content analysis based literature review

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Supply Chain Management

ISSN : 1359-8546

Article publication date: 3 August 2012

Inconsistent research output makes critical literature reviews crucial tools for assessing and developing the knowledge base within a research field. Literature reviews in the field of supply chain management (SCM) are often considerably less stringently presented than other empirical research. Replicability of the research and traceability of the arguments and conclusions call for more transparent and systematic procedures. The purpose of this paper is to elaborate on the importance of literature reviews in SCM.

Design/methodology/approach

Literature reviews are defined as primarily qualitative synthesis. Content analysis is introduced and applied for reviewing 22 literature reviews of seven sub‐fields of SCM, published in English‐speaking peer‐reviewed journals between 2000 and 2009. A descriptive evaluation of the literature body is followed by a content analysis on the basis of a specific pattern of analytic categories derived from a typical research process.

Each paper was assessed for the aim of research, the method of data gathering, the method of data analysis, and quality measures. While some papers provide information on all of these categories, many fail to provide all the information. This questions the quality of the literature review process and the findings presented in respective papers.

Research limitations/implications

While 22 literature reviews are taken into account in this paper as the basis of the empirical analysis, this allows for assessing the range of procedures applied in previous literature reviews and for pointing to their strengths and shortcomings.

Originality/value

The findings and subsequent methodological discussions aim at providing practical guidance for SCM researchers on how to use content analysis for conducting literature reviews.

• Supply chain management
• Literature review
• Research process
• Content analysis
• Replicability
• Research results
• Research methods

Seuring, S. and Gold, S. (2012), "Conducting content‐analysis based literature reviews in supply chain management", Supply Chain Management , Vol. 17 No. 5, pp. 544-555. https://doi.org/10.1108/13598541211258609

Emerald Group Publishing Limited

Copyright © 2012, Emerald Group Publishing Limited

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A Content-Analysis Based Literature Review in Blockchain Adoption within Food Supply Chain

Affiliations.

• 1 Blockchain Research Center of China, Southwestern University of Finance and Economics, Chengdu 611130, China.
• 2 Southampton Business School, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
• 3 School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
• PMID: 32182951
• PMCID: PMC7084604
• DOI: 10.3390/ijerph17051784

According to the World Health Organization (WHO), one out of 10 people get sick from eating contaminated food. Complex food production process and globalization make food supply chain more delicate. Many technologies have been investigated in recent years to address food insecurity and achieve efficiency in dealing with food recalls. One of the most promising technologies is Blockchain, which has already been used successfully in financial aspects, such as bitcoin, and it is attracting interests from food supply chain organizations. As blockchain has characteristics, such as decentralization, security, immutability, smart contract, it is therefore expected to improve sustainable food supply chain management and food traceability. This paper applies a content-analysis based literature review in blockchain adoption within food supply chain. We propose four benefits. Blockchain can help to improve food traceability, information transparency, and recall efficiency; it can also be combined with Internet of things (IoT) to achieve better efficiency. We also propose five potential challenges, including lack of deeper understanding of blockchain, technology difficulties, raw data manipulation, difficulties of getting all stakeholders on board, and the deficiency of regulations.

Keywords: blockchain; food supply chain.

Publication types

• Research Support, Non-U.S. Gov't
• Blockchain*
• Food Supply*

• Open access
• Published: 29 April 2024

Development and psychometric evaluation of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS): a sequential exploratory mixed-method study

• Saleheh Tajalli   ORCID: orcid.org/0000-0002-2045-6430 1 ,
• Abbas Ebadi   ORCID: orcid.org/0000-0002-2911-7005 2 ,
• Soroor Parvizy   ORCID: orcid.org/0000-0002-9361-9923 3 , 4 &
• Carole Kenner   ORCID: orcid.org/0000-0002-1573-5240 5  

BMC Nursing volume  23 , Article number:  297 ( 2024 ) Cite this article

Metrics details

Caring ability is one of the most important indicators regarding care outcomes. A valid and reliable scale for the evaluation of caring ability in mothers with preterm infants is lacking.

The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants.

A mixed-method exploratory design was conducted from 2021 to 2023. First the concept of caring ability of mothers with preterm infants was clarified using literature review and comparative content analysis, and a pool of items was created. Then, in the quantitative study, the psychometric properties of the scale were evaluated using validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 401 mothers with the mean age of 31.67 ± 6.14 years to assess the construct validity.

Initial caring ability of mother with preterm infant scale (CAMPIS) was developed with 64 items by findings of the literature review, comparative content analysis, and other related questionnaire items, on a 5-point Likert scale to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS. So, the initial survey yielded 201 valid responses. The three components: 'cognitive ability'; knowledge and skills abilities'; and 'psychological ability'; explained 47.44% of the total observed variance for CAMPIS with 21 items. A subsequent survey garnered 200 valid responses. The confirmatory factor analysis results indicated: χ2/df = 1.972, comparative fit index (CFI) = 0.933, and incremental fit index (IFI) = 0.933. These results demonstrate good structural, convergent, discriminant validity and reliability. OMEGA, average inter-item correlation (AIC), intraclass correlation coefficients (ICC) for the entire scale were at 0.900, 0.27 and 0.91 respectively.

Based on the results of the psychometric evaluation of CAMPIS, it was found that the concept of caring ability in the Iranian mothers with preterm infants is a multi-dimensional concept, which mainly focuses on cognitive ability, technical ability, and psychological ability. The designed scale has acceptable validity and reliability characteristics that can be used in future studies to assess this concept in the mothers of preterm infants.

Peer Review reports

Introduction

In recent years, the technology advancements in the field of caring for mothers during pregnancy and delivery, and their infants resulted in increased survival of preterm infants [ 1 ]. According to the assessment of the world health organization (WHO), the prevalence of preterm birth globally is 10.6% [ 2 ].

Preterm birth is often an unexpected event for women [ 3 ], and hospitalization in the NICU is considered unavoidable [ 4 ]. The birth of a preterm infant and hospital stay in the NICU is very stressful for parents. The source of this stress includes the medical condition and parental separation from their infant. Mother-infant separation often results in the feelings of anxiety, fear, depression thus potentially decreasing the mother’s sensitivity to infant cues, which in turn, may delay infant development [ 5 ]. Many mothers experience acute stress disorder, which can last from 3 days to 1 month. It can be associated with symptoms such as troublesome memories, frequent and annoying restlessness and sadness, as well as post-traumatic stress [ 6 ].

The feeling of loss is a source of suffering and grief for the mothers of preterm infants. In the initial days following birth, the primary focus of parents is often on the infant's chances for survival. However, as time passes, this preoccupation can evolve into a potential cause of grief, anxiety, and feelings of culpability (related to an incomplete pregnancy)[ 6 ]. Therefore, in some cases, the mothers cannot focus on their preterm infants. Becoming a mother requires reorganizing and changing one’s personal identity. Mothers must change their identity from being a daughter and a wife in the generation to which they belong to being a mother for the next generation. They start this process from the pregnancy period, initially fantasizing about motherhood [ 7 ]. However, at the end of the pregnancy period, with the birth of a preterm infant, this process stops. In fact, preterm birth is a sudden stop in the process of mother's self-representation [ 8 ]. Consequently, the experience of transitioning into motherhood for women who give birth prematurely may differ from that of others. This is due to the fact that the psychological readiness and preparation required for assuming the role of a mother comes to an abrupt halt upon the premature birth of their infant. As a result, these women are forced to quickly adapt to their new circumstances [ 9 ].

