Furthermore, it helps identify correlations among topic s . Even when not mandatory, this activity can be constructive for researchers to position their work, find trends, and find collaboration opportunities. Next, data from the selected articles can be analyzed using bibliometric analysis (BA). BA summarizes large amounts of bibliometric data to present the state of intellectual structure and emerging trends in a topic or field of research [4] . Table 7 sets out some of the most common bibliometric analysis representations.

Techniques for bibliometric analysis and examples.

Several tools can perform this type of analysis, such as Excel and Google Sheets for statistical graphs or using programming languages such as Python that has available multiple  data visualization libraries (i.e. Matplotlib, Seaborn). Cluster maps based on bibliographic data(i.e keywords, authors) can be developed in VosViewer which makes it easy to identify clusters of related items [18] . In Fig. 4 , node size is representative of the number of papers related to the keyword, and lines represent the links among keyword terms.

[1] Keyword co-relationship analysis using clusterization in vos viewer.

This second and most important goal is to answer the formulated research questions, which should include a quantitative and qualitative analysis. The quantitative analysis can make use of data categorized, labelled, or coded in the extraction form (see Section 1.6). This data can be transformed into numerical values to perform statistical analysis. One of the most widely employed method is frequency analysis, which shows the recurrence of an event, and can also represent the percental distribution of the population (i.e., percentage by technology type, frequency of use of different frameworks, etc.). Q ualitative analysis includes the narration of the results, the discussion indicating the way forward in future research work, and inferring a conclusion.

Finally, the literature review report should state the protocol to ensure others researchers can replicate the process and understand how the analysis was performed. In the protocol, it is essential to present the inclusion and exclusion criteria, quality assessment, and rationality beyond these aspects.

The presentation and reporting of results will depend on the structure of the review given by the researchers conducting the SLR, there is no one answer. This structure should tie the studies together into key themes, characteristics, or subgroups [ 28 ].

SLR can be an extensive and demanding task, however the results are beneficial in providing a comprehensive overview of the available evidence on a given topic. For this reason, researchers should keep in mind that the entire process of the SLR is tailored to answer the research question(s). This article has detailed a practical guide with the essential steps to conducting an SLR in the context of computer science and software engineering while citing multiple helpful examples and tools. It is envisaged that this method will assist researchers, and particularly early-stage researchers, in following an algorithmic approach to fulfill this task. Finally, a quick checklist is presented in Appendix A as a companion of this article.

CRediT author statement

Angela Carrera-Rivera: Conceptualization, Methodology, Writing-Original. William Ochoa-Agurto : Methodology, Writing-Original. Felix Larrinaga : Reviewing and Supervision Ganix Lasa: Reviewing and Supervision.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Funding : This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Grant No. 814078.

Carrera-Rivera, A., Larrinaga, F., & Lasa, G. (2022). Context-awareness for the design of Smart-product service systems: Literature review. Computers in Industry, 142, 103730.

1 https://parsif.al/

Data Availability

Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website: https://www.cambridge.org/news-and-insights/technical-incident

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > The Cambridge Handbook of Research Methods and Statistics for the Social and Behavioral Sciences
• > Literature Review

Book contents

• The Cambridge Handbook of Research Methods and Statistics for the Social and Behavioral Sciences
• Cambridge Handbooks in Psychology
• Copyright page
• Contributors
• Part I From Idea to Reality: The Basics of Research
• 1 Promises and Pitfalls of Theory
• 2 Research Ethics for the Social and Behavioral Sciences
• 3 Getting Good Ideas and Making the Most of Them
• 4 Literature Review
• 5 Choosing a Research Design
• 6 Building the Study
• 7 Analyzing Data
• 8 Writing the Paper
• Part II The Building Blocks of a Study
• Part III Data Collection
• Part IV Statistical Approaches
• Part V Tips for a Successful Research Career

4 - Literature Review

from Part I - From Idea to Reality: The Basics of Research

Published online by Cambridge University Press:  25 May 2023

A literature review is a survey of scholarly sources that establishes familiarity with and an understanding of current research in a particular field. It includes a critical analysis of the relationship among different works, seeking a synthesis and an explanation of gaps, while relating findings to the project at hand. It also serves as a foundational aspect of a well-grounded thesis or dissertation, reveals gaps in a specific field, and establishes credibility and need for those applying for a grant. The enormous amount of textual information necessitates the development of tools to help researchers effectively and efficiently process huge amounts of data and quickly search, classify, and assess their relevance. This chapter presents an assessable guide to writing a comprehensive review of literature. It begins with a discussion of the purpose of the literature review and then presents steps to conduct an organized, relevant review.

Access options

Save book to kindle.

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service .

• Literature Review
• By Rachel Adams Goertel
• Edited by Austin Lee Nichols , Central European University, Vienna , John Edlund , Rochester Institute of Technology, New York
• Book: The Cambridge Handbook of Research Methods and Statistics for the Social and Behavioral Sciences
• Online publication: 25 May 2023
• Chapter DOI: https://doi.org/10.1017/9781009010054.005

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox .

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive .

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: Jan 4, 2024 10:52 AM
• URL: https://guides.library.yale.edu/YSNDoctoral

• Privacy Policy

Home » Literature Review – Types Writing Guide and Examples

Literature Review – Types Writing Guide and Examples

Table of Contents

Literature Review

Definition:

A literature review is a comprehensive and critical analysis of the existing literature on a particular topic or research question. It involves identifying, evaluating, and synthesizing relevant literature, including scholarly articles, books, and other sources, to provide a summary and critical assessment of what is known about the topic.

Types of Literature Review

Types of Literature Review are as follows:

• Narrative literature review : This type of review involves a comprehensive summary and critical analysis of the available literature on a particular topic or research question. It is often used as an introductory section of a research paper.
• Systematic literature review: This is a rigorous and structured review that follows a pre-defined protocol to identify, evaluate, and synthesize all relevant studies on a specific research question. It is often used in evidence-based practice and systematic reviews.
• Meta-analysis: This is a quantitative review that uses statistical methods to combine data from multiple studies to derive a summary effect size. It provides a more precise estimate of the overall effect than any individual study.
• Scoping review: This is a preliminary review that aims to map the existing literature on a broad topic area to identify research gaps and areas for further investigation.
• Critical literature review : This type of review evaluates the strengths and weaknesses of the existing literature on a particular topic or research question. It aims to provide a critical analysis of the literature and identify areas where further research is needed.
• Conceptual literature review: This review synthesizes and integrates theories and concepts from multiple sources to provide a new perspective on a particular topic. It aims to provide a theoretical framework for understanding a particular research question.
• Rapid literature review: This is a quick review that provides a snapshot of the current state of knowledge on a specific research question or topic. It is often used when time and resources are limited.
• Thematic literature review : This review identifies and analyzes common themes and patterns across a body of literature on a particular topic. It aims to provide a comprehensive overview of the literature and identify key themes and concepts.
• Realist literature review: This review is often used in social science research and aims to identify how and why certain interventions work in certain contexts. It takes into account the context and complexities of real-world situations.
• State-of-the-art literature review : This type of review provides an overview of the current state of knowledge in a particular field, highlighting the most recent and relevant research. It is often used in fields where knowledge is rapidly evolving, such as technology or medicine.
• Integrative literature review: This type of review synthesizes and integrates findings from multiple studies on a particular topic to identify patterns, themes, and gaps in the literature. It aims to provide a comprehensive understanding of the current state of knowledge on a particular topic.
• Umbrella literature review : This review is used to provide a broad overview of a large and diverse body of literature on a particular topic. It aims to identify common themes and patterns across different areas of research.
• Historical literature review: This type of review examines the historical development of research on a particular topic or research question. It aims to provide a historical context for understanding the current state of knowledge on a particular topic.
• Problem-oriented literature review : This review focuses on a specific problem or issue and examines the literature to identify potential solutions or interventions. It aims to provide practical recommendations for addressing a particular problem or issue.
• Mixed-methods literature review : This type of review combines quantitative and qualitative methods to synthesize and analyze the available literature on a particular topic. It aims to provide a more comprehensive understanding of the research question by combining different types of evidence.

Parts of Literature Review

Parts of a literature review are as follows:

Introduction

The introduction of a literature review typically provides background information on the research topic and why it is important. It outlines the objectives of the review, the research question or hypothesis, and the scope of the review.

Literature Search

This section outlines the search strategy and databases used to identify relevant literature. The search terms used, inclusion and exclusion criteria, and any limitations of the search are described.

Literature Analysis

The literature analysis is the main body of the literature review. This section summarizes and synthesizes the literature that is relevant to the research question or hypothesis. The review should be organized thematically, chronologically, or by methodology, depending on the research objectives.

Critical Evaluation

Critical evaluation involves assessing the quality and validity of the literature. This includes evaluating the reliability and validity of the studies reviewed, the methodology used, and the strength of the evidence.

The conclusion of the literature review should summarize the main findings, identify any gaps in the literature, and suggest areas for future research. It should also reiterate the importance of the research question or hypothesis and the contribution of the literature review to the overall research project.

The references list includes all the sources cited in the literature review, and follows a specific referencing style (e.g., APA, MLA, Harvard).

How to write Literature Review

Here are some steps to follow when writing a literature review:

• Define your research question or topic : Before starting your literature review, it is essential to define your research question or topic. This will help you identify relevant literature and determine the scope of your review.
• Conduct a comprehensive search: Use databases and search engines to find relevant literature. Look for peer-reviewed articles, books, and other academic sources that are relevant to your research question or topic.
• Evaluate the sources: Once you have found potential sources, evaluate them critically to determine their relevance, credibility, and quality. Look for recent publications, reputable authors, and reliable sources of data and evidence.
• Organize your sources: Group the sources by theme, method, or research question. This will help you identify similarities and differences among the literature, and provide a structure for your literature review.
• Analyze and synthesize the literature : Analyze each source in depth, identifying the key findings, methodologies, and conclusions. Then, synthesize the information from the sources, identifying patterns and themes in the literature.
• Write the literature review : Start with an introduction that provides an overview of the topic and the purpose of the literature review. Then, organize the literature according to your chosen structure, and analyze and synthesize the sources. Finally, provide a conclusion that summarizes the key findings of the literature review, identifies gaps in knowledge, and suggests areas for future research.
• Edit and proofread: Once you have written your literature review, edit and proofread it carefully to ensure that it is well-organized, clear, and concise.

Examples of Literature Review

Here’s an example of how a literature review can be conducted for a thesis on the topic of “ The Impact of Social Media on Teenagers’ Mental Health”:

• Start by identifying the key terms related to your research topic. In this case, the key terms are “social media,” “teenagers,” and “mental health.”
• Use academic databases like Google Scholar, JSTOR, or PubMed to search for relevant articles, books, and other publications. Use these keywords in your search to narrow down your results.
• Evaluate the sources you find to determine if they are relevant to your research question. You may want to consider the publication date, author’s credentials, and the journal or book publisher.
• Begin reading and taking notes on each source, paying attention to key findings, methodologies used, and any gaps in the research.
• Organize your findings into themes or categories. For example, you might categorize your sources into those that examine the impact of social media on self-esteem, those that explore the effects of cyberbullying, and those that investigate the relationship between social media use and depression.
• Synthesize your findings by summarizing the key themes and highlighting any gaps or inconsistencies in the research. Identify areas where further research is needed.
• Use your literature review to inform your research questions and hypotheses for your thesis.

For example, after conducting a literature review on the impact of social media on teenagers’ mental health, a thesis might look like this:

“Using a mixed-methods approach, this study aims to investigate the relationship between social media use and mental health outcomes in teenagers. Specifically, the study will examine the effects of cyberbullying, social comparison, and excessive social media use on self-esteem, anxiety, and depression. Through an analysis of survey data and qualitative interviews with teenagers, the study will provide insight into the complex relationship between social media use and mental health outcomes, and identify strategies for promoting positive mental health outcomes in young people.”

Reference: Smith, J., Jones, M., & Lee, S. (2019). The effects of social media use on adolescent mental health: A systematic review. Journal of Adolescent Health, 65(2), 154-165. doi:10.1016/j.jadohealth.2019.03.024

Reference Example: Author, A. A., Author, B. B., & Author, C. C. (Year). Title of article. Title of Journal, volume number(issue number), page range. doi:0000000/000000000000 or URL

Applications of Literature Review

some applications of literature review in different fields:

• Social Sciences: In social sciences, literature reviews are used to identify gaps in existing research, to develop research questions, and to provide a theoretical framework for research. Literature reviews are commonly used in fields such as sociology, psychology, anthropology, and political science.
• Natural Sciences: In natural sciences, literature reviews are used to summarize and evaluate the current state of knowledge in a particular field or subfield. Literature reviews can help researchers identify areas where more research is needed and provide insights into the latest developments in a particular field. Fields such as biology, chemistry, and physics commonly use literature reviews.
• Health Sciences: In health sciences, literature reviews are used to evaluate the effectiveness of treatments, identify best practices, and determine areas where more research is needed. Literature reviews are commonly used in fields such as medicine, nursing, and public health.
• Humanities: In humanities, literature reviews are used to identify gaps in existing knowledge, develop new interpretations of texts or cultural artifacts, and provide a theoretical framework for research. Literature reviews are commonly used in fields such as history, literary studies, and philosophy.

Role of Literature Review in Research

Here are some applications of literature review in research:

• Identifying Research Gaps : Literature review helps researchers identify gaps in existing research and literature related to their research question. This allows them to develop new research questions and hypotheses to fill those gaps.
• Developing Theoretical Framework: Literature review helps researchers develop a theoretical framework for their research. By analyzing and synthesizing existing literature, researchers can identify the key concepts, theories, and models that are relevant to their research.
• Selecting Research Methods : Literature review helps researchers select appropriate research methods and techniques based on previous research. It also helps researchers to identify potential biases or limitations of certain methods and techniques.
• Data Collection and Analysis: Literature review helps researchers in data collection and analysis by providing a foundation for the development of data collection instruments and methods. It also helps researchers to identify relevant data sources and identify potential data analysis techniques.
• Communicating Results: Literature review helps researchers to communicate their results effectively by providing a context for their research. It also helps to justify the significance of their findings in relation to existing research and literature.

Purpose of Literature Review

Some of the specific purposes of a literature review are as follows:

• To provide context: A literature review helps to provide context for your research by situating it within the broader body of literature on the topic.
• To identify gaps and inconsistencies: A literature review helps to identify areas where further research is needed or where there are inconsistencies in the existing literature.
• To synthesize information: A literature review helps to synthesize the information from multiple sources and present a coherent and comprehensive picture of the current state of knowledge on the topic.
• To identify key concepts and theories : A literature review helps to identify key concepts and theories that are relevant to your research question and provide a theoretical framework for your study.
• To inform research design: A literature review can inform the design of your research study by identifying appropriate research methods, data sources, and research questions.

Characteristics of Literature Review

Some Characteristics of Literature Review are as follows:

• Identifying gaps in knowledge: A literature review helps to identify gaps in the existing knowledge and research on a specific topic or research question. By analyzing and synthesizing the literature, you can identify areas where further research is needed and where new insights can be gained.
• Establishing the significance of your research: A literature review helps to establish the significance of your own research by placing it in the context of existing research. By demonstrating the relevance of your research to the existing literature, you can establish its importance and value.
• Informing research design and methodology : A literature review helps to inform research design and methodology by identifying the most appropriate research methods, techniques, and instruments. By reviewing the literature, you can identify the strengths and limitations of different research methods and techniques, and select the most appropriate ones for your own research.
• Supporting arguments and claims: A literature review provides evidence to support arguments and claims made in academic writing. By citing and analyzing the literature, you can provide a solid foundation for your own arguments and claims.
• I dentifying potential collaborators and mentors: A literature review can help identify potential collaborators and mentors by identifying researchers and practitioners who are working on related topics or using similar methods. By building relationships with these individuals, you can gain valuable insights and support for your own research and practice.
• Keeping up-to-date with the latest research : A literature review helps to keep you up-to-date with the latest research on a specific topic or research question. By regularly reviewing the literature, you can stay informed about the latest findings and developments in your field.

Advantages of Literature Review

There are several advantages to conducting a literature review as part of a research project, including:

• Establishing the significance of the research : A literature review helps to establish the significance of the research by demonstrating the gap or problem in the existing literature that the study aims to address.
• Identifying key concepts and theories: A literature review can help to identify key concepts and theories that are relevant to the research question, and provide a theoretical framework for the study.
• Supporting the research methodology : A literature review can inform the research methodology by identifying appropriate research methods, data sources, and research questions.
• Providing a comprehensive overview of the literature : A literature review provides a comprehensive overview of the current state of knowledge on a topic, allowing the researcher to identify key themes, debates, and areas of agreement or disagreement.
• Identifying potential research questions: A literature review can help to identify potential research questions and areas for further investigation.
• Avoiding duplication of research: A literature review can help to avoid duplication of research by identifying what has already been done on a topic, and what remains to be done.
• Enhancing the credibility of the research : A literature review helps to enhance the credibility of the research by demonstrating the researcher’s knowledge of the existing literature and their ability to situate their research within a broader context.

Limitations of Literature Review

Limitations of Literature Review are as follows:

• Limited scope : Literature reviews can only cover the existing literature on a particular topic, which may be limited in scope or depth.
• Publication bias : Literature reviews may be influenced by publication bias, which occurs when researchers are more likely to publish positive results than negative ones. This can lead to an incomplete or biased picture of the literature.
• Quality of sources : The quality of the literature reviewed can vary widely, and not all sources may be reliable or valid.
• Time-limited: Literature reviews can become quickly outdated as new research is published, making it difficult to keep up with the latest developments in a field.
• Subjective interpretation : Literature reviews can be subjective, and the interpretation of the findings can vary depending on the researcher’s perspective or bias.
• Lack of original data : Literature reviews do not generate new data, but rather rely on the analysis of existing studies.
• Risk of plagiarism: It is important to ensure that literature reviews do not inadvertently contain plagiarism, which can occur when researchers use the work of others without proper attribution.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Background of The Study – Examples and Writing...

Research Summary – Structure, Examples and...

Research Approach – Types Methods and Examples

Survey Instruments – List and Their Uses

Research Results Section – Writing Guide and...

Delimitations in Research – Types, Examples and...

Research Methods: Literature Reviews

• Annotated Bibliographies
• Literature Reviews
• Scoping Reviews
• Systematic Reviews
• Scholarship of Teaching and Learning
• Persuasive Arguments
• Subject Specific Methodology

A literature review involves researching, reading, analyzing, evaluating, and summarizing scholarly literature (typically journals and articles) about a specific topic. The results of a literature review may be an entire report or article OR may be part of a article, thesis, dissertation, or grant proposal. A literature review helps the author learn about the history and nature of their topic, and identify research gaps and problems.

