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Library Guide to Capstone Literature Reviews: Role of the Literature Review

The role of the literature review.

Your literature review gives readers an understanding of the scholarly research on your topic.

In your literature review you will:

  • demonstrate that you are a well-informed scholar with expertise and knowledge in the field by giving an overview of the current state of the literature
  • find a gap in the literature, or address a business or professional issue, depending on your doctoral study program; the literature review will illustrate how your research contributes to the scholarly conversation
  • provide a synthesis of the issues, trends, and concepts surrounding your research

what is the role of review of literature in research

Be aware that the literature review is an iterative process. As you read and write initial drafts, you will find new threads and complementary themes, at which point you will return to search, find out about these new themes, and incorporate them into your review.

The purpose of this guide is to help you through the literature review process. Take some time to look over the resources in order to become familiar with them. The tabs on the left side of this page have additional information.

Short video: Research for the Literature Review

Short Video: Research for the Literature Review

(4 min 10 sec) Recorded August 2019 Transcript 

Literature review as a dinner party

To think about the role of the literature review, consider this analogy:  pretend that you throw a dinner party for the other researchers working in your topic area. First, you’d need to develop a guest list.

  • The guests of honor would be early researchers or theorists; their work likely inspired subsequent studies, ideas, or controversies that the current researchers pursue.
  • Then, think about the important current researchers to invite. Which guests might agree with each other?  Which others might provide useful counterpoints?
  • You likely won’t be able to include everyone on the guest list, so you may need to choose carefully so that you don’t leave important figures out. 
  • Alternatively, if there aren’t many researchers working in your topic area, then your guest list will need to include people working in other, related areas, who can still contribute to the conversation.

After the party, you describe the evening to a friend. You’ll summarize the evening’s conversation. Perhaps one guest made a comment that sparked a conversation, and then you describe who responded and how the topic evolved. There are other conversations to share, too. This is how you synthesize the themes and developments that you find in your research. Thinking about your literature research this way will help you to present your dinner party (and your literature review) in a lively and engaging way.

Short video: Empirical research

Video: How to locate and identify empirical research for your literature review

(6 min 16 sec) Recorded May 2020 Transcript 

Here are some useful resources from the Writing Center, the Office of Research and Doctoral Services, and other departments within the Office of Academic Support. Take some time to look at what is available to help you with your capstone/dissertation.

  • Familiarize yourself with Walden support
  • Doctoral Capstone Resources website
  • Capstone writing resources
  • Office of Student Research Administration
  • Office of Research and Doctoral Services
  • Visit the Writing Center

You can watch recorded webinars on the literature review in our Library Webinar Archives .

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Literature Reviews

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

What is a Literature Review?

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

A literature review should: 

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

From  S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

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

Larayne Dallas : Engineering

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

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

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

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

  • October 26, 2022 recording
  • Last Updated: Oct 26, 2022 2:49 PM
  • URL: https://guides.lib.utexas.edu/literaturereviews

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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

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  • Next: Planning the Review >>
  • Last Updated: Jan 17, 2024 10:05 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

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Grad Coach

What Is A Literature Review?

A plain-language explainer (with examples).

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

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

Literature Review 101

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

What is a literature review?

The word “literature review” can refer to two related things that are part of the broader literature review process. The first is the task of  reviewing the literature  – i.e. sourcing and reading through the existing research relating to your research topic. The second is the  actual chapter  that you write up in your dissertation, thesis or research project. Let’s look at each of them:

Reviewing the literature

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

The literature review chapter

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

Starting point for the literature review

What’s the purpose of a literature review?

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

Purpose #1 – Demonstrate your topic knowledge

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

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

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

Purpose #3 – Lay the foundation for your conceptual framework

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

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

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

Purpose #4 – To inform your methodology

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

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

Free Webinar: Literature Review 101

How do I find articles for my literature review?

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

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

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

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

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

Need a helping hand?

what is the role of review of literature in research

How should I structure my literature review?

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

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

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

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

A good literature review should synthesise the existing research in relation to the research aims, not simply summarise it.

Example of a literature review

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

Wrapping Up

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

Literature Review Course

Psst… there’s more!

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

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

Derek Jansen

Thanks for the kind words, Becky. Good luck with your literature review 🙂


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Hi, Concept was explained nicely by both of you. Thanks a lot for sharing it. It will surely help research scholars to start their Research Journey.


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Well-presented overview of the literature!

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This was brilliant. So clear. Thank you

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Frequently asked questions

What is the purpose of a literature review.

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.

Frequently asked questions: Academic writing

A rhetorical tautology is the repetition of an idea of concept using different words.

Rhetorical tautologies occur when additional words are used to convey a meaning that has already been expressed or implied. For example, the phrase “armed gunman” is a tautology because a “gunman” is by definition “armed.”

A logical tautology is a statement that is always true because it includes all logical possibilities.

Logical tautologies often take the form of “either/or” statements (e.g., “It will rain, or it will not rain”) or employ circular reasoning (e.g., “she is untrustworthy because she can’t be trusted”).

You may have seen both “appendices” or “appendixes” as pluralizations of “ appendix .” Either spelling can be used, but “appendices” is more common (including in APA Style ). Consistency is key here: make sure you use the same spelling throughout your paper.

The purpose of a lab report is to demonstrate your understanding of the scientific method with a hands-on lab experiment. Course instructors will often provide you with an experimental design and procedure. Your task is to write up how you actually performed the experiment and evaluate the outcome.

In contrast, a research paper requires you to independently develop an original argument. It involves more in-depth research and interpretation of sources and data.

A lab report is usually shorter than a research paper.

The sections of a lab report can vary between scientific fields and course requirements, but it usually contains the following:

  • Title: expresses the topic of your study
  • Abstract: summarizes your research aims, methods, results, and conclusions
  • Introduction: establishes the context needed to understand the topic
  • Method: describes the materials and procedures used in the experiment
  • Results: reports all descriptive and inferential statistical analyses
  • Discussion: interprets and evaluates results and identifies limitations
  • Conclusion: sums up the main findings of your experiment
  • References: list of all sources cited using a specific style (e.g. APA)
  • Appendices: contains lengthy materials, procedures, tables or figures

A lab report conveys the aim, methods, results, and conclusions of a scientific experiment . Lab reports are commonly assigned in science, technology, engineering, and mathematics (STEM) fields.

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .

If you’ve gone over the word limit set for your assignment, shorten your sentences and cut repetition and redundancy during the editing process. If you use a lot of long quotes , consider shortening them to just the essentials.

If you need to remove a lot of words, you may have to cut certain passages. Remember that everything in the text should be there to support your argument; look for any information that’s not essential to your point and remove it.

To make this process easier and faster, you can use a paraphrasing tool . With this tool, you can rewrite your text to make it simpler and shorter. If that’s not enough, you can copy-paste your paraphrased text into the summarizer . This tool will distill your text to its core message.

Revising, proofreading, and editing are different stages of the writing process .

  • Revising is making structural and logical changes to your text—reformulating arguments and reordering information.
  • Editing refers to making more local changes to things like sentence structure and phrasing to make sure your meaning is conveyed clearly and concisely.
  • Proofreading involves looking at the text closely, line by line, to spot any typos and issues with consistency and correct them.

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

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

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

Avoid citing sources in your abstract . There are two reasons for this:

  • The abstract should focus on your original research, not on the work of others.
  • The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

  • To help potential readers determine the relevance of your paper for their own research.
  • To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.

In a scientific paper, the methodology always comes after the introduction and before the results , discussion and conclusion . The same basic structure also applies to a thesis, dissertation , or research proposal .

Depending on the length and type of document, you might also include a literature review or theoretical framework before the methodology.

Whether you’re publishing a blog, submitting a research paper , or even just writing an important email, there are a few techniques you can use to make sure it’s error-free:

  • Take a break : Set your work aside for at least a few hours so that you can look at it with fresh eyes.
  • Proofread a printout : Staring at a screen for too long can cause fatigue – sit down with a pen and paper to check the final version.
  • Use digital shortcuts : Take note of any recurring mistakes (for example, misspelling a particular word, switching between US and UK English , or inconsistently capitalizing a term), and use Find and Replace to fix it throughout the document.

If you want to be confident that an important text is error-free, it might be worth choosing a professional proofreading service instead.

Editing and proofreading are different steps in the process of revising a text.

Editing comes first, and can involve major changes to content, structure and language. The first stages of editing are often done by authors themselves, while a professional editor makes the final improvements to grammar and style (for example, by improving sentence structure and word choice ).

Proofreading is the final stage of checking a text before it is published or shared. It focuses on correcting minor errors and inconsistencies (for example, in punctuation and capitalization ). Proofreaders often also check for formatting issues, especially in print publishing.

The cost of proofreading depends on the type and length of text, the turnaround time, and the level of services required. Most proofreading companies charge per word or page, while freelancers sometimes charge an hourly rate.

For proofreading alone, which involves only basic corrections of typos and formatting mistakes, you might pay as little as $0.01 per word, but in many cases, your text will also require some level of editing , which costs slightly more.

It’s often possible to purchase combined proofreading and editing services and calculate the price in advance based on your requirements.

There are many different routes to becoming a professional proofreader or editor. The necessary qualifications depend on the field – to be an academic or scientific proofreader, for example, you will need at least a university degree in a relevant subject.

For most proofreading jobs, experience and demonstrated skills are more important than specific qualifications. Often your skills will be tested as part of the application process.

To learn practical proofreading skills, you can choose to take a course with a professional organization such as the Society for Editors and Proofreaders . Alternatively, you can apply to companies that offer specialized on-the-job training programmes, such as the Scribbr Academy .

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Conducting a literature review: why do a literature review, why do a literature review.

  • How To Find "The Literature"
  • Found it -- Now What?

Besides the obvious reason for students -- because it is assigned! -- a literature review helps you explore the research that has come before you, to see how your research question has (or has not) already been addressed.

You identify:

  • core research in the field
  • experts in the subject area
  • methodology you may want to use (or avoid)
  • gaps in knowledge -- or where your research would fit in

It Also Helps You:

  • Publish and share your findings
  • Justify requests for grants and other funding
  • Identify best practices to inform practice
  • Set wider context for a program evaluation
  • Compile information to support community organizing

Great brief overview, from NCSU

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  • 1. Define your research question
  • 2. Plan your search
  • 3. Search the literature
  • 4. Organize your results
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what is the role of review of literature in research

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what is the role of review of literature in research

Definition: A literature review is a systematic examination and synthesis of existing scholarly research on a specific topic or subject.

Purpose: It serves to provide a comprehensive overview of the current state of knowledge within a particular field.

Analysis: Involves critically evaluating and summarizing key findings, methodologies, and debates found in academic literature.

Identifying Gaps: Aims to pinpoint areas where there is a lack of research or unresolved questions, highlighting opportunities for further investigation.

Contextualization: Enables researchers to understand how their work fits into the broader academic conversation and contributes to the existing body of knowledge.

what is the role of review of literature in research

tl;dr  A literature review critically examines and synthesizes existing scholarly research and publications on a specific topic to provide a comprehensive understanding of the current state of knowledge in the field.

What is a literature review NOT?

❌ An annotated bibliography

❌ Original research

❌ A summary

❌ Something to be conducted at the end of your research

❌ An opinion piece

❌ A chronological compilation of studies

The reason for conducting a literature review is to:

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Literature Reviews: An Overview for Graduate Students

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Research Method

Home » Literature Review – Types Writing Guide and Examples

Literature Review – Types Writing Guide and Examples

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Literature Review

Literature Review


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:


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.

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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.

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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?


  • 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.
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What is the Purpose of a Literature Review?

What is the Purpose of a Literature Review?

4-minute read

  • 23rd October 2023

If you’re writing a research paper or dissertation , then you’ll most likely need to include a comprehensive literature review . In this post, we’ll review the purpose of literature reviews, why they are so significant, and the specific elements to include in one. Literature reviews can:

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

A literature review is a critical summary and evaluation of the existing research (e.g., academic journal articles and books) on a specific topic. It is typically included as a separate section or chapter of a research paper or dissertation, serving as a contextual framework for a study. Literature reviews can vary in length depending on the subject and nature of the study, with most being about equal length to other sections or chapters included in the paper. Essentially, the literature review highlights previous studies in the context of your research and summarizes your insights in a structured, organized format. Next, let’s look at the overall purpose of a literature review.

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Literature reviews are considered an integral part of research across most academic subjects and fields. The primary purpose of a literature review in your study is to:

Provide a Foundation for Current Research

Since the literature review provides a comprehensive evaluation of the existing research, it serves as a solid foundation for your current study. It’s a way to contextualize your work and show how your research fits into the broader landscape of your specific area of study.  

Define Key Concepts and Theories

The literature review highlights the central theories and concepts that have arisen from previous research on your chosen topic. It gives your readers a more thorough understanding of the background of your study and why your research is particularly significant .

Demonstrate Critical Evaluation 

A comprehensive literature review shows your ability to critically analyze and evaluate a broad range of source material. And since you’re considering and acknowledging the contribution of key scholars alongside your own, it establishes your own credibility and knowledge.

Show How Research and Methodologies Have Evolved

Another purpose of literature reviews is to provide a historical perspective and demonstrate how research and methodologies have changed over time, especially as data collection methods and technology have advanced. And studying past methodologies allows you, as the researcher, to understand what did and did not work and apply that knowledge to your own research.  

Identify Gaps in Existing Research

Besides discussing current research and methodologies, the literature review should also address areas that are lacking in the existing literature. This helps further demonstrate the relevance of your own research by explaining why your study is necessary to fill the gaps.

Support Your Argument

A good literature review should provide evidence that supports your research questions and hypothesis. For example, your study may show that your research supports existing theories or builds on them in some way. Referencing previous related studies shows your work is grounded in established research and will ultimately be a contribution to the field.  

Literature Review Editing Services 

Ensure your literature review is polished and ready for submission by having it professionally proofread and edited by our expert team. Our literature review editing services will help your research stand out and make an impact. Not convinced yet? Send in your free sample today and see for yourself! 

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Literature Review: Purpose of a Literature Review

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The purpose of a literature review is to:

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

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

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Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

Literature reviews play a critical role in scholarship because science remains, first and foremost, a cumulative endeavour ( vom Brocke et al., 2009 ). As in any academic discipline, rigorous knowledge syntheses are becoming indispensable in keeping up with an exponentially growing eHealth literature, assisting practitioners, academics, and graduate students in finding, evaluating, and synthesizing the contents of many empirical and conceptual papers. Among other methods, literature reviews are essential for: (a) identifying what has been written on a subject or topic; (b) determining the extent to which a specific research area reveals any interpretable trends or patterns; (c) aggregating empirical findings related to a narrow research question to support evidence-based practice; (d) generating new frameworks and theories; and (e) identifying topics or questions requiring more investigation ( Paré, Trudel, Jaana, & Kitsiou, 2015 ).

Literature reviews can take two major forms. The most prevalent one is the “literature review” or “background” section within a journal paper or a chapter in a graduate thesis. This section synthesizes the extant literature and usually identifies the gaps in knowledge that the empirical study addresses ( Sylvester, Tate, & Johnstone, 2013 ). It may also provide a theoretical foundation for the proposed study, substantiate the presence of the research problem, justify the research as one that contributes something new to the cumulated knowledge, or validate the methods and approaches for the proposed study ( Hart, 1998 ; Levy & Ellis, 2006 ).

The second form of literature review, which is the focus of this chapter, constitutes an original and valuable work of research in and of itself ( Paré et al., 2015 ). Rather than providing a base for a researcher’s own work, it creates a solid starting point for all members of the community interested in a particular area or topic ( Mulrow, 1987 ). The so-called “review article” is a journal-length paper which has an overarching purpose to synthesize the literature in a field, without collecting or analyzing any primary data ( Green, Johnson, & Adams, 2006 ).

When appropriately conducted, review articles represent powerful information sources for practitioners looking for state-of-the art evidence to guide their decision-making and work practices ( Paré et al., 2015 ). Further, high-quality reviews become frequently cited pieces of work which researchers seek out as a first clear outline of the literature when undertaking empirical studies ( Cooper, 1988 ; Rowe, 2014 ). Scholars who track and gauge the impact of articles have found that review papers are cited and downloaded more often than any other type of published article ( Cronin, Ryan, & Coughlan, 2008 ; Montori, Wilczynski, Morgan, Haynes, & Hedges, 2003 ; Patsopoulos, Analatos, & Ioannidis, 2005 ). The reason for their popularity may be the fact that reading the review enables one to have an overview, if not a detailed knowledge of the area in question, as well as references to the most useful primary sources ( Cronin et al., 2008 ). Although they are not easy to conduct, the commitment to complete a review article provides a tremendous service to one’s academic community ( Paré et al., 2015 ; Petticrew & Roberts, 2006 ). Most, if not all, peer-reviewed journals in the fields of medical informatics publish review articles of some type.

The main objectives of this chapter are fourfold: (a) to provide an overview of the major steps and activities involved in conducting a stand-alone literature review; (b) to describe and contrast the different types of review articles that can contribute to the eHealth knowledge base; (c) to illustrate each review type with one or two examples from the eHealth literature; and (d) to provide a series of recommendations for prospective authors of review articles in this domain.

9.2. Overview of the Literature Review Process and Steps

As explained in Templier and Paré (2015) , there are six generic steps involved in conducting a review article:

  • formulating the research question(s) and objective(s),
  • searching the extant literature,
  • screening for inclusion,
  • assessing the quality of primary studies,
  • extracting data, and
  • analyzing data.

Although these steps are presented here in sequential order, one must keep in mind that the review process can be iterative and that many activities can be initiated during the planning stage and later refined during subsequent phases ( Finfgeld-Connett & Johnson, 2013 ; Kitchenham & Charters, 2007 ).

Formulating the research question(s) and objective(s): As a first step, members of the review team must appropriately justify the need for the review itself ( Petticrew & Roberts, 2006 ), identify the review’s main objective(s) ( Okoli & Schabram, 2010 ), and define the concepts or variables at the heart of their synthesis ( Cooper & Hedges, 2009 ; Webster & Watson, 2002 ). Importantly, they also need to articulate the research question(s) they propose to investigate ( Kitchenham & Charters, 2007 ). In this regard, we concur with Jesson, Matheson, and Lacey (2011) that clearly articulated research questions are key ingredients that guide the entire review methodology; they underscore the type of information that is needed, inform the search for and selection of relevant literature, and guide or orient the subsequent analysis. Searching the extant literature: The next step consists of searching the literature and making decisions about the suitability of material to be considered in the review ( Cooper, 1988 ). There exist three main coverage strategies. First, exhaustive coverage means an effort is made to be as comprehensive as possible in order to ensure that all relevant studies, published and unpublished, are included in the review and, thus, conclusions are based on this all-inclusive knowledge base. The second type of coverage consists of presenting materials that are representative of most other works in a given field or area. Often authors who adopt this strategy will search for relevant articles in a small number of top-tier journals in a field ( Paré et al., 2015 ). In the third strategy, the review team concentrates on prior works that have been central or pivotal to a particular topic. This may include empirical studies or conceptual papers that initiated a line of investigation, changed how problems or questions were framed, introduced new methods or concepts, or engendered important debate ( Cooper, 1988 ). Screening for inclusion: The following step consists of evaluating the applicability of the material identified in the preceding step ( Levy & Ellis, 2006 ; vom Brocke et al., 2009 ). Once a group of potential studies has been identified, members of the review team must screen them to determine their relevance ( Petticrew & Roberts, 2006 ). A set of predetermined rules provides a basis for including or excluding certain studies. This exercise requires a significant investment on the part of researchers, who must ensure enhanced objectivity and avoid biases or mistakes. As discussed later in this chapter, for certain types of reviews there must be at least two independent reviewers involved in the screening process and a procedure to resolve disagreements must also be in place ( Liberati et al., 2009 ; Shea et al., 2009 ). Assessing the quality of primary studies: In addition to screening material for inclusion, members of the review team may need to assess the scientific quality of the selected studies, that is, appraise the rigour of the research design and methods. Such formal assessment, which is usually conducted independently by at least two coders, helps members of the review team refine which studies to include in the final sample, determine whether or not the differences in quality may affect their conclusions, or guide how they analyze the data and interpret the findings ( Petticrew & Roberts, 2006 ). Ascribing quality scores to each primary study or considering through domain-based evaluations which study components have or have not been designed and executed appropriately makes it possible to reflect on the extent to which the selected study addresses possible biases and maximizes validity ( Shea et al., 2009 ). Extracting data: The following step involves gathering or extracting applicable information from each primary study included in the sample and deciding what is relevant to the problem of interest ( Cooper & Hedges, 2009 ). Indeed, the type of data that should be recorded mainly depends on the initial research questions ( Okoli & Schabram, 2010 ). However, important information may also be gathered about how, when, where and by whom the primary study was conducted, the research design and methods, or qualitative/quantitative results ( Cooper & Hedges, 2009 ). Analyzing and synthesizing data : As a final step, members of the review team must collate, summarize, aggregate, organize, and compare the evidence extracted from the included studies. The extracted data must be presented in a meaningful way that suggests a new contribution to the extant literature ( Jesson et al., 2011 ). Webster and Watson (2002) warn researchers that literature reviews should be much more than lists of papers and should provide a coherent lens to make sense of extant knowledge on a given topic. There exist several methods and techniques for synthesizing quantitative (e.g., frequency analysis, meta-analysis) and qualitative (e.g., grounded theory, narrative analysis, meta-ethnography) evidence ( Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005 ; Thomas & Harden, 2008 ).

9.3. Types of Review Articles and Brief Illustrations

EHealth researchers have at their disposal a number of approaches and methods for making sense out of existing literature, all with the purpose of casting current research findings into historical contexts or explaining contradictions that might exist among a set of primary research studies conducted on a particular topic. Our classification scheme is largely inspired from Paré and colleagues’ (2015) typology. Below we present and illustrate those review types that we feel are central to the growth and development of the eHealth domain.

9.3.1. Narrative Reviews

The narrative review is the “traditional” way of reviewing the extant literature and is skewed towards a qualitative interpretation of prior knowledge ( Sylvester et al., 2013 ). Put simply, a narrative review attempts to summarize or synthesize what has been written on a particular topic but does not seek generalization or cumulative knowledge from what is reviewed ( Davies, 2000 ; Green et al., 2006 ). Instead, the review team often undertakes the task of accumulating and synthesizing the literature to demonstrate the value of a particular point of view ( Baumeister & Leary, 1997 ). As such, reviewers may selectively ignore or limit the attention paid to certain studies in order to make a point. In this rather unsystematic approach, the selection of information from primary articles is subjective, lacks explicit criteria for inclusion and can lead to biased interpretations or inferences ( Green et al., 2006 ). There are several narrative reviews in the particular eHealth domain, as in all fields, which follow such an unstructured approach ( Silva et al., 2015 ; Paul et al., 2015 ).