Review of literature shows caring ability concept have three dimensions: cognitive, knowledge and patience [ 10 ]. Published caring ability scales evaluate ability of take care in informal caregiver of patient with cancer named ‘caring ability of family caregivers of patients with cancer scale (CAFCPCS)’ [ 11 ] or professional care giver named ‘The caring ability inventory’[ 10 ]. Also, published tools, focused on others aspects of take caring ability. So family empowerment tool named ‘Family Empowerment Scale’ [ 12 ], asses the empowerment of family members of patients with chronic disease as an outcome of taking care empowerment. The parent Engagement tool is another scale named ‘parent risk evaluation and engagement model and instrument (PREEMI)’ that evaluates parent risk evaluation and engagement of mothers with preterm infants [ 13 ]. The discharge preparedness scales were ‘perceived readiness for discharge after birth scale (PRDBS) and ‘Parent discharge readiness’ [ 14 ], that evaluate readiness for discharge. These evaluate postpartum mother’s perceptions of readiness for discharge from the hospital that was adapted from a scale measuring adult and elderly postsurgical patients’ perceptions of their readiness for discharge. Also assert for readiness is different from the ability to continue taking care after discharge. The scales 'Perceived maternal parenting self‐efficacy (PMP S‐E)' and 'Self‐efficacy in infant care scale' [ 15 , 16 ] were developed to assess the caregiver's belief in their ability to effectively care for their child, with a specific emphasis on self-confidence. These scales aim to provide a means of measuring the caregiver's expectations regarding the outcomes of their caregiving efforts. Although our previous study show a mother with optimal caring ability has sufficient cognitive ability, technical ability, and psychological ability [ 17 ]. This is a clear gap in the designed scale that could be overcome by a new scale that focuses take caring ability of mother with preterm infants. To sum up, there is no scale developed for the caring ability of mothers with preterm infants; therefore, the purpose of this study is to examine the real-life experiences of mothers with preterm infants and other professional and family. Caregivers, who have directly experienced taking care of preterm infants in order to then, design and perform the psychometric evaluation of a tool to assess the caring ability of mothers with preterm infants.

The purpose of this study was to develop a preterm caring ability scale and to examine its psychodynamic properties in mother of preterm infants with gestational age less than 32 weeks.

This study utilized a mixed-method exploratory design to develop and psychometric evaluate the caring ability of mother with preterm infant scale (CAMPIS) from July 2021 to October 2023. The research involved both mothers and professionals caring for preterm infants. The research consisted of two main phases: first, a qualitative study was conducted to generate the scale items, followed by a quantitative approach to evaluate the psychometric properties of the scale.

First step: qualitative study and item generation

The purpose of this step was to explain the concept of caring ability in the mothers of preterm infants, and to create a set of items to design the target scale. This step involved the identification of concepts through literature review published from 1995 to 2020 [ 17 ] .

In the second step, 18 semi-structured individual interviews of 60–80 min were organized to understand better the caring ability of mother with preterm infant concept. The face-to-face semi-structured interviews were conducted in a serene setting, either in the hospital room or the participants' home, as per their request and preference. The interviews involved mothers, grandmothers, and fathers, and were carried out without the presence of any other individuals. Due to the coronavirus social distance limitation, the interviews with the physicians and the nurses were conducted online and also recorded via Skyroom software.

We decided to finish the interview, when we interviewed the 18 participants, the information he/she provided is similar to those provided by the former ten participants (data saturation). Totally, 11 mothers, 2 fathers, 2 grandmothers of preterm infants, 1 neonatal nurse, and 2 neonatologists working in these wards participated in the present study. The participants were residents in the NICU in 5 hospitals in Tehran, Iran, representing a range of ages, genders, and caring role. The interview process started with a general question such as "Would you please explain mothers’ ability to take care of a preterm infant?", "In which situations do you feel she are more capable?", and "Which factors decreased her ability?" Then, based on the participant’s responses, the interviews continued with exploratory questions such as "Could you please explain more? or “Could you give an example in this regard?".

All participants were interviewed individually and each interview lasted between 60 and 80 min. The texts of the interviews were analyzed using the using Lindgern et al. [ 18 ] approach by MAXQDA software version 10. Qualitative interview resulted in initial items generation.

Second step: quantitative study and CAMPIS psychometric properties evaluation

Face validity.

Face validity was evaluated through qualitative and quantitative approaches. In the qualitative approach, the scale was sent to 10 mothers of preterm infants, they were asked to evaluate the scale in terms of difficulty, relevance, and ambiguity. The participants assessed the items based on their own judgment, ensuring that they were able to understand them. In order to further evaluate the suitability of the items, five additional mothers were included in the quantitative approach. These mothers were asked to rate the items on a 5-point Likert scale, ranging from completely suitable to not suitable at all. The impact score was calculated through the following equation: impact score = frequency (%) × appropriateness. A score above 1.5 was considered acceptable [ 19 ].

Content validity

The content validity of CAMPIS was evaluated through quantitative and qualitative approaches. In the qualitative approach, the scale was distributed among 22 neonatal nursing specialists, neonatal subspecialists, and scale development specialists to evaluate the items in terms of grammar and wording, item allocation, and scaling.

Then the content validity of the scale was modified by measuring content validity ratio (CVR) and content validity index (CVI) to ensure that the scale measures the intended construct in two separate stages. So, the 26 specialists, as highly knowledgeable about the mother of preterm infant or scale development, were asked to evaluate the items regarding necessity and relevancy. In CVR, 12 specialists evaluated the necessity of CAMPIS on a 3-point Likert scale (1 = not necessary, 2 = useful but not necessary, and 3 = necessary). CVR was calculated through the following formula: [ne – (N/2)]/(N/2), where “ne” is the number of the experts who rate the items as “essential”, and N is the total number of the items. The result was interpreted using Lawshe's content validity ratio [ 20 ].

Following the implementation of the required modifications based on the feedback provided by experts, the effectiveness of CAMPIS was further evaluated by 14 additional specialists in terms of the CVI. This evaluation was conducted using a four-point Likert scale, where a score of 1 indicated irrelevance, 2 denoted relative relevance, 3 represented relevance, and 4 signified complete relevance. The I-CVI, Kappa statistic, and S-CVI/Ave were computed to assess the content validity index at both the item-level and scale-level. A Kappa value exceeding 0.75 was deemed indicative of excellent agreement [ 19 ].

Item analysis

Before construct validity of the structure, the items were analyzed to identify the possible problems. At this step, 48 mothers of preterm infants, with the mean age of 31.88 ± 5.9 years, were selected through convenience sampling and enrolled. They were asked to identify that there were problems such as inappropriate reverse questions. Also they were asked to completed the hardcopy of CAMPIS and item-total correlations was evaluated for some items. A correlation coefficient lower than 0.32 or above 0.9 was considered as the criteria for removing the items [ 19 ].

Participants

The sample included the mothers of the preterm infants with a gestational age < 34 weeks. The criteria for entering the study consisted of the infant’s having been hospitalized in the NICU for more than two weeks, the infant’s not suffering from any major congenital anomalies, giving consent to participate in the study, and being able to use social networks such as WhatsApp. Based on the rule of thumb, that is, which considers 200 participants as an appropriate sample size [ 19 ], 401 mothers were considered for two phases at this step: 201 for the exploratory factor analysis (EFA) assessment, and 200 for the confirmatory factor analysis (CFA).

The participants were selected using convenience sampling through being in the hospital on the day of discharge, membership in the social groups related to following up mothers with preterm infants discharged from the NICU, and recommendations. In this step, data was collected online. For this purpose, an online questionnaire was created through the Porsline form, and its URL link ( https://survey.porsline.ir/s/d8uW4Jp ) was sent to the participants through the Telegram or WhatsApp social network applications (as the most common social networks among Iranian users).

The questionnaire used in this step included two parts. The first part was related to the infant's demographic characteristics, such as the infant's gender, and gestational age, and the mother's demographic characteristics, such as the mother's age, the infant's age, the mother's education, mothers' parity, assisted reproductive methods, the type of delivery, and previous experience in caring for infants. The second part included initial CAMPIS, with 38 items, for measuring the concept of the caring ability of mothers with preterm infants, on a five-point Likert scale (1 = never to 5 = always).