Steps & Elements

Problem formulation

• Determine your topic and its components by asking a question
• Research: locate literature related to your topic to identify the gap(s) that can be addressed
• Read: read the articles or other sources of information
• Analyze: assess the findings for relevancy
• Evaluating: determine how the article are relevant to your research and what are the key findings
• Synthesis: write about the key findings and how it is relevant to your research

Elements of a Literature Review

• Summarize subject, issue or theory under consideration, along with objectives of the review
• Divide works under review into categories (e.g. those in support of a particular position, those against, those offering alternative theories entirely)
• Explain how each work is similar to and how it varies from the others
• Conclude which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of an area of research

Writing a Literature Review Resources

• How to Write a Literature Review From the Wesleyan University Library
• Write a Literature Review From the University of California Santa Cruz Library. A Brief overview of a literature review, includes a list of stages for writing a lit review.
• Literature Reviews From the University of North Carolina Writing Center. Detailed information about writing a literature review.
• Undertaking a literature review: a step-by-step approach Cronin, P., Ryan, F., & Coughan, M. (2008). Undertaking a literature review: A step-by-step approach. British Journal of Nursing, 17(1), p.38-43

Literature Review Tutorial

• << Previous: Annotated Bibliographies
• Next: Scoping Reviews >>
• Last Updated: Feb 29, 2024 12:00 PM
• URL: https://guides.auraria.edu/researchmethods

1100 Lawrence Street Denver, CO 80204 303-315-7700 Ask Us Directions

• Process: Literature Reviews
• Literature Review
• Managing Sources

Ask a Librarian

Does your assignment or publication require that you write a literature review? This guide is intended to help you understand what a literature is, why it is worth doing, and some quick tips composing one.

Understanding Literature Reviews

What is a literature review  .

Typically, a literature review is a written discussion that examines publications about  a particular subject area or topic. Depending on disciplines, publications, or authors a literature review may be: 

A summary of sources An organized presentation of sources A synthesis or interpretation of sources An evaluative analysis of sources

A Literature Review may be part of a process or a product. It may be:

A part of your research process A part of your final research publication An independent publication

Why do a literature review?

The Literature Review will place your research in context. It will help you and your readers:  

Locate patterns, relationships, connections, agreements, disagreements, & gaps in understanding Identify methodological and theoretical foundations Identify landmark and exemplary works Situate your voice in a broader conversation with other writers, thinkers, and scholars

The Literature Review will aid your research process. It will help you to:

Establish your knowledge Understand what has been said Define your questions Establish a relevant methodology Refine your voice Situate your voice in the conversation

What does a literature review look like?

The Literature Review structure and organization may include sections such as:  

An introduction or overview A body or organizational sub-divisions A conclusion or an explanation of significance

The body of a literature review may be organized in several ways, including:

Chronologically: organized by date of publication Methodologically: organized by type of research method used Thematically: organized by concept, trend, or theme Ideologically: organized by belief, ideology, or school of thought

• Find a focus
• Find models
• Review your target publication
• Track citations
• Read critically
• Manage your citations
• Ask friends, faculty, and librarians

Additional Sources

• Reviewing the literature. Project Planner.
• Literature Review: By UNC Writing Center
• PhD on Track
• CU Graduate Students Thesis & Dissertation Guidance
• CU Honors Thesis Guidance

• Next: Managing Sources >>
• University of Colorado Boulder Libraries
• Research Guides
• Research Strategies
• Last Updated: Jun 10, 2024 3:24 PM
• URL: https://libguides.colorado.edu/strategies/litreview
• © Regents of the University of Colorado

Research Methods and Design

• Action Research
• Case Study Design

Literature Review

• Quantitative Research Methods
• Qualitative Research Methods
• Mixed Methods Study
• Indigenous Research and Ethics This link opens in a new window
• Identifying Empirical Research Articles This link opens in a new window
• Research Ethics and Quality
• Data Literacy
• Get Help with Writing Assignments

A literature review is a discussion of the literature (aka. the "research" or "scholarship") surrounding a certain topic. A good literature review doesn't simply summarize the existing material, but provides thoughtful synthesis and analysis. The purpose of a literature review is to orient your own work within an existing body of knowledge. A literature review may be written as a standalone piece or be included in a larger body of work.

You can read more about literature reviews, what they entail, and how to write one, using the resources below. 

Am I the only one struggling to write a literature review?

Dr. Zina O'Leary explains the misconceptions and struggles students often have with writing a literature review. She also provides step-by-step guidance on writing a persuasive literature review.

An Introduction to Literature Reviews

Dr. Eric Jensen, Professor of Sociology at the University of Warwick, and Dr. Charles Laurie, Director of Research at Verisk Maplecroft, explain how to write a literature review, and why researchers need to do so. Literature reviews can be stand-alone research or part of a larger project. They communicate the state of academic knowledge on a given topic, specifically detailing what is still unknown.

This is the first video in a whole series about literature reviews. You can find the rest of the series in our SAGE database, Research Methods:

Videos covering research methods and statistics

Identify Themes and Gaps in Literature (with real examples) | Scribbr

Finding connections between sources is key to organizing the arguments and structure of a good literature review. In this video, you'll learn how to identify themes, debates, and gaps between sources, using examples from real papers.

4 Tips for Writing a Literature Review's Intro, Body, and Conclusion | Scribbr

While each review will be unique in its structure--based on both the existing body of both literature and the overall goals of your own paper, dissertation, or research--this video from Scribbr does a good job simplifying the goals of writing a literature review for those who are new to the process. In this video, you’ll learn what to include in each section, as well as 4 tips for the main body illustrated with an example.

• Literature Review This chapter in SAGE's Encyclopedia of Research Design describes the types of literature reviews and scientific standards for conducting literature reviews.
• UNC Writing Center: Literature Reviews This handout from the Writing Center at UNC will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.
• Purdue OWL: Writing a Literature Review The overview of literature reviews comes from Purdue's Online Writing Lab. It explains the basic why, what, and how of writing a literature review.

Organizational Tools for Literature Reviews

One of the most daunting aspects of writing a literature review is organizing your research. There are a variety of strategies that you can use to help you in this task. We've highlighted just a few ways writers keep track of all that information! You can use a combination of these tools or come up with your own organizational process. The key is choosing something that works with your own learning style.

Citation Managers

Citation managers are great tools, in general, for organizing research, but can be especially helpful when writing a literature review. You can keep all of your research in one place, take notes, and organize your materials into different folders or categories. Read more about citations managers here:

• Manage Citations & Sources

Concept Mapping

Some writers use concept mapping (sometimes called flow or bubble charts or "mind maps") to help them visualize the ways in which the research they found connects.

There is no right or wrong way to make a concept map. There are a variety of online tools that can help you create a concept map or you can simply put pen to paper. To read more about concept mapping, take a look at the following help guides:

• Using Concept Maps From Williams College's guide, Literature Review: A Self-guided Tutorial

Synthesis Matrix

A synthesis matrix is is a chart you can use to help you organize your research into thematic categories. By organizing your research into a matrix, like the examples below, can help you visualize the ways in which your sources connect. 

• Walden University Writing Center: Literature Review Matrix Find a variety of literature review matrix examples and templates from Walden University.
• Writing A Literature Review and Using a Synthesis Matrix An example synthesis matrix created by NC State University Writing and Speaking Tutorial Service Tutors. If you would like a copy of this synthesis matrix in a different format, like a Word document, please ask a librarian. CC-BY-SA 3.0
• << Previous: Case Study Design
• Next: Quantitative Research Methods >>
• Last Updated: May 7, 2024 9:51 AM

CityU Home - CityU Catalog

• Locations and Hours
• UCLA Library
• Research Guides
• Biomedical Library Guides

Systematic Reviews

• Types of Literature Reviews

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

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

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

• << Previous: Home
• Next: Planning Your Systematic Review >>
• Last Updated: Apr 17, 2024 2:02 PM
• URL: https://guides.library.ucla.edu/systematicreviews

Teaching and Research guides

Literature reviews.

• Introduction
• Plan your search
• Where to search
• Refine and update your search
• Finding grey literature
• Writing the review
• Referencing

Research methods overview

Finding literature on research methodologies, sage research methods online.

• Get material not at RMIT
• Further help

What are research methods?

Research methodology is the specific strategies, processes, or techniques utilised in the collection of information that is created and analysed.

The methodology section of a research paper, or thesis, enables the reader to critically evaluate the study’s validity and reliability by addressing how the data was collected or generated, and how it was analysed.

Types of research methods

There are three main types of research methods which use different designs for data collection.  

(1) Qualitative research

Qualitative research gathers data about lived experiences, emotions or behaviours, and the meanings individuals attach to them. It assists in enabling researchers to gain a better understanding of complex concepts, social interactions or cultural phenomena. This type of research is useful in the exploration of how or why things have occurred, interpreting events and describing actions.

Examples of qualitative research designs include:

• focus groups
• observations
• document analysis
• oral history or life stories  

(2) Quantitative research

Quantitative research gathers numerical data which can be ranked, measured or categorised through statistical analysis. It assists with uncovering patterns or relationships, and for making generalisations. This type of research is useful for finding out how many, how much, how often, or to what extent.

Examples of quantitative research designs include:

• surveys or questionnaires
• observation
• document screening
• experiments  

(3) Mixed method research

Mixed Methods research integrates both Qualitative research and Quantitative research. It provides a holistic approach combining and analysing the statistical data with deeper contextualised insights. Using Mixed Methods also enables triangulation, or verification, of the data from two or more sources.

Sometimes in your literature review, you might need to discuss and evaluate relevant research methodologies in order to justify your own choice of research methodology.

When searching for literature on research methodologies it is important to search across a range of sources. No single information source will supply all that you need. Selecting appropriate sources will depend upon your research topic.

Developing a robust search strategy will help reduce irrelevant results. It is good practice to plan a strategy before you start to search.

Search tips

(1) free text keywords.

Free text searching is the use of natural language words to conduct your search. Use selective free text keywords such as: phenomenological, "lived experience", "grounded theory", "life experiences", "focus groups", interview, quantitative, survey, validity, variance, correlation and statistical.

To locate books on your desired methodology, try LibrarySearch . Remember to use  refine  options such as books, ebooks, subject, and publication date.  

(2) Subject headings in Databases

Databases categorise their records using subject terms, or a controlled vocabulary (thesaurus). These subject headings may be useful to use, in addition to utilising free text keywords in a database search.

Subject headings will differ across databases, for example, the PubMed database uses 'Qualitative Research' whilst the CINHAL database uses 'Qualitative Studies.'  

(3) Limiting search results

Databases enable sets of results to be limited or filtered by specific fields, look for options such as Publication Type, Article Type, etc. and apply them to your search.  

(4) Browse the Library shelves

To find books on  research methods  browse the Library shelves at call number  001.42

• SAGE Research Methods Online SAGE Research Methods Online (SRMO) is a research tool supported by a newly devised taxonomy that links content and methods terms. It provides the most comprehensive picture available today of research methods (quantitative, qualitative and mixed methods) across the social and behavioural sciences.

SAGE Research Methods Overview  (2:07 min) by SAGE Publishing  ( YouTube ) 

• << Previous: Referencing
• Next: Get material not at RMIT >>

• Last Updated: May 28, 2024 11:17 AM
• URL: https://rmit.libguides.com/literature-review

Types of Literature Review

There are many types of literature review. The choice of a specific type depends on your research approach and design. The following types of literature review are the most popular in business studies:

Narrative literature review , also referred to as traditional literature review, critiques literature and summarizes the body of a literature. Narrative review also draws conclusions about the topic and identifies gaps or inconsistencies in a body of knowledge. You need to have a sufficiently focused research question to conduct a narrative literature review

Systematic literature review requires more rigorous and well-defined approach compared to most other types of literature review. Systematic literature review is comprehensive and details the timeframe within which the literature was selected. Systematic literature review can be divided into two categories: meta-analysis and meta-synthesis.

When you conduct meta-analysis you take findings from several studies on the same subject and analyze these using standardized statistical procedures. In meta-analysis patterns and relationships are detected and conclusions are drawn. Meta-analysis is associated with deductive research approach.

Meta-synthesis, on the other hand, is based on non-statistical techniques. This technique integrates, evaluates and interprets findings of multiple qualitative research studies. Meta-synthesis literature review is conducted usually when following inductive research approach.

Scoping literature review , as implied by its name is used to identify the scope or coverage of a body of literature on a given topic. It has been noted that “scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review.” [1] The main difference between systematic and scoping types of literature review is that, systematic literature review is conducted to find answer to more specific research questions, whereas scoping literature review is conducted to explore more general research question.

Argumentative literature review , as the name implies, examines literature selectively in order to support or refute an argument, deeply imbedded assumption, or philosophical problem already established in the literature. It should be noted that a potential for bias is a major shortcoming associated with argumentative literature review.

Integrative literature review reviews , critiques, and synthesizes secondary data about research topic in an integrated way such that new frameworks and perspectives on the topic are generated. If your research does not involve primary data collection and data analysis, then using integrative literature review will be your only option.

Theoretical literature review focuses on a pool of theory that has accumulated in regard to an issue, concept, theory, phenomena. Theoretical literature reviews play an instrumental role in establishing what theories already exist, the relationships between them, to what degree existing theories have been investigated, and to develop new hypotheses to be tested.

At the earlier parts of the literature review chapter, you need to specify the type of your literature review your chose and justify your choice. Your choice of a specific type of literature review should be based upon your research area, research problem and research methods.  Also, you can briefly discuss other most popular types of literature review mentioned above, to illustrate your awareness of them.

[1] Munn, A. et. al. (2018) “Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach” BMC Medical Research Methodology

  John Dudovskiy

• Search Menu
• Sign in through your institution
• Advance Articles
• Editor's Choice
• Supplements
• E-Collections
• Virtual Roundtables
• Author Videos
• Author Guidelines
• Submission Site
• Open Access Options
• About The European Journal of Public Health
• About the European Public Health Association
• Editorial Board
• Advertising and Corporate Services
• Journals Career Network
• Self-Archiving Policy
• Terms and Conditions
• Explore Publishing with EJPH
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction, conclusions, recommendations and limitations of the study, supplementary data, data availability.

• < Previous

A systematic review of literature examining the application of a social model of health and wellbeing

• Article contents
• Figures & tables
• Supplementary Data

Rachel Rahman, Caitlin Reid, Philip Kloer, Anna Henchie, Andrew Thomas, Reyer Zwiggelaar, A systematic review of literature examining the application of a social model of health and wellbeing, European Journal of Public Health , Volume 34, Issue 3, June 2024, Pages 467–472, https://doi.org/10.1093/eurpub/ckae008

• Permissions Icon Permissions

Following years of sustained pressure on the UK health service, there is recognition amongst health professionals and stakeholders that current models of healthcare are likely to be inadequate going forward. Therefore, a fundamental review of existing social models of healthcare is needed to ascertain current thinking in this area, and whether there is a need to change perspective on current thinking.

Through a systematic research review, this paper seeks to address how previous literature has conceptualized a social model of healthcare and, how implementation of the models has been evaluated. Analysis and data were extracted from 222 publications and explored the country of origin, methodological approach, and the health and social care contexts which they were set.

The publications predominantly drawn from the USA, UK, Australia, Canada and Europe identified five themes namely: the lack of a clear and unified definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health.

The review identified a need for a clear definition of a social model of health and wellbeing. Furthermore, consideration is needed on how a model integrates with current models and whether it will act as a descriptive framework or, will be developed into an operational model. The review highlights the importance of engagement with users and partner organizations in the co-creation of a model of healthcare.

Following years of sustained and increasing pressure brought about through inadequate planning and chronic under-resourcing including the unprecedented challenges of the Covid-19 pandemic, the UK NHS is at crisis point. 1 The incidents of chronic disease continue to increase alongside an ageing population who have more complex health and wellbeing needs, whilst recruitment and retention of staff continue to be insufficient to meet these increased demands. 1 Furthermore, the Covid-19 pandemic has only served to exacerbate pressures, resulting in delays in; patient presentation, 2 poor public mental health 3 strain and burnout amongst workforce. 4 However, preceding the pandemic there was already recognition of a need for a change to the current biomedical model of care to better prevent and treat the needs of the population. 5

While it is recognized that demands on the healthcare system are increasing rapidly, the biomedical model used to deal with these issues (which is the current model of healthcare provision in the UK) has largely remained unchanged over the years. The biomedical model takes the perspective that ill-health stems from biological factors and operates on the theory that good health and wellbeing is merely the absence of illness. Application of the model therefore focuses treatment on the management of symptoms and cure of disease from a biological perspective. This suggests that the biomedical approach is mainly reactive in nature and whilst rapid advancements in technology such as diagnostics and robotics have significantly improved patient outcomes and identification of early onset of disease, it does not fully extend into managing the social determinants that can play an important role in the prevention of disease. Therefore, despite its contribution in advancing many areas of biological and health research, the biomedical model has come under increasing scrutiny. 6 This is in part due to the growing recognition of the impact of those wider social determinants on health, ill-health and wellbeing including physical, mental and social wellbeing which moves the focus beyond individual physical abilities or dysfunction. 7–9 In order to address these determinants, action needs to be taken through developing policies in a range of non-medical areas such as social, economic and environment so that they regulate the commercial and corporate determinants. In this sense, we can quickly see that the traditional biological model rapidly becomes inadequate. With the current model, health care and clinical staff can do little to affect these determinants and as such can do little to assist the individual patient or society. The efficiency and effectiveness of clinical work will undoubtedly improve if staff have the ability to observe and understand the wider social determinants and consequences of the individual patients’ condition. Therefore, in order to provide a basis for understanding the determinants of disease and arriving at rational treatments and patterns of health care, a medical model must also take into account the patient, the social context in which they live, and a system devised by society to deal with the disruptive effects of illness, that is, the physician’s role and that of the health care system. Models such as Engel’s biopsychosocial model, 9 , 10 the social model of disability, social–ecological models of health 10 , 11 including the World Health Organisation’s framework for action on social determinants of health 8 , 9 are all proposed as attempting to integrate these wider social determinants.