Despite these criticisms, this type of review can be very useful in gathering together a volume of literature in a specific subject area and synthesizing it. As mentioned above, its primary purpose is to provide the reader with a comprehensive background for understanding current knowledge and highlighting the significance of new research ( Cronin et al., 2008 ). Faculty like to use narrative reviews in the classroom because they are often more up to date than textbooks, provide a single source for students to reference, and expose students to peer-reviewed literature ( Green et al., 2006 ). For researchers, narrative reviews can inspire research ideas by identifying gaps or inconsistencies in a body of knowledge, thus helping researchers to determine research questions or formulate hypotheses. Importantly, narrative reviews can also be used as educational articles to bring practitioners up to date with certain topics of issues ( Green et al., 2006 ).

Recently, there have been several efforts to introduce more rigour in narrative reviews that will elucidate common pitfalls and bring changes into their publication standards. Information systems researchers, among others, have contributed to advancing knowledge on how to structure a “traditional” review. For instance, Levy and Ellis (2006) proposed a generic framework for conducting such reviews. Their model follows the systematic data processing approach comprised of three steps, namely: (a) literature search and screening; (b) data extraction and analysis; and (c) writing the literature review. They provide detailed and very helpful instructions on how to conduct each step of the review process. As another methodological contribution, vom Brocke et al. (2009) offered a series of guidelines for conducting literature reviews, with a particular focus on how to search and extract the relevant body of knowledge. Last, Bandara, Miskon, and Fielt (2011) proposed a structured, predefined and tool-supported method to identify primary studies within a feasible scope, extract relevant content from identified articles, synthesize and analyze the findings, and effectively write and present the results of the literature review. We highly recommend that prospective authors of narrative reviews consult these useful sources before embarking on their work.

Darlow and Wen (2015) provide a good example of a highly structured narrative review in the eHealth field. These authors synthesized published articles that describe the development process of mobile health ( m-health ) interventions for patients’ cancer care self-management. As in most narrative reviews, the scope of the research questions being investigated is broad: (a) how development of these systems are carried out; (b) which methods are used to investigate these systems; and (c) what conclusions can be drawn as a result of the development of these systems. To provide clear answers to these questions, a literature search was conducted on six electronic databases and Google Scholar . The search was performed using several terms and free text words, combining them in an appropriate manner. Four inclusion and three exclusion criteria were utilized during the screening process. Both authors independently reviewed each of the identified articles to determine eligibility and extract study information. A flow diagram shows the number of studies identified, screened, and included or excluded at each stage of study selection. In terms of contributions, this review provides a series of practical recommendations for m-health intervention development.

9.3.2. Descriptive or Mapping Reviews

The primary goal of a descriptive review is to determine the extent to which a body of knowledge in a particular research topic reveals any interpretable pattern or trend with respect to pre-existing propositions, theories, methodologies or findings ( King & He, 2005 ; Paré et al., 2015 ). In contrast with narrative reviews, descriptive reviews follow a systematic and transparent procedure, including searching, screening and classifying studies ( Petersen, Vakkalanka, & Kuzniarz, 2015 ). Indeed, structured search methods are used to form a representative sample of a larger group of published works ( Paré et al., 2015 ). Further, authors of descriptive reviews extract from each study certain characteristics of interest, such as publication year, research methods, data collection techniques, and direction or strength of research outcomes (e.g., positive, negative, or non-significant) in the form of frequency analysis to produce quantitative results ( Sylvester et al., 2013 ). In essence, each study included in a descriptive review is treated as the unit of analysis and the published literature as a whole provides a database from which the authors attempt to identify any interpretable trends or draw overall conclusions about the merits of existing conceptualizations, propositions, methods or findings ( Paré et al., 2015 ). In doing so, a descriptive review may claim that its findings represent the state of the art in a particular domain ( King & He, 2005 ).

In the fields of health sciences and medical informatics, reviews that focus on examining the range, nature and evolution of a topic area are described by Anderson, Allen, Peckham, and Goodwin (2008) as mapping reviews . Like descriptive reviews, the research questions are generic and usually relate to publication patterns and trends. There is no preconceived plan to systematically review all of the literature although this can be done. Instead, researchers often present studies that are representative of most works published in a particular area and they consider a specific time frame to be mapped.

An example of this approach in the eHealth domain is offered by DeShazo, Lavallie, and Wolf (2009). The purpose of this descriptive or mapping review was to characterize publication trends in the medical informatics literature over a 20-year period (1987 to 2006). To achieve this ambitious objective, the authors performed a bibliometric analysis of medical informatics citations indexed in medline using publication trends, journal frequencies, impact factors, Medical Subject Headings (MeSH) term frequencies, and characteristics of citations. Findings revealed that there were over 77,000 medical informatics articles published during the covered period in numerous journals and that the average annual growth rate was 12%. The MeSH term analysis also suggested a strong interdisciplinary trend. Finally, average impact scores increased over time with two notable growth periods. Overall, patterns in research outputs that seem to characterize the historic trends and current components of the field of medical informatics suggest it may be a maturing discipline (DeShazo et al., 2009).

9.3.3. Scoping Reviews

Scoping reviews attempt to provide an initial indication of the potential size and nature of the extant literature on an emergent topic (Arksey & O’Malley, 2005; Daudt, van Mossel, & Scott, 2013 ; Levac, Colquhoun, & O’Brien, 2010). A scoping review may be conducted to examine the extent, range and nature of research activities in a particular area, determine the value of undertaking a full systematic review (discussed next), or identify research gaps in the extant literature ( Paré et al., 2015 ). In line with their main objective, scoping reviews usually conclude with the presentation of a detailed research agenda for future works along with potential implications for both practice and research.

Unlike narrative and descriptive reviews, the whole point of scoping the field is to be as comprehensive as possible, including grey literature (Arksey & O’Malley, 2005). Inclusion and exclusion criteria must be established to help researchers eliminate studies that are not aligned with the research questions. It is also recommended that at least two independent coders review abstracts yielded from the search strategy and then the full articles for study selection ( Daudt et al., 2013 ). The synthesized evidence from content or thematic analysis is relatively easy to present in tabular form (Arksey & O’Malley, 2005; Thomas & Harden, 2008 ).

One of the most highly cited scoping reviews in the eHealth domain was published by Archer, Fevrier-Thomas, Lokker, McKibbon, and Straus (2011) . These authors reviewed the existing literature on personal health record ( phr ) systems including design, functionality, implementation, applications, outcomes, and benefits. Seven databases were searched from 1985 to March 2010. Several search terms relating to phr s were used during this process. Two authors independently screened titles and abstracts to determine inclusion status. A second screen of full-text articles, again by two independent members of the research team, ensured that the studies described phr s. All in all, 130 articles met the criteria and their data were extracted manually into a database. The authors concluded that although there is a large amount of survey, observational, cohort/panel, and anecdotal evidence of phr benefits and satisfaction for patients, more research is needed to evaluate the results of phr implementations. Their in-depth analysis of the literature signalled that there is little solid evidence from randomized controlled trials or other studies through the use of phr s. Hence, they suggested that more research is needed that addresses the current lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting patient self-management ( Archer et al., 2011 ).

9.3.4. Forms of Aggregative Reviews

Healthcare providers, practitioners, and policy-makers are nowadays overwhelmed with large volumes of information, including research-based evidence from numerous clinical trials and evaluation studies, assessing the effectiveness of health information technologies and interventions ( Ammenwerth & de Keizer, 2004 ; Deshazo et al., 2009 ). It is unrealistic to expect that all these disparate actors will have the time, skills, and necessary resources to identify the available evidence in the area of their expertise and consider it when making decisions. Systematic reviews that involve the rigorous application of scientific strategies aimed at limiting subjectivity and bias (i.e., systematic and random errors) can respond to this challenge.

Systematic reviews attempt to aggregate, appraise, and synthesize in a single source all empirical evidence that meet a set of previously specified eligibility criteria in order to answer a clearly formulated and often narrow research question on a particular topic of interest to support evidence-based practice ( Liberati et al., 2009 ). They adhere closely to explicit scientific principles ( Liberati et al., 2009 ) and rigorous methodological guidelines (Higgins & Green, 2008) aimed at reducing random and systematic errors that can lead to deviations from the truth in results or inferences. The use of explicit methods allows systematic reviews to aggregate a large body of research evidence, assess whether effects or relationships are in the same direction and of the same general magnitude, explain possible inconsistencies between study results, and determine the strength of the overall evidence for every outcome of interest based on the quality of included studies and the general consistency among them ( Cook, Mulrow, & Haynes, 1997 ). The main procedures of a systematic review involve:

  • Formulating a review question and developing a search strategy based on explicit inclusion criteria for the identification of eligible studies (usually described in the context of a detailed review protocol).
  • Searching for eligible studies using multiple databases and information sources, including grey literature sources, without any language restrictions.
  • Selecting studies, extracting data, and assessing risk of bias in a duplicate manner using two independent reviewers to avoid random or systematic errors in the process.
  • Analyzing data using quantitative or qualitative methods.
  • Presenting results in summary of findings tables.
  • Interpreting results and drawing conclusions.

Many systematic reviews, but not all, use statistical methods to combine the results of independent studies into a single quantitative estimate or summary effect size. Known as meta-analyses , these reviews use specific data extraction and statistical techniques (e.g., network, frequentist, or Bayesian meta-analyses) to calculate from each study by outcome of interest an effect size along with a confidence interval that reflects the degree of uncertainty behind the point estimate of effect ( Borenstein, Hedges, Higgins, & Rothstein, 2009 ; Deeks, Higgins, & Altman, 2008 ). Subsequently, they use fixed or random-effects analysis models to combine the results of the included studies, assess statistical heterogeneity, and calculate a weighted average of the effect estimates from the different studies, taking into account their sample sizes. The summary effect size is a value that reflects the average magnitude of the intervention effect for a particular outcome of interest or, more generally, the strength of a relationship between two variables across all studies included in the systematic review. By statistically combining data from multiple studies, meta-analyses can create more precise and reliable estimates of intervention effects than those derived from individual studies alone, when these are examined independently as discrete sources of information.

The review by Gurol-Urganci, de Jongh, Vodopivec-Jamsek, Atun, and Car (2013) on the effects of mobile phone messaging reminders for attendance at healthcare appointments is an illustrative example of a high-quality systematic review with meta-analysis. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs to health systems. These authors sought to assess whether mobile phone-based appointment reminders delivered through Short Message Service ( sms ) or Multimedia Messaging Service ( mms ) are effective in improving rates of patient attendance and reducing overall costs. To this end, they conducted a comprehensive search on multiple databases using highly sensitive search strategies without language or publication-type restrictions to identify all rct s that are eligible for inclusion. In order to minimize the risk of omitting eligible studies not captured by the original search, they supplemented all electronic searches with manual screening of trial registers and references contained in the included studies. Study selection, data extraction, and risk of bias assessments were performed inde­­pen­dently by two coders using standardized methods to ensure consistency and to eliminate potential errors. Findings from eight rct s involving 6,615 participants were pooled into meta-analyses to calculate the magnitude of effects that mobile text message reminders have on the rate of attendance at healthcare appointments compared to no reminders and phone call reminders.

Meta-analyses are regarded as powerful tools for deriving meaningful conclusions. However, there are situations in which it is neither reasonable nor appropriate to pool studies together using meta-analytic methods simply because there is extensive clinical heterogeneity between the included studies or variation in measurement tools, comparisons, or outcomes of interest. In these cases, systematic reviews can use qualitative synthesis methods such as vote counting, content analysis, classification schemes and tabulations, as an alternative approach to narratively synthesize the results of the independent studies included in the review. This form of review is known as qualitative systematic review.

A rigorous example of one such review in the eHealth domain is presented by Mickan, Atherton, Roberts, Heneghan, and Tilson (2014) on the use of handheld computers by healthcare professionals and their impact on access to information and clinical decision-making. In line with the methodological guide­lines for systematic reviews, these authors: (a) developed and registered with prospero ( www.crd.york.ac.uk/ prospero / ) an a priori review protocol; (b) conducted comprehensive searches for eligible studies using multiple databases and other supplementary strategies (e.g., forward searches); and (c) subsequently carried out study selection, data extraction, and risk of bias assessments in a duplicate manner to eliminate potential errors in the review process. Heterogeneity between the included studies in terms of reported outcomes and measures precluded the use of meta-analytic methods. To this end, the authors resorted to using narrative analysis and synthesis to describe the effectiveness of handheld computers on accessing information for clinical knowledge, adherence to safety and clinical quality guidelines, and diagnostic decision-making.

In recent years, the number of systematic reviews in the field of health informatics has increased considerably. Systematic reviews with discordant findings can cause great confusion and make it difficult for decision-makers to interpret the review-level evidence ( Moher, 2013 ). Therefore, there is a growing need for appraisal and synthesis of prior systematic reviews to ensure that decision-making is constantly informed by the best available accumulated evidence. Umbrella reviews , also known as overviews of systematic reviews, are tertiary types of evidence synthesis that aim to accomplish this; that is, they aim to compare and contrast findings from multiple systematic reviews and meta-analyses ( Becker & Oxman, 2008 ). Umbrella reviews generally adhere to the same principles and rigorous methodological guidelines used in systematic reviews. However, the unit of analysis in umbrella reviews is the systematic review rather than the primary study ( Becker & Oxman, 2008 ). Unlike systematic reviews that have a narrow focus of inquiry, umbrella reviews focus on broader research topics for which there are several potential interventions ( Smith, Devane, Begley, & Clarke, 2011 ). A recent umbrella review on the effects of home telemonitoring interventions for patients with heart failure critically appraised, compared, and synthesized evidence from 15 systematic reviews to investigate which types of home telemonitoring technologies and forms of interventions are more effective in reducing mortality and hospital admissions ( Kitsiou, Paré, & Jaana, 2015 ).

9.3.5. Realist Reviews

Realist reviews are theory-driven interpretative reviews developed to inform, enhance, or supplement conventional systematic reviews by making sense of heterogeneous evidence about complex interventions applied in diverse contexts in a way that informs policy decision-making ( Greenhalgh, Wong, Westhorp, & Pawson, 2011 ). They originated from criticisms of positivist systematic reviews which centre on their “simplistic” underlying assumptions ( Oates, 2011 ). As explained above, systematic reviews seek to identify causation. Such logic is appropriate for fields like medicine and education where findings of randomized controlled trials can be aggregated to see whether a new treatment or intervention does improve outcomes. However, many argue that it is not possible to establish such direct causal links between interventions and outcomes in fields such as social policy, management, and information systems where for any intervention there is unlikely to be a regular or consistent outcome ( Oates, 2011 ; Pawson, 2006 ; Rousseau, Manning, & Denyer, 2008 ).

To circumvent these limitations, Pawson, Greenhalgh, Harvey, and Walshe (2005) have proposed a new approach for synthesizing knowledge that seeks to unpack the mechanism of how “complex interventions” work in particular contexts. The basic research question — what works? — which is usually associated with systematic reviews changes to: what is it about this intervention that works, for whom, in what circumstances, in what respects and why? Realist reviews have no particular preference for either quantitative or qualitative evidence. As a theory-building approach, a realist review usually starts by articulating likely underlying mechanisms and then scrutinizes available evidence to find out whether and where these mechanisms are applicable ( Shepperd et al., 2009 ). Primary studies found in the extant literature are viewed as case studies which can test and modify the initial theories ( Rousseau et al., 2008 ).

The main objective pursued in the realist review conducted by Otte-Trojel, de Bont, Rundall, and van de Klundert (2014) was to examine how patient portals contribute to health service delivery and patient outcomes. The specific goals were to investigate how outcomes are produced and, most importantly, how variations in outcomes can be explained. The research team started with an exploratory review of background documents and research studies to identify ways in which patient portals may contribute to health service delivery and patient outcomes. The authors identified six main ways which represent “educated guesses” to be tested against the data in the evaluation studies. These studies were identified through a formal and systematic search in four databases between 2003 and 2013. Two members of the research team selected the articles using a pre-established list of inclusion and exclusion criteria and following a two-step procedure. The authors then extracted data from the selected articles and created several tables, one for each outcome category. They organized information to bring forward those mechanisms where patient portals contribute to outcomes and the variation in outcomes across different contexts.

9.3.6. Critical Reviews

Lastly, critical reviews aim to provide a critical evaluation and interpretive analysis of existing literature on a particular topic of interest to reveal strengths, weaknesses, contradictions, controversies, inconsistencies, and/or other important issues with respect to theories, hypotheses, research methods or results ( Baumeister & Leary, 1997 ; Kirkevold, 1997 ). Unlike other review types, critical reviews attempt to take a reflective account of the research that has been done in a particular area of interest, and assess its credibility by using appraisal instruments or critical interpretive methods. In this way, critical reviews attempt to constructively inform other scholars about the weaknesses of prior research and strengthen knowledge development by giving focus and direction to studies for further improvement ( Kirkevold, 1997 ).

Kitsiou, Paré, and Jaana (2013) provide an example of a critical review that assessed the methodological quality of prior systematic reviews of home telemonitoring studies for chronic patients. The authors conducted a comprehensive search on multiple databases to identify eligible reviews and subsequently used a validated instrument to conduct an in-depth quality appraisal. Results indicate that the majority of systematic reviews in this particular area suffer from important methodological flaws and biases that impair their internal validity and limit their usefulness for clinical and decision-making purposes. To this end, they provide a number of recommendations to strengthen knowledge development towards improving the design and execution of future reviews on home telemonitoring.

9.4. Summary

Table 9.1 outlines the main types of literature reviews that were described in the previous sub-sections and summarizes the main characteristics that distinguish one review type from another. It also includes key references to methodological guidelines and useful sources that can be used by eHealth scholars and researchers for planning and developing reviews.

Table 9.1. Typology of Literature Reviews (adapted from Paré et al., 2015).

Typology of Literature Reviews (adapted from Paré et al., 2015).

As shown in Table 9.1 , each review type addresses different kinds of research questions or objectives, which subsequently define and dictate the methods and approaches that need to be used to achieve the overarching goal(s) of the review. For example, in the case of narrative reviews, there is greater flexibility in searching and synthesizing articles ( Green et al., 2006 ). Researchers are often relatively free to use a diversity of approaches to search, identify, and select relevant scientific articles, describe their operational characteristics, present how the individual studies fit together, and formulate conclusions. On the other hand, systematic reviews are characterized by their high level of systematicity, rigour, and use of explicit methods, based on an “a priori” review plan that aims to minimize bias in the analysis and synthesis process (Higgins & Green, 2008). Some reviews are exploratory in nature (e.g., scoping/mapping reviews), whereas others may be conducted to discover patterns (e.g., descriptive reviews) or involve a synthesis approach that may include the critical analysis of prior research ( Paré et al., 2015 ). Hence, in order to select the most appropriate type of review, it is critical to know before embarking on a review project, why the research synthesis is conducted and what type of methods are best aligned with the pursued goals.

9.5. Concluding Remarks

In light of the increased use of evidence-based practice and research generating stronger evidence ( Grady et al., 2011 ; Lyden et al., 2013 ), review articles have become essential tools for summarizing, synthesizing, integrating or critically appraising prior knowledge in the eHealth field. As mentioned earlier, when rigorously conducted review articles represent powerful information sources for eHealth scholars and practitioners looking for state-of-the-art evidence. The typology of literature reviews we used herein will allow eHealth researchers, graduate students and practitioners to gain a better understanding of the similarities and differences between review types.

We must stress that this classification scheme does not privilege any specific type of review as being of higher quality than another ( Paré et al., 2015 ). As explained above, each type of review has its own strengths and limitations. Having said that, we realize that the methodological rigour of any review — be it qualitative, quantitative or mixed — is a critical aspect that should be considered seriously by prospective authors. In the present context, the notion of rigour refers to the reliability and validity of the review process described in section 9.2. For one thing, reliability is related to the reproducibility of the review process and steps, which is facilitated by a comprehensive documentation of the literature search process, extraction, coding and analysis performed in the review. Whether the search is comprehensive or not, whether it involves a methodical approach for data extraction and synthesis or not, it is important that the review documents in an explicit and transparent manner the steps and approach that were used in the process of its development. Next, validity characterizes the degree to which the review process was conducted appropriately. It goes beyond documentation and reflects decisions related to the selection of the sources, the search terms used, the period of time covered, the articles selected in the search, and the application of backward and forward searches ( vom Brocke et al., 2009 ). In short, the rigour of any review article is reflected by the explicitness of its methods (i.e., transparency) and the soundness of the approach used. We refer those interested in the concepts of rigour and quality to the work of Templier and Paré (2015) which offers a detailed set of methodological guidelines for conducting and evaluating various types of review articles.

To conclude, our main objective in this chapter was to demystify the various types of literature reviews that are central to the continuous development of the eHealth field. It is our hope that our descriptive account will serve as a valuable source for those conducting, evaluating or using reviews in this important and growing domain.

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  • Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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Writing a Literature Review

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

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

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

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

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

What are the parts of a lit review?

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


  • 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.


  • 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.

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Literature Review in Research Writing

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Research on research? If you find this idea rather peculiar, know that nowadays, with the huge amount of information produced daily all around the world, it is becoming more and more difficult to keep up to date with all of it. In addition to the sheer amount of research, there is also its origin. We are witnessing the economic and intellectual emergence of countries like China, Brazil, Turkey, and United Arab Emirates, for example, that are producing scholarly literature in their own languages. So, apart from the effort of gathering information, there must also be translators prepared to unify all of it in a single language to be the object of the literature survey. At Elsevier, our team of translators is ready to support researchers by delivering high-quality scientific translations , in several languages, to serve their research – no matter the topic.

What is a literature review?

A literature review is a study – or, more accurately, a survey – involving scholarly material, with the aim to discuss published information about a specific topic or research question. Therefore, to write a literature review, it is compulsory that you are a real expert in the object of study. The results and findings will be published and made available to the public, namely scientists working in the same area of research.

How to Write a Literature Review

First of all, don’t forget that writing a literature review is a great responsibility. It’s a document that is expected to be highly reliable, especially concerning its sources and findings. You have to feel intellectually comfortable in the area of study and highly proficient in the target language; misconceptions and errors do not have a place in a document as important as a literature review. In fact, you might want to consider text editing services, like those offered at Elsevier, to make sure your literature is following the highest standards of text quality. You want to make sure your literature review is memorable by its novelty and quality rather than language errors.

Writing a literature review requires expertise but also organization. We cannot teach you about your topic of research, but we can provide a few steps to guide you through conducting a literature review:

  • Choose your topic or research question: It should not be too comprehensive or too limited. You have to complete your task within a feasible time frame.
  • Set the scope: Define boundaries concerning the number of sources, time frame to be covered, geographical area, etc.
  • Decide which databases you will use for your searches: In order to search the best viable sources for your literature review, use highly regarded, comprehensive databases to get a big picture of the literature related to your topic.
  • Search, search, and search: Now you’ll start to investigate the research on your topic. It’s critical that you keep track of all the sources. Start by looking at research abstracts in detail to see if their respective studies relate to or are useful for your own work. Next, search for bibliographies and references that can help you broaden your list of resources. Choose the most relevant literature and remember to keep notes of their bibliographic references to be used later on.
  • Review all the literature, appraising carefully it’s content: After reading the study’s abstract, pay attention to the rest of the content of the articles you deem the “most relevant.” Identify methodologies, the most important questions they address, if they are well-designed and executed, and if they are cited enough, etc.