Construct validity

The construct validity of this scale was evaluated using EFA and CFA by SPSS 26 (SPSS Inc., Chicago, IL, USA). According to normal distribution of variables (skewness of ± 3, kurtosis of ± 7 and Mardia's coefficient less than 20) EFA was evaluated through Maximum likelihood factor analysis using Promax rotation. In addition, Kaiser–Meyer–Olkin (KMO) and Bartlett tests were used to estimate the adequacy and the appropriateness of the sample. KMO values higher than 0.9 were interpreted as excellent [ 19 ]. In order to extract the factors according to Thompson and Daniel recommendation [ 21 ] multivariate approach was used to identify the number of factors to extract in the EFA.

Then the factors were analyzed using the method of maximum likelihood analysis, which is one of the most common methods of data reduction. At first, 5 factors had an eigenvalue greater than 1, but considering that 3 factors explained an eigenvalue greater than 1.5 and a variance greater than 5%.

To extract the factor structure, exploratory graph analysis was used. The actual values ​​of the matrix were compared with the randomly generated matrix. The number of the components which have a higher variance in comparison with the components obtained from random data, after successive repetitions, is considered as the correct number of factors for extraction [ 22 ]. A factor loading of approximately 0.3 was considered to determine the presence of an item in a latent factor, and the items with communalities < 0.2 were excluded from EFA. The factor loading was estimated using the following formula: CV = 5.152 ÷ √ (n—2), where CV is the number of the extractable factors, and N is the sample size.

In the next step, the factor structure determined by EFA was evaluated by CFA. For this purpose, CFA was evaluated using Maximum likelihood factor analysis and the most common goodness-of-fit indices using SPSS/AMOS 26 software [ 22 ].

To discuss the fitness of the model on CFA, we can consider the various criteria for model fit indices. It has been suggested that Root Mean Square Error of Approximation (RMSEA) values less than 0.05 are good, and values between 0.05 and 0.08 are acceptable [ 23 ]. Therefore, the RMSEA value of 0.059 in this sample indicates an acceptable fit. The goodness of fit index (GFI) value of this sample, 0.88, is below 0.9, but the GFI is known depending on the sample size [ 24 ]. The frequency interference index (RFI) value, 0.085, is close to 0.9, which shows a relatively good fit [ 25 ]. The other fit indices, comparative fit index (CFI), incremental fit index (IFI), and Tucker-Lewis index (TLI), should be over 0.9 and parsimonious normed fit index (PNFI) should be over 0.5 for a good fit [ 25 ].

Reliability

The reliability was evaluated using internal consistency, stability, and absolute reliability approaches with SPSS 26. The internal consistency was evaluated using, McDonald's omega (Ω), and average inter-item correlation (AIC). The McDonald Omega of 0.7 or above, and the AIC of 0.2 to 0.4 were considered as acceptable criteria to evaluate the internal consistency. The consistency of CAMPIS was evaluated through calculating intraclass correlation coefficients (ICC) using a two-way random effects model [ 19 ]. The retest method with a time interval of 72 h (the day before discharge and 72 h after discharge) was used in 48 mothers with preterm infants. An ICC value > 0.8 is considered as the acceptable value for stability. In addition, the absolute reliability was evaluated using the standard error of measurement with the formula Standard Error of Measurement (SEM) = SD √ (1- ICC).

Finally, the responsiveness was evaluated using minimum detectable change (MDC) with the formula MDC = SEM × Z × √ 2, and minimal important change (MIC) with the following formula: MIC = SD × 0.5. If the MIC is smaller than the MDC, the scale is responsive. Besides, the interpretability was evaluated through calculating the MDC and testing the hypothesis [ 22 ].

Ethical consideration

The present study was extracted from the nursing Ph.D. thesis fund by Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. All ethical considerations of the study were approved by the ethics committee at the University of Medical Sciences (IR. IUMS. REC.1398.1407).

In qualitative step a total of 43 articles were selected in the study after reviewing 23291 extracted articles. We explored attribute of take caring ability concept. Findings showed a mother with optimal caring ability has sufficient knowledge, high skills, a sense of sufficient self-efficacy [ 17 ]. This step resulted in 69 initial items generation.

Using the findings of the literature review, comparative content analysis, and other related questionnaire items, the research teammates designed the initial items to measure the caring ability of mothers with preterm infants. An example of item generation has been presented in Table  1 . Then all the initial items (n: 104) were reviewed, and the generation of items was completed. In the selection of items, the focus was mainly on the features of the concept. The items of the pool were examined during joint meetings with the research team, and the items that were not in line with the purpose of this study were omitted according to experts’ opinions. First, repetitive descriptive items were deleted. For example, “I have access to healthcare providers and whenever I have questions, I can ask them” and “A healthcare provider answers my questions regarding the care of my child all day long 7 days a week.” This step resulted in 71 items. In the next step, the items with similar descriptions items were combined. For example, “I simply understand my child's needs.” and “When my child severely cries, I can figure out what my child wants.”

Therefore, at this step, CAMPIS was developed with 64 items, descriptions about behaviors and attitudes, on a 5-point Likert scale (always, most of the time, sometimes, rarely, never) to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS.

In quantitative study and CAMPIS psychometric properties evaluation phase the impact score evaluation of face validity step, score of all items were above 1.5, and was considered appropriate. According to degree of mothers’ judgement all items of CAMPIS were appropriate to assessment of take caring ability. Therefore, no item was deleted.

During the process of content validity, some items were modified according to panelist feedbacks. While evaluating content validity, in the qualitative approach, 8 items were merged into one item based on the suggestion of the expert panel. Regarding number of participants for CVR were 12, the minimum acceptable CVR score was 0.56. In this step, the CVRs of 7 items were less than 0.56 and removed. In the CVI assessment, the I-CVI for all the items was in the range of 0.83–1, the modified Kappa was in the range of 0.84–1, and the total S-CVI/Ave and S-CVI/UA were 0.93 and 0.40 respectively. In content validity step according to the results, the Kappa values of 8 items were lower than 0.75, so they were removed. Therefore, 23 items were eliminated and the total number of CAMPIS was reduced from 64 to 41 items in content validity evaluation step.

In the item analysis step, the item-total correlation for 3 items was 0.32 or less, therefore were removed. The final CAMPIS with 38 items entered the factor analysis step.

In construct validity step, totally 401 mothers with a gestational age of 34 weeks or less participated in the present study. Their infants did not have any major surgical problems/anomalies, and had been hospitalized in the NICU for more than two weeks. The mean age of the mothers was 31.77 ± 6.02 years, with the minimum age of 16 and the maximum of 53 years. Out of 401 mothers, 204 (50.87%) had other children. All of them were married and lived with their spouses. The details of the socio-demographic characteristics of the participants have been shown in Table  2 .

In the construct validity phase, based on the results, the sample’s KMO and Bartlett's values were sufficient and appropriate, 0.897 and 1758.593, respectively ( P  ≤ 0.001). In this step, 17 items were removed as their shared values ​​were less than 0.2 and their factor loadings were less than 0.3. After Promax rotation, 3 factors (totally 21 items) were extracted: cognitive ability (9 items), technical ability (7 items), and psychological ability (5 items). These factors respectively explained 30.59, 9.62, and 7.28% of the total variance (47.44%) of the concept of the caring ability of mothers with preterm infants. The details of the factor analysis result have been presented in Table  3 .

Based on CFA indices, this sample has an acceptable fit to the 3 factors model and all of these indices in our study are excellent. The results of model fit indices have been given in Table  4 .

Prior to modeling modification, the goodness of fit measures for the CFA-generated 3-factor model indicated that the model fit but not optimally. To improve the factor structure model, we identified the following item content redundancies: Item 24 (If I see signs of an feeding difficulties, I know what to do) is related to Item 23 (I can recognize the signs and symptoms of shortness of breath and cyanosis), and item 8 (Given that my baby was born preterm, I am aware of the differences in growth and development with other babies.) is related to item 7 (I have enough information about my baby being preterm and its complications.).

Also, item 18 (I'm afraid my baby might be harmed.) is related to item 17 (I do not sleep well because I am worried about my baby's health.) Given the similarities of conceptual meaning, these correlated error terms indicated that these variables may share specific variances.