However, the ability of health systems to effectively transition away from a dominant biomedical model to the adoption of a social model of health and care have yet to be fully developed. Responsibility for taking action on these social determinants will need to come from other sectors and policy areas and so future health policy will need to evolve into a more comprehensive and holistic social model of health and wellbeing. Wales’ flagship Wellbeing of Future Generations Act 12 for instance outlines ways of working towards sustainable development and includes the need to collaborate with society and communities in developing and achieving wellbeing goals. However, developing and implementing an effective operational model that allows multi-stakeholder integration will prove far more difficult to achieve than creating the polices. Furthermore, if the implementation of a robust model of social health is achievable, it’s efficiency, effectiveness and ability to deliver has yet to be proven. Therefore, any future model will need to extend past its conceptual development and provide an ability to manage the complex interactions that will exist between the stakeholders and polices.

Therefore, the use of the term ‘model’ poses its own challenges and debates. Different disciplines attribute differing parameters to what constitutes a model and this in turn may influence the interpretations or expectations surrounding what a model should comprise of or deliver. 13 According to numerous authors, a model has no ontological category and as such anything from physical entities, theoretical concepts, descriptive frameworks or equations can feasibly be considered a model. 14 It appears therefore, that much discussion has focussed on the move towards a ‘descriptive’ Social Model of Health and Wellbeing in an attempt to view health more holistically and identify a wider range of determinants that can impact on the health of the population. However, in defining an operational social model of health that can facilitate organizational change, there may be a need to consider a more systems- or process-based approach.

As a result, this review seeks to systematically explore the academic literature in order to better understand how a social model of health and wellbeing is conceptualized, implemented, operationalized and evaluated in health and social care.

The review seeks to address the research questions:

How is ‘a social model of health and wellbeing’ conceptualized?

How have social models of health and wellbeing been implemented and evaluated?

A systematic search of the literature was carried out between 6 January 2022 and 20 January 2022. Using the search terms shown in table 1 , a systematic search was carried out using online databases PsycINFO, ASSIA, IBSS, Medline, Web of Science, CINHAL and SCOPUS. English language and peer-reviewed journals were selected as limiters.

Search terms

Selection and extraction criteria

The search strategy considered research that explicitly included, framed, or adopted a ‘social model of health and wellbeing’. Each paper was checked for relevance and screened. The authors reviewed the literature using the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) method using the updated guidelines from 2020. 15   Figure 1 represents the process followed.

PRISMA flow chart.

Data extraction and analysis

A systematic search of the literature identified 222 eligible papers for inclusion in the final review. A data extraction table was used to extract information regarding location of the research, type of paper (e.g. review, empirical), service of interest and key findings. Quantitative studies were explored with a view to conducting a quantitative meta-analysis; however, given the disparate nature of the outcome measures, and research designs, this was deemed unfeasible. All included papers were coded using NVivo software with the identified research questions in mind, and re-analysed using Thematic Analysis 16 to explore common themes of relevance.

The majority of papers were from the USA (34%), with the UK (28%), Australia (16%), Canada (6%) and wider Europe (10%) also contributing to the field. The ‘other’ category (6%) was made up of single papers from other countries. Papers ranged in date from 1983 to 2021 with no noticeable temporal patterns in country of origin, health context or model definition. However, the volume of papers published relating to the social model for healthcare in each decade increased significantly, thus suggesting the increasing research interest towards the social model of healthcare. Table 2 shows the number of publications per decade that were identified from this study.

Publications identifying social models of healthcare.

Most of the papers were narrative reviews ( n  = 90) with a smaller number of systematic reviews ( n  = 9) and empirical research studies including qualitative ( n  = 47), quantitative ( n  = 39) and mixed methods ( n  = 14) research. The remaining papers ( n  = 23) comprised small samples of, for example, clinical commentaries, cost effectiveness analysis, discussion papers and impact assessment development papers. The qualitative meta-analysis identified five overarching themes in relation to the research questions, some with underlying sub-themes, which are outlined in figure 2 .

Overview of meta-synthesis themes.

The lack of a clear and unified definition of a social model of health and wellbeing

There was common recognition amongst the papers that a key aim of applying a social model of health and wellbeing was to better address the social determinants of health. Papers identified and reviewed relevant frameworks and models, which they later used to conceptualize or frame their approach when attempting to apply a social model of health. Amongst the most commonly referenced was the WHO’s framework. 17 Engel’s biopsychosocial model 9 which was referred to as a seminal framework by many of the researchers. However, once criticism of the biopsychosocial model was its inability to fully address social needs. As a result, a number of papers reported the development of new or enhanced models that used the biopsychosocial model as their underpinning ‘social model’ 18 , 19 but then extended their work by including a wider set of social elements in their resulting models. 20 The Social ecological model, 11 the Society-Behaviour-Biology Nexus, 21 and the Environmental Affordances Model are such examples. 22 Further examples of ‘Social Models’ included the Model of Social Determinants of Health 23 which framed specific determinants of interest (namely social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food and transport). Similarly, Dahlgren and Whitehead’s ‘social model’ 10 illustrates social determinants via a range of influential factors from the individual to the wider cultural and socioeconomic influences. However, none of these papers formally developed a working ‘definition’ of a social model of health and wellbeing, instead applying guiding principles and philosophies associated with a social model to their discussions or interventions. 24 , 25

The need to understand context

Numerous articles highlight that in order to move towards a social model of health and wellbeing, it is important to understand the context of the environment in which the model will need to operate. This includes balancing the needs of the individual with the resulting model to have been co-created, developed and implemented within the community whilst ensuring that the complexity of interaction between the social determinants of health and their influence on health and wellbeing outcomes are delivered effectively and efficiently.

The literature identified the complex multi-disciplinary nature of a variety of conditions or situations involving medical care. These included issues such as, but not exclusively, chronic pain, 26 cancer, 27 older adult care 28 and dementia, 29 thus indicating the complex arrangement of medical issues that a model will need to address and, where many authors acknowledged that the frequently used biomedical models failed to fully capture the holistic nature and need of patients. Papers outlined some of the key social determinants of health affecting the specific population of interest in their own context, highlighting the interactions between wider socioeconomic and cultural factors such as poverty, housing, isolation and transport and health and wellbeing outcomes. Interventions that had successfully addressed individual needs and successful embedded services in communities reported improved outcomes for end users and staff in the form of empowerment, agency, education and belonging. 30 There was also recognition that the transition to more community-based care could be challenging for health and social care providers who were having to work outside of their traditional models of care and accept a certain level of risk.

The need for cultural change

A number of papers referred to the need for a ‘culture change’ or ‘cultural shift’ in order to move towards a social model of health and wellbeing. Papers identified how ‘culture change models’ were implemented as a way of adapting to a social model. It was recognized that for culture change models to be effective, staff and the general public needed to be fully engaged with the entire move towards a social model, informing and shaping the mechanisms for the cultural shift as well as the application of the model itself.

Integration and collaboration towards a holistic and person-centred approach

The importance of integration and collaboration between health professionals, (which includes public, private and third sector organizations), services users and patients were emphasized in the ambition to achieve best practice when applying a social model of health and wellbeing. Papers identified the reported benefits of improved collaboration between, and integration of services which included improved continuity of care throughout complex pathways, 31 improved return to home or other setting on discharge, 25 and social connectedness. 32 Numerous papers discussed the importance of multi-disciplinary teams who were able to support individuals beyond the medicalized model.

A number of papers suggested specific professional roles or structures that would be ideal to act as champions or integrators of collaborative services and communities. 25 , 33 These could act as a link between secondary, primary and community level care helping to identify patient needs and supporting the integration of relevant services.

Measuring and evaluating a social model of health

Individual papers applying and evaluating interventions based on a social model used a variety of methods to evaluate success. Amongst these, some of the most common outcome measures included; general self-report measures of outcomes such as mental health and perceptions of safety, 34 wellbeing, 35 life satisfaction and health social networks and support 19 Some included condition specific self-report outcomes relevant to the condition in question (e.g. pregnancy, anxiety) and pain inventories. 36 Other papers considered the in-depth experiences of users or service implementers through qualitative techniques such as in-person interviews. 37 , 38

However, the complexity of developing effective methods to evaluate social models of health were recognized. The need to consider the complex interactions between social determinants, and health, wellbeing, economic and societal outcomes posed particular challenges in developing consistency across evaluations that would enable a conclusive evaluation of the benefits of social models to wider health systems and societal health. Some criticized the over-reliance of quantitative and evidence-based practice methods of evaluation highlighting how these could fail to fully capture the complexity of human behaviour and the manner in which their lives could be affected.

The aim of this systematic review was to better understand how a social model of health and wellbeing is conceptualized, implemented and evaluated in health and social care. The review sought to address the research questions identified in the ‘Introduction’ section of this paper.

With regards to the conceptualization of a social model of health and wellbeing, analysis of the literature suggests that whilst the ethos, values and aspirations of achieving a unified model appears to have consensus. However, a fundamental weakness exists in that there is no single unified definition or operational model of a social model of health and wellbeing applied to the health and social care sector. The decision about how best to conceptualize a ‘social model’ is important both in terms of its operational value but also the implication of the associated semantics. However, without a single or unified definition then implementation or further, operationalization of any model will be almost impossible to develop. Furthermore, use of the term ‘social model’ arguably loses site of the biological factors that are clearly relevant in many elements of clinical medicine. Furthermore, there is no clarification in the literature about what would ‘not’ be considered a social model of health and wellbeing, potentially leading to confusion within health and social care sectors when addressing their wider social remit. This raises questions and requires decisions about whether implementation of a social model of health and wellbeing will need to work alongside or replace the existing biomedical approach.

Authors have advocated that a social model provides a way of ‘thinking’ or articulating an organization’s values and culture. 24 Common elements of the values associated with a social model amongst the papers reviewed included recognition and awareness of the social determinants of health, increased focus on preventative rather than reactive care, and similarly the importance of quality of ‘life’ as opposed to a focus on quality of ‘care’. However, whilst this approach enables individual services to consider how well their own practices align with a social model, the authors suggest that this does not provide large organizations such as the NHS, with multifaceted services and complex internal and external connections and networks, sufficient guidance to enable large scale evaluation or transition to a widespread operational model of a social model of health and wellbeing. This raises questions about what the model should be: whether its function is to support communication of a complex ethos to encourage reflection and engagement of its staff and end users, or to develop the current illustrative framework into a predictive model that can be utilized as an evaluative tool to inform and measure the success of widespread systems change.

Regarding the potential implementation of a future social model of health and wellbeing, none of the papers evaluated the complex widespread organizational implementation of a social model, instead focusing on specific organizational contexts of services such as long-term care in care homes, etc. Despite this, common elements of successful implementation did emerge from the synthesis. This included the need to wholeheartedly engage and be inclusive of end users in policy and practice change to fully understand the complexity of their social worlds and to ensure that changes to practice and policy were ‘developed with’, as opposed to ‘create for’, the wider public. This also involved ensuring that health, social care and wider multi-disciplinary teams were actively included in the process of culture change from an early stage.

Implications for future research

The analysis identifies that a significant change of mindset and removal of perceived and actual hierarchical structures (that are historically embedded in health and social care structures) amongst both staff and public is needed although, eradicating socially embedded hierarchies will pose significant challenges in practice. Furthermore, the study revealed that many of the models proposed were conceptually underdeveloped and lacked the capability to be operationalized which in turn compromised their ability to be empirically tested. Therefore, in order that a future ‘implementable and operational’ model of social care and wellbeing can be created, further research into organizational behaviours, organizational learning and stakeholder theory (amongst others) applied to the social care and health environment is needed.

Towards defining a social model of health and wellbeing

In attempting to conceptualize a definition for a social model of health and wellbeing, it is important to note that the model needs to be sufficiently broad in scope in order to include the prevailing biomedical while also including the need to draw in the social determinants that provide a view and future trajectory towards social health and wellbeing. Therefore, the authors suggest that the ‘preventative’ approach brought by the improvements in the social health determinants (social, cultural, political, environmental ) need to be balanced effectively with the ‘remedial/preventative’ focus of the biomedical model (and the associated advancements in diagnostics, technology, vaccines, etc), ensuring that a future model drives cultural change; improved integration and collaboration towards a holistic and person-centred approach whilst ensuring engagement with citizens, users, multi-disciplinary teams and partner organizations to ensure that transition towards a social model of health and wellbeing is undertaken.

Through a comprehensive literature analysis, this paper has provided evidence that advocates a move towards a social model of health and wellbeing. However, the study has predominantly considered mainly literature from the USA, UK, Canada and Australia and therefore is limited in scope at this stage. The authors are aware of the need to consider research undertaken in non-English speaking countries where a considerable body of knowledge also exists and which will add to further discussion about how that work dovetails into this body of literature and, how it aligns with the biomedical perspective. There is a need for complex organizations such as the NHS and allied organizations to agree a working definition of their model of health and wellbeing, whether that be a social model of health and wellbeing, a biopsychosocial model, a combined model, or indeed a new or revised perspective. 39

One limitation seen of the models within this study is that at a systems level, most models were conceptual models that characterized current systems or conditions and interventions to the current system that result in localized improvements in systems’ performance. However, for meaningful change to occur, a ‘future state’ model may need to focus on a behavioural systems approach allowing modelling of the complete system to take place in order to understand how the elements within the model 40 behave under different external conditions and how these behaviours affect overall system performance.

Furthermore, considerable work will be required to engage on a more equal footing with the public, health and social care staff as well as wider supporting organizations in developing workable principles and processes that fully embrace the equality of a social model and challenging the ‘power’ imbalances of the current biomedical model.

Supplementary data are available at EURPUB online.

This research was funded/commissioned by Hywel Dda University Health Board. The research was funded in two phases.

Conflicts of interest: None declared.

The datasets generated and/or analysed during the current study are available in the Data Archive at Aberystwyth University and have been included in the supplementary file attached to this submission. A full table of references for studies included in the review will be provided as a supplementary document. The references below refer to citations in the report which are in addition to the included studies of the synthesis.

The review identified five themes namely: the lack of a clear definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health.

The review identified a need for organizations to decide on how a social model is to be defined especially at the interfaces between partner organizations and communities.

The implications for public policy in this paper highlights the importance of engagement with citizens, users, multi-disciplinary teams and partner organizations to ensure that transition towards a social model of health and wellbeing is undertaken with holistic needs as a central value.

British Medical Association (ND). An NHS under pressure. Accessed via An NHS under pressure (bma.org.uk). https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/an-nhs-under-pressure (26 June 2023, date last accessed).

Nuffield Trust ( 2022 ). NHS performance summary. Accessed via NHS performance summary | The Nuffield Trust. https://www.nuffieldtrust.org.uk/news-item/nhs-performance-summary-january-february-2022 (26 June 2023, date last accessed).

NHS confederation , ( 2022 ) Running hot: The impact of the Covid-19 pandemic on mental health services. Accessed via Running hot | NHS Confederation. https://www.nhsconfed.org/publications/running-hot (26 June 2023, date last accessed).

Gemine R , Davies GR , Tarrant S , et al.    Factors associated with work-related burnout in NHS staff during COVID-19: a cross-sectional mixed methods study . BMJ Open   2021 ; 11 : e042591 .

Google Scholar

Iacobucci G.   Medical models of care needs updating say experts . BMJ   2018 ; 360 : K1034 .

Podgorski CA , Anderson SD , Parmar J.   A biopsychosocial-ecological framework for family-framed dementia care . Front Psychiatry   2021 ; 12 : 744806 .

Marmot M.   Social determinants of health inequalities . Lancet   2005 ; 365 : 1099 – 104 .

World Health Organisation ( 1946 ) Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference . New York: World Health Organization, 19–22 June, 1946.

World Health Organisation ( 2010 ). A conceptual framework for action on the social determinants of health. Accessed via A Conceptual Framework for Action on the Social Determinants of Health (who.int) (26 June 2023, date last accessed).

Engel G.   The need for a new medical model: a challenge for biomedicine . Science   1977 ; 196 : 129 – 36 .

Dahlgren G , Whitehead M. ( 2006 ). European strategies for tackling social inequities in health: Levelling up part 2. Studies on Social Economic Determinants of Population Health, 1–105. Available at: http://www.euro.who.int/__data/assets/pdf_file/0018/103824/E89384.pdf (12 October 2023, date last accessed).

McLeroy KR , Bibeau D , Steckler A , Glanz K.   An ecological perspective on health promotion programs . Health Educ Q   1988 ; 15 : 351 – 77 .

Welsh Government , Wellbeing of Future Generations Act 2015. Available at: https://www.gov.wales/sites/default/files/publications/2021-10/well-being-future-generations-wales-act-2015-the-essentials-2021.pdf (12 October 2023, date last accessed).

Stanford Encyclopaedia of Philosophy ( 2006 , 2020). Models in Science. Available at: https://plato.stanford.edu/entries/models-science/ (26 June 2023, date last accessed).

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

Braun V , Clarke V.   Using thematic analysis in psychology . Qual Res Psychol   2006 ; 3 : 77 – 101 .

Thomas J , Harden A.   Methods for the thematic synthesis of qualitative research in systematic reviews . BMC Med Res Methodol   2008 ; 8 : 45 .

Solar O , Irwin A. ( 2016 ) “A conceptual framework for action on the social determinants of health. Geneva, Switzerland: WHO; 2010”. (Social determinants of health discussion paper 2 (policy and practice)). Available at: http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf (12 October 2023, date last accessed).

Farre A , Rapley T.   The new old (and old new) medical model: four decades navigating the biomedical and psychosocial understandings of health and illness . Healthcare   2017 ; 5 : 88 .

Smedema SM.   Evaluation of a concentric biopsychosocial model of well-being in persons with spinal cord injuries . Rehabil Psychol   2017 ; 62 : 186 – 97 . PMID: 28569533.

Robles B , Kuo T , Thomas Tobin CS.   What are the relationships between psychosocial community characteristics and dietary behaviors in a racially/ethnically diverse urban population in Los Angeles county? . Int J Environ Res Public Health   2021 ; 18 : 9868 .

Glass TA , McAtee MJ.   Behavioral science at the crossroads in public health: extending horizons, envisioning the future . Soc Sci Med   2006 ; 62 : 1650 – 71 .

Mezuk B , Abdou CM , Hudson D , et al.    "White Box" epidemiology and the social neuroscience of health behaviors: the environmental affordances model . Soc Ment Health   2013 ; 3 : 10.1177/2156869313480892

Wilkinson RG , Marmot M , editors. Social Determinants of Health: The Solid Facts . Copenhagen, Denmark: World Health Organization , 2003 .

Google Preview

Mannion R , Davies H.   Understanding organisational culture for healthcare quality improvement . BMJ   2018 ; 363 : k4907 .

Blount A , Bayona J.   Toward a system of integrated primary care . Fam Syst Health   1994 ; 12 : 171 – 82 .

Berger MY , Gieteling MJ , Benninga MA.   Chronic abdominal pain in children . BMJ   2007 ; 334 : 997 – 1002 . PMID: 17494020; PMCID: PMC1867894.