If it’s the first time you’ve published a literature review, note that it is important to follow a special structure. Just like in a thesis, for example, it is expected that you have an introduction – giving the general idea of the central topic and organizational pattern – a body – which contains the actual discussion of the sources – and finally the conclusion or recommendations – where you bring forward whatever you have drawn from the reviewed literature. The conclusion may even suggest there are no agreeable findings and that the discussion should be continued.

Why are literature reviews important?

Literature reviews constantly feed new research, that constantly feeds literature reviews…and we could go on and on. The fact is, one acts like a force over the other and this is what makes science, as a global discipline, constantly develop and evolve. As a scientist, writing a literature review can be very beneficial to your career, and set you apart from the expert elite in your field of interest. But it also can be an overwhelming task, so don’t hesitate in contacting Elsevier for text editing services, either for profound edition or just a last revision. We guarantee the very highest standards. You can also save time by letting us suggest and make the necessary amendments to your manuscript, so that it fits the structural pattern of a literature review. Who knows how many worldwide researchers you will impact with your next perfectly written literature review.

Know more: How to Find a Gap in Research .

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

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

Importance of Literature Review In Research

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

The common perception of literature review and reality:

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

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

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

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

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

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

Importance of literature review in research:

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

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

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

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

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



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How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses


  • 1 Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling FK9 4LA, United Kingdom; email: [email protected].
  • 2 Department of Psychological and Behavioural Science, London School of Economics and Political Science, London WC2A 2AE, United Kingdom.
  • 3 Department of Statistics, Northwestern University, Evanston, Illinois 60208, USA; email: [email protected].
  • PMID: 30089228
  • DOI: 10.1146/annurev-psych-010418-102803

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

Keywords: evidence; guide; meta-analysis; meta-synthesis; narrative; systematic review; theory.

  • Guidelines as Topic
  • Meta-Analysis as Topic*
  • Publication Bias
  • Review Literature as Topic
  • Systematic Reviews as Topic*

Literature Reviews

  • Getting Started
  • Choosing a Type of Review
  • Developing a Research Question
  • Searching the Literature
  • Searching Tips
  • ChatGPT [beta]
  • Documenting your Search
  • Using Citation Managers
  • Concept Mapping
  • Concept Map Definition


  • Writing the Review
  • Further Resources

Additional Tools

Google slides.

GSlides can create concept maps using their Diagram feature. Insert > Diagram > Hierarchy will give you some editable templates to use.

Tutorial on diagrams in GSlides .


MS Word can create concept maps using Insert > SmartArt Graphic. Select Process, Cycle, Hierarchy, or Relationship to see templates.

NVivo  is software for qualitative analysis that has a concept map feature. Zotero libraries can be uploaded using ris files. NVivo Concept Map information.

A concept map or mind map is a visual representation of knowledge that illustrates relationships between concepts or ideas. It is a tool for organizing and representing information in a hierarchical and interconnected manner. At its core, a concept map consists of nodes, which represent individual concepts or ideas, and links, which depict the relationships between these concepts .

Below is a non-exhaustive list of tools that can facilitate the creation of concept maps.

what is the role of review of literature in research


Canva is a user-friendly graphic design platform that enables individuals to create visual content quickly and easily. It offers a diverse array of customizable templates, design elements, and tools, making it accessible to users with varying levels of design experience. 

Pros: comes with many pre-made concept map templates to get you started

Cons : not all features are available in the free version

Explore Canva concept map templates here .

Note: Although Canva advertises an "education" option, this is for K-12 only and does not apply to university users.

what is the role of review of literature in research


Lucid has two tools that can create mind maps (what they're called inside Lucid): Lucidchart is the place to build, document, and diagram, and Lucidspark is the place to ideate, connect, and plan.

Lucidchart is a collaborative online diagramming and visualization tool that allows users to create a wide range of diagrams, including flowcharts, org charts, wireframes, and mind maps. Its mind-mapping feature provides a structured framework for brainstorming ideas, organizing thoughts, and visualizing relationships between concepts. 

Lucidspark , works as a virtual whiteboard. Here, you can add sticky notes, develop ideas through freehand drawing, and collaborate with your teammates. Has only one template for mind mapping.

Explore Lucid mind map creation here .

How to create mind maps using LucidSpark: 

Note: U-M students have access to Lucid through ITS. [ info here ] Choose the "Login w Google" option, use your @umich.edu account, and access should happen automatically.

what is the role of review of literature in research


Figma is a cloud-based design tool that enables collaborative interface design and prototyping. It's widely used by UI/UX designers to create, prototype, and iterate on digital designs. Figma is the main design tool, and FigJam is their virtual whiteboard:

Figma  is a comprehensive design tool that enables designers to create and prototype high-fidelity designs

FigJam focuses on collaboration and brainstorming, providing a virtual whiteboard-like experience, best for concept maps

Explore FigJam concept maps here .

what is the role of review of literature in research

Note: There is a " Figma for Education " version for students that will provide access. Choose the "Login w Google" option, use your @umich.edu account, and access should happen automatically.

what is the role of review of literature in research


MindMeister  is an online mind mapping tool that allows users to visually organize their thoughts, ideas, and information in a structured and hierarchical format. It provides a digital canvas where users can create and manipulate nodes representing concepts or topics, and connect them with lines to show relationships and associations.

Features : collaborative, permits multiple co-authors, and multiple export formats. The free version allows up to 3 mind maps.

Explore  MindMeister templates here .

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  • Last Updated: Feb 15, 2024 1:47 PM
  • URL: https://guides.lib.umich.edu/litreview

Academic Entrepreneurship Ecosystems: Systematic Literature Review and Future Research Directions

  • Open access
  • Published: 16 February 2024

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  • Maria Patrocínia Correia 1 , 2 ,
  • Carla Susana Marques   ORCID: orcid.org/0000-0003-1557-1319 2 ,
  • Rui Silva 2 &
  • Veland Ramadani 3  

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Research on the entrepreneurship ecosystem, based on different data and scales, limits the acceptance of a single definition. This conceptual limitation and the still recent research and higher education institutions have come to be seen as ecosystems associated with entrepreneurship. The aim of this study is to contribute to the field of knowledge, identify current and emerging thematic areas and trends and reveal the scientific roots of research on entrepreneurial ecosystems and their relationship with higher education institutions. A bibliometric analysis was developed to analyse a final sample of 110 articles published between 2011 and 2022. In order to develop the analysis, Bibliometrix R-Tool was used and the metadata of two databases (Web of Science and Scopus) was retrieved and merged. The software creates a reference co-citation’s map, which allowed emphasize the state of the art and indicate three thematic clusters: (i) the importance of the higher education context for the entrepreneurial ecosystem, (ii) the evolution and challenges of entrepreneurship education and (iii) academic entrepreneurship ecosystems. The paper concludes by suggesting future research focused on the importance of building an integrated approach to entrepreneurial ecosystems and higher education institutions on a context regional scale.

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Avoid common mistakes on your manuscript.


The new research on the “entrepreneurship ecosystem” (EE) limits the acceptance of a single definition. According to this conceptual limitation and the still recent research, higher education institutions (HEIs) have come to be seen as ecosystems associated with entrepreneurship. While several bibliometric and systematic literature reviews have advanced for a research agenda for academic entrepreneurial ecosystems (AEEs), a holistic approach that integrates theories, attributes and methods is still necessary.

The concept of EE in HEIs has emerged in the literature (Fetters et al., 2010 ). Consequently, initial studies have addressed the components of these ecosystems (Fetters et al., 2010 ; Graham, 2014 ; Meyer et al., 2020 ), and internal and external actors have been identified (e.g. Hayter, 2016 ; Hayter et al., 2018 ; Meyer et al., 2020 ). Hayter ( 2016 ) and Hayter et al. ( 2018 ) further elaborated on the research by relating the effectiveness of academic EEs to the levels of the interconnectedness of the constituent elements and their collective capacity.

Higher education institutions (HEIs) and their surroundings play a “fundamental role for contemporary societies in the field of education and knowledge generation” (Kobylinska & Lavios, 2020 : 118). For the authors, during the last decade, the university and its surroundings have become a special ecosystem. Specifically, favourable conditions are created for cooperation between various entities, namely, HEI, business incubators, technology transfer centres and funding institutions, which contribute to developing academic entrepreneurship ecosystem (AEE) (Meyer et al., 2020 ; Kobylinska & Lavios, 2020 ). The combination of EE and HEI requires further research.

The systematic literature review (SLR) developed in this article found five studies that allow us to assess what is known about this subject. Malecki ( 2018 ) reviews the literature, concepts and operationalizations of the concept of EE with a bibliometric analysis. Kansheba and Wald ( 2020 ) present a systematic review of the existing literature, develop a research agenda and analysing, only, articles that focused on EEs (conceptual, theoretical or empirical). They concluded that the concept of EEs is poorly theorised and dominated by conceptual studies, revealing existing theoretical and empirical gaps on EEs. In the third SLR found, Kobylinska and Lavios ( 2020 ) aimed to analyse the state of research on University EE and to identify research trends related to the topic. They concluded that the study of University EE is little recognized in the literature, lacking a solid methodological basis and revealed that the topic may constitute a research area of interest. In the fourth review, Guindalini et al. ( 2021 ) present an SLR with bibliometric and network analysis, with the aim of mapping AEE. In this SLR, as in the two previously mentioned, the authors conclude that this topic is at an “embryonic stage of academic research” (Guindalini et al., 2021 : 6). They also find a gap in research regarding evaluation studies that support the targeting of potential scientific discoveries in the market. With bibliometric and SLR, the study develops a holistic framework that integrates sustainability factors into the EE literature. They confirm that EE research has mostly focused on academic entrepreneurship, innovation and regional development, among others.

The originality of this research is directly linked to the chosen emerging theme. In this context, this study aims to complement and stand out from the five reviews found and understand the characteristics of an AEE and their successful development as a potential research area relevant in the future. To this end, a bibliometric analysis is proposed to answer the following research questions: (a) RQ1: Is it possible establish common attributes for AEE?; (b) RQ2: What are the opportunities and challenges that HEIs must recognize to achieve an successful EE?; (c) RQ3: What key areas require further research with regards to AEE?

In order to complement the proposed research questions, this study also responds to the subsequent objectives: to provide a comprehensive overview of the origins of the EE concept, to explore the research conducted so far in this field of study, to reveal the scientific roots of research on EEs and their relationship with the HEIs and to create knowledge for future research on AEEs.

To achieve them, the SLR followed in this article included a rigorous protocol and definition of research steps and a literature review based on scientific articles published in Web of Science (WoS) and Scopus. In addition, the 110 articles related to EEs were submitted to a bibliometric analysis with the Bibliometrix-R tool . In this quantitative bibliometric, we used the analysis of co-citations, which allowed obtaining a citation network composed of clusters.

The article is structured in seven parts. After this introductory section, the theoretical framework on the concept is presented in the second section of the paper and is organized as follows: entrepreneurial ecosystems and academic entrepreneurial ecosystems. In the third section, the methodological characteristics of the research used in the SLR, the sample and the bibliometric analysis method are presented. The results are explained in the fourth section. The thematic analysis exposing the resulting visual maps and discussing the results of the articles classified by clusters is the fifth section. In the sixth and final section, the future lines of research and conclusions are addressed presenting limitations that resulted from the review and future of research.

Theoretical Framework

Defining entrepreneurial ecosystems and academic entrepreneurship ecosystem.

The concept of entrepreneurial ecosystem is an ambiguous term, but, in fact, this concept has been increasingly explored by researchers over the years (Bischoff et al., 2018 ; Clarysse et al., 2014 ; Cohen, 2006 ; Isenberg, 2010 , 2011 ; Kansheba & Wald, 2020 ; Stam & Spigel, 2017 ; Van de Ven, 1993 ). The term entrepreneurial ecosystem (EE) is a composite of two terms.

The component of the term—entrepreneur—according to Mason and Brown ( 2014 ) is often associated with “high growth start-ups” or “economies of scale” as being a source of innovation and growth in productivity and employment. The other component of the term—ecosystem—is associated with biology and is defined as the physical environment and all possible interactions in the complex of living and non-living components (Stam, 2015 ). As in ecology, the biological perspective focuses on the rise and fall of many organizations and institutions that are mutually related and play different but complementary roles that enable their birth, growth and survival (Astley & Van de Ven, 1983 ; Freeman & Audia, 2006 ).

Cohen ( 2006 ) was the first to use the concept of EE building on the study of Neck et al. ( 2004 ). Neck et al. ( 2004 ) used qualitative analysis to identify the components present in the EE in Boulder, USA. This concept became more prominent through Daniel Isenberg, in 2010. For this author, an EE is a set of individual elements combined in a complex way. In isolation, each can generate entrepreneurship but cannot sustain it (Isenberg, 2010 , 2011 ). Mason and Brown ( 2014 : 5) more broadly defined an EE as a “set of interrelated entrepreneurial actors, entrepreneurial organizations, institutions and entrepreneurial processes that formally or informally cooperate in relating and mediate performance within the local entrepreneurial environment.” Audretsh and Belitski ( 2017 : 1031) define EE as “institutional and organisational systems as well as other systemic factors that interact and influence the identification and commercialisation of entrepreneurial opportunities.” Acs et al. ( 2014 ) defined entrepreneurial ecosystems as a dynamic, institutionally embedded interaction between entrepreneurial attitudes, capabilities and aspirations of individuals that drives the allocation of resources through the creation and operation of new projects. Stam and Spigel ( 2017 ) point out that it is the coordination that occurs between actors and interdependent factors that enables productive entrepreneurship in each territory.

As this term has captured the attention of researchers, experts and policymakers significant knowledge gaps have also emerged in terms of its conceptual meaning, theoretical foundation and application (Audretsh et al., 2019 ; Kansheba & Wald, 2020 ). According to Audretsh et al. ( 2019 ), the question remains as to what exactly an EE is and what it comprises. It also mentions that the definition of EE does not add value to academic discourses that rely on “networks”, “cluster initiatives”, “triple helix initiatives” or “public–private partnerships”. For the authors, thinking in terms of EEs may only reflect the importance of a particular topic, such as “business ecosystems”, “digital ecosystems”, “financial ecosystems” and “university ecosystems”, among others.

Combining EEs and HEIs: An Overview of Academic Entrepreneurship Ecosystems

In recent decades, some universities have oriented themselves towards a more entrepreneurial direction through the realization of the third mission as a key player in promoting national and regional economic and social development (Etzkowitz & Leydesdorff, 2000 ; Yi & Uyarra, 2018 ) resulting from the interaction of three actors belonging to different helixes—university-industry-government: triple helix model (Etzkowitz & Leydesdorff, 2000 ). Etzkowitz and Zhou ( 2017 ) point out that the thesis of the model is that the university starts to abandon a social, yet important, role of providing higher education and research and starts to assume an essential role equivalent to that of industry and government as a generator of new industries and enterprises. As a result, the entrepreneurial university has become an increasingly significant academic configuration and is considered a vital element (Etzkowitz & Zhou, 2017 ; Wang et al., 2021 ). Pita et al. ( 2021 ) agree, pointing out that universities actively contribute to the development of EEs by providing a skilled workforce and stimulating new enterprises, such as start-ups or spin-offs.

In the entrepreneurial university, knowledge-sharing processes are outlined, which requires the university to reconfigure its traditional educational programmes and approaches to create a favourable context for university entrepreneurship by supporting students in a process that moves from idea generation to idea development, business model and commercialisation (Secundo et al., 2021 ). Another challenge facing HEIs is to shift their focus from education about entrepreneurship to educating for entrepreneurship. This encompasses any programme or pedagogical process of education aimed at achieving entrepreneurial skills and attitudes (Bischoff et al., 2018 ).

Against entrepreneurial HEIs and their pedagogical competencies of entrepreneurship education, researchers highlight that the entrepreneurial university itself can form an EE (Miller & Acs, 2017 ; Wang et al., 2021 ). The EE developed with an academic campus as a context is referred to as “University-based Entrepreneurship Ecosystem” (UBEE) or “University Entrepreneurship Ecosystem” (UEE) or “Academic Entrepreneurship Ecosystem” (AEE). All these terms refer to the ecosystem developed on the university campus, which are part of a wider ecosystem. For Wang et al., ( 2021 : 2), the creation of UEEs, currently, is a “hot topic.”

Naturally, many definitions were put forward, leading to the decision to present, chronologically, a selection of definitions (Table  1 ).

An effective AEE is critical for entrepreneurial academic activities as they not only act as a catalyst for the acceleration of knowledge commercialisation but also as a platform and dynamic in maintaining the sustainable development of academic entrepreneurship (Yi & Uyarra, 2018 ). However, little literature exists on the AEE’s structure and function and particularly how the transition from the academic entrepreneurial system to an AEE occurs (Hayter, 2016 ; Yi & Uyarra, 2018 ).

Similarly, to research on EE, academics attach greater importance to the conceptualisation and elements of the UEE. Several authors identify the factors contributing to the evolution of EEUs (Fetters et al., 2010 ; Graham, 2014 ; Meyer et al., 2020 ). Fetters et al. ( 2010 ) cite seven factors contributing to the evolution of UBEEs: senior leadership, strong teaching and programmatic capacity, long-term commitment, the commitment of financial resources, the commitment to continuous innovation in programmes and curricula, adequate organizational infrastructure and the commitment to increasing critical mass and creating enterprises. Graham ( 2014 ) also identifies seven factors that underpin UEEs: institutions, culture, university leadership, university research capacity, regional or governmental support, effective institutional strategies and strong demand for entrepreneurial students.

Brush ( 2014 ) believed that entrepreneurship education is the core of the UEE. The researcher divided the internal entrepreneurial education ecosystem into three broad areas (introductory/curricular courses, extracurricular activities and research) and four dimensions (stakeholders, resources, infrastructure and culture). Sherwood ( 2018 ), in addition to the elements, identified curricular, extra-curricular components, Technology Transfer Offices (TTO), resources and informal and community engagement. For Wang et al. ( 2021 ), diversified extracurricular activities have played an important role in stimulating students’ interest in entrepreneurship by providing them with a large number of resources. For the authors, student entrepreneurs also tend to get the guidance and resources they need through these activities.

For Bischoff et al. ( 2018 ), although the concrete strengths and conceptualization of UBEEs generally vary between universities, a number of common characteristics can be identified. Secundo et al. ( 2021 ) mention that UBEE facilitates innovation and entrepreneurial opportunities thanks to the knowledge-sharing processes between the various actors. Within a UBEE, for the author, each actor needs to be connected to the other members through a constant flow of knowledge from information that enables the overflow of entrepreneurial knowledge. The author points out that universities may assume different roles according to the size and composition of the entrepreneurial ecosystem, interacting through different channels.

In accordance with the review carried out, the other authors initiate the development of methods to evaluate an AEE. Table 2 shows three of the conceptual models highlighted in the literature review and published chronologically in the last 5 years.

Within this context, further research work on evaluations of AEE is needed. The findings draw attention to considerations as “unique entrepreneurial architecture” (Prokop & Thompson, 2022 : 17). The Prokop and Thompson ( 2022 : 181) study include 81 UEE and, according to the author, “it is in no way reflective of all types of sub-ecosystems, or broader ecosystems.” The study of university and broader EEs is a critical feature to recognize and involve in future studies. This study aims to contribute to this challenge.


To produce a comprehensive review article, Hulland ( 2020 ) refers that authors should carry out their studies in a systematic way. A systematic review needs the definition of clear questions, criteria and conclusions that provide new information based on the examined content. According to Aria and Cuccurullo ( 2017 ), this means that the phases adopted in the review can be replicated in all procedures and there should be clarity in all of them. The authors state that the working model of an SLR is based on five stages: study design, data collection, data analysis, data visualization and interpretation.

Ferreira et al. ( 2019 ) mention that one of the most suitable methods for analysing past research works is bibliometric analysis. According to Aria and Cuccurullo ( 2017 ) and Thelwall ( 2008 ), there are relevant points when using bibliometric. For Aria and Cuccurullo ( 2017 ), there are three types of research questions that can be answered using bibliometrics: identify the knowledge base of a topic or field of research, examine the conceptual structure of a topic or field of research and produce a network structure based on a particular scientific community. The relevance for Thelwall ( 2008 ) concerns the types of procedures in bibliometric analysis. The author identified two types of procedures, evaluation bibliometric and relational bibliometric. The first evaluates the productivity and impact of researchers, research centres and countries. The second type examines the similarity and relationship between publications, authors and keywords using co-word, co-authorship and co-citation analyses.

The article will use the suggestions of both authors in bibliometric analysis. It will respond to the three types of questions posed by Aria and Cuccurullo ( 2017 ) and uses both types of procedures, evaluation bibliometric and relational bibliometric. In evaluation bibliometric, mappings, qualitative analyses and baseline indicators are carried out. In relational bibliometrics will analyse co-citations and the respective clusters.

Data Collection and Eligibility Criteria

In additional search, the research papers were determined through the comprehensive advanced search in two databases including Scopus and Web of Science. These choices were justified for two reasons: they are two multidisciplinary databases that include all indexed journals with the highest number of citations in their respective areas of scientific specialization (Huang et al., 2020 ; Pranckuté, 2021 ). They also provide a citation index, generating information about each publication in documents that cite them as well as cited.

Table 3 elucidates the stages that followed in this study.

The keywords come from the research question and was defined the following search query: “entrepreneur* ecosystem*” (in title) AND “universit*” OR “polytechnic*” OR “higher education institution*” (in topic). All the articles from the current year were excluded because at the time of this research the year had not finished. The document type was limited to “article” and “review.” After applying these criteria, it was obtained 183 papers from the research process (104 obtained in SCOPUS and 79 results in Web of Science) (stages 1 and 2 from Table  3 and Fig.  1 ).

figure 1

Process of data collection and analysis

In the third stage, wherein some records were excluded, the data was filtered. To this end, other restrictions were applied:

Eliminating the repeats by cross-referencing the databases (62 documents)

The exclusion of 11 documents, after analysing the content of each, because the global subject of the articles was different from the scope of the study

Although language was not a filter, it should be noted that the search was developed utilizing English, which could be understood as “quasi-filter.”

The procedures followed in the data collection and the application of the eligibility criteria complete Fig.  1 which demonstrates the careful way in which the final database was obtained ( n  = 110).

Mapping and Qualitative Analysis

R-Bibliometrix summarized the mapping of the documents included in the final database with the information considered relevant, as shown in Table  4 . Table 4 reveals that the dataset contains 110 documents published between 2011 and 2022, representing the work of 276 authors from 32 different countries. The average years from publication is 3.31 and the average number of citations per documents 13.4. The number of authors and co-authors per document is 2.5 and 2.7.