As shown in Fig.  1 , the aforementioned changes improved the goodness of fit of the model. This indicated the model of the caring ability of mothers with preterm infants fits the data (Fig.  1 ).

The results of CFA showed that a three-factor model of the care ability of the mothers with preterm infants indicated that the model fitted well. F1: Cognitive Ability; F2: Knowledge and Skills Abilities; F3: Psychological Ability

The retest method with a time interval of 72 h (the day before discharge and 72 h after discharge) was used in 48 mothers with preterm infants. An ICC value > 0.8 is considered as the acceptable value for stability. In addition, the absolute reliability was evaluated using the standard error of measurement with the formula Standard Error of Measurement (SEM) = SD √ (1- ICC). The details of the responsiveness are reported in Fig.  1 .

The results of McDonald Omega coefficient (ω = 0.90), and AIC (0.27) for the 3 factors were excellent. Based on the result, the ICC was 0.91 in the confidence interval of 0.84%-0.95%, which shows that the tool has acceptable measurement stability over time. Based on the SEM results, the absolute reliability was 3.18. This value shows that the scale scores of an individual vary ± 3.18 in repeated tests (Table  5 ). Based on the results, MDC = 8.78, MDC% = 11.79 and MIC = 0.50, this scale is responsive and interpretable.

The study’s results demonstrated that the concept of caring ability in mothers with preterm infants has three dimensions: cognitive ability, knowledge and skills abilities, and psychological ability. Therefore, CAMPIS is a valid and reliable scale to assess this concept in mothers with preterm infants. This scale includes 21 items, and three factors, cognitive, knowledge and skills, and psychological abilities, which explained 47.44% of the total variance of this concept. The CAMPIS model obtained through EFA was confirmed using CFA.

CAMPIS has three factors: "cognitive ability ", "knowledge and skills abilities" and "psychological ability". The first factor extracted from the scale was "cognitive ability". This factor includes 9 items regarding perception skills, cognitive skills, decision-making skills, movement skills, and attitude, which were extracted with the highest variance (30.59%). Cognitive abilities are the skills that a person needs to do anything from the simplest to the most complex, including perception skills, decision-making skills, movement skills, language skills, and social skills [ 26 ]. Cognitive abilities are the link between behavior and the brain structure, which include a wide range of abilities including planning, paying attention, problem solving, performing tasks simultaneously, and cognitive flexibility [ 27 ]. In this scale, cognitive ability was defined as the ability of a mother with a preterm baby to use skills which help her process information, think, reason, and solve problems faster and more efficiently. By developing cognitive skills, a person can go through the process of reasoning, decision making, and taking action. In this way, she can make sure that she can perceive the new situation, and perform her role effectively. The findings of a study conducted in 2004 showed that the mother’s possessing the desired attitudinal-cognitive ability had a significant impact on the infant’s health [ 28 ].

The second factor extracted from the scale was "technical ability". This factor includes 7 items regarding care knowledge and skills, as well as the ability to apply them; it was extracted with an acceptable variance (9.62%). In the science of care, knowledge is defined as the caregiver's awareness of the care recipient’s needs, strengths, and weaknesses as a unique member [ 10 ]. Moreover, in a study conducted by Galvin et al. in 2017, which was conducted with the aim of investigating the analytical features of the concept of readiness for discharge from the hospital, having sufficient knowledge and skills was mentioned as one of the characteristics of readiness for discharge [ 29 ]. In this scale, knowledge-skill ability is defined as that the mother’s awareness of the tasks that she must know how to perform in order to provide effective, efficient, and reliable care for her infant. The mothers of preterm infants often have poor knowledge regarding infant care after discharge [ 30 ], while the main factor which shows the mother's ability to provide care for the infant is having sufficient knowledge and skills. The mother should know what, how, why, and when to provide care for her infant [ 30 ].

The lived experience of the parents with preterm infants showed that in most cases, they are not prepared for the infant’s birth. The birth of a preterm infant puts them in a special situation which requires new care skills [ 31 ]. The parents need to acquire these skills that are a prelude to the discharge and transfer of the infant to home [ 32 ]. Providing quality care for complex disorders requires specialized caregiving knowledge and skills. When there is a deficiency in these areas, negative psychological impact on the parents and their relationship with their infant can ensue [ 33 ]. Studies have shown that having sufficient preparation for discharge and transitional care can help the families of preterm infants with a successful transition from the hospital to the family, reducing the rehospitalization rates [ 34 ]. To this end, health care professionals should provide the parents with useful information regarding illness management, strengthen their relationships with the hospital staff, encourage sharing experiences and emotions, and perform home visits [ 35 ]. The empowerment method should be appropriate to the caregiver's conditions. It should predict the caregiver's psychological condition as well as his/her emotional and behavioral responses. It should be used to train and support the caregiver in decision-making and managing the caregiving situation, considering his/her experiences, social status, cultural level, and beliefs [ 36 ].

The third factor extracted from the scale was "psychological ability". This factor includes 5 items regarding the psychological characteristics of the mothers taking care of preterm infants, with an acceptable variance (7.28%). An individual who is aware of his/her abilities and need for self-dependence, to manage care after discharge, has good psychological ability [ 29 ]. It is necessary to achieve psychological ability for an individual to deal with post-discharge challenges and have control over the situation [ 37 ]. In the present study, the mother's psychological ability is defined as her possessing the psychological characteristics and mental makeup to feel ready to continue care provision after discharge from the NICU, and to be able to fulfill her caring role successfully. During a traumatic event such as an infant's hospitalization in the NICU, the mothers try to improve their psychological ability [ 38 ].

The most mothers of preterm infants are not psychologically prepared for delivery and motherhood [ 39 ]. Preterm birth is considered a sudden and unpredictable event, which is accompanied by a feeling of shock and helplessness. The mothers of preterm infants often describe these conditions using terms such as falling to the bottom of a deep well, and being stuck in a whirlwind and storm happening around them; they admit they do not have enough control over what is happening, and lack the ability to take care of their infants [ 40 ]. Hospitalization in the NICU and mother-infant separation cause a feeling of inadequacy in the mother [ 41 ], which can subsequently affect her psychological ability. This maybe cause using different methods to deal with it. Using ineffective coping methods regarding changes in lifestyle and playing one’s role impacts on mother's caretaking tasks. If the use of ineffective coping methods is not recognized at the right time, and if appropriate measures are not taken, then the nursing diagnosis of coping disability disorder will be imminent [ 42 ]. Improved mental health and sufficient psychological ability are an important prerequisite for behavior change, which acts as a link between awareness and action. It can have a moderating role in empowering individuals, leading to positive thoughts, greater self-esteem and goals, more positive emotions and desirable behaviors [ 43 ]. Therefore, it is very important to measure the psychological ability of the mother in order for her to acquire the ability to provide quality care for the preterm infant.

Being aware of the caring ability of their mothers, as the main care givers, and designing an intervention to improve their caring ability can prevent negative side effects and help to improve the quality of care. The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants. Since one of the main goals of psychometric evaluation and factor analysis is to maximizing the explained variance by the model, in this research, the variance was 47.44%. Among the scales designed to measure caring ability, regardless of factor analysis extraction method, only one scale, the caring ability scale of the caregivers of cancer patients (67.7%), explains variance more than CAMPIS does [ 11 ].

In addition, this CAMPIS had very good internal consistency based on the results of Cronbach's alpha, AIC, and McDonald omega. It should be noted that one of the advantages of this scale is having strong stability based on the ICC value. Another advantage of this study was the assessment of measurement error, responsiveness, and interpretation of the CAMPIS. The results showed that the CAMPIS has the minimum amount of SEM, responsiveness, and interpretability. SEM shows the accuracy of the measurement for each individual, and it is important that this value be small. Responsiveness refers to the ability of a scale to reflect changes in an individual's position over a period. Finally, interpretability refers to the scale's ability to show the significance of changes. These characteristics are an important and necessary part of consensus-based standards for the selection of health measurement tools, which have not been reported in the previous studies on the psychometric characteristics of caring ability.