Berríos-Rivera R , Rivero-Vergne A , Romero I.   The pediatric cancer hospitalization experience: reality co-constructed . J Pediatr Oncol Nurs   2008 ; 25 : 340 – 53 .

Doty MM , Koren MJ , Sturla EL. ( 2008 ). Culture change in nursing homes: How far have we come? Findings from the Commonwealth Fund 2007 National Survey. The Commonwealth Fund, 91. Available at: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/May/Culture-Change-in-NursingHomes-How-Far-Have-We-Come-Findings-FromThe-Commonwealth-Fund-2007-Nati.aspx (16 October 2023, date last accessed).

Robinson L , Tang E , Taylor J.   Dementia: timely diagnosis and early intervention . BMJ   2015 ; 350 : h3029 .

Baxter S , Johnson M , Chambers D , et al.    Understanding new models of integrated care in developed countries: a systematic review . Health Serv Deliv Res   2018 ; 6 : 1 .

Seys D , Panella M , VanZelm R , et al.    Care pathways are complex interventions in complex systems: new European Pathway Association framework . Int J Care Coord   2019 ; 22 : 5 – 9 .

Agarwal G , Brydges M.   Effects of a community health promotion program on social factors in a vulnerable older adult population residing in social housing” . BMC Geriatr   2018 ; 18 : 95 . PMID: 29661136; PMCID: PMC5902999.

Franklin CM , Bernhardt JM , Lopez RP , et al.    Interprofessional teamwork and collaboration between community health workers and healthcare teams: an integrative review . Health Serv Res Manag Epidemiol   2015 ; 2 : 2333392815573312 . PMID: 28462254; PMCID: PMC5266454.

Gagné T , Henderson C , McMunn A.   Is the self-reporting of mental health problems sensitive to public stigma towards mental illness? A comparison of time trends across English regions (2009-19) . Soc Psychiatry Psychiatr Epidemiol   2023 ; 58 : 671 – 80 . PMID: 36473961; PMCID: PMC9735159.

Geyh S , Nick E , Stirnimann D , et al.    Biopsychosocial outcomes in individuals with and without spinal cord injury: a Swiss comparative study . Spinal Cord   2012 ; 50 : 614 – 22 .

Davies C , Knuiman M , Rosenberg M.   The art of being mentally healthy: a study to quantify the relationship between recreational arts engagement and mental well-being in the general population . BMC Public Health   2016 ; 16 : 15 . PMID: 26733272; PMCID: PMC4702355.

Duberstein Z , Brunner J , Panisch L , et al.    The biopsychosocial model and perinatal health care: determinants of perinatal care in a community sample . Front Psychiatry   2021 ; 12 : 746803 .

The King’s Fund , ( 2021 ). Health inequalities in a nutshell. Accessed via Health inequalities in a nutshell | The King's Fund (kingsfund.org.uk) https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-inequalities (23 October 2023, date last accessed)

Blount A.   Integrated primary care: organizing the evidence . Fam Syst Health   2003 ; 21 : 121 – 33 .

Email alerts

Citing articles via.

• Contact EUPHA
• Recommend to your Library

Affiliations

• Online ISSN 1464-360X
• Print ISSN 1101-1262
• Copyright © 2024 European Public Health Association
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Connecting to

Sign in with your account to access State.gov CMS

Javascript is required

Javascript is disabled on your browser. please enable javascript and refresh this page., your onedrive version is not supported.

Upgrade now by installing the OneDrive for Business Next Generation Sync Client to login to Okta

Cookies are required

Cookies are disabled on your browser. Please enable Cookies and refresh this page.

Powered by Okta

Privacy Policy

The page has timed out

If this page does not reload automatically, please refresh your browser.

Loading metrics

Open Access

Peer-reviewed

Research Article

Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Child and Adolescent Mental Health, Department of Brain Sciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom

Roles Conceptualization, Supervision, Validation, Writing – review & editing

* E-mail: [email protected]

Affiliation Behavioural Brain Sciences Unit, Population Policy Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom

• Max L. Y. Chang, 
• Irene O. Lee

• Published: June 4, 2024
• https://doi.org/10.1371/journal.pmen.0000022
• Peer Review
• Reader Comments

Internet usage has seen a stark global rise over the last few decades, particularly among adolescents and young people, who have also been diagnosed increasingly with internet addiction (IA). IA impacts several neural networks that influence an adolescent’s behaviour and development. This article issued a literature review on the resting-state and task-based functional magnetic resonance imaging (fMRI) studies to inspect the consequences of IA on the functional connectivity (FC) in the adolescent brain and its subsequent effects on their behaviour and development. A systematic search was conducted from two databases, PubMed and PsycINFO, to select eligible articles according to the inclusion and exclusion criteria. Eligibility criteria was especially stringent regarding the adolescent age range (10–19) and formal diagnosis of IA. Bias and quality of individual studies were evaluated. The fMRI results from 12 articles demonstrated that the effects of IA were seen throughout multiple neural networks: a mix of increases/decreases in FC in the default mode network; an overall decrease in FC in the executive control network; and no clear increase or decrease in FC within the salience network and reward pathway. The FC changes led to addictive behaviour and tendencies in adolescents. The subsequent behavioural changes are associated with the mechanisms relating to the areas of cognitive control, reward valuation, motor coordination, and the developing adolescent brain. Our results presented the FC alterations in numerous brain regions of adolescents with IA leading to the behavioural and developmental changes. Research on this topic had a low frequency with adolescent samples and were primarily produced in Asian countries. Future research studies of comparing results from Western adolescent samples provide more insight on therapeutic intervention.

Citation: Chang MLY, Lee IO (2024) Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies. PLOS Ment Health 1(1): e0000022. https://doi.org/10.1371/journal.pmen.0000022

Editor: Kizito Omona, Uganda Martyrs University, UGANDA

Received: December 29, 2023; Accepted: March 18, 2024; Published: June 4, 2024

Copyright: © 2024 Chang, Lee. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The behavioural addiction brought on by excessive internet use has become a rising source of concern [ 1 ] since the last decade. According to clinical studies, individuals with Internet Addiction (IA) or Internet Gaming Disorder (IGD) may have a range of biopsychosocial effects and is classified as an impulse-control disorder owing to its resemblance to pathological gambling and substance addiction [ 2 , 3 ]. IA has been defined by researchers as a person’s inability to resist the urge to use the internet, which has negative effects on their psychological well-being as well as their social, academic, and professional lives [ 4 ]. The symptoms can have serious physical and interpersonal repercussions and are linked to mood modification, salience, tolerance, impulsivity, and conflict [ 5 ]. In severe circumstances, people may experience severe pain in their bodies or health issues like carpal tunnel syndrome, dry eyes, irregular eating and disrupted sleep [ 6 ]. Additionally, IA is significantly linked to comorbidities with other psychiatric disorders [ 7 ].

Stevens et al (2021) reviewed 53 studies including 17 countries and reported the global prevalence of IA was 3.05% [ 8 ]. Asian countries had a higher prevalence (5.1%) than European countries (2.7%) [ 8 ]. Strikingly, adolescents and young adults had a global IGD prevalence rate of 9.9% which matches previous literature that reported historically higher prevalence among adolescent populations compared to adults [ 8 , 9 ]. Over 80% of adolescent population in the UK, the USA, and Asia have direct access to the internet [ 10 ]. Children and adolescents frequently spend more time on media (possibly 7 hours and 22 minutes per day) than at school or sleeping [ 11 ]. Developing nations have also shown a sharp rise in teenage internet usage despite having lower internet penetration rates [ 10 ]. Concerns regarding the possible harms that overt internet use could do to adolescents and their development have arisen because of this surge, especially the significant impacts by the COVID-19 pandemic [ 12 ]. The growing prevalence and neurocognitive consequences of IA among adolescents makes this population a vital area of study [ 13 ].

Adolescence is a crucial developmental stage during which people go through significant changes in their biology, cognition, and personalities [ 14 ]. Adolescents’ emotional-behavioural functioning is hyperactivated, which creates risk of psychopathological vulnerability [ 15 ]. In accordance with clinical study results [ 16 ], this emotional hyperactivity is supported by a high level of neuronal plasticity. This plasticity enables teenagers to adapt to the numerous physical and emotional changes that occur during puberty as well as develop communication techniques and gain independence [ 16 ]. However, the strong neuronal plasticity is also associated with risk-taking and sensation seeking [ 17 ] which may lead to IA.

Despite the fact that the precise neuronal mechanisms underlying IA are still largely unclear, functional magnetic resonance imaging (fMRI) method has been used by scientists as an important framework to examine the neuropathological changes occurring in IA, particularly in the form of functional connectivity (FC) [ 18 ]. fMRI research study has shown that IA alters both the functional and structural makeup of the brain [ 3 ].

We hypothesise that IA has widespread neurological alteration effects rather than being limited to a few specific brain regions. Further hypothesis holds that according to these alterations of FC between the brain regions or certain neural networks, adolescents with IA would experience behavioural changes. An investigation of these domains could be useful for creating better procedures and standards as well as minimising the negative effects of overt internet use. This literature review aims to summarise and analyse the evidence of various imaging studies that have investigated the effects of IA on the FC in adolescents. This will be addressed through two research questions:

• How does internet addiction affect the functional connectivity in the adolescent brain?
• How is adolescent behaviour and development impacted by functional connectivity changes due to internet addiction?

The review protocol was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (see S1 Checklist ).

Search strategy and selection process

A systematic search was conducted up until April 2023 from two sources of database, PubMed and PsycINFO, using a range of terms relevant to the title and research questions (see full list of search terms in S1 Appendix ). All the searched articles can be accessed in the S1 Data . The eligible articles were selected according to the inclusion and exclusion criteria. Inclusion criteria used for the present review were: (i) participants in the studies with clinical diagnosis of IA; (ii) participants between the ages of 10 and 19; (iii) imaging research investigations; (iv) works published between January 2013 and April 2023; (v) written in English language; (vi) peer-reviewed papers and (vii) full text. The numbers of articles excluded due to not meeting the inclusion criteria are shown in Fig 1 . Each study’s title and abstract were screened for eligibility.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pmen.0000022.g001

Quality appraisal

Full texts of all potentially relevant studies were then retrieved and further appraised for eligibility. Furthermore, articles were critically appraised based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to evaluate the individual study for both quality and bias. The subsequent quality levels were then appraised to each article and listed as either low, moderate, or high.

Data collection process

Data that satisfied the inclusion requirements was entered into an excel sheet for data extraction and further selection. An article’s author, publication year, country, age range, participant sample size, sex, area of interest, measures, outcome and article quality were all included in the data extraction spreadsheet. Studies looking at FC, for instance, were grouped, while studies looking at FC in specific area were further divided into sub-groups.

Data synthesis and analysis

Articles were classified according to their location in the brain as well as the network or pathway they were a part of to create a coherent narrative between the selected studies. Conclusions concerning various research trends relevant to particular groupings were drawn from these groupings and subgroupings. To maintain the offered information in a prominent manner, these assertions were entered into the data extraction excel spreadsheet.

With the search performed on the selected databases, 238 articles in total were identified (see Fig 1 ). 15 duplicated articles were eliminated, and another 6 items were removed for various other reasons. Title and abstract screening eliminated 184 articles because they were not in English (number of article, n, = 7), did not include imaging components (n = 47), had adult participants (n = 53), did not have a clinical diagnosis of IA (n = 19), did not address FC in the brain (n = 20), and were published outside the desired timeframe (n = 38). A further 21 papers were eliminated for failing to meet inclusion requirements after the remaining 33 articles underwent full-text eligibility screening. A total of 12 papers were deemed eligible for this review analysis.

Characteristics of the included studies, as depicted in the data extraction sheet in Table 1 provide information of the author(s), publication year, sample size, study location, age range, gender, area of interest, outcome, measures used and quality appraisal. Most of the studies in this review utilised resting state functional magnetic resonance imaging techniques (n = 7), with several studies demonstrating task-based fMRI procedures (n = 3), and the remaining studies utilising whole-brain imaging measures (n = 2). The studies were all conducted in Asiatic countries, specifically coming from China (8), Korea (3), and Indonesia (1). Sample sizes ranged from 12 to 31 participants with most of the imaging studies having comparable sample sizes. Majority of the studies included a mix of male and female participants (n = 8) with several studies having a male only participant pool (n = 3). All except one of the mixed gender studies had a majority male participant pool. One study did not disclose their data on the gender demographics of their experiment. Study years ranged from 2013–2022, with 2 studies in 2013, 3 studies in 2014, 3 studies in 2015, 1 study in 2017, 1 study in 2020, 1 study in 2021, and 1 study in 2022.

https://doi.org/10.1371/journal.pmen.0000022.t001

(1) How does internet addiction affect the functional connectivity in the adolescent brain?

The included studies were organised according to the brain region or network that they were observing. The specific networks affected by IA were the default mode network, executive control system, salience network and reward pathway. These networks are vital components of adolescent behaviour and development [ 31 ]. The studies in each section were then grouped into subsections according to their specific brain regions within their network.

Default mode network (DMN)/reward network.

Out of the 12 studies, 3 have specifically studied the default mode network (DMN), and 3 observed whole-brain FC that partially included components of the DMN. The effect of IA on the various centres of the DMN was not unilaterally the same. The findings illustrate a complex mix of increases and decreases in FC depending on the specific region in the DMN (see Table 2 and Fig 2 ). The alteration of FC in posterior cingulate cortex (PCC) in the DMN was the most frequently reported area in adolescents with IA, which involved in attentional processes [ 32 ], but Lee et al. (2020) additionally found alterations of FC in other brain regions, such as anterior insula cortex, a node in the DMN that controls the integration of motivational and cognitive processes [ 20 ].

https://doi.org/10.1371/journal.pmen.0000022.g002

The overall changes of functional connectivity in the brain network including default mode network (DMN), executive control network (ECN), salience network (SN) and reward network. IA = Internet Addiction, FC = Functional Connectivity.

https://doi.org/10.1371/journal.pmen.0000022.t002

Ding et al. (2013) revealed altered FC in the cerebellum, the middle temporal gyrus, and the medial prefrontal cortex (mPFC) [ 22 ]. They found that the bilateral inferior parietal lobule, left superior parietal lobule, and right inferior temporal gyrus had decreased FC, while the bilateral posterior lobe of the cerebellum and the medial temporal gyrus had increased FC [ 22 ]. The right middle temporal gyrus was found to have 111 cluster voxels (t = 3.52, p<0.05) and the right inferior parietal lobule was found to have 324 cluster voxels (t = -4.07, p<0.05) with an extent threshold of 54 voxels (figures above this threshold are deemed significant) [ 22 ]. Additionally, there was a negative correlation, with 95 cluster voxels (p<0.05) between the FC of the left superior parietal lobule and the PCC with the Chen Internet Addiction Scores (CIAS) which are used to determine the severity of IA [ 22 ]. On the other hand, in regions of the reward system, connection with the PCC was positively connected with CIAS scores [ 22 ]. The most significant was the right praecuneus with 219 cluster voxels (p<0.05) [ 22 ]. Wang et al. (2017) also discovered that adolescents with IA had 33% less FC in the left inferior parietal lobule and 20% less FC in the dorsal mPFC [ 24 ]. A potential connection between the effects of substance use and overt internet use is revealed by the generally decreased FC in these areas of the DMN of teenagers with drug addiction and IA [ 35 ].

The putamen was one of the main regions of reduced FC in adolescents with IA [ 19 ]. The putamen and the insula-operculum demonstrated significant group differences regarding functional connectivity with a cluster size of 251 and an extent threshold of 250 (Z = 3.40, p<0.05) [ 19 ]. The molecular mechanisms behind addiction disorders have been intimately connected to decreased striatal dopaminergic function [ 19 ], making this function crucial.

Executive Control Network (ECN).

5 studies out of 12 have specifically viewed parts of the executive control network (ECN) and 3 studies observed whole-brain FC. The effects of IA on the ECN’s constituent parts were consistent across all the studies examined for this analysis (see Table 2 and Fig 3 ). The results showed a notable decline in all the ECN’s major centres. Li et al. (2014) used fMRI imaging and a behavioural task to study response inhibition in adolescents with IA [ 25 ] and found decreased activation at the striatum and frontal gyrus, particularly a reduction in FC at inferior frontal gyrus, in the IA group compared to controls [ 25 ]. The inferior frontal gyrus showed a reduction in FC in comparison to the controls with a cluster size of 71 (t = 4.18, p<0.05) [ 25 ]. In addition, the frontal-basal ganglia pathways in the adolescents with IA showed little effective connection between areas and increased degrees of response inhibition [ 25 ].

https://doi.org/10.1371/journal.pmen.0000022.g003

Lin et al. (2015) found that adolescents with IA demonstrated disrupted corticostriatal FC compared to controls [ 33 ]. The corticostriatal circuitry experienced decreased connectivity with the caudate, bilateral anterior cingulate cortex (ACC), as well as the striatum and frontal gyrus [ 33 ]. The inferior ventral striatum showed significantly reduced FC with the subcallosal ACC and caudate head with cluster size of 101 (t = -4.64, p<0.05) [ 33 ]. Decreased FC in the caudate implies dysfunction of the corticostriatal-limbic circuitry involved in cognitive and emotional control [ 36 ]. The decrease in FC in both the striatum and frontal gyrus is related to inhibitory control, a common deficit seen with disruptions with the ECN [ 33 ].

The dorsolateral prefrontal cortex (DLPFC), ACC, and right supplementary motor area (SMA) of the prefrontal cortex were all found to have significantly decreased grey matter volume [ 29 ]. In addition, the DLPFC, insula, temporal cortices, as well as significant subcortical regions like the striatum and thalamus, showed decreased FC [ 29 ]. According to Tremblay (2009), the striatum plays a significant role in the processing of rewards, decision-making, and motivation [ 37 ]. Chen et al. (2020) reported that the IA group demonstrated increased impulsivity as well as decreased reaction inhibition using a Stroop colour-word task [ 26 ]. Furthermore, Chen et al. (2020) observed that the left DLPFC and dorsal striatum experienced a negative connection efficiency value, specifically demonstrating that the dorsal striatum activity suppressed the left DLPFC [ 27 ].

Salience network (SN).