The first study in the final database addressed the entrepreneurship ecosystems, and the global innovation networks were written by Malecki in 2011. For the author, the existing knowledge is dispersed as it results from entrepreneurial activity originating from small and medium enterprises, research institutes and universities. Malecki ( 2011 ) suggested the simultaneous integration of local and global knowledge as well as internal and external.

A reading of Tables  4 and  5 reveals that various articles have been published recently (during 2011–2022). Moreover, an increase of publications (except 2012 and 2013) shows an increasing trend, suggesting that the subject has been progressively gaining popularity in the academic community. The results reveal and confirm the increase prevalence of research on EEs over the past 11 years.

In 2022, the number reached 24 articles in the last year of the period. After 2014, there was a considerable increase in the number of published articles. The data shows a turning point in 2018 (14) and 2019 (23). This latter year and 2022 standing out with the highest number of published articles. It is important to mention that more than half of the articles (62) were published in the last 3 years. The production growth rate is 33.5%.

According to the average number of citations, per year, the articles written in 2022 were those with a higher number (9.79) followed by articles from the years 2011, 2018 and 2019. This increment in the interest of EE results from the fact that this concept has assumed a global and multidisciplinary dimension recognized and associated with innovation by the various economic and social actors.

Table 6 presents the five authors and journals that have contributed for research’s development. The most cited papers by author were those of Malecki, with 185, followed by Audretsh, with 111, and Carayannis, with 110. The three authors who have published the most with the highest local impact (TC index) are Cunningham (4 publications, TC 156), Audretsh (3 publications, TC 184) and Menter (3 publications, TC 154).

R-Bibliometrix software was used to identify the keywords mentioned in the 110 documents of the final sample. As can be seen in the Fig.  2 , the most frequently terms mentioned are “entrepreneurial ecosystem”, “entrepreneurial university”, “entrepreneurial education”, “university”, innovation” and “higher education”. This also shows that of the studies analysed word association results as “academic entrepreneurship”.

figure 2

Most mentioned keywords

Table 7 summarizes the applied methodologies. As an emerging theoretical stream, EEs have been studied through qualitative methods. Thus, several articles use a case study technique. There is an increase on quantitative methods using factor analysis and structural equation modelling to understand variations in entrepreneurship and develop metrics. Researchers have used mixed methods, both qualitative and quantitative data collection techniques to address the complexity of the phenomenon.

Concerning methodologies, of a total 110 articles, 59 documents (54%) use a qualitative approach, through the technique of data collection via interviews (in-depth and semi-structured), samples, observation and documentary analysis. The case study technique, inserted in this approach, focuses on 25 articles, meaning that its weighting is 42% in relation to the total number of articles that use qualitative methodologies. The 28 articles (around 25%) use a quantitative approach through data collection techniques involving the application of questionnaires and secondary data (statistics) and eight articles (7%) use mixed methods, namely, they use both qualitative and quantitative data collection techniques. Eight conceptual articles (7%) and seven literature review articles (6%) were identified. Of this literature review, five are based on systematic literature reviews. From the numbers, we deduce that there is no balance of methods in EE and HEI studies and literature reviews are the least frequent type of publication.

Thematic Analysis

In this part of the article, the thematic analysis results will be examined. It will start with the strategic and evolutionary analysis and, subsequently, the networks created by the co-citation analysis. The subsequent figures will be presented all results.

Strategic and Evolutionary Thematic Analysis

The strategic diagram for the studied subject is presented in Fig.  3 . The size of the circles represents the number of occurrences of these words. The upper right quadrant represents the main themes, and the upper left quadrant depicts the more specific themes, considered niche themes. The lower right quadrant represents the basic themes, and the lower left means that the theme may be emerging or disappearing.

figure 3

Strategic diagram

The themes in the upper right quadrant are “academic entrepreneurship” and “entrepreneurial”. All these sets of themes are crucial to the research in this paper.

The theme in the upper left quadrant is “start-ups”, “case study” and “networks.

The lower right quadrant represents the basic themes necessary for understanding the present study: “entrepreneurial ecosystem”, “entrepreneurial education”, “entrepreneurial university”. Also “university” and “technology transfer” are essential for the understanding on the topic. The lower left quadrant given the inexistence of declining themes but also gives the emerging themes, “entrepreneurial education” and “entrepreneur”. All this fact enhances the importance of the sets of themes in the article.

Thus, “networks”, “case study” and “academic entrepreneurship” reveal themselves as major themes. The transversal themes are “entrepreneurial ecosystems” and “university incubators”. This last phase, 2022, was the growth stage of an approach integrating Entrepreneurial Ecosystems and the Entrepreneurial University. Therefore, 2023 could be a high growth phase for an integrated approach to AEEs.

Figure  4 presents the evolution of research topics in entrepreneurial ecosystems and the relationship with the university. The data were analysed using the author’s keywords and cut-off points in the years 2014, 2018 and 2020. The results reveal a thematic evolution of the conceptual frameworks from 2011 to 2022. From the general concept of “Entrepreneurial Ecosystem” (2011–2014), “innovation” emerges in the thematic evolution (2015–2017). Therefore, the cut-off points were two periods when the first publications on the topic of the paper appeared (three publications in 2011–2014 and nine publications in 2015–2017).

figure 4

Thematic evolution, with cut-off points

In 2018, results of the emergence of thematic areas such as “education” and “higher education” are revealed. From 2019, “entrepreneurial ecosystem” gives way to “entrepreneurial education”, “entrepreneurial university” and its “ecosystem”. Likewise, the area of “innovation” gives way to a unique “entrepreneurial ecosystem” based on “entrepreneurial education”, “university”, “higher education” and “academic entrepreneurship”. The thematic evolution of the conceptual framework between 2018 and 2022 revealed that these periods are the most productive and creative with the highest number of base themes and driving themes evolving in these periods.

Cluster Analysis

A bibliometric analysis was carried out to understand how this field of study is divided into research clusters, and the co-citations were analysed. No cut-off point for the number of citations per document has been defined. All linked documents were selected, leaving us with a final analysis with 50 documents distributed by clusters. Each of the clusters, identified with different colours, can be observed in Fig.  5 . The colours indicate the clusters and the articles belonging to them. In addition, each article’s weight is assigned based on the links’ total strength, and the number of citations the publication has received. The top nodes are the publications with the highest link strength.

figure 5

Clusters networks through the co-citation analysis technique

Based on the visualization of Fig.  5 and after analysing the resulting network and the content of the articles, it is concluded that the research is divided into three thematic clusters (Table  8 ).

Cluster 1 (Blue)—Conceptualization and Attributes of Entrepreneurship Ecosystems

The first cluster is focused on the definition and attributes present in EEs. No consensus has been reached in the academic community on the theoretical characterization of the concept and the elements that characterize it.

While there is none accepted definition of an EE, as Spigel ( 2018 ) points out, the most active area of interest has been around the types of domains (Isenberg, 2010 , 2011 ), components (Cohen, 2006 ) or attributes (Spigel, 2017 ).

Diverse literature provides tools that show several factors considered important for a successful EE. Cohen ( 2006 ) refers to formal and informal networks, government, university, skilled human resources, support services, funding and talent. The works of Isenberg ( 2010 , 2011 ) list six domains present in the ecosystem: policy, funding, culture, support, human capital and markets.

Spigel ( 2017 ) efforts to rank the categories of an EE in terms of (i) cultural attributes (entrepreneurship stories, supportive culture), (ii) social attributes (talent, mentors, networks, investment capital) and (iii) material attributes (infrastructure, universities, support services, public policies, open markets). Spigel and Harrison ( 2018 ) give attention to several factors such as governance, knowledge, industry, actors, resources and benefits.

Table 9 summarizes the attributes by applying them to the EEs.

Although the topic on the attributes of EEs is innovative, it has not been without trials. Several articles highlight criticisms of previous work (Alvedalen & Boschma, 2017 ; Brown & Mason, 2017 ; Malecki, 2018 ; Nicotra et al., 2018 ; Stam & Spigel, 2017 ). Alvedalen and Boschma ( 2017 ), Nicotra et al. ( 2018 ) and Stam and Spigel ( 2017 ) highlighted the lack of a clear analytical framework to empirically explain the cause-effect relationship of EEs’ attributes and their effects on productive entrepreneurship. The static approach of EE studies was another criticism highlighted as its evolution over time was not considered. Finally, Malecki ( 2018 ) noted the lack of an issue related to spatial scale.

Cluster 2 (Red)—Spatial Context and Knowledge Ecosystems

Beyond definitional debates, the lead author of this cluster, Stam ( 2015 ), expresses himself critically concerning studies of EEs. He underlines that it is not only generating entrepreneurship that makes it a good EE. He also mentions that the approaches only offer a long list of elements without a cause-effect relationship and concludes that it is unclear what level of geographical analysis the approaches have taken into consideration. The author refers that a new emerging approach to EE occurs, conveying a new view on people, networks and institutions. From this emerging approach, differentiations have emerged at two levels: spatial context and dynamics of knowledge ecosystems.

The first sub-division of this cluster refers to the importance of context in EEs (Acs et al., 2014 ; Cohen, 2006 ; Spigel, 2017 ; Stam, 2015 ). For Stam ( 2015 ), the common denominator in this sub-cluster seems to be that entrepreneurs create value in a specific institutional context. The author approach emphasizes the interdependencies within the context and provides a bottom-up analysis of the performance of regional economies. Stam ( 2015 ) argues that EEs open the door to a shared responsibility among actors that foster, encourage and support entrepreneurs, asking about the systemic services that a region tries to achieve.

The second sub-cluster analyses the dynamics of knowledge ecosystems, namely, the role of HEIs for value creation in a given context. Kuratko ( 2005 ), in his study, notes that younger people have become the most entrepreneurial generation since the Industrial Revolution. The growth and development in programmes and curricula dedicated to entrepreneurship and the creation of new projects have been remarkable. The number of colleges and universities offering entrepreneurship-related courses has increased. However, among this enormous expansion, for Kuratko ( 2005 ) there remains the challenge of the academic legitimacy of entrepreneurship. Although there has been this significant growth, the author points out two specific challenges to academia: (i) development of academic programmes and specialized human resources to improve the quality of courses and (ii) commitment by institutions to create formal academic programmes.

Clarysse et al. ( 2014 ) analysed the tension between knowledge and business ecosystems. In relation to the success factors, they seem similar: diversity of organizations and key actors. However, regarding the factors, anchor organizations in knowledge are universities and public research organizations that do not directly compete with the ecosystem. In contrast, key actors in EEs are based on companies that are competitors in the ecosystem. Another difference lies in value creation. In knowledge ecosystems, to Clarysse et al. ( 2014 ), the value creation flows from upstream to downstream, while in EEs, the value creation process is non-linear . The author’s note that some studies already include universities as part of the knowledge system but that further research could focus on analysing the circumstances under which a university could be considered an ecosystem and how the interaction between knowledge and business ecosystems would occur. Miller and Acs ( 2017 ) explore the EE of higher education by choosing a university campus because the “entrepreneurial opportunities had been identified and/or the process of firm-formation had begun by multiple founders…” (p. 82).

Cluster 3 (Green)—Inter-institutional Relationships in University’s Ecosystem

This third cluster leads us to the wider set of relationships in the university’s ecosystem, strategies and their specificities of regional/local factors. Audretsch et al. ( 2019 ) refers that EE is a vehicle for carrying entrepreneurs, policymakers and managers of linked companies and all their relationships organizing the EE. For the author, an EE is defined by frontiers, and the necessary resources are produced and absorbed within and beyond those boundaries.

Audretsch and Belitski ( 2017 ) set out to develop a model that captured both regional and local systemic factors to better understand and explain variations in entrepreneurial activity. In their study, they found four domains under EEs in European cities: norms and culture, infrastructure and equipment, formal institutions and Internet access and connections. To Audretsch and Link ( 2017 : 431), conceptually a university represents a “reservoir of knowledge, knowledge embodied in faculty…”. Universities are one part of the complexity of the research. They have evolved towards taking an active role in regional development and the dynamics of local networks. This evolution in the model involves inter-institutional relationships between the three actors, leading to an increasing overlap of their roles. The work of Schaeffer and Matt ( 2016 ) showed that universities cannot replicate the mechanisms that lead to the success of an EE but rather adapt their strategies to the specificities of each regional context.

Can academia encompass a third mission, beyond research and teaching? This question was formulated by Etzkowitz and Leydesdorff ( 2000 : 110). Three spaces emerge from the triple helix model: the consensus space, a knowledge space (R&D activities) and innovation space.

Schaeffer and Matt ( 2016 ) state these are coordinated and managed by a regional innovation officer. The authors refer that this responsibility can be assigned to the university to contribute to developing the regional networks. They analysed the university of Strasbourg’s Technology Transfer Offices (TTO) and supported entrepreneurial academic activities over 15 years. The study reveals a strong growth in the structure of the TTO and its role as a boundary, changing objectives and developing collaborations with other regional actors. As pointed by Fini et al. ( 2011 ) and Vohora et al. ( 2004 ), since university faculty have limited entrepreneurial experience, networks with outside contacts are crucial to motivate the creation of entrepreneurial activities as well as their success.

In addition to TTOs, entrepreneurship education, either as part of the academic programme or as an extra-curricular offering, can provide students and faculty with important knowledge to stimulate and support entrepreneurial efforts (relationship to Cluster 2). While most of the study streams have focused on the role of faculty as academic entrepreneurs, Boh et al. ( 2016 ) focused on the role of students. The typology created by the authors provides insight into the various responsibilities of students and faculty in technology commercialisation. It is the different relationships between students, faculty and entrepreneurs and the analysis of the strengths and weaknesses of each that can lead to the creation of a successful spinoff. The authors, Boh et al. ( 2016 ), group into six the university practices, independent of the TTOs: project disciplines for technology commercialisation, mentoring programmes, incubator programmes, entrepreneurial business plans and entrepreneurial education for students and university professionals.

Other authors analyse the relation between social networks and academic entrepreneurship (Clarysse et al., 2011 ; Fini et al., 2011 ; Vohora et al., 2004 ), Spinoffs (Lockett & Wright, 2005 ; Fini et al, 2011 , 2017 ; Vohora et al., 2004 ; Clarysse et al., 2011 ; Hayter, 2016 ) and the entrepreneurial environment and academic programmes supporting entrepreneurship (Fini et al., 2011 ). As pointed by Fini et al. ( 2011 ) and Vohora et al. ( 2004 ), since university faculty have limited entrepreneurial experience, networks with outside contacts are crucial to motivate the creation of entrepreneurial activities as well as their success. Vohora et al. ( 2004 ) argues that networks are pathways through which access to opportunities will be achieved, for example, gaining knowledge of the market that motivates the creation of the spinoff. Hayter ( 2016 ) uses Vohora et al. ( 2004 ) qualitative model of entrepreneurial development and that includes four stages of development: opportunity recognition, commitment, credibility and sustainability, as well as the resources and network elements associated with each stage. Entrepreneurial development and its success are reflected in the progression of the university spinoff , overcoming the obstacles of each stage, with the aim of achieving entrepreneurial sustainability.

Hayter ( 2016 ), using mixed methods, compares the composition and contribution of social networks among entrepreneurial academics and analyses how these networks relate to the development trajectory of university spinoffs . The traditional definition of spinoff , according to Hayter et al. ( 2017 ) focuses on the role of faculty establishing a company based on a technology licensing agreement, with their home university. University spinoffs , for Hayter ( 2016 ), are an important vehicle for generating productivity, job creation and prosperity for regional economies. The author also mentions that spinoffs are a window through which the contributions of universities can be examined. He compares the composition and contribution of social networks among entrepreneurial academics and analyses how these networks relate to the development trajectory of university spinoffs.

Cluster Relations

The three clusters are related. The cluster 2 indicates the importance of higher education for EE and cluster 3 leads us to the triple helix model with the focus on university entrepreneurial experience. Cluster 1 introduces definitions and attributes necessaries to understand the EE and their relationship with or within the HEIs. This cluster creates a theoretical background with relevant publications in entrepreneurship research.

Clusters 2 and 3 have a robust relation. Notably, the position of Stam ( 2015 ) and Spigel ( 2017 ) influences 2 clusters, indicating higher link strength and confirming its centrality in the EE literature. Various articles from cluster 2 criticize the analytical framework that produces long lists of factors that enhance entrepreneurship. Their perspective enables researchers to measure an EE within a country or territory by considering their specificities. This understanding highlights the configuration, structure and evolution of ecosystems influenced by ecosystem process and territorial boundaries.

In cluster 3 it is evident that the challenge of the third mission that academia encompass emphasizes entrepreneurship and the corresponding emergence of the entrepreneurial university. The relationships between students, faculty and entrepreneurs and the analysis of the strengths and weaknesses of each can lead to the creation of a successful spinoff.

To understand the substance of AEE and how the broad research was advanced, the group of these three clusters creates a fundamental and theoretical base to: the terminology of EE, the higher education context and the emergence of an AEE (Fig.  6 ).

figure 6

Academic entrepreneurship ecosystem model

Contributions and Future Research Directions

The scientific literature about entrepreneurial ecosystems has been growing, and within it, one area that has been gaining impulse has been the academic ecosystem. This paper contributes by attempting to consolidate the most important of this growing literature and to try to confirm it.

This study brings important theoretical contributions to the existing literature. Firstly, this study led to a survey and mapping of the main investigations on EE and their relationship with the HEI. Secondly, this study strengthens the credibility of the AEE theoretical frameworks in lending support to the importance of analysing the specific contributions of HEIs to the development of an EE. Thirdly, the developed co-citation analysis allowed obtaining an understanding about the existing field of knowledge on EEs and AEE, identifying their scientific origins and revealing research roots.

Most contributions are conceptual providing an understanding of the different elements that form conducive AEE. Therefore, as a fourth contribution, this study emphasizes the need for more empirical research, especially regarding potential causal relations between elements, context factors, outputs and outcomes of entrepreneurial ecosystems. The few empirical studies on entrepreneurial ecosystems have majorly applied case studies including qualitative methods (Kansheba & Wald, 2020 ; Malecki, 2018 ; Nicotra et al., 2018 ). There is a need of deploying other methodological approaches for more rigor and generalizability purposes.

The above leads us to propose as possible future research directions. As mentioned, most research studies on EEs and AEEs have adopted the qualitative methodological approach (particularly case studies), which is understandable since the research topic is emergent. However, considering the systematic research conducted here, it is believed that this topic would benefit from implementing mixed methodologies (as has already been carried out by some of the authors included here). Thus, with the adoption of qualitative and quantitative methodologies, it will be attempted, in a future line of research, to build an assessment tool for an AEE.

The composition of clusters groups generated research points. Studying an AEE based on a regional scale will imply, firstly, building a theoretical framework, based on multiple dimensions, which allows the development of the EE model. HEIs are a complex process which involves an extensive research approach to accurately represent the levels and components of the entire entrepreneurial ecosystem (cluster 1). It will be necessary to study whether the HEI develops strategies adapted to the specificities of its EE. Likewise, to explore the pillars of the model from the point of view of young university students who show varying degrees of entrepreneurial intention (cluster 2). Several studies have found that entrepreneurship education has a positive impact on students’ entrepreneurial intention (Peterman & Kennedy, 2003 ; Souitaris et al., 2007 ; Pruett et al., 2009 ; Engle et al., 2010 ; Lanero et al., 2011 ; Sanchez, 2013 ; Bae et al., 2014 ; Sansone et al., 2021 ). Vanevenhoven ( 2013 ) and Fiore et al. ( 2019 ) have warned of the need for more research into the impact of entrepreneurship education on students in different contexts. Although there has been a growing number of publications on the role of intentions in the entrepreneurial process (Liñán & Fayolle, 2015 ; Ferreira-Neto et al, 2023 ), there is still a gap in research on how to improve the presence of higher education students in entrepreneurial activities so that they can face the problems of the labour market. A broader study could be undertaken, from a mixed approach, to establish mechanisms to collect appropriate data and to establish the different levels of success of EE outcomes, by the HEI (cluster 3).

Finally, the relevance of knowledge of skilled people has brought to the policy agenda of governments worldwide the need to modernize science and higher education systems and institutions (Santos et al., 2016 ; Scott, 2000 ). Portugal is characterized as a developed country but with a poorly qualified workforce in European average terms, facing structural barriers to economic growth (Carneiro et al., 2014 ). It was also a country that has seen one of the fastest developments in its scientific system at the beginning of the twenty-first century (Heitor et al., 2014 ). The emergence of the COVID-19 pandemic has brought new challenges to the country: the establishment of telework and the intense decline in economic activity were some of the most evident cross-cutting changes, with direct consequences for the emergence of new forms and policies to support the employment (Sousa & Paiva, 2023 ).

All these reasons have been supporting the need to make a RSL focused on how young graduates capture new forms and conditions of the exercise of work. This knowledge is crucial to investigate wow the entrepreneurial skills or the academic entrepreneurship path is in the future.

Conclusions and Limitations

The quest to identify and define EEs has become an issue of great importance as countries, regions and cities handle with an entrepreneurial economy. The range of these topics is wide and ambiguous. Researchers and practitioners have assessed various contributions, most of which identify HEIs as important development institutions. Marques et al., ( 2021 : 133) highlight their importance, stating that HEIs “… are seen as organizations responsible for human resource training, knowledge transfer, and regional development”.

This work used data from the Scopus and WoS databases. Based on 110 academic articles obtained through a rigorous data collection process, the study went beyond describing elementary information, standing out in relation to the review studies found and filling a gap in the field of EEs taking into consideration higher education institutions. It also revealed the embryonic state of research (2011–2022) and reinforced the scientific importance of the topic since about 56% of the articles were published in the last 3 years. The results were published in a variety of indexed journals. However, this study shows the limitations in other literature reviews.

Despite considering that this study constitutes a work that will be the object of the development in the coming years, the study is not without limitations. The first limitation concerns to the search strategy. This study is based on the regular updating of databases with the consequent increase or decrease in the number of indexed journals, so a bibliometric analysis of an emerging topic can be subject to substantial variations in just a very few years. The other limitation of this study is that it used two different databases to analyse a particular topic. Despite being two of the most influential databases, the overview could be improved by including other databases. Another limitation is the subjectivity present in the scientific articles analysis. Although bibliometric methods help to reduce subjectivity, it is not possible to completely exclude some interpretative biases.

Data Availability

Available upon reasonable request from the corresponding author.

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Maria Patrocínia Correia, Carla Susana Marques & Rui Silva

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Correia, M.P., Marques, C.S., Silva, R. et al. Academic Entrepreneurship Ecosystems: Systematic Literature Review and Future Research Directions. J Knowl Econ (2024). https://doi.org/10.1007/s13132-024-01819-x

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The complexity of leadership in coproduction practices: a guiding framework based on a systematic literature review

  • Sofia Kjellström 1 , 2 ,
  • Sophie Sarre 2 &
  • Daniel Masterson 1  

BMC Health Services Research volume  24 , Article number:  219 ( 2024 ) Cite this article

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As coproduction in public services increases, understanding the role of leadership in this context is essential to the tasks of establishing relational partnerships and addressing power differentials among groups. The aims of this review are to explore models of coproduction leadership and the processes involved in leading coproduction as well as, based on that exploration, to develop a guiding framework for coproduction practices.