CAMPIS measures the caring ability of the mother of a preterm infant in the three factors namely ‘Cognitive Ability’ (items: 1–9), ‘knowledge and skills abilities' (items: 10–16), and ‘Psychological Ability’ (items: 17–21). The answer to the items is based on a five-point Likert scale (always (5), most of the time (4), sometimes (3), rarely (2), never (1)). Scoring of items 17,18,19,20 and 21 is reverse so (always (1), most of the time (2), sometimes (3), rarely (4), never (5)). To have an overall score: Sum cognitive ability + sum knowledge and skills abilities + sum psychological ability = Total score. The best way is to calculate the average score for every scale, and compare the results with the average score. In our studies we set the average score for cognitive ability from 9–45, knowledge and skills abilities 7–35, psychological ability 5–25, and overall score 21–105 (Additional file 1 : Appendix A). CAMPIS, is a useful scale for professional caregivers and researchers, thanks to its brief items, good variance, reliability, as well as exclusively belonging to this group.

The findings of this study demonstrated that CAMPIS is a reliable and valid scale with 21 items, which includes the 3 dimensions of attitudinal-cognitive ability, knowledge-skill ability, and psychological ability for measuring the concept of tenacity in family caregivers. Although the exclusiveness of CAMPIS to evaluate the caring ability of mothers with preterm infants is one of the points of strengths in this study, but considering that the samples were selected from the population of Iranian mothers with preterm infants with a gestational age of 34 weeks or less. It should be used with caution in mothers with preterm infants with a gestational age over 34 weeks. Therefore, one of the important limitations was the concern about the generalizability of the findings.

Limitations and strength

In the construct validity step, data collection was done online. Although the use of online questionnaires, especially during the period of social restrictions due to COVID-19 pandemic, has many advantages, such as the possibility of eliminating the missing data, speeding up the data collection process, and the possibility of collecting data from other provinces and counties. There are also some limitations like self-selection bias, and the lack of interaction with the participants. Furthermore, some qualified mothers were excluded from the study due to illiteracy, the lack of internet access, and the inability to use the phone/laptop to access social networks.

During the item generation step, we considered the different directions of items, but during data reduction, opposite directions were removed. Finally, all items of each factor of CAMPIS have oriented in the same direction, and it is imaginable to create a possibility for response tendency.

One of the problems of self-report scales is that they are subject to the respondent's interpretation of the items, which may not be what the scale designer has intended. In order to reduce this potential problem, continuous testing and modification of the scale has been done. Since ability is a personal matter, the participants were asked not to reveal their names, cities, and the name of the hospitals where their infants were hospitalized. This study has points of strength. One of them is the evaluation of SEM, ICC, responsiveness, and interpretability as important and required items of the COSMIN checklist, which had not been reported previously regarding caring ability scales, but were evaluated in this study.

Availability of data and materials

The original contributions presented in the study are included in the article. Request access to other supplementary material can be directed to the first or corresponding author.

Abbreviations

Caring Ability of Mother with Preterm Infant Scale

Exploratory factor analysis

Confirmatory factor analysis

Neonatal Intensive Care Unit

World Health Organization

Content validity ratio

Content validity index

Item-level content validity index,

Scale-level content validity index average

Kaiser–Meyer–Olkin

Average Inter-Item Correlation

Intraclass correlation coefficients

Minimum Detectable Change Analysis

Minimal Important Change

Comparative Fit Index

Incremental Fit Index

Frequency Interference Index

Parsimonious Normed Fit Index

Tucker-Lewis Index

Goodness of Fit Index

Root Mean Square Error of Approximation

Confidence Interval

Standard Error of Measurement

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Acknowledgements

This article extracted from Ph.D. thesis of the first author, which was financially supported by the Nursing and Midwifery Care Research Center in ……… University of Medical Sciences (NCRC-1407). The authors would like to extend their sincere thanks to mothers, healthcare providers and other participants who shared their experiences with us.

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Saleheh Tajalli, Abbas Ebadi and Carole Kenner have no funding to disclose. Soroor Parvizy is supported by a grant from the vice chancellor of research from Nursing and Midwifery Care Research Center in Iran University of Medical Sciences under Grant number [1398–12-27–1407] CRediT.

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Nursing and Midwifery Care Research Center, Pediatric Nursing Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

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Contributions

S.T: Conceptualization, Investigation, Methodology, Software, Writing—original draft, Writing—review & editing. S.P: Data curation, Formal analysis, Investigation, Methodology, Software, Writing—original draft, Writing—review & editing, Validation, Funding acquisition. A.E: Investigation, Methodology, Project administration, Supervision, Validation, Writing review & editing, Resources. C.K: Writing -review & editing, Resources. All authors contributed to the article and approved the submitted version.

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Additional file 1: appendix a..

The last version of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS).

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Tajalli, S., Ebadi, A., Parvizy, S. et al. Development and psychometric evaluation of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS): a sequential exploratory mixed-method study. BMC Nurs 23 , 297 (2024). https://doi.org/10.1186/s12912-024-01960-7

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Innovation dynamics within the entrepreneurial ecosystem: a content analysis-based literature review

• Rishi Kant Kumar   ORCID: orcid.org/0000-0001-5681-0203 1 ,
• Srinivas Subbarao Pasumarti 2 ,
• Ronnie Joshe Figueiredo 3 ,
• Rana Singh 1 ,
• Sachi Rana 4 ,
• Kumod Kumar 1 &
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Entrepreneurial ecosystems (EEs) delineate concepts from varied streams of literature originating from multiple stakeholders and are diagnosed by different levels of analysis. Taking up a sample of 392 articles, this study examines how innovation fosters the emergence of self-operative and self-corrective entrepreneurial ecosystems in the wake of automatic market disruptions. It also finds that measures lending vitality and sustainability to economic systems across the world through a mediating role played by governments, along with synergies exhibited by academia and “visionpreneurs” at large, give rise to aspiring entrepreneurs. The study also aligns past practices with trending technologies to enrich job markets and strengthen entrepreneurial networks through spillover and speciation. The research offers valuable insights into entrepreneurial ecosystems’ practical policy implications and self-regulating mechanisms, and it suggests that governments overseeing these entrepreneurial ecosystems should identify and nurture the existing strengths within them. Additionally, entrepreneurial ecosystems can benefit from government support through subsidies and incentives to encourage growth. In collaboration with university research, specialized incubation centers can play a pivotal role in creating new infrastructures that foster current and future entrepreneurial development.

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Introduction.

Innovation provides a gateway to products/services in varied market dynamism by transcending time horizons. Innovations work on the back and call of automatic disruptions that happen in markets through the mediating role of governments, institutions, and academicians, leading to “self-operative” and “self-corrective ecosystems.” Most of the time, innovative processes are self-corrective and operate without much effort. As innovations in products keep evolving, they rekindle customers’ interest and increase the prospects of products for better sales and a long-life cycle (for example, entrepreneurs may offer new features or new looks to older products). To undertake this sort of initiative, commercial freedoms must be guaranteed, which can be used to create, deploy, and protect intangible assets (Teece, 2007 ; Sprinkle, 2003 ). Thus, innovations together with entrepreneurial networks or ecosystems provide dynamic capabilities to the economy by imparting continuity. In that process, entrepreneurs, through their better learning skills and novel methods, create opportunities in changing markets (Garnsey and Leong, 2008 ; Garnsey et al., 2008 ; Kantarelis, 2009 ; Levinson, 2010 ; Biggs et al., 2010 ), as markets are always fueled by disruptions in entrepreneurial ventures, and old products must be replaced by newer ones.