Out of the 12 chosen studies, 3 studies specifically looked at the salience network (SN) and 3 studies have observed whole-brain FC. Relative to the DMN and ECN, the findings on the SN were slightly sparser. Despite this, adolescents with IA demonstrated a moderate decrease in FC, as well as other measures like fibre connectivity and cognitive control, when compared to healthy control (see Table 2 and Fig 4 ).

https://doi.org/10.1371/journal.pmen.0000022.g004

Xing et al. (2014) used both dorsal anterior cingulate cortex (dACC) and insula to test FC changes in the SN of adolescents with IA and found decreased structural connectivity in the SN as well as decreased fractional anisotropy (FA) that correlated to behaviour performance in the Stroop colour word-task [ 21 ]. They examined the dACC and insula to determine whether the SN’s disrupted connectivity may be linked to the SN’s disruption of regulation, which would explain the impaired cognitive control seen in adolescents with IA. However, researchers did not find significant FC differences in the SN when compared to the controls [ 21 ]. These results provided evidence for the structural changes in the interconnectivity within SN in adolescents with IA.

Wang et al. (2017) investigated network interactions between the DMN, ECN, SN and reward pathway in IA subjects [ 24 ] (see Fig 5 ), and found 40% reduction of FC between the DMN and specific regions of the SN, such as the insula, in comparison to the controls (p = 0.008) [ 24 ]. The anterior insula and dACC are two areas that are impacted by this altered FC [ 24 ]. This finding supports the idea that IA has similar neurobiological abnormalities with other addictive illnesses, which is in line with a study that discovered disruptive changes in the SN and DMN’s interaction in cocaine addiction [ 38 ]. The insula has also been linked to the intensity of symptoms and has been implicated in the development of IA [ 39 ].

“+” indicates an increase in behaivour; “-”indicates a decrease in behaviour; solid arrows indicate a direct network interaction; and the dotted arrows indicates a reduction in network interaction. This diagram depicts network interactions juxtaposed with engaging in internet related behaviours. Through the neural interactions, the diagram illustrates how the networks inhibit or amplify internet usage and vice versa. Furthermore, it demonstrates how the SN mediates both the DMN and ECN.

https://doi.org/10.1371/journal.pmen.0000022.g005

(2) How is adolescent behaviour and development impacted by functional connectivity changes due to internet addiction?

The findings that IA individuals demonstrate an overall decrease in FC in the DMN is supported by numerous research [ 24 ]. Drug addict populations also exhibited similar decline in FC in the DMN [ 40 ]. The disruption of attentional orientation and self-referential processing for both substance and behavioural addiction was then hypothesised to be caused by DMN anomalies in FC [ 41 ].

In adolescents with IA, decline of FC in the parietal lobule affects visuospatial task-related behaviour [ 22 ], short-term memory [ 42 ], and the ability of controlling attention or restraining motor responses during response inhibition tests [ 42 ]. Cue-induced gaming cravings are influenced by the DMN [ 43 ]. A visual processing area called the praecuneus links gaming cues to internal information [ 22 ]. A meta-analysis found that the posterior cingulate cortex activity of individuals with IA during cue-reactivity tasks was connected with their gaming time [ 44 ], suggesting that excessive gaming may impair DMN function and that individuals with IA exert more cognitive effort to control it. Findings for the behavioural consequences of FC changes in the DMN illustrate its underlying role in regulating impulsivity, self-monitoring, and cognitive control.

Furthermore, Ding et al. (2013) reported an activation of components of the reward pathway, including areas like the nucleus accumbens, praecuneus, SMA, caudate, and thalamus, in connection to the DMN [ 22 ]. The increased FC of the limbic and reward networks have been confirmed to be a major biomarker for IA [ 45 , 46 ]. The increased reinforcement in these networks increases the strength of reward stimuli and makes it more difficult for other networks, namely the ECN, to down-regulate the increased attention [ 29 ] (See Fig 5 ).

Executive control network (ECN).

The numerous IA-affected components in the ECN have a role in a variety of behaviours that are connected to both response inhibition and emotional regulation [ 47 ]. For instance, brain regions like the striatum, which are linked to impulsivity and the reward system, are heavily involved in the act of playing online games [ 47 ]. Online game play activates the striatum, which suppresses the left DLPFC in ECN [ 48 ]. As a result, people with IA may find it difficult to control their want to play online games [ 48 ]. This system thus causes impulsive and protracted gaming conduct, lack of inhibitory control leading to the continued use of internet in an overt manner despite a variety of negative effects, personal distress, and signs of psychological dependence [ 33 ] (See Fig 5 ).

Wang et al. (2017) report that disruptions in cognitive control networks within the ECN are frequently linked to characteristics of substance addiction [ 24 ]. With samples that were addicted to heroin and cocaine, previous studies discovered abnormal FC in the ECN and the PFC [ 49 ]. Electronic gaming is known to promote striatal dopamine release, similar to drug addiction [ 50 ]. According to Drgonova and Walther (2016), it is hypothesised that dopamine could stimulate the reward system of the striatum in the brain, leading to a loss of impulse control and a failure of prefrontal lobe executive inhibitory control [ 51 ]. In the end, IA’s resemblance to drug use disorders may point to vital biomarkers or underlying mechanisms that explain how cognitive control and impulsive behaviour are related.

A task-related fMRI study found that the decrease in FC between the left DLPFC and dorsal striatum was congruent with an increase in impulsivity in adolescents with IA [ 26 ]. The lack of response inhibition from the ECN results in a loss of control over internet usage and a reduced capacity to display goal-directed behaviour [ 33 ]. Previous studies have linked the alteration of the ECN in IA with higher cue reactivity and impaired ability to self-regulate internet specific stimuli [ 52 ].

Salience network (SN)/ other networks.

Xing et al. (2014) investigated the significance of the SN regarding cognitive control in teenagers with IA [ 21 ]. The SN, which is composed of the ACC and insula, has been demonstrated to control dynamic changes in other networks to modify cognitive performance [ 21 ]. The ACC is engaged in conflict monitoring and cognitive control, according to previous neuroimaging research [ 53 ]. The insula is a region that integrates interoceptive states into conscious feelings [ 54 ]. The results from Xing et al. (2014) showed declines in the SN regarding its structural connectivity and fractional anisotropy, even though they did not observe any appreciable change in FC in the IA participants [ 21 ]. Due to the small sample size, the results may have indicated that FC methods are not sensitive enough to detect the significant functional changes [ 21 ]. However, task performance behaviours associated with impaired cognitive control in adolescents with IA were correlated with these findings [ 21 ]. Our comprehension of the SN’s broader function in IA can be enhanced by this relationship.

Research study supports the idea that different psychological issues are caused by the functional reorganisation of expansive brain networks, such that strong association between SN and DMN may provide neurological underpinnings at the system level for the uncontrollable character of internet-using behaviours [ 24 ]. In the study by Wang et al. (2017), the decreased interconnectivity between the SN and DMN, comprising regions such the DLPFC and the insula, suggests that adolescents with IA may struggle to effectively inhibit DMN activity during internally focused processing, leading to poorly managed desires or preoccupations to use the internet [ 24 ] (See Fig 5 ). Subsequently, this may cause a failure to inhibit DMN activity as well as a restriction of ECN functionality [ 55 ]. As a result, the adolescent experiences an increased salience and sensitivity towards internet addicting cues making it difficult to avoid these triggers [ 56 ].

The primary aim of this review was to present a summary of how internet addiction impacts on the functional connectivity of adolescent brain. Subsequently, the influence of IA on the adolescent brain was compartmentalised into three sections: alterations of FC at various brain regions, specific FC relationships, and behavioural/developmental changes. Overall, the specific effects of IA on the adolescent brain were not completely clear, given the variety of FC changes. However, there were overarching behavioural, network and developmental trends that were supported that provided insight on adolescent development.

The first hypothesis that was held about this question was that IA was widespread and would be regionally similar to substance-use and gambling addiction. After conducting a review of the information in the chosen articles, the hypothesis was predictably supported. The regions of the brain affected by IA are widespread and influence multiple networks, mainly DMN, ECN, SN and reward pathway. In the DMN, there was a complex mix of increases and decreases within the network. However, in the ECN, the alterations of FC were more unilaterally decreased, but the findings of SN and reward pathway were not quite clear. Overall, the FC changes within adolescents with IA are very much network specific and lay a solid foundation from which to understand the subsequent behaviour changes that arise from the disorder.

The second hypothesis placed emphasis on the importance of between network interactions and within network interactions in the continuation of IA and the development of its behavioural symptoms. The results from the findings involving the networks, DMN, SN, ECN and reward system, support this hypothesis (see Fig 5 ). Studies confirm the influence of all these neural networks on reward valuation, impulsivity, salience to stimuli, cue reactivity and other changes that alter behaviour towards the internet use. Many of these changes are connected to the inherent nature of the adolescent brain.

There are multiple explanations that underlie the vulnerability of the adolescent brain towards IA related urges. Several of them have to do with the inherent nature and underlying mechanisms of the adolescent brain. Children’s emotional, social, and cognitive capacities grow exponentially during childhood and adolescence [ 57 ]. Early teenagers go through a process called “social reorientation” that is characterised by heightened sensitivity to social cues and peer connections [ 58 ]. Adolescents’ improvements in their social skills coincide with changes in their brains’ anatomical and functional organisation [ 59 ]. Functional hubs exhibit growing connectivity strength [ 60 ], suggesting increased functional integration during development. During this time, the brain’s functional networks change from an anatomically dominant structure to a scattered architecture [ 60 ].

The adolescent brain is very responsive to synaptic reorganisation and experience cues [ 61 ]. As a result, one of the distinguishing traits of the maturation of adolescent brains is the variation in neural network trajectory [ 62 ]. Important weaknesses of the adolescent brain that may explain the neurobiological change brought on by external stimuli are illustrated by features like the functional gaps between networks and the inadequate segregation of networks [ 62 ].

The implications of these findings towards adolescent behaviour are significant. Although the exact changes and mechanisms are not fully clear, the observed changes in functional connectivity have the capacity of influencing several aspects of adolescent development. For example, functional connectivity has been utilised to investigate attachment styles in adolescents [ 63 ]. It was observed that adolescent attachment styles were negatively associated with caudate-prefrontal connectivity, but positively with the putamen-visual area connectivity [ 63 ]. Both named areas were also influenced by the onset of internet addiction, possibly providing a connection between the two. Another study associated neighbourhood/socioeconomic disadvantage with functional connectivity alterations in the DMN and dorsal attention network [ 64 ]. The study also found multivariate brain behaviour relationships between the altered/disadvantaged functional connectivity and mental health and cognition [ 64 ]. This conclusion supports the notion that the functional connectivity alterations observed in IA are associated with specific adolescent behaviours as well as the fact that functional connectivity can be utilised as a platform onto which to compare various neurologic conditions.

Limitations/strengths

There were several limitations that were related to the conduction of the review as well as the data extracted from the articles. Firstly, the study followed a systematic literature review design when analysing the fMRI studies. The data pulled from these imaging studies were namely qualitative and were subject to bias contrasting the quantitative nature of statistical analysis. Components of the study, such as sample sizes, effect sizes, and demographics were not weighted or controlled. The second limitation brought up by a similar review was the lack of a universal consensus of terminology given IA [ 47 ]. Globally, authors writing about this topic use an array of terminology including online gaming addiction, internet addiction, internet gaming disorder, and problematic internet use. Often, authors use multiple terms interchangeably which makes it difficult to depict the subtle similarities and differences between the terms.

Reviewing the explicit limitations in each of the included studies, two major limitations were brought up in many of the articles. One was relating to the cross-sectional nature of the included studies. Due to the inherent qualities of a cross-sectional study, the studies did not provide clear evidence that IA played a causal role towards the development of the adolescent brain. While several biopsychosocial factors mediate these interactions, task-based measures that combine executive functions with imaging results reinforce the assumed connection between the two that is utilised by the papers studying IA. Another limitation regarded the small sample size of the included studies, which averaged to around 20 participants. The small sample size can influence the generalisation of the results as well as the effectiveness of statistical analyses. Ultimately, both included study specific limitations illustrate the need for future studies to clarify the causal relationship between the alterations of FC and the development of IA.

Another vital limitation was the limited number of studies applying imaging techniques for investigations on IA in adolescents were a uniformly Far East collection of studies. The reason for this was because the studies included in this review were the only fMRI studies that were found that adhered to the strict adolescent age restriction. The adolescent age range given by the WHO (10–19 years old) [ 65 ] was strictly followed. It is important to note that a multitude of studies found in the initial search utilised an older adolescent demographic that was slightly higher than the WHO age range and had a mean age that was outside of the limitations. As a result, the results of this review are biased and based on the 12 studies that met the inclusion and exclusion criteria.

Regarding the global nature of the research, although the journals that the studies were published in were all established western journals, the collection of studies were found to all originate from Asian countries, namely China and Korea. Subsequently, it pulls into question if the results and measures from these studies are generalisable towards a western population. As stated previously, Asian countries have a higher prevalence of IA, which may be the reasoning to why the majority of studies are from there [ 8 ]. However, in an additional search including other age groups, it was found that a high majority of all FC studies on IA were done in Asian countries. Interestingly, western papers studying fMRI FC were primarily focused on gambling and substance-use addiction disorders. The western papers on IA were less focused on fMRI FC but more on other components of IA such as sleep, game-genre, and other non-imaging related factors. This demonstrated an overall lack of western fMRI studies on IA. It is important to note that both western and eastern fMRI studies on IA presented an overall lack on children and adolescents in general.

Despite the several limitations, this review provided a clear reflection on the state of the data. The strengths of the review include the strict inclusion/exclusion criteria that filtered through studies and only included ones that contained a purely adolescent sample. As a result, the information presented in this review was specific to the review’s aims. Given the sparse nature of adolescent specific fMRI studies on the FC changes in IA, this review successfully provided a much-needed niche representation of adolescent specific results. Furthermore, the review provided a thorough functional explanation of the DMN, ECN, SN and reward pathway making it accessible to readers new to the topic.

Future directions and implications

Through the search process of the review, there were more imaging studies focused on older adolescence and adulthood. Furthermore, finding a review that covered a strictly adolescent population, focused on FC changes, and was specifically depicting IA, was proven difficult. Many related reviews, such as Tereshchenko and Kasparov (2019), looked at risk factors related to the biopsychosocial model, but did not tackle specific alterations in specific structural or functional changes in the brain [ 66 ]. Weinstein (2017) found similar structural and functional results as well as the role IA has in altering response inhibition and reward valuation in adolescents with IA [ 47 ]. Overall, the accumulated findings only paint an emerging pattern which aligns with similar substance-use and gambling disorders. Future studies require more specificity in depicting the interactions between neural networks, as well as more literature on adolescent and comorbid populations. One future field of interest is the incorporation of more task-based fMRI data. Advances in resting-state fMRI methods have yet to be reflected or confirmed in task-based fMRI methods [ 62 ]. Due to the fact that network connectivity is shaped by different tasks, it is critical to confirm that the findings of the resting state fMRI studies also apply to the task based ones [ 62 ]. Subsequently, work in this area will confirm if intrinsic connectivity networks function in resting state will function similarly during goal directed behaviour [ 62 ]. An elevated focus on adolescent populations as well as task-based fMRI methodology will help uncover to what extent adolescent network connectivity maturation facilitates behavioural and cognitive development [ 62 ].

A treatment implication is the potential usage of bupropion for the treatment of IA. Bupropion has been previously used to treat patients with gambling disorder and has been effective in decreasing overall gambling behaviour as well as money spent while gambling [ 67 ]. Bae et al. (2018) found a decrease in clinical symptoms of IA in line with a 12-week bupropion treatment [ 31 ]. The study found that bupropion altered the FC of both the DMN and ECN which in turn decreased impulsivity and attentional deficits for the individuals with IA [ 31 ]. Interventions like bupropion illustrate the importance of understanding the fundamental mechanisms that underlie disorders like IA.

The goal for this review was to summarise the current literature on functional connectivity changes in adolescents with internet addiction. The findings answered the primary research questions that were directed at FC alterations within several networks of the adolescent brain and how that influenced their behaviour and development. Overall, the research demonstrated several wide-ranging effects that influenced the DMN, SN, ECN, and reward centres. Additionally, the findings gave ground to important details such as the maturation of the adolescent brain, the high prevalence of Asian originated studies, and the importance of task-based studies in this field. The process of making this review allowed for a thorough understanding IA and adolescent brain interactions.

Given the influx of technology and media in the lives and education of children and adolescents, an increase in prevalence and focus on internet related behavioural changes is imperative towards future children/adolescent mental health. Events such as COVID-19 act to expose the consequences of extended internet usage on the development and lifestyle of specifically young people. While it is important for parents and older generations to be wary of these changes, it is important for them to develop a base understanding of the issue and not dismiss it as an all-bad or all-good scenario. Future research on IA will aim to better understand the causal relationship between IA and psychological symptoms that coincide with it. The current literature regarding functional connectivity changes in adolescents is limited and requires future studies to test with larger sample sizes, comorbid populations, and populations outside Far East Asia.

This review aimed to demonstrate the inner workings of how IA alters the connection between the primary behavioural networks in the adolescent brain. Predictably, the present answers merely paint an unfinished picture that does not necessarily depict internet usage as overwhelmingly positive or negative. Alternatively, the research points towards emerging patterns that can direct individuals on the consequences of certain variables or risk factors. A clearer depiction of the mechanisms of IA would allow physicians to screen and treat the onset of IA more effectively. Clinically, this could be in the form of more streamlined and accurate sessions of CBT or family therapy, targeting key symptoms of IA. Alternatively clinicians could potentially prescribe treatment such as bupropion to target FC in certain regions of the brain. Furthermore, parental education on IA is another possible avenue of prevention from a public health standpoint. Parents who are aware of the early signs and onset of IA will more effectively handle screen time, impulsivity, and minimize the risk factors surrounding IA.

Additionally, an increased attention towards internet related fMRI research is needed in the West, as mentioned previously. Despite cultural differences, Western countries may hold similarities to the eastern countries with a high prevalence of IA, like China and Korea, regarding the implications of the internet and IA. The increasing influence of the internet on the world may contribute to an overall increase in the global prevalence of IA. Nonetheless, the high saturation of eastern studies in this field should be replicated with a Western sample to determine if the same FC alterations occur. A growing interest in internet related research and education within the West will hopefully lead to the knowledge of healthier internet habits and coping strategies among parents with children and adolescents. Furthermore, IA research has the potential to become a crucial proxy for which to study adolescent brain maturation and development.

Supporting information

S1 checklist. prisma checklist..

https://doi.org/10.1371/journal.pmen.0000022.s001

S1 Appendix. Search strategies with all the terms.

https://doi.org/10.1371/journal.pmen.0000022.s002

S1 Data. Article screening records with details of categorized content.

https://doi.org/10.1371/journal.pmen.0000022.s003

Acknowledgments

The authors thank https://www.stockio.com/free-clipart/brain-01 (with attribution to Stockio.com); and https://www.rawpixel.com/image/6442258/png-sticker-vintage for the free images used to create Figs 2 – 4 .