A systematic review that synthesizes the evidence reported by 73 papers related to coproduction of health and welfare.

Despite the fact that models of coleadership and collective leadership exhibit a better fit with the relational character of coproduction, the majority of the articles included in this review employed a leader-centric underlying theory. The practice of coproduction leadership is a complex activity pertaining to interactions among people, encompassing nine essential practices: initiating, power-sharing, training, supporting, establishing trust, communicating, networking, orchestration, and implementation.


This paper proposes a novel framework for coproduction leadership practices based on a systematic review of the literature and a set of reflective questions. This framework aims to help coproduction leaders and participants understand the complexity, diversity, and flexibility of coproduction leadership and to challenge and enhance their capacity to collaborate effectively.

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For more than 40 years, scholars and practitioners have sought to identify and understand various aspects of coproduction with the goal of improving services as well as equalizing (or at least reorganizing) power relations in service design and delivery [ 1 ]. More recently, such discussion has focused on the roles of leaders and leadership in coproduction, seeking to describe and assess the various types of leaders and leadership that might maximize the goals of coproduction processes and outcomes. Leaders can act to make coproduction, in all its forms, happen [ 2 , 3 ]. Leaders can enhance coproduction by providing resources, establishing inviting structures, and prioritizing the involvement of various stakeholders. Conversely, they can inhibit coproduction by perpetuating conservative administrative cultures, failing to provide training, or being reluctant to share power [ 3 ]. Coproduction relies on leadership at all levels, ranging from senior managers to local “champions” and including the citizens and third-sector organizations that participate in coproduction activities and practices.

This review presents a synthesis of research on the leadership of coproduction, which has been recognized for its scarcity [ 3 , 4 , 5 , 6 ]. The review provides new knowledge regarding the fact that coproduction leadership must become more deliberately (in)formed by collective leadership models. It also illustrates the multiplicity and complexity associated with coproduction leadership activities by outlining practices in which leaders must engage to ensure success. This review can inform a framework that offers guiding insights on which commissioners, evaluators, managers and leaders of coproduction can reflect as well as suggestions and directions for future research.

  • Coproduction

Coproduction is a broad concept that is associated with different meanings across a range of contexts [ 1 ]. Many definitions and uses of the term coproduction and codesign have been identified [ 7 ]. Throughout this paper, although we acknowledge the distinctions associated with the concepts and origins of the notion of codesign, we use the broad term coproduction to refer to some form of collaboration or partnership between service providers and service users or citizens. For this review, we follow the definitions provided by Osborne and Strokosch [ 8 ], who identified ‘ consumer coproduction’ as an inevitable component of value creation in interactions among service providers; ‘participatory coproduction’, in which context participation is deliberative and occurs at the strategic level of service design and planning; and ‘enhanced coproduction’, which represents a potential mechanism for transforming organizational processes and boundaries.

Power is inevitably central to coproduction. Schlappa and Ymani claimed that the coproduction process is “inherently negotiated, emergent and reliant on a range of actors who may have both common and contrasting motivations, and are able to exercise power, which in turn is moderated by the context in which these relations occur” [ 6 ]. This sensitivity to motivation, context and power is helpful for our understanding of leadership in coproduction.

Leadership models

Most conceptualizations of leadership have been based on the claim that leadership is a kind of inherent characteristic exhibited by human beings, such that leaders are depicted as heroes with unique traits, styles or behaviours [ 9 ]. However, research on leadership in coproduction is important in relation to an emerging body of research that focuses on the notion of “leadership in the plural” [ 10 ] or “collective leadership” [ 11 , 12 ]. These phrases act as umbrella terms that refer to overlapping concepts such as shared, collaborative, distributed, pooled and relational leadership. A core feature of these models is that leadership is not (only) viewed as a property of individuals and their behaviours but rather as a collective phenomenon that is distributed or shared among different people [ 10 ]. A distinction can be made between two types of collective leadership. Leadership can be shared in interpersonal relationships; for example, it can be pooled among duos or trios at the top of an organization, or shared leadership can be exercised within teams working on a project. This notion is based upon the assumption that people have different skills that complement each other. The second kind of collective leadership is a more radical version of this notion, according to which leadership emerges as a result of direction, alignment, and commitment within a group [ 11 ] or can be observed to reside within the system, for example, in the form of distributed leadership across interorganizational and intraorganizational boundaries and networks [ 10 , 12 ]. In cross-sectoral collaboration, leadership is distributed across time and space, which requires structures to guide how leadership is shared and organized. It has been argued that collective leadership is best suited to the analysis of coproduction practices [ 4 , 6 , 13 , 14 ].

It is important to note that distinctions have been made between management (planning, monitoring and controlling) and leadership (creating a vision, inspiring and changing) based on behaviours [ 15 ]. However, many authors have not made such a distinction, and the terms have frequently been used interchangeably. We therefore adopt the practice employed in the papers included in this review and use the terms leadership and leader as catch-all terms; we only use the words management or manager when the papers refer to job titles or ‘public management’.

Leadership models can be regarded as resembling a colour palette that offers a variety of choices, and similar to colours, some models fit a situation better than others. This paper investigates the use and fit of various leadership models for coproduction.

Leadership of coproduction research

Extant research on the leadership of coproduction has been described as “sparse” [ 4 ], a “neglected area” [ 5 ] and “overlooked” [ 3 , 6 ]. Despite a recent resurgence of interest in the potential of coproduction as a means of maintaining and improving the quality of health and social care, significant questions regarding how coproduction can and should be led in this context remain unanswered. Most reviews of coproduction have not addressed this issue [ 2 , 16 , 17 , 18 ]. Clarke et al.’s (2017) review identified the lack of managerial authority and leadership as a key barrier to the implementation of coproduced interventions but did not explore the implications of this finding for future practice. The review conducted by Bussu and Galanti (2018) stands alone in its focus on leadership, although the empirical cases explored by those authors were restricted to the context of local government in the UK. Recent empirical case studies that have explored leadership [ 13 , 14 , 15 , 19 ] have focused on public managers [ 3 , 5 , 14 ] or on identifying the consequences of different models of leadership. This review contributes to the literature by providing knowledge regarding how to make deliberate choices pertaining to coproduction leadership in terms of how it is conceptualized and shared and the activities that are necessary for leading coproduction.

Coproduction leadership practices

The leadership of coproduction poses a number of challenges. A proposed aim of coproduction is to drive change within services and in traditional state-citizen relationships by establishing equal and reciprocal relationships among professionals, the people using services, and their families and neighbours. This task requires a restructuring of health and welfare services to equalize power between providers and other stakeholders with an interest in the design and provision of these services. However, it has been suggested that coproduction runs the risk of reproducing existing inequalities in power rather than mitigating them since coproduction is inevitably saturated with unequal power relations that must be acknowledged but cannot be managed away [ 20 ].

In this paper, we present the findings of a systematic review of the literature on leadership in coproduction. The purpose of this review is to explore models of coproduction leadership and the practices involved in leading coproduction in the context of health and social care sectors [ 7 ]. The results are synthesized to develop a framework for actors who seek to commission, design, lead or evaluate coproduction processes. This framework emphasizes the need to make more deliberate choices regarding the underlying conceptualization of leadership and the ways in which such a conceptualization is related to the activities necessary for leading coproduction. Based on the framework, we also propose specific guiding questions for individuals involved in coproduction in practice and make suggestions for future research.

This systematic literature review is based on a study protocol on coproduction research in the context of health and social care sectors [ 21 ], and data were obtained from a published scoping review, where the full search strategy is provided [ 7 ]. The scoping review set out to identify ‘what is out there’ and to explore the definitions of the concepts of coproduction and codesign. In brief, the following search terms for the relevant concept (co-produc* OR coproduc* OR co-design* OR codesign*) and context (health OR social OR & “public service*” OR “public sector”) were used to query the following databases: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled Trials (Wiley), MEDLINE (EBSCOhost), PsycINFO (ProQuest), PubMed (legacy), and Scopus (Elsevier). This paper focused on leadership. All titles and abstracts included in the scoping review ( n  = 979) were obtained and searched for leadership concepts (leader* OR manage*) ( n  = 415). These materials were reviewed independently by SK and SS using the following inclusion criterion: conceptual, empirical and reflection papers that included references to the management and/or leadership of coproduction. Study protocols were excluded because we wanted to capture lessons drawn from implementation, and conference papers were excluded because they lacked sufficient detail. Articles focusing on the context of individual-level coproduction (i.e., cases in which an individual client or patient was the focus of coproduction) were excluded, as we were interested in the leadership processes involved in collective coproduction. Conflicts were resolved through discussion and further consideration of disputed papers. This process led to the inclusion of 73 articles (Fig.  1 – PRISMA flow chart).

figure 1

PRISMA flow chart

The method used for this research was a systematic review with qualitative synthesis. The strength of this approach lies in its ability to complement research evidence with user and practitioner considerations [ 22 ]. In the process of examining the full texts of the papers, two researchers (SK and SS) extracted background data independently. To promote coproduction, four stakeholders were strategically selected through the personal networks of one of the authors, SK. These stakeholders exhibited diverse expertise in the leadership of coproduction. One was a leadership developer and family member of an individual with 24/7 care needs. Another was a physician. The third worked in peer support and had personal experience with mental health services. The fourth was a health care leader. Four key articles were chosen due to the diversity of leadership ideas they exhibit and the depth of the explicit text on leadership they provided. During the analysis by stakeholders, no themes were changed or refined; instead, the analysis confirmed the relevance of the initially identified themes, thus emphasizing the robustness of our findings based on a process that involved reading four key articles and identifying the perceived key implications for our research aim.

A qualitative synthesis unites the findings of individual studies in a different arrangement, thereby constructing new knowledge that is not apparent from the individual studies in isolation [ 23 ]. This fact is particularly evident in this review, since leadership was seldom the main focus of the included articles. Accordingly, we employed multiple pieces of information to construct a pattern. The process of synthesis started at a very broad level with the goal of understanding which aspects of leadership were addressed in the literature. This process then separated into two strands. One such strand focused on interpreting the data from the perspective of current leadership models, while the other focused on interpreting leadership practices – i.e., the activities and relationships that are part of the process of leading coproduction. We searched for themes both within and across individual articles, and our goal was interpretative rather than purely aggregative. This process resulted in three themes pertaining to coproduction leadership models and nine coproduction leadership practices. We present these findings together in the form of a framework because consideration of both leadership models and practices prompts better and more conscious choices, which can improve the quality of coproduction. Persons one and two from the stakeholder group also provided feedback on a draft of this paper, and their insights were integrated into this research.

Sample description

We included 73 papers (Additional file 1 ) dating from 1994 to 2019 (the year in which the initial search was performed). Most of these papers were empirical ( n  = 54), and more than half of them were case studies ( n  = 30). Fifteen articles were conceptual papers, and four were literature reviews. The setting or focus of the papers was predominantly on services ( n  = 66), while the remainder of the papers were on research ( n  = 4) or policy ( n  = 3). The papers drew on evidence collected from 13 countries, and the most common national setting was the UK ( n  = 29). Nine cross-national papers were also included. Issues related to leadership were rarely the focus of the papers.

Results: A coproduction leadership framework

The synthesis consists of three parts (roles, models and practices), which are combined to develop an overarching and integrative framework for essential issues pertaining to coproduction leadership [ 4 , 24 ].

People and roles

The way in which the leadership of coproduction has been conceptualized in the literature suggests that a range of actors are involved in the coproduction of health and wellbeing and that these actors can take on different leadership roles and functions. Service users, community members and community representatives can play a vital role in the task of deliberatively coproducing or even transforming services, as can third-sector organizations, external experts, politicians, mid-level facilitators, managers, and senior leaders.

It has been argued that it is important to involve leaders from diverse backgrounds who have personal experiential knowledge of public involvement to encourage involvement from a broader population [ 25 , 26 , 27 ]. Service users and community members play leadership roles in coproduction initiatives related to health or well-being. These roles involve shared decision-making and accountability at various levels, ranging from the personal to the systemic.

Senior leaders include formal representatives of organizations (executives, politicians, or formal managers) and formal or respected leaders of communities. They play an important role throughout this process. During the initiation stage, by implementing and sustaining the outcomes of coproduction, they play a crucial role in the provision of resources such as time, money, materials, and access to networks. In the interim stages, their commitment to coproduction, sponsorship, and engagement is vital.

Champions and ambassadors use their expertise and passion to drive coproduction efforts. In particular, "insider" champions can establish trust among participants and help service providers understand the importance of coproduction. These champions advocate for coproduction and actively support initiatives [ 28 , 29 , 30 , 31 ]. Ambassadors are individuals who have expertise and volunteer their time to train others or work with clients in coproduced services. They play a crucial role in the tasks of supporting and promoting coproduction [ 28 , 32 , 33 ].

Project leaders and facilitators are individuals who are responsible for guiding and supporting coproduction projects, thereby ensuring their smooth operation and collaborative nature. Project leaders are responsible for overall project management, including the setting of goals, objectives, and timelines. They play a pivotal role in ensuring that projects remain on track, and they facilitate accessible and transparent dialogue among stakeholders and ensure equal representation [ 34 , 35 ]. Facilitators focus on supporting the group involved in coproduction, maintaining respectful interactions, empowering service users and carers, and addressing any tensions that may arise during the collaborative process [ 36 , 37 ].

In summary, senior leaders sponsor and support coproduction. Champions and ambassadors are individuals who advocate for and support coproduction initiatives, while project leaders and facilitators are responsible for managing and guiding coproduction projects themselves, thereby ensuring effective collaboration among stakeholders. All of these roles can be played by people drawn from various backgrounds, including senior staff, health care professionals, experts in coproduction, researchers, citizens, or volunteers.

Three models of leadership in coproduction

These actors play different leadership roles, and leadership can be exercised by individuals or groups. Three leadership models have been proposed: leadership as enacted by individual leaders, coleadership and collective leadership.

Leadership by individual leaders

A leader-centric view has been the dominant interpretation of leadership in the field of coproduction. Many references were made to “senior leaders”. This term was used to describe formal representatives of organizations or services (senior managers, executives), formally appointed community leaders (policy-makers, local government leaders), or respected leaders of communities. Senior support was described as an important success factor in coproduction [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Other leadership roles included project leaders, facilitators, ambassadors, and champions – as described in the previous section.

Some papers referred to traits and characteristics exhibited by leaders that facilitate coproduction. These factors included innovativeness, personability, action orientation [ 46 ], courage [ 47 ], passion [ 32 , 46 ], and empathy [ 25 , 46 , 48 ]. “Strong leadership” was often mentioned, albeit without elaboration [ 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. By implication, “strong leadership” appeared to include providing clear direction and guidance, having a clear vision [ 53 ], holding onto a vision [ 34 ], and keeping the vision alive for the team [ 43 ].

Other researchers noted a more collaborative and democratic leadership style that is characterized by listening, transparency, deliberation, and nurturing coproductive behaviours [ 27 , 30 , 48 ]. Senior leaders could use a “top-down” approach to promote user involvement. Alternatively, they could “learn to manage horizontally not top down; embrace ground up initiatives; [and] aim to empower partners” [ 32 , 45 , 51 ] and be “open to changes that would disturb traditional relationships and power disparities between service users and providers” [ 41 ]. Respondents to a survey of participants in a peer-led support network favoured a traditional directive model of leadership alongside a more facilitative and enabling style [ 56 ]. However, they found it challenging to transition to a more distributed and collective leadership approach.


The terms “co-lead”, “co-leadership” and “dual leadership” refer to situations in which a formal leadership role is allocated to more than one person, in which context the relevant people may represent different institutions or different groups, e.g., different professional groups, researchers and service users/citizens, or teachers and students [ 28 , 31 , 40 , 41 , 57 , 58 ]. Coleads were defined as “individuals who led and made joint decisions” [ 59 ]. Some papers explored the leadership role of service users or community members in the coproduction of research related to health or wellbeing [ 35 , 60 , 61 ]. In these studies, areas of research were proposed by patients/community members, who then collaborated with academic researchers, thereby playing an equal or leading role. Coleadership was reported to result in shared learning.

Collective leadership

Few discernible differences among “ shared”, “distributed” and “collective” leadership were found in the papers included in this review. The approaches examined in this context were characterized by distributed roles and responsibilities in which different individuals’ skills and expertise were identified as best suited to the task at hand. Shared leadership depends on willingness on the part of leaders (implicitly non-community leaders) to be challenged and directed by community members rather than rigidly maintaining their previous conceptions of the issues and the appropriate means of addressing them [ 36 ].

Ward, De Brún, Beirne, Conway, Cunningham, English, Fitzsimons, Furlong, Kane and Kelly [ 62 ] referred to collective leadership as an emergent and dynamic team phenomenon. Other authors argued for a more structured approach to shared leadership [ 36 , 41 ] or distributed leadership [ 28 , 42 , 56 , 59 , 63 ]. Such an approach could involve allocating specific roles to service users, engaging them in a formal structure and/or enabling them to set an agenda [ 41 ], specifying shared roles and responsibilities [ 36 ], and/or providing dedicated support to lay “champions” in research studies [ 28 ]. Various benefits were attributed to collective leadership, such as empowering people to speak up [ 36 , 51 ] and feel engaged.

Nine practices associated with leading coproduction

We identified nine processes that encompass wide-ranging activities and interactions between individuals and groups with regard to leading the coproduction of health and wellbeing. As Farr noted, “Coproduction and codesign […] involves facilitating, managing and co-ordinating a complex set of psychological, social, cultural and institutional interactions” [ 64 ]. In some cases, these processes naturally align with certain actors—for instance, senior leaders play key roles in the tasks of initiating coproduction and implementing and sustaining its results—but other processes (championing coproduction, establishing trusting relationships, and ensuring good communication) are applicable to any and all participants in the coproduction process. Similarly, some of these practices occur at particular timepoints in a coproduction arc (namely, during the stages of initiation or implementation), while others can occur at any or all timepoints (i.e., during the assimilation stage or beyond). Deliberately considering the most suitable leadership model with regard to the aims and context of an initiative is useful at the start, but reflecting on the operation and appropriateness of the model is always salient.

Initiating coproduction

The initiation of coproduction entails recognizing the need for coproduction, dedicating resources, inviting and establishing relevant multi-stakeholder coproduction networks, and coproducing a vision and goals.

It has been argued that senior leaders act as gatekeepers for coproduction because they must recognize the need for it [ 45 ]. Senior leaders play a role in the task of determining the extent to which communities are given the opportunity to influence service design and integration [ 38 , 51 ]. Coproduction requires resources (principally time and money but also networks), which can be used to take advantage of other resources such as skills [ 29 , 31 , 34 , 40 ]. Senior leaders often control or provide access to such resources, which means that they are best positioned to initiate coproduction initiatives [ 41 , 65 ]. However, the findings of a cross-national study on the coproduction of policy showed that, in practice, senior leaders’ control over resources meant that they tended to define the means, methods and forms of participation [ 65 ].

In the task of establishing a conducive environment for coproduction, it is important to pay attention to which actors (organizations or individuals) are participating in the process [ 33 , 42 , 64 , 66 ] and to factors that may delimit those participants or their involvement [ 36 , 42 , 67 ]. Several papers emphasized the need to ensure that all stakeholders are involved from the outset [ 37 , 38 , 41 , 48 , 51 ]. In the initiation stages, a shared vision should be created [ 36 , 61 , 68 ], goals should be coproduced, and responsibilities should be clearly allocated [ 65 ]. Role clarity, ability, and motivation have been identified as determinants of coproductive behaviour, and leaders must implement arrangements to achieve these goals for coproducers [ 69 ].

Power sharing

It has been argued that coproduction leadership must attend to issues pertaining to power redistribution [ 60 , 61 , 63 , 64 ] and uphold the ideology of coproduction by promoting the values of democracy and transparency [ 30 , 32 , 70 , 71 , 72 , 73 , 74 ]. This process can occur at different levels.

At the macro system level, several cultural shifts have been implicated in the redistribution of power – a shift in current professional and stakeholder identities; more fluid, flattened and consensus-based ways of working; and a willingness to accommodate ‘messy’ issues [ 75 ]. The last of those issues was highlighted by Hopkins, Foster and Nikitin [ 29 , s 192], who suggested that coproduction requires service providers to “sit more easily with the unknown, to be comfortable in not having all the answers.” Similarly, “The challenge is that to be transformative, power must be shared with health service users. To do this entails building new relationships and fostering a new culture in health-care institutions that is supportive of participatory approaches” [ 42 , p 379].

At the meso level, several practices could be used to share power. Greenhalgh, Jackson, Shaw and Janamian [ 30 ] identified the importance of equitable decision-making practices and “evenly distributed power constellations.” This goal can be achieved, for instance, by ensuring that service users represent a majority on the project management committee or in codesign events with the goal of challenging dominant professional structures and discourses [ 37 ]. Other scholars called for clear roles and responsibilities [ 38 , 59 , 65 ]. Mulvale, Moll, Miatello, Robert, Larkin, Palmer, Powell, Gable and Girling [ 36 ] recommended the establishment of shared roles and responsibilities, the creation of a representative expert panel to resolve stalemates, and possibly the implementation of formal agreements regarding data and reporting. Importantly, however, Greenhalgh, Jackson, Shaw and Janamian [ 30 ] noted that governance structures and processes alone do not automatically overcome the subtle and inconspicuous uses of power. Farr [ 64 ] recommended the constant practice of critical reflection and dialogue and posed several questions for participants to consider: who is involved, what the interactions are like, how coproduction efforts are implemented within and across structures, and what changes are made.

Although sharing power has been described as an essential component in coproduction, the involvement of stakeholders does not necessarily entail empowerment [ 47 ], and case studies have demonstrated that service improvement initiatives that involve citizens or service users can be instrumental and effective with regard to improving services without enhancing or sharing power or political consciousness if stakeholders are invited but power is not shared [ 32 ]. Farr [ 64 ] noted that rather than coproduction being inherently emancipatory, coproduction and codesign processes can have either dominating or emancipatory effects [ 33 ], and the exclusion of vulnerable groups from coproduction has the potential to reinforce existing inequities [ 75 ].

Training and development for emerging leadership

The importance of appropriate training and mutual learning was noted in several papers [ 36 , 42 , 48 , 63 , 69 , 76 , 77 ]. Implicitly, training for professionals was framed in terms of training in the process of sharing power with service users or facilitating collaboration, whereas training for service users was framed as capacity-building in terms of collaboration and/or leadership. In one case study focusing on coproduced research, participants rejected the notion of “training” from academic researchers with the aim of avoiding suggesting that a certain level of “expertise” needed to be transferred [ 60 ].