Further, synergy between entrepreneurial ecosystems and research plays a pivotal role in fostering disruptive innovations within contemporary markets. This collaboration, exemplified by the establishment of “spin-off companies” from academic research, is instrumental in guiding aspiring talent and cultivating growth in local economies. However, despite this symbiosis, a notable gap exists in knowledge spillovers between universities and their surrounding entrepreneurial and innovation ecosystems. To address this, collaborative and interactive research is recommended, as proposed by Mehta et al. ( 2016 ). Such initiatives not only facilitate self-operative and self-corrective entrepreneurial ecosystems but also contribute to knowledge spillovers that fuel product development and speciation. The interconnected processes of institutionalizing methods, policy entrepreneurship, and knowledge spillovers underscore the intricate relationship between academia, institutional research, and market dynamics, emphasizing the need for cohesive strategies to bridge existing gaps and maximizing the impact of disruptive tendencies in entrepreneurship. This mechanism can receive a boost with the assistance of sustainable innovation of society through “social entrepreneurship education (SEE) programs” (Kim et al., 2020 ), which can be designed and operated to cultivate social entrepreneurial abilities and contribute to the development of innovation hubs for entrepreneurial ecosystems (EEs). For example, a study by Igwe et al. ( 2020 ) focused on frugal innovations and informal entrepreneurship, which could lead to the creation of fresh, innovative tendencies in informal sectors of different nations.

So, looking forward, the relevance for the development of entrepreneurial networks (Teece, 2007 ), where innovation can accentuate the need for the intersection of researchers, entrepreneurship, and regional economic development while holding entrepreneurship as a key mechanism. Although there has been much innovative research done in recent years using a systematic literature review approach, it was observed that existing literature typically lacked the required comprehensive theoretical foundations; more work can contribute to the development of suitable theoretical methodologies for practical results in economic development. For example, past literature is focused on intervention of innovation with digital entrepreneurship (Satalkina and Steiner, 2020 ), social entrepreneurship (Fauzi et al., 2022 ). In a similar way, Montes-Martínez and Ramírez-Montoya ( 2022 ) oriented their research towards finding the relationship between educational and social entrepreneurship innovations using a systematic mapping technique and suggested a potential research gap in this area by collating the number of articles published and geographical contributions. Further, the literature also talked about sustainable entrepreneurship (Thananusak, 2019 ), technological innovation and entrepreneurship in management science (Shane and Ulrich, 2004 ), or the role of open innovation in entrepreneurship (Portuguez-Castro, 2023 ).

Conversely, most of these studies deliberated on the genesis, development, and operation of innovative entrepreneurial ecosystems and subsidiary literature contributing to their existence and growth, then those for laying down foundations for newer tendencies the world is witnessing and vying to enable and sustain them during the times of “Contaminant Economic Trends” (abrupt economic disruptions due to the advent of some natural, environmental, or manmade phenomenon such as COVID-19). It is essential to combine and progress research in several important areas to fill the current gaps in the literature on innovation and entrepreneurship. First, a thorough investigation of information effects is necessary for the present connection between innovation and entrepreneurial ecosystems, especially through subsidiaries businesses. Mehta et al. ( 2016 ) support collaborative research, but more research is required to understand the mechanisms and obstacles preventing knowledge transfer from institutions to entrepreneurial ecosystems. This research aims to examine the following research questions:

What are the key thematic progressions in innovation research within the field of entrepreneurial ecosystems?

What conceptual models can be recommended based on the existing literature to guide and inform future research endeavors at the intersection of innovation and entrepreneurial ecosystems?

To examine the research questions, we applied the text mining approach of the content analysis method on the articles collected on the keywords related to innovation and entrepreneurship for a selected period. This study also aims to fill this gap by designing a model of EE offering multidimensional insights into recent developments in the field of entrepreneurial ecosystems. This study contributes theoretically by synthesizing insights from a systematic literature review to construct a comprehensive model elucidating the intricate dynamics influencing entrepreneurial ecosystems. Identified decisive components—namely, “Evolutionary Theories,” “Governmental Assistance,” “Global Outreach of Academic Innovations,” “Open and Distributed Models of Innovation,” “Entrepreneurial Learning Experience,” and “Social Entrepreneurship”—provide a nuanced understanding of factors shaping enhanced entrepreneurial landscapes. The structured model unveils the synergies underpinning ecosystem development across diverse nations and economies amid economic uncertainties. Moreover, the study posits that government policies, such as subsidized infrastructural support, play a pivotal role in fostering entrepreneurial growth, thereby contributing novel perspectives to the scholarly discourse on entrepreneurial ecosystem evolution.

From this point forward, the paper progresses as follows: Section “Theoretical background and analysis” explains the meaning of innovation and its place in entrepreneurship development and entrepreneurial ecosystem networks; Section “Methodology” reviews prior literature on innovation in the entrepreneurship context; Section “Results” discusses the methodology adopted for the present study and delves into the methods of data collection and analysis for present research; Section “Discussion” discusses the results and analysis done in the present study; Section “Implications, Limitations, and Future Trends” delineates the theoretical implications of the present research and proposes a conceptual model for better innovation in entrepreneurship; and Section “Conclusion” takes up the conclusion part of the study.

Theoretical background and analysis

Past research has mainly focused on developing entrepreneurial ecosystems and their genesis. They hardly focused on what is mainly lacking in the growth process of these ecosystems and why academic knowledge fully fails to translate into entrepreneurial achievements. Moreover, past studies have explored and delineated the extant ecosystems with their peculiarities without looking deep down into the self-operative and self-corrective mechanisms of entrepreneurial ecosystems, which have their own strengths that make them resilient to economic turbulences. The present study highlights this mechanism and forwards a model that explains the process of enhanced ecosystems.

What is innovation?

As per the Schumpeterian view, the practical implementation of ideas for developing new goods and services is innovation (Mehmood et al., 2019 ). ISO TC 279, in the standard of ISO 56000:2020, states that innovation is “a new or changed entity realizing or redistributing value” (ISO, 2020). Definitions of innovations focus on newness, improvement, and the spread of ideas or technologies, products, processes, services, technologies, and artworks (Lijster, 2018 ). Business models that are brought forward by innovators to the market, governments (Bhasin, 2012 ), and society are certain modes through which innovation takes place.

Innovation and entrepreneurship

The advancement of entrepreneurial innovation has necessitated an increased demand for policy interventions that encourage and complement entrepreneurial ecosystems. These interventions are crucial for managing and containing emerging disruptions by introducing effective strategies. The goal is to harness these disruptions for the development of newer and improved entrepreneurial ecosystems, ultimately bringing greater benefits to entrepreneurial ventures. By employing business strategies in indigenous markets, entrepreneurs can carve out niches to meet existing demands and expand into international markets (Sprinkle, 2003 ).

This approach not only enhances enterprise performance in an open economy but also stimulates rapid innovation and disperses dynamic capacities across enterprises, entities, and institutions. According to Teece ( 2007 ), it establishes micro-foundations for entrepreneurial ecosystems, contributing to the formation of innovative networks that support emerging industries (Garnsey and Leong, 2008 ). Additionally, it generates conceptual dimensions by developing complementarities that assist in the adoption of compatible applications (Garnsey et al., 2008 ).

For instance, recent literature on entrepreneurial practices during the ongoing COVID-19 pandemic and post-pandemic business activities catalyzed by the digital revolution highlights the acceleratory role of digitization in expanding the business world. This digital transformation has led to the development of novel social innovations, transforming entrepreneurial practices and liberating the workforce from being “cabin cooped in individuals” to “flexible timers.” These social disruptors have also prompted the exploration of groundbreaking approaches for assessing nuances that emphasize sustainable entrepreneurial ecosystems. Lastly, we present the core concepts related to these domains in Table 1 .

Methodology

Many researchers have applied different methodologies for literature review, such as theory-based review (Debellis et al., 2021 ); framework-based systematic review (Rosado-Serrano et al., 2018 ); theme-based structured review (Pansari and Kumar, 2017 ); techno-commercial literature review (Chatterjee et al., 2018 ; Kumar et al., 2020 ); and literature review based on text mining (Kumar et al., 2019 ). As for article selection, researchers indicate selecting a database such as Scopus or Web of Science (Kumar et al., 2023 ; Donthu et al., 2021 ), with which researchers get a better grasp of a specific domain of research (Alvesson & Sandberg, 2020 ) and set the stage for future research (Elsbach & Knippenberg, 2020 ). By looking at our research questions, we have employed content analysis with a text mining approach in this study, which presents thematic analysis and helps present contextual analysis.