• View Article
• PubMed/NCBI
• Google Scholar
• 2. Association AP. Diagnostic and statistical manual of mental disorders: DSM-5. 5 ed. Washington, D.C.: American Psychiatric Publishing; 2013.
• 10. Stats IW. World Internet Users Statistics and World Population Stats 2013 [ http://www.internetworldstats.com/stats.htm .
• 11. Rideout VJR M. B. The common sense census: media use by tweens and teens. San Francisco, CA: Common Sense Media; 2019.
• 37. Tremblay L. The Ventral Striatum. Handbook of Reward and Decision Making: Academic Press; 2009.
• 57. Bhana A. Middle childhood and pre-adolescence. Promoting mental health in scarce-resource contexts: emerging evidence and practice. Cape Town: HSRC Press; 2010. p. 124–42.
• 65. Organization WH. Adolescent Health 2023 [ https://www.who.int/health-topics/adolescent-health#tab=tab_1 .

• Systematic Review
• Open access
• Published: 13 June 2024

Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature

• Hiliary Monteith 1 ,
• Carly Checholik 2 ,
• Tracey Galloway 2 ,
• Hosna Sahak 1 ,
• Amy Shawanda 3 ,
• Christina Liu 1 &
• Anthony J. G. Hanley 1 , 4 , 5  

BMC Public Health volume  24 , Article number:  1583 ( 2024 ) Cite this article

152 Accesses

Metrics details

Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa.

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open.

Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge , and milk substitutes , with family and culture having the most influence on infant feeding experiences based on frequency of themes.

Conclusions

This review highlights key influencers of Indigenous caregivers’ infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.

Peer Review reports

Introduction

Nutritional status is a key aspect of infant health with recommendations for exclusive breastfeeding for the first six months of life, which can also influence and be influenced by maternal health and wellbeing [ 1 , 2 ]. Breastfeeding has several benefits for the health and development of infants, including a reduced risk of ear and respiratory infections, obesity, asthma, skin conditions, childhood leukemia, and gastroenteritis [ 3 , 4 , 5 ]. It also supports bonding between the child and parent with improved intimacy [ 3 ]. Additionally, breastfeeding has several maternal physical and mental health benefits, including a reduced risk of breast and ovarian cancer, depression, and type 2 diabetes due to immunoprotective antibodies in breastmilk [ 3 ]. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life and initiation within the first hour after birth; however, less than half of infants 0–6 months old are exclusively breastfed worldwide [ 6 ]. Many countries are not meeting the WHO recommendations, with notable differences between low, middle, and high-income countries [ 2 ]. Differences in breastfeeding initiation rates and duration have been observed between Indigenous and non-Indigenous groups, with 6–10% lower breastfeeding initiation rates and shorter duration for Indigenous peoples [ 7 , 8 , 9 ].

Despite the many benefits of breastfeeding, bottle feeding with milk substitutes is a common form of infant nutrition and its common usage is related to a multi-dimensional set of factors influencing infant feeding decision-making. Breastfeeding is considered a traditional practice within many Indigenous cultures; however, disruptions to traditional lifeways through colonization have influenced intergenerational knowledge sharing, particularly within high-income, settler states like Canada, the US, Australia, and Aotearoa (New Zealand) [ 10 ]. Rollins et al. [ 1 ] summarize factors that influence the global breastfeeding environment including the sociocultural and market contexts, the healthcare system and services, family and community settings, employment, and individual determinants like the mother and infant attributes. However, these core breastfeeding environments for general populations overlook key considerations for Indigenous communities given the unique historical, cultural, and socio-economic contexts specific to Indigenous groups [ 11 ].

Many studies to date have focused on quantitative infant feeding data, incorporating structured questionnaires that have provided some insight into breastfeeding barriers and enablers for Indigenous caregivers [ 7 , 12 , 13 , 14 ]. However, these studies are informed by specific research questions and do not capture important nuances that caregivers experience related to infant feeding. Qualitative research can enhance our understanding of phenomena by providing flexible means for participants to engage in the research topic of interest without the constraints of structured instruments, and can even transform the research by highlighting community needs [ 15 , 16 ]. Qualitative research can also have synergy with Indigenous methodologies, supporting the use of qualitative research with Indigenous communities [ 17 ]. Given the value of qualitative inquiry and breastfeeding as traditional practice for many Indigenous cultures, disrupted by colonial influences and the burden of conditions that breastfeeding has been shown to mitigate [ 3 , 5 , 10 , 11 , 16 , 17 ], it is imperative that we consider Indigenous caregiver infant feeding experiences and perspectives to understand what needs exist as defined by communities and caregivers. Therefore, the overall aim of this scoping review was to identify and summarize the qualitative literature on infant nutrition experiences to inform needs as expressed qualitatively by Indigenous caregivers in Canada, the US, Australia, and Aotearoa. These regions are included given the shared colonial influences on Indigenous peoples with overlapping outcomes on health [ 10 , 18 ]. This review will also assess the qualitative methodologies used to understand what can be learned to inform Indigenous infant feeding services, policies, and research gaps.

Protocol and registration

This scoping review adheres to guidelines from Tricco and colleagues’ [ 19 ] Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA) extension for scoping reviews , the Joanna Briggs Institute’s Reviewer’s Manual Chap. 11 [ 20 ], as well as Arksey & O’Malley’s [ 21 ] foundational article on scoping studies. The protocol for the review is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/J8ZW2 ) and published with BMJ Open [ 22 ].

Eligibility criteria

Works included in this review must have focused on Indigenous populations in Canada, the United States, Australia, and/or Aotearoa. These four countries share commonalities in that they are colonial countries in which Indigenous peoples face inequitable health outcomes [ 10 , 18 , 23 ]. The topic of interest for this review was caregivers’ experiences of infant feeding within one or more of these regions. “Caregivers” refer to individuals in the infants’ immediate familial and social circles who are directly responsible for the regular care of the infant. A broad definition of those involved in caregiving was used, recognizing that within many Indigenous communities, traditional adoption practices occur, or biological parents may not be the primary caregivers in part related to complex socio-ecological challenges. The experiences of healthcare professionals were not included as they were not considered “caregivers” by this definition. Works that discussed breastfeeding, as well as alternative forms of infant feeding, such as formula and cow’s milk, were included. Works that only focused on the introduction of solid foods were excluded. To capture caregivers’ experiences of infant feeding, qualitative and mixed-method studies that discussed experiences, perspectives, and/or practices as described by caregivers were included. Studies that used exclusively quantitative methods or that only described an outsider perspective (e.g. health professional) were excluded. Peer-reviewed journal articles and grey literature were included if they met the above criteria, were published in the English language, and were published after 1969 [ 22 ].

Various types of grey literature such as government documents, dissertations, and research reports by academic and non-academic institutions, including Indigenous organizations, were included. Media reports (including videos, news, and blogs) were excluded from the grey literature as they did not follow a research design with results that could be considered alongside the studies included in the review, hindering our ability to compare and critically analyze the results. Similarly, publications that consisted of only an abstract were excluded from both grey and database publications during full-text review as not enough information was present for analysis.

Information sources

The search strategy was created with guidance from a research librarian at the Gerstein Science Information Centre, University of Toronto. The complete search strategy can be found as supplementary material in our published protocol [ 22 ]. Search terms primarily included broad terminology for Indigenous peoples (e.g. Native American) rather than specific Nation names (e.g. Ojibwe) as this would have significantly extended the search term list while not resulting in additional sources given how sources are indexed within Library systems. A database and grey literature search were conducted for this scoping review, completed independently from one another until final data extraction when the data were combined for analysis. For both searches, the reviewers followed a step-by-step process of title and abstract screening, followed by full-text screening, and then data extraction.

The database search planning and calibration occurred in August and September of 2020, and all data were exported in English on October 20, 21, and 22 of 2020. Exportation occurred over three days given feasibility of exporting the high number of citations and time capacity of the reviewers. A total of 16734 relevant sources available in the following databases were included: Medline, Embase, CINAHL, PsycINFO, and Scopus. These databases were selected to ensure a broad range of research given the multidisciplinary nature of research on this topic. The grey literature search consisted of a targeted search of a variety of Indigenous focused websites specific to the four countries and a thorough Google search with each of the country-specific Google versions (Google.com.au, Google.co.nz, Google.ca, and Google.com) where the first 10 pages of results were reviewed (Supplementary File 1 ). Lastly, Indigenous Studies Portal (I-Portal) was searched as part of the grey literature as this database uses a different indexing system than other research databases. The Canadian Agency for Drugs and Technologies in Health (CADTH)’s “Grey Matters” checklist [ 24 ] was used in the planning and tracking of grey literature searches and findings.

The results of the database search including 16734 citations were uploaded to Covidence (Veritas Health Innovation Ltd., Melbourne, Australia), a data management platform for systematic and scoping reviews, where 3928 duplicates were automatically removed. The 284 results of the grey literature search were recorded on Google Sheets (Alphabet Inc. California, USA) and 146 duplicates were manually removed by the reviewers. Due to the large number of results retrieved in the database and grey literature search, a hand-search of reference lists was not conducted.

A list of key words developed by HM were searched on each site and can be found in Supplementary File 1 . The grey literature search was completed by HM, CC, and HS with all reviewers assigned to search a Country-specific Google database for one of the included countries. Using a template created by Stapleton [ 25 ] at the University of Waterloo based on methods described by Godin et al. [ 26 ], the reviewers kept track of which search terms were searched on the websites, the number of results retrieved, and the number of items screened and saved for further full-text analysis. If a website did not have a search bar, relevant tabs were examined for research, resources, and other publications. I-Portal was originally searched on August 15th, 2021 (yielding 10 results), however the search was revised to remove Indigenous search terms as the database was already Indigenous-specific. The search was repeated on August 18th, 2021, and yielded 77 additional results. The grey literature search was completed between May 25, 2021 – August 18, 2021. No search limitations or filters were used for the grey literature search or the database search.

The database abstract screening was initially completed by HM and CC starting in October 2020. They were then joined by HS and CL in February 2021. To ensure all reviewers had a shared understanding of the eligibility criteria, two search results were screened together and each reviewer discussed their reasoning for inclusion or exclusion. HM also hosted an introductory meeting to review the screening process using Covidence Software [ 27 ] in detail. All 12806 database results were saved in Covidence [ 27 ].

Abstract and full-text screening was completed in Covidence by two independent reviewers. Any conflicts at the screening stage were resolved by AH after all the results had been screened by two reviewers. Full-text screening was completed by HM, AH, and CC, and when conflicts arose, the reviewers met to discuss the difference in opinion until a consensus was reached. A third reviewer joined to offer impartial opinions for full-text conflicts.

Grey literature results were not imported to Covidence. Instead, the team used Google Sheets to organize the publications. Similar to the database review process, each study was screened by two independent reviewers and conflicts were resolved by a third party and discussed for consensus. Full-text review of the grey literature was completed by HM, AH, CC, and HS.

Data extraction and analysis

HM compiled a list of variables to extract (Supplementary File 2 ), and the data extraction was completed by HM, AH, and CC in Covidence for database results and Google Sheets for the grey literature. The extraction template was reviewed and tested by all three reviewers using the same two articles. Discussion about any areas of confusion followed by minor edits to the data extraction template were completed prior to extraction.

Only one reviewer extracted data from most publications, however in circumstances where an article was complex or data extraction was not clear given the format of the article, two reviewers extracted data from the publication. An additional subset of five publications were also randomly double-reviewed by HM to ensure consistency in data extraction. There were an additional two articles that were excluded at this step after review and discussion by AH and HM.

Review findings using the extraction template (supplementary file 2 ) were exported into Microsoft Excel (Microsoft Corporation, Washington, USA) and reviewed by HM. HM compiled all data and completed summary figures for variables of interest. The primary analysis consisted of a qualitative review of the included papers’ results and recommendations using a thematic synthesis informed by grounded theory and meta-ethnography, where the included papers are synthesized together, and interpreted using descriptive and analytical themes [ 28 ]. Similar to grounded theory, this process was inductive and identifies themes through comparisons. HM reviewed all extracted data from the excel files, coding for overlapping themes and taking notes throughout. The full-text of the extracted papers were then revisited to identify overall concepts, followed by descriptive themes. Categorization of descriptive themes was completed based on the results and interpretations of included papers. Descriptive themes were refined through additional comparisons between papers. The same analytical process was used for both database and grey literature results, and final analysis involved the integration of themes from the database and grey literature papers. Supplementary file 3 provides a summary table of the included papers in this scoping review.

Characteristics of included articles

Of the final sample of 46 articles from which data was extracted (Fig.  1 ), there were studies from each of the four countries, with the most studies (39%) published from Canada. In addition, this qualitative literature on infant feeding included several Indigenous groups within the four countries. The studies retained in this review included authors who identified as either Indigenous or non-Indigenous, and several did not mention positionality (Fig.  2 ). 13% more grey literature studies discussed positionality and had Indigenous sole authorship compared to the database papers. Regarding methodologies utilized, several described Indigenous methodologies and used thematic analysis as an analytic tool (Figs.  3 and 4 ). However, a third of the studies did not describe their theoretical foundations for the qualitative inquiry. Over 60% of the studies were published in the fields of public health and/or nursing as per the authors stated fields of study and/or the Journal’s field, and although there were studies published from 1984 to 2019, 50% of the retained papers were published after 2010.

PRISMA flow diagram for studies identified, screened, and included in this review from both database and grey literature searches. Note that records not retrived are those in which the full-text was not accessible. This diagram was created from the PRISMA 2020 statement [ 29 ]

Author positionality as described in the retained papers

Summary of analytic tools used in the retained studies

Summary of theoretical foundations informing the retained studies’ methodologies

Analysis revealed a variety of important themes that aligned with Indigenous and public health perspectives on health, including the socioecological model. There were twelve final overarching themes including colonization, social perceptions, family, professional influences, culture and traditionality , environment (i.e. built environment) , autonomy, survivance, infant feeding knowledge, cultural safety , milk substitutes , and establishing breastfeeding with evidence of connections among these themes. These themes are shown in Fig.  5 in a circular pattern where the themes intersect with the infant and caregiver represented at the centre. This model is conceptually aligned with that of Dodgson et al. [ 30 ], who considered the “contextual influences within the social structures of family and community, Ojibwe culture, and mainstream culture.”

Scoping review research model of themes

The twelve final themes are shown as the main influences on infant feeding experiences. The themes are arranged in a circular pattern with the infant and caregiver represented at the centre, emphasizing the connection between all of the themes

Theme one: colonization

There were 14 papers that discussed colonization of Indigenous peoples as a key factor influencing infant feeding decisions and experiences (Fig.  6 ) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Colonization has meant the dispossession of land and limited access to culturally safe healthcare, malnutrition, and loss of language through residential schools, loss of culture and traditional knowledge through assimilation and separation of families, disrupting breastfeeding practices and limiting income for infant formula. Eni et al. [ 36 ] described the policies leading to evacuation from communities to tertiary-care hospitals for birthing as the medicalization of birthing practices, which creates various challenges for First Nations women in Canada. One participant also shared about the impacts of intergenerational trauma related to colonization on breastfeeding, ‘‘You can’t teach about breastfeeding technique and think things will change. It’s the spirit that’s been affected, our experience with trauma. Our women need to relearn how to bond with their children.’’.

A qualitative study with Aboriginal Australian first-time mothers noted the disruptions to breastfeeding practices over time, providing a historical chart detailing how infant feeding practices changed as a result of colonial influences [ 38 ]. Brittany Luby [ 39 ] described how hydroelectric flooding from 1900 to 1975 in Northwestern Ontario reduced breastfeeding practices for Anishinabek mothers and their infants. Although not all studies specifically discussed history and colonization, those that considered the broader historical context highlighted how important this issue is in understanding the factors that lead to infant feeding decisions, particularly those that do not align with breastfeeding as a traditional feeding practice.

Frequency of identified themes in the database papers and the grey literature

Theme two: culture and traditionality

Culture , including traditionality, was the second most described theme throughout all papers, identified both directly and indirectly in 31 papers (Fig.  6 ) [ 30 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. The Navajo Infant Feeding Project focused on cultural beliefs influencing infant feeding practices within three Navajo communities in the United States [ 48 ] and emphasized breastfeeding’s significance for nutritional, physical, and psychological health where mothers not only pass along physical health benefits, but also their wellbeing to their children. The Baby Teeth Talk Study in Cree communities in Northern Manitoba, Canada, has identified breastfeeding as a cultural intervention for the prevention of early childhood caries [ 52 ]. Several studies included a variety of generations in data collection, contributing to rich discussion of how breastfeeding rates and connection to traditionality has changed in some communities [ 48 , 57 , 64 , 65 ]. For example, grandmothers living on the Fort Peck Reservation in Montana, US, were interviewed about their perspectives on infant feeding [ 65 ]. In one of the ethnographic studies, there was a specific focus on the Ojibwe culture relating to infant feeding practices from the perspective of mothers, professionals who were also community members, and Elders [ 35 ]. This study emphasized the holistic and collective worldview of the community, influencing women’s roles within the family and how teachings were passed on from generation to generation [ 35 ]. This was considered to be important in influencing effective and culturally safe breastfeeding promotion. Within the Northwest Territories, Canada, Moffitt and Dickinson [ 53 ] supported breastfeeding knowledge translation tools for Tłı̨chǫ women with one of the themes focused on factors that “pull to breastfeeding,” including breastfeeding as a traditional feeding method. In general, Indigenous communities described breastfeeding as a cultural practice; however, how this is supported and the traditional knowledge surrounding this practice may differ from community to community. Therefore, health providers must be aware of community-specific protocols and support these within programs and recommendations.

Theme three: social perceptions

Societal influences are often considered alongside cultural perspectives of infant feeding; therefore, this theme was also commonly discussed in the papers retained in this scoping review (Fig.  6 ) [ 30 , 32 , 33 , 36 , 37 , 38 , 40 , 42 , 49 , 50 , 52 , 54 , 57 , 58 , 59 , 61 , 64 , 66 , 67 , 68 , 69 , 70 , 71 ]. In New South Wales, Australia, Aboriginal mothers and key informants noted the need for “a safe place to feed,” including concerns about the social acceptability to breastfeed in public [ 32 ]. Broader social “norms” are also discussed as influencing maternal behavior [ 68 ], and respondents in some studies expressed concern about judgements from others [ 32 , 36 ]. Tapera et al. [ 40 ] described concerns about social pressures and a lack of support with one grandparent sharing, “well here in New Zealand, I know we have a problem with this [breast-feeding], especially when mothers go out and they breast-feed their babies in public. There’s a lot of people that moan and groan about this.” Similarly, regarding social norms, a grandmother living in the US shared,

“a long time ago that, it [breastfeeding] was acceptable and nobody had any qualms about it but today, I mean you read continually about, people, mother’s tryin’ ta breastfeed and they’re being chased out a places or stores or people are rude about it […]. Society’s changed, you know, it’s […] society, has come to the point where it’s […] trying to tell us what’s the right way ta live what’s the right way ta raise our kids” [ 65 ].