Playing a leadership role can be empowering [ 51 , 71 ], but for some individuals, it can be overwhelming [ 71 ]. Leading coproduction requires practice and the development of skills and capacities [ 26 , 48 ]. In some initiatives, lay partners were initially involved in limited roles and gradually took on more responsible leadership tasks over time [ 28 , 42 , 78 ]. In addition, community members’ level of involvement was flexible—they could be participants or take on additional roles as volunteers, paid staff members or directors of organizations. This flexibility offered participants the opportunity to "begin sharing, as opposed to shouldering, the burden of involvement” [ 71 ].

The provision of support

Support is necessary throughout the coproduction process from its outset to the stages of implementation and sustainment [ 25 , 34 , 68 ]. Key dimensions of support include facilitating, advocating for, and championing coproduction. Project management is instrumental to the smooth operation and facilitation of coproduction [ 34 , 35 , 37 , 44 ]. Several facilitation activities are conducted by project leaders and facilitators [ 41 , 42 , 59 , 61 , 78 ]. These activities include holding onto a vision and keeping it alive for the team, ensuring that the project remains on track, and helping maintain momentum. In one codesign case study, facilitators helped people focus on quick wins with the goal of maintaining motivation and engagement; they "needed to support movement from inaction to action, by sifting through group ideas to fix a plan" [ 34 ]. Although these authors acknowledged that this approach may have limited coproduction, they argued that such initiatives would not be sustainable if they were perceived to be “unfeasible.”

Another key function entails advocating for and championing coproduction initiatives to ensure that the process remains ongoing [ 25 , 28 , 29 , 30 , 31 , 32 , 37 , 41 , 74 , 79 ]. Senior leaders play an important role in the task of championing coproduction, and their support has often been described as an important success factor [ 34 , 38 , 39 , 43 , 80 ]. However, effective champions could equally include health care professionals [ 37 ], experts in coproduction [ 51 ], researchers [ 35 , 60 , 61 ], volunteers [ 51 ] or other citizens [ 41 , 61 ]. Champions with lived experience can gain the confidence of their peers and help create understanding among service providers [ 28 , 36 ].

Establishing trusting relationships

Coproduction is essentially relational and requires concerted efforts to establish trusting relationships and a sense of commitment. The importance of trust among stakeholders in coproduction has been noted in several papers [ 28 , 30 , 36 , 37 , 38 , 46 , 48 , 64 , 74 , 81 , 82 ]. In the field of health research, it is difficult to secure funding for the process of establishing relationships and working in the context of partnerships during the early stages of development [ 25 ]. It can therefore be helpful to base recruitment for coproduction initiatives on pre-existing trusting relationships [ 36 ]. If such pre-existing trusting relationships do not exist, policy-makers and senior leaders play a role in the creation of frameworks that can facilitate the development of trust both among organizations and between organizations and citizens, such as political and bureaucratic commitment on the part of regional and local governments and the engagement of actors who play a “boundary-spanning” role in the relationships between service providers, non-government organizations and communities [ 38 ]. Trust is established based on clear responsibilities [ 38 ] and adherence to the principles of engagement in coproduction. In addition to these frameworks, individual leaders must develop trust through interactions with coproducers, using collaborative skills such as those pertaining to communication and listening [ 48 ]. In one case study, through the frank sharing of the organizational, financial, and governance challenges and opportunities faced by stakeholders, people reached a growing understanding and appreciation of each other’s positions, which engendered trust [ 30 ]. Mulvale, Moll, Miatello, Robert, Larkin, Palmer, Powell, Gable [ 36 ] highlighted the importance of understanding and responding to participants’ histories, contexts, and cultural differences.

Commitment can be viewed as more important than resources [ 59 ]. The commitment to and engagement in coproduction exhibited by an organization’s senior leaders demonstrate organizational commitment and lend credibility to coproduction initiatives [ 25 , 34 , 38 , 41 , 47 , 59 , 80 , 83 ]. On some occasions, coproduction initiatives are reported to senior leaders, while on other occasions, the senior leaders were part of the coproduction team. Senior leaders who adopt a more hands-on approach serve as role models [ 25 ], advocating for patient engagement and engendering commitment on the part of staff and patients [ 28 ]. In public health initiatives, buy-in from community leaders confers legitimacy on innovations, helps ensure community trust [ 61 , 78 ], increases the engagement of community members [ 78 ] and is key to a project’s success [ 83 ].


Communication is a key activity in coproduction, and leaders must establish an environment that is conducive to “epistemological tolerance” [ 47 ], such that different perspectives are valued and appreciated. Such environments facilitate dialogue among partners [ 28 , 30 , 35 , 51 ] and allow critical voices to be heard [ 42 ] . Open dialogue among stakeholders is a starting point for the task of identifying the sources of assumptions and stereotypes, which is itself a prerequisite for change in attitudes and practice [ 28 ]. Project leaders must also facilitate accessible and transparent dialogue and ensure the equal representation of all stakeholders, including those who are less able to communicate verbally [ 57 , 71 ]. Professional leaders are responsible for critically reviewing their professional norms, organizational/institutional processes and past and present policies and practices [ 55 , 75 ].

Dealing with multiple stakeholders, which is inevitably required in coproduction, requires addressing multiple perspectives in an attempt to bring them together. This task frequently involves a degree of conflict and peace negotiation [ 30 , 34 , 41 , 48 , 61 , 64 ]. Leaders should be alert to conflict and power dynamics [ 34 , 36 ]. It may be necessary for meeting chairs to encourage participants to move on from their familiar, entrenched positions to avoid descending into circular arguments and stalemates (Chisholm et al. 2018). This task could require the injection of a critical voice, as Greenhalgh explained:

“Meeting chairs were selected for their leadership qualities, ability to identify and rise above “groupthink” (bland consensus was explicitly discouraged), and commitment to ensuring that potential challenges to new ideas were identified and vigorously discussed. They set an important ethos of constructive criticism and creative innovation, with the patient experience as the central focus. They recognized that if properly handled, conflict was not merely healthy and constructive, but an essential process in achieving successful change in a complex adaptive system. ” [ 30 ]

Leaders must acknowledge the facts that discomfort can arise when more equitable relationships are established [ 61 ] and that challenges to professional identity [ 84 ] and the loss of control [ 72 ] are factors in this process.

Networking refers to the practice of establishing and maintaining relationships with various stakeholders both within and outside the coproduction initiative. Since coproduction involves working with different stakeholders in networks, several papers have discussed the vital mediating processes associated with this context.

“Bridging, brokering and boundary spanning roles have a key role in cross fertilization of ideas between groups, for generating new ideas and for increasing understanding and cooperation” [ 32 , 53 ].

In policy-making, it is helpful to develop coordination structures and processes such as cross-sector working groups and committees, intersector communication channels [ 65 ], and relationship and dialogue structures [ 42 ]. Community representatives can play a mediating role between individuals and public organizations and may alleviate professionals’ concerns regarding the transaction costs of coproduction in the planning and management of services [ 26 , 81 ]. However, these representatives may or may not use this power to amplify the voices of individual coproducers [ 81 ].

An important role of project leaders is that of the “broker” [ 32 , 85 ], who focuses on mediating among different stakeholders in an attempt to align their perspectives [ 26 ,  37 ,  72 , 86 ]. Another role focuses on spanning the boundaries across sites [ 50 ], between local service providers [ 68 ], or among local services, non-government organizations and the community [ 38 ]. Bovaird, drawing on a number of cases of coproduction, came to the following conclusion:

“ there is a need for a new type of public service professional: the coproduction development officer, who can help to overcome the reluctance of many professionals to share power with users and their communities and who can act internally in organizations (and partnerships) to broker new roles for coproduction between traditional service professionals, service managers, and the political decision-makers who shape the strategic direction of the service system.” [ 81 ]


This practice involves reflecting on and improving coproduction itself. It includes activities such as evaluating the effectiveness of coproduction efforts, assessing the impact of coproduction on outcomes, and making adjustments to improve the coproduction process. Several papers have addressed the roles of local government or public managers or health professionals in overseeing and (as we refer to this process) ‘orchestrating’ the networks involved in coproduction at the community or local government level [ 30 , 33 , 65 , 74 , 87 ]. Orchestration involves recruiting the appropriate actors as noted above as well as directing and coordinating activities, thereby ensuring that the whole is more than the sum of its parts. As part of their orchestration work, leaders play a role in the task of managing risk in service innovation [ 55 , 87 ] and must commit to self-reflexivity and a critical review of norms, policies and practices to alert themselves to any unintended negative consequences and strive to counteract them [ 55 ]. Sturmberg, Martin and O’Halloran [ 88 ] used the metaphor of ‘conducting’ to describe the function of leadership in health care – i.e., leading the orchestra through inspiration and empowerment rather than control, leading to the provision of feedback as the performance unfolds.

From a public service perspective, Powers and Thompson [ 69 ] argued that coproduction requires the leader (“usually a public official”) to mobilize the community on behalf of the public good, organize the provision of the good, create incentives, and supervise the enforcement of community norms. Sancino [ 74 ] argued that local governments play a ‘meta-coproduction role’ that requires them to maximize the coproduction and peer-production of community outcomes by taking into account community contributions and deciding which services should be commissioned or decommissioned (a point that was also made by Wilson [ 87 ]) and to promote coproduction and peer-production in such a way as to promote the coproduction of outcomes that have been decided through a democratic process. In this way, he argued,

"the local government becomes the pivot of different kinds of relationships and networks made up of different actors who collectively assume the responsibility for implementing an overall strategic plan of the community beyond their specific roles and interests." [ 74 ]

Sancino [ 74 ] attempted to draw out the leadership implications of this situation, arguing that rather than focusing on service delivery, public managers must create appropriate conditions for such meta-coproduction. This task entails a directing role based on framing shared scenarios for change in the community through sense-making; an activator role based on activating, mobilizing and consolidating the social capital of the community to promote diffused public leadership; a convenor role based on serving as a meta-manager in the process of self-organizing the knowledge, resources and competencies pertaining to the community in question; and an empowering role based on creating conditions in which peer production and coproduction can be combined to create the corresponding added value (i.e., higher levels of community outcomes) [ 74 ]. This practice essentially focuses on self-assessment and continuous improvement within the coproduction framework.


It has been argued that coproduction in services [ 30 , 79 ] or policy-making [ 65 ] may improve implementation. The role of leadership in supporting the implementation of the outcomes of coproduction is essential [ 37 , 41 , 49 , 52 , 64 , 65 , 85 , 86 ]. Leaders can argue for the legitimacy of coproduced innovations [ 89 ] and implement mechanisms aimed at acting on the issues thus raised and continuing to promote patients’ involvement [ 28 , 41 ]. Implementing the outcomes of coproduction relies on outcome-focused leadership [ 30 ]. The results of coproduction initiatives must be transformed into strategic plans and policies [ 41 ], and patient perspectives must be translated into actionable quality improvement initiatives [ 49 ]. Conversely, implementation can be blocked by leaders who fail to respond to the results of coproduction initiatives or who implement policies or procedures that are poorly aligned with the recommendations arising from coproduction [ 30 , 41 ]. It should also be acknowledged that not all demands thus generated can always be met [ 61 ]. Failures of implementation run the risk of stakeholder disillusionment; thus, the management of expectations is important.

A framework for coproduction leadership

When coproduction is initiated, it is possible to consider the actors involved and to imagine various forms of coproduction. In the design process, it is possible to make a deliberate choice with regard to the most appropriate model of leadership, and depending on the leadership model selected (leader-centric, coleadership, or collective leadership), different leadership practices emerge. The nine leadership practices identified can be enacted by different people and in different ways. The leadership of coproduction that thus emerges is shaped by issues such as the model of coproduction, the stakeholders involved, participants’ motivations and the context of coproduction. A main concern lies in the need to design project structures and work practices that are aligned and that enable leadership to emerge. We thus created a table (Table  1 ) that illustrates potential reflective questions in this context.

This discussion highlights and problematizes the two main findings of this systematic review, namely, the need to deliberately consider underlying models of leadership and the complex character of leading coproduction.

The need for the deliberate use of leadership in the plural

A focus on leader-centric approaches and the quality of leaders has characterized public leadership research [ 90 ]. Such a focus is echoed in our findings on coproduction leadership, first with regard to the prominence of senior leaders and, to a lesser extent, facilitators. Politicians were rarely identified in the papers included in our review despite representing some of the main actors identified in a previous review [ 4 , 91 ]. Second, many papers referenced the need for “strong” leaders, and the skills and behaviours of individual leaders were noted. As other researchers have found, despite the focus of this field on relationships and interactions, its emphasis has frequently remained on the individual leader and their ability to engage and inspire followers [ 13 ]. Furthermore, even in papers that emphasized ‘coleadership’ or ‘collective leadership,’ the focus remained on public managers, service managers and facilitators. Very little evidence has been reported concerning individual service users’ or citizens’ leadership of (as distinct from involvement in ) coproduction. Although the involvement of community leaders was reported to play a role in project success, no articles explored this issue.

However, some important exceptions should be noted. For example, some studies exhibited a preference for mixed models, employing both a directive approach (particularly in the beginning) and a more facilitative and distributed leadership approach [ 56 ]. Rycroft-Malone, Burton, Wilkinson, Harvey, McCormack, Baker, Dopson, Graham, Staniszewska and Thompson [ 53 ] concluded that consideration should be given to models that combine hierarchical, directive structures with distributed facilitative forms of leadership.

One explanation for this rather narrow view of leadership is that despite the rapidly increasing number of publications in the general field of coproduction [ 7 , 18 ], empirical studies have still lacked depth with regard to investigations of the leadership of this process. Most empirical studies included in this review mentioned leadership only in passing or derived some conclusions regarding leadership from case studies focusing on other aspects of the coproduction process.

Another explanation for this situation is that although coproduction focuses on partnership, in most cases, senior leaders have control over resources and the power to define the means, methods, extent and forms of participation [ 65 ]. Even shared leadership models seem to rely on traditional leaders’ willingness to share power [ 10 ], as leaders are the actors who invite, facilitate, and support the participation of coleaders. However, some signs of change towards a broader view should be noted. Recent publications have theorized the leadership of coproduction and included case studies that have demonstrated leadership to be a social, collective and relational phenomenon that emerges as a property of interactions among individuals in given contexts [ 13 , 19 ].

The complexity of coproduction leadership practices

Our findings indicate that the leadership of coproduction practices entails challenging and complex tasks. Complexity emerges in cases in which many parts are interrelated in multiple ways. Different kinds of leadership activities may be necessary depending on the stakeholders involved [ 92 ], the context [ 13 ], and the mode, level, and phase of coproduction [ 93 ]. A complexity perspective based on systems thinking is therefore useful [ 13 , 19 ]. All actors involved in coproduction are potential leaders, but for that potential to be realized, the coproduction initiative and its leadership must be framed and comprehended in a more plural way. A recent study on systems thinking and complex adaptive thinking as means of initiating coproduction advocated a collective leadership approach [ 19 ].

Our findings highlight the need for a complex way of making meaning of leadership throughout the coproduction process, such as the ability to be flexible due to circumstances and employ both strong leadership and more facilitative approaches when necessary. Leaders must also promote the values of democracy, transparency and the redistribution of power among stakeholders throughout the process [ 64 , 94 ]. These practices and tasks are complex, which must be matched by an inner mental complexity [ 95 , 96 ]. Several practices identified in this research, such as genuinely valuing diverse perspectives, promoting mutual transformative power sharing and welcoming conflicts, require a complex mode of meaning-making that results from psychological development. These issues warrant further exploration. Future studies featuring a thoughtful choice of leadership and complexity models as well as a broader methodological repertoire are thus necessary (see Table  2 for an overview).

Methodological strengths and limitations

A strength of this review lies in its integration of research on the sparse and overlooked issue of leadership in coproduction. Our search strategy, which involved using the key words manag* and lead*, may have excluded some relevant papers. To verify that this approach did not represent an excessively blunt exclusion criterion, we checked 10% of the articles that were excluded based on this criterion. All of these articles would also have been excluded for failing to include any exploration of the management or leadership of coproduction. We therefore determined that this exclusion criterion was justifiable. Many papers did not have an explicit focus on leadership; however, by synthesizing the data, all data were treated as reflections that jointly created a larger pattern, similar to a kaleidoscope. The exclusion of non-peer-reviewed papers is likely to have led to the exclusion of coproduced outputs, which may have offered important insights into the leadership of coproduction, particularly with regard to the experiences of service users and citizens playing leadership roles. In the reporting of this review, the PRISMA guidelines were followed (Additional file 2 ). It should be noted that the lack of reporting bias assessment and certainty assessment represents a limitation of this study.

Future research

Future research (see Table  2 ) should focus on under-represented roles, such as those of politicians and community leaders, and explore emerging collective leadership models based on real-time observational studies. It should also investigate the balance between strong and shared leadership by using qualitative and participatory research methods. Incorporating systems thinking and relevant leadership models can offer new perspectives on collective leadership practices.

Practical implications

This paper explored coproduction leadership practices and revealed that they require a deliberate and plural understanding of leadership roles and tasks. We proposed a framework for coproduction leadership that takes into account the actors involved, the models of leadership, and the leadership practices that emerge in different contexts and during different phases of coproduction. We also provided a set of reflective considerations that can help all actors involved in this process make more deliberate choices regarding the parties involved, leadership models of coproduction, and practices (Table  1 ).

Our systematic review revealed some gaps in the literature on coproduction leadership, such as the lack of attention to the mental complexity of coproduction leaders, the under-representation of service users and citizens as leaders, and the need for more empirical studies that use appropriate models and methods to capture the complexity of coproduction leadership. We suggest that future research should address these gaps, thus contributing to the advancement of coproduction theory and practice.

Our framework also has some practical implications for coproduction leaders and participants. At the start of coproduction process, all people, particularly leaders, must learn more about different models of leadership and how power is shared. Throughout this process, flexibility is necessary because leadership constellations change over time; they emerge and fade away, thus implying different underlying leadership models. A multitude of practices must be implemented throughout the coproduction process. People in leader roles must be aware of their personal strengths and limitations, not only with the goal of sharing leadership but also with the aim of establishing partnerships with others who have competence in certain practices, such as facilitation or addressing conflicts. Reflecting upon the guiding questions can also help illustrate the extent to which power and leadership are being shared. In conclusion, to create more equal power relations over time, we must challenge our current practices and work deliberately to enhance the capacity of individuals and groups to effectively engage in coproduction leadership.

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The authors wish to thank Forte, the Swedish Research Council for Health, Working Life and Welfare. In particular, we would like to thank Mary McCall for valuable help.

Open access funding provided by Jönköping University. The study of Samskapa, a coproduction research programme, received funding from Forte, the Swedish Research Council for Health, Working Life and Welfare, under grant agreement no. 2018–01431.

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SK and SS performed the data extraction, qualitative synthesis and drafted the manuscript and Table 1 . SK finalized the manuscript. D.M. screened the data from a previous scoping review, provided the search strategy (Additional file 1 : Appendix 1) and constructed the Prisma flowchart. SS compiled sample description in Additional file 2 : Appendix 2. All authors reviewed and approved the manuscript and agreed to be accountable for all aspects of the work.

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Kjellström, S., Sarre, S. & Masterson, D. The complexity of leadership in coproduction practices: a guiding framework based on a systematic literature review. BMC Health Serv Res 24 , 219 (2024). https://doi.org/10.1186/s12913-024-10549-4

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Factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs: a scoping review

  • Charlene Thompson 1 ,
  • Tara Million 2 ,
  • Devan Tchir 3 ,
  • Angela Bowen 1 &
  • Michael Szafron 4  

International Journal for Equity in Health volume  23 , Article number:  28 ( 2024 ) Cite this article

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Despite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0–6 years; and (2) explore how frontline workers are included in the program process.

This scoping review was completed using the Arksey and O’Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990–2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis.

Forty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery ( n  = 45) and development ( n  = 25). Few ( n  = 6) had a role in program evaluation.

Although a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.

Health inequity is one of the key challenges to Indigenous maternal-child health [ 1 , 2 ]. Indigenous mothers and children experience a greater proportion of negative health outcomesand reduced access to care when compared to non-Indigenous mothers and children [ 2 , 3 , 4 ]. The increased burden resulting from health inequities negatively impacts mothers' health statuses and is a significant barrier to the growth and development of children [ 3 , 5 ].

Indigenous maternal-child health programs

Maternal-child health programs have an essential role in improving the health of Indigenous mothers and children and reducing health inequity [ 4 , 6 , 7 ]. In this context, Indigenous maternal-child health programs are an action or approach in the community setting aimed at mothers and their children to create a positive health impact [ 4 , 6 , 8 ]. Although there are a large number and variety of available maternal-child health programs, there has been little positive impact on the health status of Indigenous mothers and their children [ 4 , 9 ].Indigenous mothers continue to experience higher rates of gestational diabetes, postpartum diabetes, obesity, anxiety, and depression [ 10 ]. Indigenous children experience higher rates of preterm births, sudden infant death syndrome, and higher overall mortality rates [ 2 ]. With maternal-child health programs having little effect, there is a need to identify elements that can assist or hinder program success and, potentially, inform current practice [ 4 , 7 , 11 ].

Health programs have been successful when the community is included in the health program process, i.e., the development, delivery, and evaluation of a program [ 7 , 12 , 13 ].. Frontline workers are one aspect of community input that can contribute to program success [ 4 , 14 , 15 ],but it is unclear what their contributions have been in the health program process. Examining the available literature may provide insight into the role of frontline workers in the health program process and ways health program planning and evaluation may be improved. Hence this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for Indigenous mothers and their children aged 0–6 years; and (2) explore how frontline workers are included in the Indigenous maternal-child community health program process.

Scoping review rationale

One key challenge in Indigenous health program literature is evaluating research based on a western standard that does not fit the community or community definition of success [ 16 , 17 , 18 ]. This challenge has created a body of program evidence that has been criticized as weak [ 7 , 18 , 19 ].) Excluding literature based on quality alone from a review could result in the loss of valuable research that reflects the community and limit the usefulness of the review [ 16 , 20 ]. A scoping review eliminates a quality assessment from the review process, thus broadening the scope of literature beyond the western standard of evidence and generating relevant results [ 16 , 20 , 21 ] to inform Indigenous maternal-child health programs. Unlike other types of literature reviews, a scoping review is more likely to include a variety of study methods and designs [ 21 ]. The scoping review framework is an iterative process, where the team may revisit and refine the stages to ensure comprehensive and pertinent answers to the research questions [ 20 , 21 ]. Consequently, a scoping review fits the context of a review of literature pertaining to Indigenous maternal-child health where multiple methods, such as randomized control trials, community-based participatory research, and descriptive studies, have been used in health program research [ 13 , 15 , 22 ].

Scoping review process

This scoping review followed the framework that was developed by Arksey and O’Malley [ 21 ] and modified by Levac et al. [ 20 ] because Levac et al. [ 20 ] enhanced the Arksey and O’Malley framework [ 21 ] to include greater guidance to the methodology and build on the consistency of its application in the review process. Six stages make up the framework and include: Stage 1: identifying the research question; Stage 2: identifying relevant studies; Stage 3: study selection; Stage 4: charting the data; Stage 5: collating, summarizing, and reporting the results; and Stage 6: consultation. In an effort to strengthen the rigour of the scoping review, we followed the recommendation of Levac et al. [ 20 ] and formed a multi-disciplinary team, CT (team lead), TM, DT, AB, and MS, from public health, nursing, and Indigenous Studies to complete the review.