Database preparation

The present study seeks to explore the themes underlying the domain of innovation in entrepreneurial ecosystems. Considering the methodology followed by Akter and Wamba ( 2016 ), we searched keywords such as “business entrepreneurship,” “entrepreneurial ecosystem,” and “entrepreneurial networks” on Scopus in the abstract, title, and keywords fields to search relevant documents. There were 2136 articles matching the keywords in January 2023; following this, a search for “innovation” yielded 772 documents. The final filter was performed to select articles and reviews only, which left us with a batch of 392 documents belonging to different subject areas like business management (34.6%), followed by Social Sciences (17.0%), Economics (14.4%), Engineering (7.7%), Environmental Sciences (6.4%), Computer Sciences (3.1%), Decision Sciences (3.1%), Energy (2.7%), Psychology (1.9%), Biochemistry (1.7%), and others (7.4%). All 392 articles’ abstracts were subjected to content analysis (text mining) after selecting the timeframes outlining the extracted themes to showcase the changes in the research.

Different approaches exist for selecting time duration: while Leone et al. ( 2012 ) proposed three years, Kumar et al. ( 2019 ) suggested five years for getting ideal time durations. In this study, the initial timeframe covered research for 13 years (2003–15) as in these years there were very few publications. Afterward, two sets of two-year durations of 2016–17 and 2018–19 were included, followed by three sets of single-year durations (2020, 2021, and 2022). We initially categorized articles by year but found that there were relatively few articles published in the earlier years, with a significant increase after 2010. Consequently, selecting either a 3-year or 5-year timeframe would have resulted in sample size variation by including the number of articles in each timeframe. To address this, we segmented the articles into eight periods, each containing over 40 articles in each timeframe. The year selection was done to reduce the redundancy found during the content analysis of the abstracts.

Analysis method

Looking toward our first research question of key thematic progressions in the selected domain, we applied the content analysis method to the abstract of 392 articles. In the content analysis approach, text mining (Kumar et al., 2019 , Tiwary et al., 2021 ) is a natural language processing (NLP) technique used to explore valuable insights and uncover relationships from unstructured text data. Text mining provides various benefits due to its feature of processing and analyzing large volumes of data quickly, which allows researchers to find trends and patterns effectively, which could be difficult using human approaches. Furthermore, text mining makes it possible to generate useful numerical indices that support the quantification and methodical examination of word clusters, thereby improving the accuracy and effectiveness of content analysis techniques. Text mining is being used in academic research to speed up the analytical process and improve the quality and scope of insights obtained from unstructured textual material (Karami et al., 2020 ; Gurcan and Cagiltay, 2023 ). We applied text mining to capture the themes that emerged from the articles and to create meaningful numeric indices to analyze word clusters (Feldman & Sanger, 2007 ). As for text mining, we used the widely accepted bibliometric tool “VOSViewer” (Van Eck and Waltman, 2010 ) to analyze the abstract by creating a term co-occurrence map.

Following our RQ1 of exploring maturity and themes of innovations in entrepreneurial ecosystems, we first analyzed all the articles published annually as per maturity and research exploration. We present the results from each year group below separately:

Theme that emerged during the year 2003–2015

Conceptual visualization.

During this period, the focus was on exploring themes that were categorized under specific clusters (see Fig. 1 ), “business ecosystem, capability, customer, development, ecosystem service, entrepreneur, Europe, firm, goal, innovation ecosystem, new venture, opportunity, resource, student, success.” These word clusters indicate entrepreneurial symphony , especially capturing nurturing success in the business ecosystem . Further, a cluster containing words like “adoption, case study, culture, ecosystem, emergence, knowledge, phenomenon, small firm, society, strategy, transformation, value” indicates its connection with Cultural Catalysts , unveiling small firm transformation through ecosystem adoption . The third theme under these years contains words like “entrepreneurial innovation, entrepreneurship framework, government, innovation, issue, policy, region, Silicon Valley, university,” indicating its connection with Elevate by Innovation by crafting a robust entrepreneurship framework for regional growth and navigating government policies . The last theme under these years contains words such as “business, case, company, consumer, convergence, enterprises, factor, growth, medium, product, technology” grouping theme under TechConverge Enterprises , which navigates business growth through consumer-centric mediums and product innovation .

Theme of study during the years 2003–2015.

Together, these four themes delve into the complex worlds of innovation, company culture, and entrepreneurship. The focus on cultural catalysts and technological convergence offers a comprehensive knowledge of entrepreneurial alterations, geographic expansion strategies, and the complex aspects influencing global business performance, even while the European and regional views offer specialized insights. For example, Sprinkle ( 2003 ) drew attention to concurrent policy restrictions on commercial and entrepreneurial freedoms that inhibit bioscience advancement. Teece ( 2007 ) explored the globally dispersed sources of invention, innovation, and dynamic manufacturing capabilities to create a self-operative and self-corrective entrepreneurial network based on creative destruction, commercialization, and transformation of product technologies. Le and Tarafdar ( 2009 ) underscored the importance of interactive collaboration and value co-creation in the era of commerce and the Web 2.0 version, as took place on Facebook, Google, and Myspace.

Theoretical aspects

During this period, entrepreneurial success became synonymous with innovation research, primarily stemming from university research efforts. This led to creative destruction, fostering the commercialization, speciation, and transformation of existing products and strategies. Companies sought value co-creation, supported by government policies and academic advancements. Teece ( 2007 ) emphasized the importance of dynamic capabilities, in which firms deploy tangible assets for business through innovative networks. Governmental R&D played a pivotal role in shaping these networks, aligning research with policies. The collaborative nature of business models, as highlighted by Garnsey and Leong ( 2008 ), facilitated speciation, branching, and technological advancement, contributing to “techno-organizational speciation spin-offs” and niche creation for transformative innovations (Kantarelis, 2009 ). However, this perspective is challenged by evolving policies and practices leading to urbanization, expanding markets, and technological speciation across different geographic areas, negatively impacting rural vitality (Nybakk et al., 2009 ).

Proposition: University-driven efforts, collaborative business models, and government policies combined to drive the intersection of innovation research and entrepreneurial success, which resulted in commercialization and transformation. In addition, changing policies and practices have affected rural vitality through urbanization, market expansion, and technological evolution .

Theme emerged during the year 2016–2017

The emergence of clusters (see Fig. 2 ) during the timeframe of 2016–2017 majorly saw research surrounding themes of innovative interactions through entrepreneurial university dynamics community-driven economies (e.g., community, demand, design, economy, entrepreneurial university, government, growth), entrepreneurial evolution by nurturing sustainable innovation and open innovation economy (e.g., entrepreneurship, evolution, innovation, open, innovation), TechHub Nexus by maximizing R&D efficiency, fostering creative development and focusing commercialization capability (e.g., capability, commercialization, creative, economy) and urban prowess through innovative business models by crafting a dynamic entrepreneurial ecosystem (e.g., dynamic, ecosystem, business model, regional). Many articles address important aspects of contemporary enterprise, innovation, and regional development. These topics highlight the delicate interplay between academics, technology, and policy, offering nuanced viewpoints critical for supporting innovation, sustainable development, and entrepreneurial growth in a variety of situations.

Theme of study during the year 2016–2017.