Dodgson et al. [ 30 ] described how in an Ojibwe community in Minnesota, US, participants noted the dominant societal influences in contrast to community traditions, with women making an effort to engage in traditional practices. The sexualization of breasts in mainstream society sometimes influenced Indigenous mothers’ infant feeding experiences [ 36 ], although Ojibwe caregivers in Minnesota attributed shyness with breastfeeding to traditional value opposed to sexualization of breasts [ 30 ]. Eni et al. [ 36 ] included sexual objectification of the feminine body as a subtheme in their study, describing how this social perception damages maternal mental health, creating a barrier to breastfeeding. While shifting social norms is a significant challenge, breastfeeding supports can address concerns about the sexual objectification of breasts by creating safe spaces for parents to talk about the challenges and ensure that parents have access to mental health resources.

Theme four: family

Dodgson et al. [ 30 ] described family as a pattern that influences breastfeeding intersecting with the social structures of the community, culture, and the broader society. There were 33 other papers that described the influence of family on infant feeding practices making this the most discussed theme (Fig.  6 ) [ 30 , 31 , 32 , 33 , 36 , 38 , 39 , 40 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 57 , 58 , 59 , 60 , 61 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Native American mothers living in six communities highlighted the importance of family as a key theme [ 47 ]. One mother shared, “For me, it’s my mom definitely [whose advice is most important] because she has had three kids and I lived with her or near her for all of my kids. So I’ve always gone to her first for advice.” This was echoed by many other participants with a paraprofessional adding, “family [advice is most important], because they are around their family most. And they always hear from their aunties, or from grandma, baby’s fussing, baby must be hungry, baby needs this and baby needs that.” The Baby Basket Program in Cape York, Australia identified that empowering families was the foundation of the program to ensure that mothers and their partners were equipped for the arrival of their babies [ 50 ]. Family often plays an integral role in supporting mothers in infant feeding practices. Bauer and Wright [ 45 ] note that even when mothers don’t have other supports or conditions in place to support breastfeeding, they may still choose to breastfeed if their family is supportive. However, when this support is lacking, mothers find it challenging to breastfeed [ 31 , 36 ]. Some studies identified the significance of family in the study design, integrating family caregiver perspectives in data collection [ 64 , 65 ]. Therefore, health programs and research studies should consider the role and experience of non-primary caregivers within family networks for infant and maternal health and nutrition.

Theme five: professional influences

This theme represents the influence of formal systems including healthcare professionals, health and social programs, child services, and the legal system. In total, there were 26 papers that referenced professional influences on infant feeding experiences (Fig.  6 ) [ 30 , 31 , 33 , 38 , 41 , 42 , 43 , 45 , 47 , 48 , 50 , 51 , 52 , 54 , 58 , 59 , 61 , 62 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Some studies incorporate health workers as participants in data collection [ 47 , 50 , 65 ]. One health paraprofessional shares about some of the pressures experienced by mothers to formula feed, “sometimes hospitals and doctors want to push formula in bottles on moms [ 47 ].” One of the main themes in a study with Sioux and Assiniboine Nations in the US was the ‘ Overburdened Healthcare System’ , describing a lack of resources and infrastructure to support breastfeeding, including a subtheme of mistrust in the healthcare system due to previous negative experiences such as forced sterilization of Indigenous women [ 65 ]. However, some caregivers also expressed positive healthcare supports, “when I was at home, [clinic midwife] and [lactation consultant made home visits] … they encouraged me … And then it started getting a little bit better, but it was still a bit hard. Now he feeds pretty all right [ 73 ].” Professional influences on infant feeding are nuanced and may differ significantly within various contexts and individuals; therefore, tailored interventions are needed.

Theme six: environment

This theme represents the external variables within the built environment that influence decision making including work, school, remoteness, and cost of formula. Eighteen papers addressed this theme [ 30 , 31 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 53 , 58 , 59 , 66 , 67 , 68 , 70 , 71 , 72 ]. Wright et al. [ 74 ] specifically considered the challenge of breastfeeding with maternal employment among the Navajo population in the US. In Bauer and Wright’s [ 45 ] study that explored infant feeding decision models, they identified that work and school are part of the decision-making process on whether to breastfeeding or to use formula, but even when these environmental challenges are present they can be further influenced by other factors, like family . For example, a mother may choose to breastfeed and use a breast pump to navigate work/school schedules, but family members may recommend that they can incorporate formula; decision-making is not only about the main caregiver’s desires but can involve various decision-makers.

Theme seven: autonomy

This theme describes parents’ freedom to make infant feeding decisions that fit for them and their priorities. Maternal desire to breast- or bottle-feed was discussed in select papers in this review [ 45 , 51 ]. In addition, other papers describe parents’ freedom to do activities outside of infant feeding in the early months of baby’s life with discussion of time required to breastfeed or prepare bottles for feeding [ 31 , 58 , 72 , 74 ]. A key informant in a study with an Aboriginal community in Northern New South Wales, Australia, shares, “they want to breastfeed, but then it comes down to when they want to go out, or keep up with their man [ 32 ].” Some parents report that they experienced judgements from others or feel forced into making a specific decision on infant feeding method, highlighting a desire to have support and freedom to make their own decisions [ 36 , 56 ].

Theme eight: infant feeding knowledge

Several studies emphasize the importance of knowledge on infant feeding experiences, highlighting the value of infant feeding education, both within the overall healthcare system and from traditional teachings [ 30 , 32 , 35 , 40 , 42 , 43 , 47 , 52 , 57 , 58 , 62 , 64 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. Within the theme of addressing feeding challenges in one study [ 66 ], a caregiver shared how knowledge helped her to work through a challenge,

“He did start fussing at about 6 weeks and that was kind of hard because I thought, ‘No, I have got this perfect now, and he has started to muck up’. But then I read, because I had those booklets and I read that sometimes they — at a certain point — they get a bit fussy and you just have to work through it. [Ml7]” [ 66 ].

Traditional breastfeeding knowledge is important for many communities; one Anishinaabe community knowledge keeper shared that “breast milk is a gift and a medicine a mother gives her child” [ 35 ]. This study also discusses feeding patterns as shared by Elders and traditional teachers. Traditional knowledge considers holistic perspectives of health where caregivers are also focused on the baby’s spiritual wellbeing [ 48 , 56 ].

Theme nine: milk substitutes

Bottle feeding (formula or canned milk) and solid foods are described in several papers as alternatives or complements to breastfeeding [ 31 , 33 , 34 , 37 , 39 , 47 , 48 , 49 , 51 , 52 , 53 , 58 , 66 , 67 , 74 , 75 ]. In Neander and Morse’s [ 37 ] study with a Cree community in Alberta, Canada, bottle feedings were offered particularly when mothers felt that they were not producing adequate milk supply to meet the baby’s nutritional needs. Insufficient milk supply is echoed as a concern in several other papers resulting in complementary bottle feeding or weaning [ 48 , 51 , 56 , 66 , 67 ]. A Māori father shares,

“about the second week, baby just wanted more food. She (partner) would end her day and baby was just hungry. We had to [give her] the bottle and then she would be finally satisfied. It wasn’t that she made a choice. Baby was actually demanding more and more and she couldn’t produce it. (First-time father, mid 20’s) [ 56 ].”

This theme particularly overlaps with autonomy as parents balance infant feeding decisions with breastmilk supply, work, school, and other personal commitments.

Theme ten: cultural safety

Indigenous caregivers interact with a variety of health services postnatally; however, there is a need to address cultural safety within the healthcare system. Twelve retained papers highlighted this theme either directly as one of their themes or as part of another theme (Fig.  6 ) [ 30 , 31 , 44 , 47 , 50 , 64 , 66 , 67 , 69 , 71 , 73 , 74 ]. One health worker in Victoria, Australia, shared,

“I can’t say often enough or long enough, loud enough the ideal for children 0–8 is to have access to maternal and child health. You might say ‘oh yes, they’ve got access to mainstream and they’re culturally going to put up a few Indigenous prints in their rooms’ It’s not the same. Our families are telling us with their feet it’s not the same.”

Mothers expressed a desire for more traditional infant feeding knowledge within services and culturally relevant supports [ 47 , 64 ]. A study that focused on a baby basket program to support families in a Murri (Local Australian Aboriginal Group) Way identified how important culturally safe language and relationships are for families,

“…the nurse is also learning what the best way is to approach a family and what the wording has to be, what the languaging is around things, what the traditional words are for Indigenous language and are appropriate for use in certain circumstances” [ 50 ].

Theme eleven: survivance

Indigenous caregivers experience a variety of hardships; however, through resistance and survival, they practice cultural revitalization [ 76 ]. This theme is discussed in 15 papers and is often described through a lens of maternal mental health (Fig.  6 ) [ 30 , 31 , 33 , 43 , 53 , 54 , 57 , 58 , 59 , 63 , 64 , 66 , 68 , 36 , 74 ]. Some parents express feelings of guilt for the challenges they encounter, which can further contribute to negative emotions [ 58 ]. Maternal mental and emotional health can impact infant feeding experiences,

“…sometimes people’s psychological health, mental health is more of a risk factor, you know if you’re not sleeping and you’re bordering on depression and you’re not coping well and you can’t get the baby to latch and you’re constantly feeling like a failure and you can’t get out of that rut, is it worth it?…People have to decide that for themselves. (Key Informant #5)” [ 33 ].

A grandmother in the Northwest Territories of Canada noted the disembodiment caused by residential schools as expressed as a disconnection between physical experiences and relationships,

“You know in those days, I mean residential school. In those days, they never did talk about their body parts because I think they were too ashamed [of your body] to say to your kids. I never did hear it [breastfeeding] from my sisters or nobody in the family. They were so private (L151-156)” [ 57 ].

Traumatic experiences, like residential schools, can have a lasting impact on how caregivers navigate motherhood and infant feeding, and the support they receive from family members.

Theme twelve: establishing breastfeeding

There are several practical challenges that mothers encounter while breastfeeding like pain, latching issues, and low milk supply, discussed in 11 of the studies (Fig.  6 ) [ 48 , 51 , 54 , 56 , 58 , 61 , 66 , 68 , 71 , 72 ]. A mother shared,

“He wouldn’t latch on all the time, like, the nurses and stuff tried to help me but then it would be all frustrating…. He didn’t really know what to do. He tried and then they gave him formula. He really loved it. [MI5]” [ 66 ].

Although these challenges are most discussed at the beginning of breastfeeding, sometimes concerns arise when babies are older.

“Yeah it was 8 or 9 months after she was born. After a while there was too much pressure on me. She was getting up all through the night and she would eat and eat and eat and not get full…” [ 33 ].

Overall, many caregivers reported that breastfeeding is difficult; therefore, supports that consider the variety of challenges that can arise are needed.

Study recommendations

The studies included in this review were published over three decades starting in 1984 until 2019 and were completed with various Indigenous communities in four countries. We anticipated that earlier work would demonstrate markedly different infant feeding recommendations than more recent research; however, this was not necessarily the case. For example, cultural safety is a more recent discussion within the health literature; however, although we see some discussion of this in more recent studies, studies in the 80’s and 90’s also highlight the importance of incorporating traditional teaching and consulting community members [ 37 , 48 ]. Therefore, supporting Indigenous self-determination where health professionals provide culturally appropriate care is essential.

In addition to topics related to cultural safety, various studies highlight a need for community-driven and local knowledge to inform programs and policies related to infant nutrition [ 31 , 47 , 57 , 64 , 75 ]. Several studies also focus on infant feeding specific programs and behavioral changes in their recommendations [ 47 , 50 , 65 ]; however, many of these studies also highlight the need to expand beyond the individual’s role in decision making and address the broader social and environmental factors such as the workplace, healthcare infrastructure, social perceptions, among others, that influence infant feeding decisions. For example, Eni et al. [ 36 ] note that there are a complexity of factors resulting in various breastfeeding environments. These structural, social and cultural contexts are discussed throughout several of the grey literature texts as well [ 32 , 33 ]. It is also important to note that in the most recently published database paper, maternal mental health is directly addressed in the recommendations and this is the only paper with this focus for next steps [ 65 ]. Interventions that target socio-ecological factors based on the included papers’ recommendations for infant feeding are summarized in Fig.  7 .

(Adapted from Rollins et al. 2016)

The components of Indigenous infant feeding environments informed by community-based interventions

This scoping review presents and summarizes the findings reporting Indigenous infant feeding experiences within the qualitative literature in Canada, the US, Australia, and Aotearoa. Twelve themes were identified which summarize the literature including culture and traditionality , colonization, family, environment, social perceptions, professional influences, milk substitutes, breastfeeding initiation, cultural safety, survivance, infant feeding knowledge, and autonomy. The most prevalent themes discussed by caregivers and researchers in the included papers were family and culture/traditionality . The frequency of these two themes highlight the significant impact of family and culture/traditionality on infant nutrition decision-making for Indigenous caregivers and overlaps with components of the socio-ecological model [ 77 ]. This focus on family and culture/traditionality also emphasizes the importance of familial relationships and a collective mentality within traditional life ways for many Indigenous communities in these regions on infant nutrition and care practices.

In their informative global breastfeeding paper, Rollins and colleagues’ [ 1 ] conceptualize the components that contribute to the breastfeeding environment at multiple levels, overlapping with the social determinants of health. In this review, we observed that caregivers report similar components of the breastfeeding environment; however, these components seem to be described collectively, rather than as separate contexts. This is evident in the recommendations proposed by authors with a large focus on local and community-specific leadership, multidisciplinary interventions, and cultural safety in response to historical traumas, particularly within the healthcare system (Fig.  7 ). This aligns with Indigenous epistemology with an emphasis on the collective and interconnectedness of all things where power is manifested together, not over one another, and is based in local land-based knowledge [ 78 , 79 ].

A primary recommendation echoed within many of these studies was the need for community engagement in program and policy development [ 34 , 47 , 50 , 64 ]. This may need to be expanded upon to support Indigenous self-determination of policy and programs related to infant feeding where community members are not only engaged but leading the way forward in maternal and infant health. It is important to note that there have been changes over time in how these recommendations and perspectives are discussed and the role of the health professional, particularly related to cultural safety. For example, although similar concepts are discussed in Neander and Morse’s paper published in 1989, ‘cultural safety’ is not used as the terminology, which has been expanded upon in recent years by Indigenous and non-Indigenous scholars [ 37 , 80 , 81 ].

Related to this focus on health professionals and cultural safety, it’s important to distinguish that in many of the positive experiences expressed by participants in the studies, these interactions seemed to be primarily with professionals interacting closely with families. For example, midwives, who make home visits, were often included as part of positive experiences. In the literature, there is an emphasis on including practitioners who can build strong relationships with families through home visits and regular community engagement in routine services, which supports cultural safety within the healthcare system [ 82 , 83 ]. Health professional regulatory bodies should consider implementing practice competencies that support professionals to build and navigate strong and ethical relationships with clients/patients. Similarly, healthcare settings that serve Indigenous peoples should consider processes and therefore, facility infrastructures that enable close family-client-professional interactions. An example of this implementation with positive client experiences is the Toronto Birthing Centre, which uses an Indigenous framework and has birthing rooms with space for family [ 84 ].

The studies in this review are written within various fields of research; therefore, there were differences in methodological reporting. Future qualitative work should be thorough in reporting theoretical foundations to provide clarity of how the analyses and overall projects are approached (Fig.  4 ) [ 85 ]. Given the limited studies that report author/researcher positionality (Fig.  2 ), this may be an important addition in forthcoming work as a means of respecting Indigenous and qualitative literature conventions where we recognize that positionality influences ontological origins [ 86 ]. We challenge the academy to recognize that Indigenous and local knowledges are required within Indigenous health research and dissemination practices, while acknowledging our own limitation in this review of a single country authorship team.

This systematic scoping review utilized a rigorous search strategy that limited the possibility of missing relevant publications; however, it was time intensive. PRISMA-ScR guidelines were followed with two independent reviewers at each stage, enabling reproducibility of this review. The inclusion of the grey literature is a strength in this study as it captured important papers that were not published in peer-reviewed journals, often from Indigenous authors and communities (many of which were graduate dissertations), which was a priority in this review. A possible limitation is the exclusion of work that only discussed the introduction to solid foods; it is possible that this excluded an important conversation about the differences of introducing solids, like traditional foods from an Indigenous group’s perspective. In addition, the topic of this review is multidisciplinary; therefore, it is possible that although effort was made to include a broad range of research field databases in the search, relevant sources may have been missed.

In conclusion, this scoping review highlights important considerations for infant feeding environments within Indigenous communities with a focus on family and culture. Based on caregiver experiences, Indigenous breastfeeding supports must be community led with a focus on local capacity and traditional teachings. An emphasis on an intergenerational perspective that considers structural and systems approaches including cultural safety within healthcare, addressing maternal mental health, and consideration of sustainability over time is encouraged. Future work should focus on these key areas through strength-based research approaches, grounded in strong relationships and long-term follow-up.

Data availability

All data generated or analysed during this study are available from the corresponding author on reasonable request.

Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387:491–504. https://doi.org/10.1016/S0140-6736(15)01044-2

Article   PubMed   Google Scholar  

Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–90. https://doi.org/10.1016/S0140-6736(15)01024-7

Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid ReportTechnology Assess 2007:1–186.

Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. Breastfeeding and Health outcomes for the Mother-Infant Dyad. Pediatr Clin North Am. 2013;60:31–48. https://doi.org/10.1016/j.pcl.2012.09.010

Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016;28:7–14. https://doi.org/10.1177/1010539515624964

World Health Organization. Infant and young child feeding. World Health Organ 2021. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding (accessed April 28, 2022).

Manhire KM, Williams SM, Tipene-Leach D, Baddock SA, Abel S, Tangiora A, et al. Predictors of breastfeeding duration in a predominantly Māori population in New Zealand. BMC Pediatr. 2018;18. https://doi.org/10.1186/s12887-018-1274-9

Australian Government. 2.20 Breastfeeding practices. Aborig Torres Strait Isl Health Perform Framew 2021. https://www.indigenoushpf.gov.au/measures/2-20-breastfeeding-practices (accessed April 28, 2022).