Implementation of the process

Stage 1: research questions.

Based on the aims of our scoping review, the team collaboratively generated two research questions to guide our review:

For Indigenous mothers and their children aged 0–6 years, what are the factors of success and barriers to successful Indigenous maternal-child community health programs?

How are frontline workers included in the Indigenous maternal-child community health program process?

Concepts of interest

The team discussed and determined three concepts underlying the research questions needed to be defined: Indigenous Peoples, Indigenous maternal-child community health programs and frontline workers. The team developed the conceptual definitions below using multiple literature sources.

  • Indigenous peoples

In the context of this study, Indigenous Peoples identifies the ‘First Peoples’ or those that inhabited countries such as Canada, Australia, New Zealand, and the United States before colonization [ 23 ]. Indigenous Peoples have distinct languages, cultures, and beliefs with strong connections to lands, territories, and resources [ 24 ].

Indigenous maternal-child community health program

An Indigenous maternal-child community health program was considered to be an action or approach aimed at one or more levels, i.e., the individual, family, whole community, policy, to reduce the mortality rates of women and children and improve their health and well-being [ 2 , 6 , 14 , 25 , 26 , 27 ].

  • Frontline workers

Frontline workers are individuals involved in some aspect of the health program process [ 4 , 12 , 14 , 15 ]. Examples of frontline workers include nurses, Indigenous Health and Community Workers, midwives, counsellors, peer support workers, and family support workers [ 3 , 13 , 28 , 29 , 30 , 31 , 32 , 33 ].

Stage 2: identifying relevant studies

Search strategy.

The scoping review team consulted with a health sciences librarian to obtain advice on the search parameters and search strategy. We included both peer-reviewed and grey literature in our search. For this review, unless preceded by “peer-reviewed” or “grey”, the terms “articles” and “literature” refer to the combined peer-reviewed and grey literature. Articles were restricted to those written in English.

The literature was limited to Australia, Canada, New Zealand, and the United States based on these countries:

Similar histories of colonization [ 19 , 34 ]

Significant populations of Indigenous peoples with similar health status [ 34 , 35 , 36 ]

scoring near the top of the good health and living standards in the United Nations Development Programme Human Development Index [ 35 ]; and

the program was implemented in the country.

Articles were narrowed to the timeframe of 1990 to 2019 to capture the developments in health promotion occurring after the introduction of the Ottawa Charter (1986) that defined the components and strategies of health promotion still being applied in current health programs and public health practice [ 37 , 38 ]. From the Ottawa Charter: health promotion was defined as a process that places the control with people to take a participatory role in improving their health; health is considered a state of physical, social, and mental well-being; health is influenced by external determinants such as education, income, and equity; and health promotion actions were established, such as building health policy, creating supportive environments, and developing personal skills [ 37 , 38 ].

Search terms

Search terms were developed in consultation with a health sciences librarian. The medical subject headings (MeSH) found in search sources, i.e., scholarly databases, and keywords specific to Indigenous Peoples and Indigenous maternal-child health community health programs informed the development of the search term strategy. The following search terms were applied in the search strategy: (Indigenous Peoples of Canada filters [ 39 , 40 ] OR Oceanic Ancestry Group OR Indigenous OR American Indian OR Indians, North American OR Aboriginal OR Native American) AND (Maternal-Child Health Services OR Child Health OR Child Health Services OR prenatal care OR perinatal care OR postnatal care OR prenatal education OR maternal child AND Health Promotion OR Program OR Health Education OR Primary Prevention OR Immunization) AND (community health services OR community health nursing OR home care services OR community).

Search sources

The literature search was completed between May 2019 and July 2019. Table 1 illustrates the search sources for the peer-reviewed and grey literature for the review. Grey literature consisted of materials related to the review aims, such as reports and websites, not published from commercial organizations that typically produce peer-reviewed literature [ 41 ]. Based on the librarian’s advice, we completed a focused grey literature search of targeted sources [ 41 ]. Grey literature sources were determined through consultation with the librarian and reference lists from included articles, as suggested in other literature reviews [ 4 , 42 ]. See Additional file 1 for a search example.

Stage 3: study selection

Inclusion and exclusion criteria.

Following the process in Arksey and O’Malley [ 21 ], the review team established the inclusion and exclusion criteria to be applied to all citations identified in Stage 2. Inclusion criteria consisted of articles specific to Indigenous peoples; maternal-child health programs; children aged 0–6 years of age; prenatal mothers; postnatal mothers; primary prevention; located within the community; all types of studies and methods; English language; timeframe 1990-April 2019; programs implemented in the countries, Australia, Canada, New Zealand, and the United States. Exclusion criteria consisted of articles, not Indigenous-specific; children > 6 years of age; acute care-based (i.e., hospital); outside designated timeframe; focused on a specific program element (i.e., the development of a survey for the evaluation of a health program); epidemiological focused (i.e., incidence, prevalence); disease-based.

Screening process

In August 2019, two of the three (CT, TM, and DT) reviewers independently screened each Title and abstract against the inclusion and exclusion criteria using the Rayyan software developed by Ouzzani et al. [ 43 ] Once title and abstract screening were complete, the full text articles were screened against the inclusion and exclusion criteria. As suggested by Levac et al. [ 20 ], a fourth reviewer (MS) was consulted to settle any disagreements between reviewers surrounding potential inclusions. Once the screening process was complete, 45 articles remained for inclusion in the scoping review including 36 peer-reviewed articles and 9 documents from grey literature. The screening process of selected articles can be found in Fig.  1 .

figure 1

Screening process of selected articles

Stage 4: charting the data

Data extraction from included literature.

Following the Levac et al. [ 20 ] process, information was extracted from the 45 articles and summarized in a table. The data extraction table included: author, year, and title; Indigenous first author; country and population; methodology; aims/purpose; program description; reported factors of program success; reported program barriers; frontline worker role in health program process; and program outcomes. From August 2019 to October 2019, two reviewers (CT, TM, or DT) independently extracted data from each article and recorded it in a data extraction table. As suggested in Levac et al. [ 20 ], results were compared to determine consistency between reviewers. The data extraction tables can be found in Additional file 2 .

Stage 5: collating, summarizing, and reporting the results

Data analysis methods.

Analysis of the extracted data included descriptive statistics, a thematic analysis, and a Principal Component Analysis [PCA]. Descriptive statistics were compiled using the Social Sciences Statistical Package [SPSS] 25.0 from IBM Corp [ 44 ] to describe study characteristics and the role of frontline workers in the health program process.

Thematic analysis

For the thematic analysis portion of the scoping review, Levac et al. [ 20 ] recommend using a qualitative analysis technique. The review team chose the Braun and Clarke [ 45 ] thematic analysis framework to guide our analysis as this framework has been used extensively in the health field, including previous scoping reviews on health topics affecting Indigenous peoples [ 42 , 46 ].

From November 2019 to January 2020, the Braun and Clarke [ 45 ] thematic analysis framework was applied by two authors (CT and TM) to the extracted data to generate codes and develop themes. The themes and corresponding codes and definitions supporting the themes were then distributed to all scoping review team members for review and refinement. No changes to the themes were requested by the team.

Principal component analysis

In an effort to address potential reviewer bias in identifying the themes in the extracted data (i.e., codes), a PCA using SPSS 25.0 [ 44 ] was completed by an independent reviewer (MS) to identify the themes (factors) underlying program success and barriers. The PCA was conducted with Promax oblique rotations applied to the codes from the thematic analysis. To identify the number of factors related to program success and barriers, a Parallel Analysis was performed (with 1000 Monte Carlo simulation repetitions). Codes that were moderately to strongly correlated to a factor (i.e., loadings –1.0 to –0.4 and 0.4 to 1.0) were used to name the themes.

Characteristics of included literature

Reviewers (CT, TM, and DT) searched publicly available online biographies in an attempt to determine the self-situation or positionality [ 47 ] discussed by Kovach [ 48 ] of first authors of Indigenous related literature. For most articles the reviewers were unable to determine whether or not the first author self-identified as Indigenous. ( n  = 28). A self-identified Indigenous first author was determined for a small portion of articles only ( n  = 4). The majority of study designs ( n  = 16) within the literature were qualitative; followed by mixed methods ( n  = 12); quantitative ( n  = 8); program descriptions ( n  = 5); and literature reviews ( n  = 4). The majority of articles originated in Canada ( n  = 18) and Australia ( n  = 17); with the United States ( n  = 8); New Zealand ( n  = 1); and a combination of these countries ( n  = 1) rounding out the remaining articles.

Factors of program success

From the thematic analysis using the Braun and Clarke [ 45 ] framework, seven themes were identified as contributing to program success for Indigenous maternal-child community health programs: relationship building; cultural; knowledge transmission styles; community collaboration; program approaches; staff; and operational considerations. Table 2 summarizes descriptions of the identified themes.

Program barriers

The thematic analysis using the Braun and Clarke [ 44 , 45 ] framework identified six themes contributing to program barriers: impacts of colonization; power and governance; client and community barriers to accessing the program; physical and geographical challenges; staff; and operational deficits. Summary descriptions of the themes are found in Table  3 .

The PCA yielded three key factors underlying program success: relationship; program implementation; and operational delivery. The PCA identified five overarching factors relating to program barriers: colonization and its impact; interpersonal staffing issues (issues amongst the staff); staff issues resulting from lack of cultural sensitivity and a lack of resources; challenges with how programs are being implemented; and access to programs. Although the thematic analysis and PCA were completed independently, the results of the PCA illustrate themes similar to those identified through the thematic analysis.

Role of frontline workers

A large portion of the reviewed literature ( n  = 29) did not explicitly state the role of frontline workers outside of program delivery. Program descriptions provided an alternative means for the reviewers to possibly identify the role of frontline workers. Within the reviewed articles ( n  = 45), frontline workers all had a role in program delivery. For a majority of the articles ( n  = 25), we could not determine if frontline workers had been involved in program development; less than half of frontline workers ( n  = 19) had a role in program development; and one article ( n  = 1) stated no involvement of frontline workers in program development. For the largest portion of the articles ( n  = 38), we could not determine if frontline workers were involved in developing the program evaluations, i.e., determining the evaluation design, methods, and measures of success; very few frontline workers ( n  = 6) had a role in developing program evaluations; and one article ( n  = 1) reported no involvement of frontline workers in developing the program evaluation. In most of the literature ( n  = 20), we could not determine if frontline workers participated in the program evaluations; in approximately half of the reviewed literature ( n  = 22), frontline workers participated in program evaluation; and a small portion of articles ( n  = 3) reported no frontline workers participating in the evaluations.

The importance of authorship

Self-situation or positionality conveys who the author is and how the author's perspective shapes the research [ 17 , 47 , 48 ]. The lack of positionality of authors, makes it challenging to identify the voices that are communicating research in Indigenous maternal-child health. The voices sharing the findings of Indigenous maternal-child health program research are important to research consumers because they can influence how data is analyzed, interpreted, and communicated to inform practice [ 17 , 47 , 48 , 80 ].

In a large portion of articles ( n  = 28) included in this scoping review, the reviewers were unable to determine the self-situation or positionality [ 47 , 48 ] of first authors. Currently, publication guidelines and length limitations may not permit researchers to describe their background and motivation for the project [ 35 , 48 , 81 ]. One way to strengthen the literature and research for consumers is to include authors’ positionality in the literature when communicating Indigenous health research [ 48 ]. Including positionality could help decolonize the peer-reviewed literature by creating space for an Indigenous perspective and potentially influencing what research is translated into practice [ 48 , 82 ]. Changing the peer-reviewed literature may help discontinue the cycle of knowledge used in decision-making that perpetuates colonial health policy and practices that have done little to reduce Indigenous health inequity [ 79 , 82 , 83 ].

Factors of program success and barriers

Connection between the factors of success and program barriers.

There appears to be a connection between the themes or those factors important for program success and ones acting as barriers; efforts to include elements for success may also help to address a program barrier. The connectivity between themes could be used as levers to strengthen programs. For example, the inclusion of extended families within the program approach has been identified as contributing to program success [ 1 , 4 , 15 , 49 , 77 ]. Incorporating extended families into a maternal-child health program may help address an identified barrier to accessing the program, such as the exclusion of fathers [ 5 , 8 , 66 , 77 ]. The thematic results reveal linkages between factors of program success and barriers that provide insight into areas and strategies that could be used to improve the health program process, i.e., program development and evaluation, and quality improvement. Application of these findings may positively impact Indigenous maternal-child health programs to increase program success.

Culture and maternal-child health programs

Our scoping review results highlight that culture does not stand alone as an identified factor of maternal-child health program success, but is interwoven throughout the themes, from the inclusion of local culture to knowledge transmission styles [ 14 , 50 , 52 , 53 , 65 , 73 ]. Although woven through the themes, in the reviewed literature there is a lack of acknowledgement or discussion of culture’s importance as an intervention that is emphasized by Sasakamoose et al. [ 84 ]. The discourse surrounding culture in the literature focuses on the inclusion of culture within programs, such as Indigenous artwork, story, kinship systems, or cultural terms to describe the program, such as culturally-based, culturally-appropriate, and culturally-safe care [ 3 , 5 , 15 , 28 , 53 , 68 ]. Cultural inclusion within the programs is intended to create an acceptable program for participants and a good fit for the community [ 15 , 55 , 65 ].

The lack of discussion surrounding Indigenous culture as an intervention may suggest that the full benefit and impact of culture as a tool for wellness [ 84 ] are not being realized within Indigenous maternal-child health programs. A knowledge gap within health program literature exists; it is not well understood that Indigenous culture brings strengths and protective health benefits to the program itself to foster positive health outcomes and reduce health inequity [ 4 , 84 ]. Omitting the acknowledgement and discussion of culture as an intervention creates a missed opportunity to engage in reconciliation and decolonization of programs [ 84 ].

Essential role of program staff in Indigenous maternal-child health programs

The literature included in this review identified the impact of staff on the program as either positive or negative [ 1 , 5 , 52 , 53 , 61 , 62 , 72 ], demonstrating a large part of program success and challenges are dependent on the people within the program. For example, successful relationships with program participants can contribute to program success and are primarily dependent on individual staff [ 5 , 8 , 52 ]. The Indigenous program staff was identified in half of the reviewed literature ( n  = 23) as essential to providing culturally competent and culturally safe care for program participants and contributing to program success [ 15 , 52 , 62 , 67 ]. The literature discusses staff characteristics, such as valuing relationships, displaying genuine empathy, and being respectful, as important for creating successful Indigenous maternal health programs [ 8 , 29 , 77 ]. Conversely, staff who lack cultural competence and are resistant to programs can create significant program challenges and may result in clients not accessing a program or not receiving the full benefit of the program [ 29 , 61 , 64 , 65 ].

The literature identifies that staff have an important role in Indigenous maternal-child health programs [ 5 , 52 , 60 ]. Hence staffing and hiring practices are areas that may impact program success and failures. Union-based work environments can create challenges to hiring practices that support the employment of Indigenous staff and individuals who possess characteristics that make them a good fit for maternal-child health programs [ 25 , 77 , 85 ]. For example, hiring may only be available to existing staff through internal union opportunities where seniority is a primary factor in awarding positions and determining successful candidates [ 86 , 87 ]. These limitations on hiring processes can create significant challenges to implementing best practices in recruiting providers for Indigenous maternal-child health programs. To bring best practice recommendations surrounding staffing forward requires employers and unions to work together and further develop hiring practices [ 88 ] that facilitate program success.

Frontline worker role in Indigenous maternal-child health programs

With the essential role of staff in maternal-child health programs [ 4 , 5 , 15 ], there is great potential for frontline workers to take an extended role in the health program process, beyond their primary role in program delivery. Although almost half of the reviewed articles reported frontline workers participating in program development, frontline workers can offer more to health program development than the current practice found in our review that frames their contributions exclusively on providing input on methods of program delivery and adapting program resources [ 5 , 15 , 67 ].

Frontline workers have local community knowledge and relationships within the community [ 4 , 8 , 77 ]. They provide an exclusive perspective that can be used to identify community-specific needs, set health program priorities, and assume a role in program evaluation [ 4 , 5 , 8 , 77 ]. Frontline workers are part of the community in which programs are delivered and can provide valuable contributions to all aspects of the health program process, i.e., development, planning, delivery, and evaluation [ 4 , 12 , 15 ]. Providing frontline workers with the opportunity of inclusion to share their knowledge and skills can: increase the likelihood of programs that align with local community values and practices; increase program relevance to the community; and, potentially, contribute to program success and create a positive impact on health outcomes [ 4 , 8 , 52 ].

Stage 6: consultation

Consultation with stakeholders is part of the scoping review process as discussed by Arksey and O’Malley [ 21 ] and Levac et al. [ 20 ]. The inclusion of stakeholders and their input may help to inform the review, strengthen the review’s findings, and provide direction for future research [ 20 , 21 ]. In addition, the inclusion of stakeholders is an essential and ethical responsibility in research that may impact practice in Indigenous health [ 20 , 89 ]. Central to a completed community-based participatory research project was accessing the perspective of our community partner to explore the scoping review research questions from the perspectives of stakeholders such as maternal-child health program families, frontline workers, and administrators. The findings from the scoping literature review were applied to inform the methodology and discussion of the community-based research project and identify convergences or divergences between the stakeholder perspective and reviewed literature.


Some articles and programs may have been missed due to the search strategy employed. The data extraction relied on program descriptions from the included articles and there is potential that relevant data may have been missed as it was not included in the article [ 4 ]. Determining the self-situation of first authors depended on the retrieved literature and seeking out the authors’ publicly available biographies. These methods may not have been adequate to determine the published first author’s self-situation resulting in some authors being misidentified or missed.

Although the authors attempted to reduce bias by including (1) two reviewers in the study selection and data extraction and (2) a PCA in addition to the Braun and Clarke [ 45 ] thematic analysis, the potential for bias within the review remains. The review was limited to four countries: Australia, Canada, New Zealand, and the United States, based on similar histories of colonization and large Indigenous populations [ 34 , 35 ] therefore, the applicability of the results outside of these countries is unknown. Even within the countries of inclusion, Indigenous peoples, communities, and cultures are all distinct with local values, practices, and protocols [ 7 ]. The scoping review results may not apply to all Indigenous maternal-child health programs within the included countries.

This scoping review provided an overview of the literature about factors of Indigenous maternal-child health program success, barriers, and the role of frontline workers. Although a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, there was a large proportion of literature where the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. Although the researchers hypothesized the strong connection between frontline workers and maternal-child health programs, one unanticipated finding from the review was the “loud” nature of the literature supporting the importance of staff in health programs. The findings from this scoping review have informed the methodology and analysis of a community-based participatory research project. Outside of the study, the review’s findings may help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.

Availability of data and materials

The datasets supporting the conclusions of this article are included within the article and in Additional file 1 .

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The authors would like to acknowledge the support and advice of Vicky Duncan, Librarian, Health Sciences, University of Saskatchewan, Saskatoon, SK, Canada.

Funding for the scoping review was provided by: Canadian Institutes of Health Research (CIHR) Doctoral Research Award – Priority Announcement: Aboriginal Research Methodologies CIHR 201610DAR-383834–283432.

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CT, TM, and DT collected the data from the retrieved articles. CT and TM completed the data analysis and interpretation of the data regarding the factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs. CT was the main contributor in writing the manuscript, with all authors contributing feedback, reading, and approving the final manuscript. MS, AB, and DR supported the team and provided input in all aspects of the review and manuscript preparation.

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CT is a non-Indigenous woman who lives and works on Treaty 6 Territory and the Homeland of the Métis. As Assistant Professor with the College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada, her research has centered around public health, working with Indigenous mothers, children, and families to reduce the burden of health inequity. TM is a member of Saddle Lake Cree Nation in Treaty 6 Territory. As Assistant Professor in the Department of Indigenous Studies at the University of Lethbridge, Lethbridge, AB, Canada, her research has centered around identifying how Cree legal traditions can be applied to develop OH&S polices that address lateral violence in the workplace. DT works for Alberta Health Services, Edmonton, AB, Canada. MS is an Associate Professor in the School of Public Health University of Saskatchewan, Saskatoon, SK, Canada. AB is an Emeritus Professor in the College of Nursing University of Saskatchewan, Saskatoon, SK, Canada.

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Thompson, C., Million, T., Tchir, D. et al. Factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs: a scoping review. Int J Equity Health 23 , 28 (2024). https://doi.org/10.1186/s12939-024-02118-2

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International Journal for Equity in Health

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Impact of pricing and product information on consumer buying behavior with customer satisfaction in a mediating role.

\r\nHuiliang Zhao,*

  • 1 Department of Product Design, School of Fine Arts, Guizhou Minzu University, Guiyang, China
  • 2 School of Mechanical Engineering, Guizhou University, Guiyang, China
  • 3 School of Data Science and Information Engineering, Guizhou Minzu University, Guiyang, China
  • 4 School of Mechanical Engineering, Guiyang University, Guiyang, China

The relationship between product pricing and product packaging plays an important role in the buying behavior of consumers, whereas customer satisfaction plays a mediating role. To test these hypotheses, research was conducted on university students in China. Questionnaire-based convenience sampling was conducted on 500 students for data collection using online and offline sources. A total of 367 (73%) students responded, and 17 questionnaires were rejected due to missing information. SPSS and AMOS software were used for the data analysis. Product pricing and product information were independent variables in this study, whereas consumer buying behavior was a dependent variable. Customer satisfaction is mediated by one dependent and two independent variables. Confirmatory factor analysis, path analysis, and discriminant validity in structural equation modeling revealed that product pricing and packaging had a statistically significant relationship with the buyer decision process. The introduction of satisfaction as a mediating variable led to the observation of full mediation in the case of product pricing and partial mediation in product packaging. Given the results of this research, product managers should adopt pricing tactics along with product packaging to influence the buying intentions of consumers.


In the competitive market of commodities, products, varieties, consumers, ethnicities, and preferences, product pricing and product packaging information descriptions have a considerable influence on the buying behavior of consumers. To explore the cumulative effects of product pricing and packaging on the buying behavior of consumers of different ethnicities, it is essential to research these aspects of marketing. It is worth mentioning that consumer satisfaction also plays a decisive and mediating role in the development and molding of buying behavior of consumers ( Larsen et al., 2017 ). It is believed that pricing has a significant effect on the buying behavior of consumers because the higher a product is priced, the fewer units are sold. By contrast, products selling at prices lower than the market rate are assumed to sell at a higher volume ( Sadiq M. W. et al., 2020 ). Several studies have shown that pricing is more critical and relevant to consumer buying behavior ( Huo et al., 2021 ).

When discussing the combined effect of product pricing and packaging relationships on consumer buying behavior, pricing alone plays a more critical role than packaging, which has a partial role in buying behavior ( Jabarzare and Rasti-Barzoki, 2020 ). Thus, using this analogy, products can be sold, surprisingly, at a much higher volume. One can increase the prices of the products if the competitor products are scarce in the market or if the manufacturers are low in number. This behavior may not affect the number of sales or the attitude of the consumer toward buying. If the product is already in abundance in the market, then pricing will definitely play an important role because the increase in price will discourage customers from buying it. Similarly, if prices are lowered under such market conditions, then consumers will increase the amount that they purchase significantly.

Even though product pricing has a greater influence than product packaging on the decision process of a buyer ( Pratama and Suprapto, 2017 ; Abdullah et al., 2021 ), high prices in a highly competitive market can lose customers permanently due to the effect of increased pricing ( Kotler et al., 2012 ). While talking about the packaging of products, it should be kept in mind that packaging has a significant relationship on consumers and their decision making about product purchases ( Sadiq M. W. et al., 2020 ). For example, quality, color, and material can have a positive effect on consumers ( Rambabu and Porika, 2020 ). Most consumers desire a range of product choices when purchasing, in terms of packaging. Thus, marketers should place a premium on creative and exclusive packaging that is distinctive in scale, instruction, convenience, product design, and form when compared with rivals in the market segment ( Li et al., 2021 ). Marking a product with accurate information adds to its value. Consumers are attracted to detailed labels, content, and packaging. Many people are influenced by the way a product is packaged and presented in the market. While the product itself may be of any quality, the relationship it produces through its packaging has a strong influence on the purchasing attitude of the consumer. Nowadays, eco-friendly packaging is essential. Thus, advertisers should prioritize this factor and employ best practices to the maximum degree possible, including eco-friendly recyclable packaging ( Abdullah et al., 2021 ). Consumer buying behavior also has a lot to do with product selling and buying ( Brun et al., 2014 ), although some customers are not influenced by the packaging or labeling of products, buying is demand-driven or need-oriented by most consumers.

However, super packaging or labeling of products may not attract the consumer for several reasons. One of the primary reasons may be the high price and packaging, announcing the excellent quality of the product. In such cases, there may be a lack of interest by the consumer toward attractive packaging; instead, they may prefer to buy local products that are cheap and readily available in the market. According to Tu and Chih (2013) , consumer satisfaction is another aspect of product selling and consumer buying behavior. It also plays a mediating role in product buying behavior, pricing, and packaging ( Rambabu and Porika, 2020 ). Even though a price might be negotiable and the product is provided with helpful information and good, decent packaging, there is a lot to do to satisfy a consumer. All of these factors are correlated with consumer satisfaction. If the consumer is satisfied with all these, they may buy the product, but there is no guarantee of this. Thus, consumer buying behavior is also influenced by satisfaction ( Brun et al., 2014 ). This study seeks to answer several questions to explain consumer buying behavior in relation to product pricing and packaging, with consumer satisfaction as a mediating factor. In this work, we first present a brief review of this research, which differs from the current literature in various respects. The research has generated several findings.

• Product prices significantly correlate with consumer buying behavior.

• The product information available on packaging influences the consumer’s buying behavior.

• Satisfaction plays a mediating role in consumer buying behavior.

• Pricing of the product plays an essential role in customer satisfaction.

• Product information available on labels plays a significant role in customer satisfaction.

The remainder of this work is structured as follows: Section “Review of Literature and Hypothesis Development” presents a review of previous studies supporting different theoretical frameworks. Section “Research Methodology” presents the methodology adopted for the empirical analysis. Section “Data Analysis and Results” presents the results of this analysis. Section “Conclusion and Recommendations” concludes the present study, limitations and future directions.

Review of Literature and Hypothesis Development

Product pricing and consumer buying behavior.

Product pricing seems to be the only direct element that generates revenue and indicates the success or failure of a product or service. As a result, the researchers in this study chose to emphasize this aspect. Manali (2015) carried out research into the theoretical dimensions of consumer purchasing behavior and the factors that affect it. He analyzed the relationship between consumer buying behavior and factors affecting the buying process and decisions of the consumers. His research provides enough evidence to show that the internal and external influences of a consumer have a major relationship with their purchasing behavior.

According to Al-Salamin et al. (2015) , good prices of well-known brands negatively affect the purchasing process. Young people are eager to buy brands, but their low income hinders them from doing so. The only aspect of the marketing mix that generates revenue is price, whereas the others generate costs. The authors also noted that the purchasing decisions of consumers focus on their price perception and what they think about the actual price of a product. The main goal of marketing is to understand how customers move toward their price perception. We are all customers, no matter how old, educated, wealthy, or talented. Understanding customer behavior thus becomes a critical challenge for advertisers, distributors, and salespeople. Therefore, we hypothesized the following:

H 1 : Product pricing is significantly correlated with consumer buying behavior.

Product Packaging and Consumer Buying Behavior

Packaging a product with relevant product details contributes positively to consumer buying behavior. Names, features, and product packaging attract consumers. Many people are influenced by the packaging and marketing of items. While a product may be of any quality, the impact on customer purchasing is essential ( Rundh, 2009 ; Li et al., 2021 ; Naseem et al., 2021 ). The aim of this study was to determine the effect of product pricing and information about product packaging on the buying behavior of consumers. Innovation in product labeling and packing often has a major relationship with demand, which is why there are many methods for this type of action plan if a company wants to pursue this strategy with regard to its product packaging. When it comes to packaging, many buyers want a range of product choices. Therefore, marketers should pay high prices for innovative and exclusive packaging that differentiate their products from the competition in terms of size, guidance, functionality, product innovation, and shape ( Rundh, 2009 ; Li et al., 2021 ; Sarfraz et al., 2021 ). For the target consumer, product packaging acts as an outstanding networking tool, ultimately increasing their awareness levels. Packaging must highlight key aspects of the product and brand, such as material composition, purpose, and quality. To show respect for customers, packaging should include all of this information in regional languages. Not only is efficient packaging important for storing and preserving products, but it is also important for creating an interest in and generating actions toward purchasing the product. Packaging that is environmentally friendly has become increasingly important. As a result, marketers should place a high priority on this aspect and use best practices to the greatest possible extent, including the use of environmentally friendly recycled materials ( Deliza and MacFie, 2001 ; Abdullah et al., 2021 ; Mohsin et al., 2021 ).

H 2 : Product information on packaging is significantly related to consumer purchasing behavior.

Satisfaction of Consumers and Their Buying Behavior

Customer value and customer satisfaction are considered important parameters for the relationship between customer value and the willingness to sacrifice ( Zechmeister et al., 1997 ). This sacrifice is made in accordance with an exchange mechanism that includes transaction costs and the risk of the goods of the company. According to Larsen et al. (2017) , customers will be disappointed in the future if the ratio value considered by the economic sacrifice of customers with the goods sold by the company does not meet their expectations. Customers will be satisfied if the ratio value is sufficient or exceeds their expectations. Another analysis of consumer value examines the understanding of customers of the quality and benefits of toothpaste in relation to price sacrifice. Social, emotional, and functional values are all aspects of customer value ( Keller and Kotler, 2012 ).

Customer satisfaction is evaluated by obtaining feedback from customers after purchasing products or services, and then comparing it with their expectations. Customer satisfaction is calculated using the performance requirements of products or services that are capable of satisfying the needs and desires of customers. A satisfied consumer is a consumer who believes that the products or services were worth purchasing, which would encourage them to buy the products again. On the other hand, a frustrated consumer will persuade other consumers not to buy the same brand, which ultimately causes switching to rival brands. According to Tu and Chih (2013) , “customer satisfaction is perceived as affecting repurchasing intentions and actions, which, in turn, contributes to an organization’s potential sales and income.”

H 3 : Satisfaction plays a mediating role in consumer buying behavior.

Role of Product Pricing on Consumer Satisfaction

Price is regarded as something that can be calculated according to several measures, such as a reasonable price, a competitive price, a discounted price, a retailer’s price, and price suitability. Value is a higher-level definition than quality and price because it is more individualistic and personal. A satisfied consumer believes that the value of goods and services is comparable with the price, which will encourage them to repurchase the products. According to Zeithaml (1988) , “quality can be characterized as superiority or excellence in a broad sense.” From the customer’s perspective, “The price is given up or sacrificed to get the product or service” ( Zeithaml, 1988 ). According to Bei and Chiao (2001) , “[P]rice is described as giving or sacrificing for the acquisition of a service or product,” while Kotler et al. (2012) proposed that “the price is the amount paid for a product or service and the sum of the value exchanged by consumers for the advantages of a product or service available or being used.” The perceptions of customers of a given price can have a direct relationship with the their decision to buy a product ( Zechmeister et al., 1997 ). Customers will pay attention to the prices paid by their peers, and no one wants to spend more money than their peers do. The fairness of a price can affect the perception of consumers of the product, and ultimately their desire to become a consumer.

H 4 : The pricing of a product plays a significant role in customer satisfaction.

Role of Product Packaging on Consumer Satisfaction

Packaging and labeling can be considered one of the most important tools in marketing and communication, which means that a thorough examination of their components and their relationships with consumer buying behavior is necessary. According to Joewono and Kubota (2007) , consumer satisfaction results from product and service reviews based on customer perceptions and a broad assessment of the overall consumption experience. It is suggested that customer satisfaction affects repurchase intentions and actions, which, in turn, determine potential sales and revenue for a company. According to Zeithaml (2000) , consumer satisfaction is measured on a multidimensional scale that includes service quality, product quality, scenario factors, personal factors, and price factors.

Product packaging plays a variety of roles. It provides information about the product and the company, connects them with customers, and ensures product quality ( Naseem et al., 2020 ; Rambabu and Porika, 2020 ). It is important to remember that packaging has a significant influence on customers and their purchasing decisions. Consumers react positively to quality, color, and content. Similarly, if a product is labeled with accurate information about the product, it increases the value of the product. Consumers respond to a product’s specific name, ingredients, and packaging. Many consumers are concerned about the way a product is designed and advertised. Although the quality of the product itself may vary, the effect of packaging on customer purchasing decisions is important.

H 5 : Product information available on labels plays a significant role toward customer satisfaction.

Theoretical Support of the Study

The following research was conducted to investigate underlying issues. This study is a continuation of expectancy disconfirmation theory (EDT) and social cognitive theory (SCT). Both theories provide a strong background for conducting this research. According to EDT, the satisfaction of consumers is linked to the expectation and perception of product quality. A consumer sets an expectation before examining a product in real time. This comparison of preset expectations with real-sense performance is the basis of EDT. In this study, consumer satisfaction plays a mediating role between product pricing, product packaging, and consumer buying behavior. The expectations of consumers are based on the price of the product, information on product packaging, and perceived quality.

The other central backbone of this research is SCT, developed by Bandura (2012) , which explains that learning takes place in a social context with a complex and reciprocal relationship between the individual, their environment, and their actions. The emphasis on social relationships, and also external and internal social reinforcement, is a distinctive feature of SCT. SCT considers the specific ways in which people maintain their behavior and interact with others. It also considers the specific ways in which people learn and sustain behaviors and the social context in which they do so. According to this theory, past experiences strengthen ideas and expectations, all of which affect whether a person maintains his/her attitudes. Many behavioral models that are used in studies related to health do not include behavior maintenance; instead, they focus on behavior initiation. This is a shame because the real purpose of public health is to maintain conduct rather than initiate it. SCT aims to illustrate how people monitor and reinforce their actions to achieve goal-directed behavior that can be managed. Thus, the product pricing and packaging of a product with useful information on labels will surely correlate with consumer buying behavior that will persist. The customer will buy or not buy in the future on the basis of the expectations and perceptions of the product once his behavior about the product has already been initiated. A conceptual framework was developed to focus on the specific variables. The framework consists of the hypotheses shown in Figure 1 .


Figure 1. Theoretical framework.

Research Methodology

The research methodology of a study represents an essential and integral part of the entire process and explains how science contributes to aims. The behavioral approach of respondents, i.e., expectations, evidence, observations, knowledge of reality, and individual point of view, can be summarized by analytical parameters. According to James and Vinnicombe (2002) , the assurance of objectivity in the scientific procession is compulsory. Furthermore, a perspective emphasizing social variable is considered essential by the society for practical implications ( Blaikie, 2007 ). Their innovative discoveries and interpretation are leading activities of label research.

Research Design

In this research, the structure of behavior science by Zechmeister et al. (1997) is followed with mediation and description for the problem-solving process. The main focus of this research is the state of mind, mood swings, variations in feelings, and behavior toward the specific situation of the respondents. In addition, the organizational performance in the market and consumer buying behavior can solve many problems by approaching the cooperative feedback process with peers and accumulating knowledge. The analysis of buying behavior may be categorized as “co-oriented” or “comparative.” According to behavioral science, these two factors have real meaning. This study seeks to understand the effect of product pricing and packaging on the buying behavior of consumers. At the same time, satisfaction plays its role as a mediating variable ( Zechmeister et al., 1997 ; Bollen and Pearl, 2013 ). For data collection, self-administered questionnaires were used for quantitative analysis.

Study Population

The sample of this study comprises students from different universities in China. The main reason for choosing university students is that recent research concentrates on product pricing with consumer buying behavior while considering university students as their population. The population selection is based on the area of interest and importance, which covers the objectivity of this research. Divergent online and offline sources were used to collect analytical data. The questionnaires were circulated among 500 students, and the 367 replied to us regarding that, and so the aggregate received response was 73%. Seventeen answers received from respondents were rejected due to incomplete information, and 350 were finalized for the analytical process. This study used convenience sampling for data collection. Bonds-Raacke and Raacke (2012) suggested that field examinations should use a questionnaire. The researcher used a questionnaire to collect the data in this study. SPSS software was used to check the quality, validity, and scale reliability of the instrument.

Data Analysis and Results

SPSS and AMOS software were used for the data analysis. Table 1 presents the reliability analysis results. Product pricing and product information are independent variables in this study, whereas consumer buying behavior is a dependent variable. In this study, satisfaction is mediated between two independent variables and one dependent variable. All variables have acceptable reliability alpha values.


Table 1. Reliability analysis.

Table 2 shows the descriptive statistics. The mean value of product pricing is 3.4, where product information has a mean value of 3.9, satisfaction has a mean value 3.6, and consumer buying behavior has a mean value of 3.8.


Table 2. Descriptive statistics.

The product price measuring scale was introduced by Lichtenstein et al. (1993) . The Likert scale ranges from strongly agree to strongly disagree, and this scale was used in this research with slight modifications. The Lichtenstein et al. (1993) ranking was further verified by confirmatory factor analysis (CFA) analysis to meet the requirements of this research. The measuring scales of Brun et al. (2014) and Zekiri and Hasani (2015) were used to measure the product packaging and customer satisfaction. The behavior of consumers toward buying decisions, the measurement scale of Bagga and Bhatt (2013) is used with slight modification to fit the scale for scope and broaden the view of this research. All predefined models/scales were rated on 5-point Likert scale, with higher numerical values indicating greater satisfaction.

Confirmatory Factor Analysis

The pooled CFA is more reliable than other versions and the most up-to-date approach. The AMOS 24 is used to check the relationship among variables ( Afthanorhan et al., 2014 ; Chong et al., 2014 ).

The results of Table 3 declare the structural fitness of the model by meeting all criterion requirements. The reliability values or factor loading of individual items are presented in Figure 2 . The findings of Table 4 have also covered the composite reliability of a wide scale. The composite reliability is indicated by the reliability of the measurement scales while reporting reliability ( Netemeyer et al., 2003 ).


Table 3. Pooled CFA model fitness tests.


Figure 2. Pooled confirmatory factor analysis.


Table 4. Factor loading of items.

Assessment of Discriminant Validity

Discriminant validity was measured using HTMT analysis by considering two determinants, i.e., supposed to be related or unrelated. The value of cut-off criteria for strict discriminant validity was 0.850, and for liberal discriminant validity it was 0.900 ( Henseler et al., 2015 ), obtained by employing discriminant validity. The following discriminant validity criteria have provided the results of Table 5 .


Table 5. HTMT analysis.

Path Analysis in Structural Equation Modeling

In this study, structural equation modeling was used to determine the proposed relationships. Exogenous variables were included in this analysis to allow for the study of endogenous variables using AMOS 24. Here, we can see whether the independent and dependent variables are linearly related to each other. The analytical observations and their mean values are tabulated and linked with the collected information. The results of Table 6 declare the structural fitness of the model by meeting all criterion requirements.


Table 6. SEM, model fitness tests.

Figure 3 shows the direct effects of the independent variables on the dependent variable. In this figure, the mediator variable is missing from this path analysis diagram to capture the direct correlation of the independent variable on the dependent variable.


Figure 3. Direct effects of path analysis.

Table 7 shows that H 1 , H 3 , and H 5 are statistically significant, and their P-value is less than 0.05, which shows the 95% confidence interval. The structural equation modeling with the path analysis is presented in Figure 4 . The path analysis declared the nature of variables, i.e., two variables are independent: one is the mediator and the other one is dependent.


Table 7. Results of indirect effects.


Figure 4. Indirect direct effects of path analysis.

The findings of Table 8 indicate that both hypotheses are statistically significant, but the observed mediation values for these hypotheses differ. H 2 is statistically significant but has a full mediation effect, whereas H 4 is statistically significant and has a partial mediation effect.


Table 8. Results of indirect effects.

Hypothetical Results

The results of the hypothesis are shown in Table 9 in a more detailed and comprehensive manner. To calculate the standard error with T and P-values and the significance of the path coefficient, bootstrapping (1,000 subsamples) was used, which provided direct evidence of the hypotheses being accepted or rejected. The structural model analysis results show the path coefficients and their significance levels, as presented in Table 9 . The findings confirmed that all five relationships were significant, and it can be concluded that H 1 , H 2 , H 3 , H 4 , and H 5 were supported.


Table 9. Hypothesis results.

According to Sisodiya and Sharma (2018) , the marketing mix has a significant influence on the buying behavior of consumers. In this study, the main principle in packaging is to “reach a greater height of opportunity.” It is often regarded as a critical component of purchase decision making, and has often been shown to be a way of building market awareness and connecting with consumers outside the product itself and across several channels ( Rambabu and Porika, 2020 ; Sadiq W. et al., 2020 ). Packaging performs multidimensional functions. It can not only offer knowledge about products and business entities, but it is also a technique for communicating with consumers and safeguarding product quality ( Silayoi and Speece, 2007 ). Pricing can be considered one of the most vital and essential elements that can influence consumer buying behavior or the buyer decision process ( Dhurup et al., 2014 ; Sadiq W. et al., 2020 ).

According to Kotler et al. (2012) , customer satisfaction “is the extent to which a product’s perceived performance matches the buyer’s expectations.” Aslam et al. (2018) stated that price has a positive and significant correlation with customer satisfaction. Furthermore, they believed that the success of the sector was based on price fairness and customer satisfaction. Previous studies have also discussed this phenomenon in connection with other geographical locations. The price factor is more relatable to consumer buying behavior than product packaging ( Jabarzare and Rasti-Barzoki, 2020 ; Huo et al., 2021 ). Product pricing has a greater influence than product packaging on the buyers’ decision processes ( Pratama and Suprapto, 2017 ; Abdullah et al., 2021 ). Innovation in product packaging also has a significant relationship with the consumer; however, if any organization wants to follow a strategy that is relevant to its product packaging, then there are several strategies for this kind of plan of action. Most consumers desire a range of product choices when purchasing, in terms of packaging. Thus, the marketer should place a premium on creative and exclusive packaging that is distinctive in terms of scale, instruction, convenience, product design, and form when compared to rivals in market segmentation ( Rundh, 2009 ; Bollen and Pearl, 2013 ). Product packaging serves as an excellent networking medium for target customers, eventually increasing their knowledge levels. Packaging must convey pertinent details about the product and brand, including ingredient composition, intent, and consistency. In addition, packaging should provide all of this material in regional languages to demonstrate respect for consumers. Efficient packaging is critical not only for storing and protecting goods but also for generating interest in and action toward buying the commodity. Currently, eco-friendly packaging is essential. Thus, advertisers should prioritize this factor and employ best practices to the maximum degree possible, including eco-friendly recyclable packaging ( Deliza and MacFie, 2001 ; Abdullah et al., 2021 ).

Conclusion and Recommendations

The study results clearly show that both product pricing and packaging have a statistically significant relationship with the buyer’s decision process. At the same time, the introduction of satisfaction leads to the observation of full mediation in the case of product pricing and partial mediation in product packaging. Despite knowing that both the variables have a statistically significant relationship with the consumer buying behavior, it is essential to understand the managerial implications. Suppose, we would like to report and recommend these findings to different organizations looking to cut their operational costs in any possible way without compromising product quality, we suggest in such cases that they focus on pricing strategies for a better consumer response. A focus on the product packaging design process, packaging material, or the information available on product packaging positively influences consumer buying behavior. However, its effect is lower than product pricing. Therefore, it is recommended for managers that if they want to connect with their target customers more efficiently and effectively, they should focus on both product pricing and packaging options. However, if they can afford only one option from the product’s operational cost perspective, they must focus on product pricing strategies.

In future studies, it must be kept in mind that these findings pertain directly to the individuals listed as respondents. To make it more accurate, other demographic, psychographic, and geographic samples should be used. It is likely that when data are thus obtained, the findings will differ. To ensure more lasting and repeatable corporate outcomes, several studies are required to obtain results that are more accurate and reliable.

Data Availability Statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author Contributions

HZ, XY, and ZL contributed to conception and design of the study. HZ organized the database, performed the statistical analysis, and wrote the first draft of the manuscript. XY, ZL, and QY wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

This work was funded by the National Natural Science Foundation of China (52065010), Open Fund of Key Laboratory of Advanced Manufacturing Technology, Ministry of Education (GZUAMT2021KF[07] and GZUAMT2021KF[08]), Natural Science Research Project supported by the Education Department of Guizhou Province [Grant Nos. (2018)152 and (2017)239], Humanities and Social Science Research Project of Guizhou Provincial Department of Education (Grant No. 2018qn46), and the Guiyang University Teaching Research Project (Grant No. JT2019520206).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


CFA, Confirmatory Factor Analysis; RMSEA, Root Mean Square of Error Approximation; CFI, Comparative fit index; EDT, Expectancy Disconfirmation Theory; SCT, Social Cognitive Theory.

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Keywords : product pricing, product packaging, consumer buying behavior, consumer satisfaction, confirmatory factor analysis, structural equation modeling

Citation: Zhao H, Yao X, Liu Z and Yang Q (2021) Impact of Pricing and Product Information on Consumer Buying Behavior With Customer Satisfaction in a Mediating Role. Front. Psychol. 12:720151. doi: 10.3389/fpsyg.2021.720151

Received: 03 June 2021; Accepted: 08 October 2021; Published: 13 December 2021.

Reviewed by:

Copyright © 2021 Zhao, Yao, Liu and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Huiliang Zhao, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


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