Health Canada. Duration of Exclusive Breastfeeding in Canada: Key Statistics and Graphics (2009–2010). Gov Can 2012. https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs/duration-exclusive-breastfeeding-canada-key-statistics-graphics-2009-2010.html (accessed April 28, 2022).

Smylie J, Crengle S, Freemantle J, Taualii M. Indigenous birth outcomes in Australia, Canada, New Zealand and the United States – an overview. Open Womens Health J 2010:7–17. https://doi.org/10.2174/1874291201004010007

King M, Smith A, Gracey M. Indigenous health part 2: the underlying causes of the health gap. Lancet. 2009;374:76–85. https://doi.org/10.1016/S0140-6736(09)60827-8

Houghton MD, Graybeal TE. Breast-feeding practices of native American mothers participating in WIC. J Am Diet Assoc. 2001;101:245–7.

Article   CAS   PubMed   Google Scholar  

Rhodes KL, Hellerstedt WL, Davey CS, Pirie PL, Daly KA. American Indian breastfeeding attitudes and practices in Minnesota. Matern Child Health J. 2008;12(Suppl 1):46–54. https://doi.org/10.1007/s10995-008-0310-z

Eckhardt CL, Lutz T, Karanja N, Jobe JB, Maupome G, Ritenbaugh C. Knowledge, attitudes, and beliefs that can influence infant feeding practices in American Indian mothers. J Acad Nutr Diet. 2014;114:1587–93. https://doi.org/10.1016/j.jand.2014.04.021

Article   PubMed   PubMed Central   Google Scholar  

Clarke AM, Jack B. The benefits of using qualitative research. Prof Nurse Lond Engl. 1998;13:845–7.

CAS   Google Scholar  

van’t Riet A, Berg M, Hiddema F, Sol K. Meeting patients’ needs with patient information systems: potential benefits of qualitative research methods. Int J Med Inf. 2001;64:1–14. https://doi.org/10.1016/S1386-5056(01)00185-X

Article   Google Scholar  

Kovach M. Indigenous methodologies: characteristics, conversations, and contexts. Canada: University of Toronto; 2009.

Google Scholar  

Anderson I, Crengle S, Kamaka ML, Chen T-H, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet Lond Engl. 2006;367:1775–85. https://doi.org/10.1016/S0140-6736(06)68773-4

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. https://doi.org/mundel.

Peters M, Godfrey C, McInerney P, Munn Z, Tricco A, Khalil H. Chapter 11: Scoping Reviews (2020 Version). Aromataris E Munn Z Ed. Joanna Briggs Inst. Rev. Man., JBI; 2020.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32. https://doi.org/10.1080/1364557032000119616

Monteith H, Galloway T, Hanley AJ. Protocol for a scoping review of the qualitative literature on indigenous infant feeding experiences. BMJ Open. 2021;11:e043476. https://doi.org/10.1136/bmjopen-2020-043476

Yeates KE, Cass A, Sequist TD, McDonald SP, Jardine MJ, Trpeski L, et al. Indigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation. Kidney Int. 2009;76:659–64. https://doi.org/10.1038/ki.2009.236

Canadian Agency for Drugs and Technologies in Health (CADTH). Grey Matters: a practical tool for searching health-related grey literature 2015.

Stapleton J. Grey Literature Search Plan Template 2018.

Godin K, Stapleton J, Kirkpatrick SI, Hanning RM, Leatherdale ST. Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Syst Rev. 2015;4:138. https://doi.org/10.1186/s13643-015-0125-0

Covidence. Systematic Review Software n.d.

Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9:59. https://doi.org/10.1186/1471-2288-9-59

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. https://doi.org/10.1136/bmj.n71

Dodgson JE, Duckett L, Garwick A, Graham BL. An ecological perspective of breastfeeding in an indigenous community. J Nurs Scholarsh. 2002;34:235–41. https://doi.org/10.1111/j.1547-5069.2002.00235.x

Cormier JA. The infant feeding experiences of Mi’kmaw women: a Feminist Phenomenological Inquiry. Dalhousie University; 2014.

Helps C. Exploring Infant Feeding Choices in the Northern NSW Aboriginal Community 2014.

Gauld TK. The infant feeding experiences of urban Aboriginal mothers: implications for universal breastfeeding policy. Lakehead University; 2009.

Cidro J, Zahayko L, Lawrence H, McGregor M, McKay K. Traditional and cultural approaches to childrearing: preventing early childhood caries in Norway House Cree Nation, Manitoba. Rural Remote Health. 2014;14:2968.

PubMed   Google Scholar  

Dodgson J, Struthers R. Traditional breastfeeding practices of the Ojibwe of Northern Minnesota. Health Care Women Int. 2003;24:49–61.

Eni R, Phillips-Beck W, Mehta P. At the edges of embodiment: determinants of breastfeeding for first nations women. Breastfeed Med off J Acad Breastfeed Med. 2014;9:203–14. https://doi.org/10.1089/bfm.2013.0129

Neander WL, Morse JM. Tradition and change in the Northern Alberta Woodlands Cree: implications for infant feeding practices. Can J Public Health Rev Can Sante Publique. 1989;80:190–4.

Helps C, Barclay L. Aboriginal women in rural Australia; a small study of infant feeding behaviour. Women Birth J Aust Coll Midwives. 2015;28:129–36. https://doi.org/10.1016/j.wombi.2014.12.004

Luby B. From milk-medicine to Public (Re)Education Programs: an examination of Anishinabek Mothers’ responses to hydroelectric flooding in the Treaty #3 District, 1900–1975. Can Bull Med Hist Bull Can Hist Med. 2015;32:363–89. https://doi.org/10.3138/cbmh.32.2.363

Tapera R, Harwood M, Anderson A. A qualitative Kaupapa Maori approach to understanding infant and young child feeding practices of Maori and Pacific grandparents in Auckland, New Zealand. Public Health Nutr. 2017;20:1090–8. https://doi.org/10.1017/S1368980016002950

Crosschild C, URBAN INDIGENOUS MOTHERS’ EXPERIENCES WITH POSTNATAL NURSING. CARE IN SOUTHERN ALBERTA: a BLACKFOOT METHODOLOGY. Master of nursing. University of Lethbridge; 2019.

Goudman AM. Many gifts: a narrative Inquiry Study into Urban Aboriginal women’s experiences of Breastfeeding. Master of Nursing. University of Alberta; 2014.

Phillips-Beck W. Development of a Framework of Improved Childbirth Care for First Nation women in Manitoba: A First Nation Family Centred Approach. Master of Science. University of Manitoba; 2010.

Jones H, Barber CC, Nikora LW, Middlemiss W. Māori child rearing and infant sleep practices. N Z J Psychol. 2017;46:30–7.

Bauer MC, Wright AL. Integrating quantitative and quantitative methods to model infant feeding behavior among Navajo mothers. Hum Organ. 1996;55:183–92. https://doi.org/10.17730/humo.55.2.p55g316v70572732

WRIGHT AL, BAUER M, CLARK C, MORGAN F, BEGISHE K. Cultural interpretations and intracultural variability in Navajo beliefs about breastfeeding. Am Ethnol. 1993;20:781–96. https://doi.org/10.1525/ae.1993.20.4.02a00060

Horodynski MA, Calcatera M, Carpenter A. Infant feeding practices: perceptions of native American mothers and health paraprofessionals. Health Educ J. 2012;71:327–39. https://doi.org/10.1177/0017896911398814

Wright AL, Naylor A, Wester R, Bauer M, Sutcliffe E. Using cultural knowledge in health promotion: breastfeeding among the Navajo. Health Educ Behav off Publ Soc Public Health Educ. 1997;24:625–39.

MacQuarrie ME. Determination of the antecedents of infant feeding practices and the effect of choice of infant feeding on subsequent health status of Canadian ojibway infants and young children. Diss Abstr Int. 1984;44:3722.

McCalman J, Searles A, Bainbridge R, Ham R, Mein J, Neville J, et al. Empowering families by engaging and relating Murri way: a grounded theory study of the implementation of the Cape York Baby Basket program. BMC Pregnancy Childbirth. 2015. https://doi.org/10.1186/s12884-015-0543-y

Abel S, Park J, Tipene-Leach D, Finau S, Lennan M. Infant care practices in New Zealand: a cross-cultural qualitative study. Soc Sci Med 1982. 2001;53:1135–48.

Cidro J, Zahayko L, Lawrence HP, Folster S, McGregor M, McKay K. Breast feeding practices as cultural interventions for early childhood caries in Cree communities. BMC Oral Health. 2015;15:49. https://doi.org/10.1186/s12903-015-0027-5

Moffitt P, Dickinson R. Creating exclusive breastfeeding knowledge translation tools with First Nations mothers in Northwest territories, Canada. Int J Circumpolar Health. 2016;75:32989. https://doi.org/10.3402/ijch.v75.32989

Holmes W, Thorpe L, Phillips J. Influences on infant-feeding beliefs and practices in an urban aboriginal community. Aust N Z J Public Health. 1997;21:504–10.

Kruske S, Belton S, Wardaguga M, Narjic C. Growing up our way: the first year of life in remote Aboriginal Australia. Qual Health Res. 2012;22:777–87. https://doi.org/10.1177/1049732311432717

Tipene-Leach D, Abel S, Finau SA, Park J, Lenna M. Maori infant care practices: implications for health messages, infant care services and SIDS prevention in maori communities. Pac Health Dialog. 2000;7:29–37.

CAS   PubMed   Google Scholar  

Moffitt P. Learning from mothers, grandmothers & great-grandmothers about breastfeeding in the northwest territories 2018.

Wagner M. The infant feeding experiences and decision-making influences of Aboriginal women in Saskatoon. Undefined. 2005.

Archibald L. Teenage Pregnancy in Inuit Communities: Issues and Perspectives. 2004.

Glover M, Manaena-Biddle H, Waldon J. The role of Whānau in Māori women’s decisions about breast feeding. Altern Int J Indig Peoples. 2006;3:140–57. https://doi.org/10.1177/117718010600300108

Urban Indian Health Institute. Seattle Indian Health Board. Discussions with urban American Indian and Alaska native parents. Keeping Babies Healthy and Safe; 2011.

Ross Leitenberger KA. Aboriginal Midwifery and Traditional Birthing systems Revisited and revitalized: interviews with First Nations elders in the Northwest Region of British Columbia. Master of arts. University of Northern British Columbia; 1998.

Moffitt P, Lakhani S-A, Cruz S. Chapter 21: infant feeding teachings from indigenous grandmothers: Generating Knowledge through sharing circles. North. Indig. Health Healthc. Saskatoon, Saskatchewan: University of Saskatchewan; 2018. pp. 169–75.

Glover M, Waldon J, Manaena-Biddle H, Holdaway M, Cunningham C. Barriers to best outcomes in breastfeeding for Maori: mothers’ perceptions, whanau perceptions, and services. J Hum Lact off J Int Lact Consult Assoc. 2009;25:307–16. https://doi.org/10.1177/0890334409332436

Houghtaling B, Byker Shanks C, Ahmed S, Rink E. Grandmother and health care professional breastfeeding perspectives provide opportunities for health promotion in an American Indian community. Soc Sci Med. 2018;208:80–8. https://doi.org/10.1016/j.socscimed.2018.05.017

Foley W, Schubert L, Denaro T. Breastfeeding experiences of Aboriginal and Torres Strait Islander mothers in an urban setting in Brisbane. Breastfeed Rev Prof Publ Nurs Mothers Assoc Aust. 2013;21:53–61.

Myers J, Thorpe S, Browne J, Gibbons K, Brown S. Early childhood nutrition concerns, resources and services for Aboriginal families in Victoria. Aust N Z J Public Health. 2014;38:370–6. https://doi.org/10.1111/1753-6405.12206

Glover M, Manaena-Biddle H, Waldon J. Influences that affect maori women breastfeeding. Breastfeed Rev Prof Publ Nurs Mothers Assoc Aust. 2007;15:5–14.

Reinfelds MA, Kia Mau, Kia U. Supporting the breastfeeding journey of maori women and their whanau in Taranaki. Massey University; 2015.

Victorian Aboriginal Community Controlled Health Organisation. Feeding our Future: Aboriginal Early Childhood Nutrition & Physical Activity Needs Assessment Report. Fitzroy, Australia: 2012.

Oneha MFM, Dodgson JE. Community influences on Breastfeeding described by native hawaiian mothers. Pimatisiwin J Aborig Inidgenous Community Health. 2009;7:75–97.

Martens PJ. Evaluating the effectiveness of a breastfeeding promotion community strategy in Sagkeeng First Nation. University of Manitoba; 1999.

Foley W, Schubert L. Ethics of care and urban Aboriginal and Torres Strait Islander Breastfeeding beyond three months, 2016. https://doi.org/10.15226/2471-6529/2/1/00110

Wright AL, Clark C, Bauer M. Maternal employment and infant feeding practices among the Navajo. Med Anthropol Q. 1993;7:260–80. https://doi.org/10.1525/maq.1993.7.3.02a00020

Weinstein P, Troyer R, Jacobi D, Moccasin M. Dental experiences and parenting practices of native American mothers and caretakers: what we can learn for the prevention of baby bottle tooth decay. ASDC J Dent Child. 1999;66:120–85.

Survivance. Narratives of Native Presence. Lincoln: 2008.

Willows ND, Hanley AJG, Delormier T. A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Appl Physiol Nutr Metab. 2012;37:1–13. https://doi.org/10.1139/h11-128

Hickey D. Indigenous epistemologies, worldviews and theories of Power. Turt Isl J Indig Health. 2020;1:14–25. https://doi.org/10.33137/tijih.v1i1.34021

Battiste MA. Reclaiming indigenous voice and vision. Vancouver, BC: UBC; 2000.

Wylie L, McConkey S, Corrado AM. It’s a Journey not a check Box: Indigenous Cultural Safety from Training to Transformation. Int J Indig Health. 2021;16. https://doi.org/10.32799/ijih.v16i1.33240

Browne AJ, Varcoe C, Ward C. San’yas Indigenous Cultural Safety Training as an Educational intervention: promoting Anti-racism and Equity in Health Systems, policies, and practices. Int Indig Policy J. 2021;12:1–26. https://doi.org/10.18584/iipj.2021.12.3.8204

Corcoran PM, Catling C, Homer CSE. Models of midwifery care for indigenous women and babies: a meta-synthesis. Women Birth. 2016;0. https://doi.org/10.1016/j.wombi.2016.08.003

Churchill ME, Smylie JK, Wolfe SH, Bourgeois C, Moeller H, Firestone M. Conceptualising cultural safety at an indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with indigenous and non-indigenous clients. BMJ Open. 2020;10:e038168. https://doi.org/10.1136/bmjopen-2020-038168

Reszel J, Weiss D, Darling EK, Sidney D, Van Wagner V, Soderstrom B, et al. Client experience with the Ontario Birth Center Demonstration Project. J Midwifery Womens Health. 2021;66:174–84. https://doi.org/10.1111/jmwh.13164

Eakin JM, Mykhalovskiy E. Reframing the evaluation of qualitative health research: reflections on a review of appraisal guidelines in the health sciences. J Eval Clin Pract. 2003;9:187–94. https://doi.org/10.1046/j.1365-2753.2003.00392.x

Holmes AGD. Researcher positionality -- a consideration of its influence and place in qualitative research -- a new researcher guide. Shanlax Int J Educ. 2020;8:1–10.

Download references

Acknowledgements

We wish to acknowledge the important contribution of Halima Abubakar in the review process. Given the knowledge specific to Indigenous communities discussed in this scoping review and out of respect for Indigenous research conventions, the authors position themselves within the research to explain the lens from which they approach and understand the research process. TG and AH are non-Indigenous scholars and faculty members based at the University of Toronto, which rests on lands that are the traditional home of the Huron-Wendat, the Seneca, and the Mississaugas of the Credit. All other authors have had student or supporting roles throughout this work and situate themselves as follows: HM is a settler of Scottish, Irish, French, German, and English ancestry residing in Haudenosaunee and Anishinaabe territory, which is part of the dish with one spoon agreement; CC is a settler living in Treaty 7 Territory, with ancestral roots in Germany, Scotland, and the Ukraine; AS is an Odawa Kwe from Wikwemikong, Manitoulin Island, Ontario. Currently, residing in the Tiohtià:ke in Kanien’kéha unceded territory; and HS is living in Treaty 13 territory with ancestral roots in Afghanistan. The remaining co-authors identify as non-Indigenous scholars.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and affiliations.

Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical, King’s College Circle, Sciences Building, 5th Floor, Room 5253A, Toronto, ON, M5S 1A8, Canada

Hiliary Monteith, Hosna Sahak, Christina Liu & Anthony J. G. Hanley

Department of Anthropology, University of Toronto Mississauga Campus, Terrence Donnelly Health Sciences Complex, Room 354, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada

Carly Checholik & Tracey Galloway

Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada

Amy Shawanda

Epidemiology Division, University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada

Anthony J. G. Hanley

Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada

You can also search for this author in PubMed   Google Scholar

Contributions

As the first author, HM conceptualized this work and provided leadership throughout. She participated in every aspect of this review, wrote the initial manuscript, and completed revisions. CC contributed to the screening and full text review of this work. She also contributed to the analysis, and the writing and review of the manuscript. TG supported the protocol of this review and provided guidance throughout analysis. She also contributed to the final manuscript. HS supported screening and full text review. She also provided edits for the manuscript. AS provided feedback on the analysis for this review and contributed to the writing of the manuscript. CL supported screening of papers and provided edits to the final manuscript. AH provided guidance throughout the duration of this review, supported decision making, and provided edits on the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Anthony J. G. Hanley .

Ethics declarations

Ethics approval and consent to participate.

As this review involves material previously published or in the public domain, ethical approval is not required.

Consent for publication

Not applicable.

Competing interests

Authors have no competing interests to report.

Additional information

Publisher’s note.

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary material 2, supplementary material 3, supplementary material 4, 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/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Monteith, H., Checholik, C., Galloway, T. et al. Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature. BMC Public Health 24 , 1583 (2024). https://doi.org/10.1186/s12889-024-19060-1

Download citation

Received : 04 January 2024

Accepted : 05 June 2024

Published : 13 June 2024

DOI : https://doi.org/10.1186/s12889-024-19060-1

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

• Indigenous Health
• Infant feeding
• Breastfeeding
• Qualitative
• Maternal and child health
• Scoping review

BMC Public Health

ISSN: 1471-2458

• General enquiries: [email protected]