Most prominent themes, which were accentuated through the creation of academic entrepreneurship for the creation of maker spaces and creative economy which could forward and contribute towards regional innovations through the “University’s Economic Development Mission” that was instrumental in building up the prospects for “transforming economy” leading to “regional development,” which gave rise to “new ventures development” and created platforms for novel entrepreneurship. Herein, the university ecosystem examines individual intermediaries and facilitates “Student Spin-off Industries” (Hayter, 2016 ). For example, the Bayh-Dole Act in the United States takes up ownership of students’ inventions funded by the government. Consequential, novel themes and new ventures in the entrepreneurial ecosystem emerged (Soundarajan et al., 2016 ) because of emerging models of entrepreneurial universities for transforming the economy in pursuit of regional development through “University Business Cooperations (UBCs)” (Guerrero et al., 2016 ) to tackle the disruptor dilemma by showing the entrepreneurs the profitable path providing platforms for the overall development of regional innovation systems.

Proposition: Academic entrepreneurship facilitated by initiatives like maker spaces and the creative economy may foster regional innovation and new ventures driven by the university’s economic development mission and exemplified by entities such as student spin-off industries .

Theme emerged during the years 2018–2019

The course of this timeframe saw themes associated with (see Fig. 3 ) “startups,” “network,” “innovation policy,” “service innovation,” “social entrepreneurship,” and “academic,” among others. These cluster themes drew on the concepts “Innovation Driven Gazelle Enterprises (IDEs),” “prototype equipment facilities,” “translational research by local universities,” “platformization,” “Knowledge-Intensive Entrepreneurship (KIE),” “KIE Concentration,” “innovative milieus,” “voluntary horizontal knowledge spillovers,” and “Silicon Valley.”

Theme of study during the years 2018–2019.

The most prominent of all themes were “startups” and “networks,” fueling regional entrepreneurship and leading to radically innovative products and services (de Vasconcelos Gomes et al., 2018 ). The cross-connection of entrepreneurial factors and networks in academic and industrial circles is key to transmitting knowledge bases (Qian, 2018 ), leading to the growth of startups. Furthermore, the government’s innovation policies lead to the development of “services innovation” and “social entrepreneurship” through the supportive programs of entrepreneurial development that are further boosted by strong networks created by startups advancement in any regional or national entrepreneurial ecosystem. However, it is still unknown how knowledge networks (Miller et al., 2018 ) influence entrepreneurship processes through supportive environments fostering innovative startups (Spigel and Harrison, 2018 ).

Proposition: The symbiotic relationship between startups, knowledge networks, and government innovation policies may be pivotal in driving regional entrepreneurship, particularly in the development of services innovation and social entrepreneurship, yet the specific influence of knowledge networks on entrepreneurial processes within supportive environments remains unclear and requires further exploration .

Theme that emerged during the year 2020

The themes that originated during this timeframe (see Fig. 4 ) were associated with “academic entrepreneurship,” “social entrepreneurship,” “urban-rural divide,” “disruptive innovation,” and “tourism,” the origination of which was based on tagged-in factors such as “innovation hubs for Entrepreneurial Ecosystems (EEs),” “informal entrepreneurship,” “frugal innovation,” “utility-maximization,” “business incubators,” “innovation transition,” etc.

Theme of study during the year 2020.

“Academic” and “social” were the most prominent themes that emerged during this timeframe, encompassing “academic entrepreneurship,” “social entrepreneurship,” “urban–rural divide,” and “disruptive innovation.” The theme emphasized that academic and social are the two most basic and crucial benchmarks for any economy to have the presence of entrepreneurial ecosystems. They are the only factors that give rise to social entrepreneurship that use social issues as the basis for developing new entrepreneurial ideas to establish social enterprises. This is not only blurring the urban–rural divide but is also using this divide to determine, locate, and pick new opportunities and turn them into successful social entrepreneurship model firms, giving rise to informal and frugal innovations that are leading to utility maximization in resource-scarce ecosystems. This even helps in attaining sustainable innovation, which is the only way for nations to balance industrial growth and the sustainability of resources. For example, Kim et al. ( 2020 ) discussed the role of social entrepreneurship programs in developing sustainable innovation through balanced industrial growth and opined for internal and external connectivity through innovations and sustainable informal entrepreneurship (Igwe et al. 2020 ).

Proposition:The intertwining of academic and social themes within entrepreneurial ecosystems may serve as a foundational driver for social entrepreneurship, blurring the urban–rural divide and fostering sustainable innovations that balance industrial growth with resource sustainability .

Theme that emerged during the year 2021

During this timeframe (see Fig. 5 ), the research focused on “policy implication,” “frugal innovation,” “research,” “innovative behavior,” “intermediary,” “open innovation,” “empirical evidence,” “agent,” “community,” and “social entrepreneurship,” driving on concepts such as “digitization,” “digital platform,” “digital entrepreneurial ecosystems,” “COVID-19”, “pandemic” and “women entrepreneurship,” “circular entrepreneurship,” “sociology,” “emergent entrepreneurship,” “phenomenological inquiry,” “nascent,” “knowledge-intensive,” “returnee entrepreneurial firms,” “Entrepreneurial Discovery Theory,” and “artistic place-making,” among others, which were recurrently referred to by authors in their research works. Furthermore, these themes were spawned from the factors and concepts related to “moderate innovation ecosystems,” “digital platform ecosystems,” “innovation leaders,” “culture entrepreneurship,” “interacting predictors,” etc.

Theme of study during the year 2021.

Out of all themes, the most important themes that emerged were policy implication, frugal innovation (Frugal innovations encompass affordable new products, methods, and designs developed for or emerging from the underserved lower segment of the mass market, often referred to as the ‘bottom of the pyramid), and “innovative behavior,” which were heavily drawn from “digital” associated with terms such as “digitization,” “COVID-19”, “pandemic” etc., and “women entrepreneurship,” “women entrepreneurs,” “women economic empowerment,” “job losses,” and “COVID-19 impact”. These themes essentially and visibly emanated from the term COVID-19, which has been the most effective disruption witnessed in several centuries, sending shock waves and necessitating ‘totally out of the box,’ yet basic and indigenous thought processes and helping the creation of innovations outposts (Decreton et al., 2021 ). The COVID-19 crisis prompted impactful frugal innovations, particularly among jobless women, fostering widespread women’s entrepreneurship amid the digital revolution (Cullen & De Angelis, 2021 ). Digitalization facilitated startups as effective innovation brokers, connecting ecosystems, and promoting synergies. The “Waste Not” strategy contributed to resource-efficient production, circular entrepreneurship, and social purpose organizations. This global shift towards novel economic empowerment models, including priority action roadmaps for women, emerged in response to the pandemic’s impact, creating innovative approaches and strategies (Cullen & De Angelis, 2021 ).

Proposition: The unprecedented disruption caused by COVID-19 has catalyzed transformative innovations, particularly in frugal entrepreneurship driven by jobless individuals, notably women, harnessing digital revolution and waste reduction strategies, thereby fostering women’s entrepreneurship, circular economies, and social purpose organizations on a global scale .

Theme that emerged during the year 2022

The clusters that were accentuated in this timeframe (see Fig. 6 ) were: “biomedical entrepreneurship,” “sustainability,” “translational research,” “demand,” “databases,” “social innovator,” etc. among others, which had their origination from themes such as “digital entrepreneurship,” “digital entrepreneurial ecosystems,” “smart cities,” “circular business models,” “incremental innovation,” “Schumpeterian Entrepreneurship,” “social innovations’ systems,” “Isenberg’s Entrepreneurial Ecosystem Model” (international reference guide for collecting and using data on innovation), “Financial Technology (FinTech) Innovation,” “investment advisory sector,” “trans-disciplinary research,” and “cross cutting themes,” which got frequently referred to by authors in their articles.

Theme of study during the year 2022.

This time period saw the emergence of many “incremental innovations” adding to and revitalizing the existing ones in the wake of COVID-19 (Henrekson et al., 2022 ). To this end, every nation was endeavoring to get hold of resources and diverting them towards translational research, comprising academic entrepreneurial innovations and social innovations (Audretsch et al., 2022 ), culminating in biomedical research and entrepreneurship. Biomedical entrepreneurship was in its heyday as it was the most important aspect related to the major disruptor COVID-19 at the time. As a result, there was a mushrooming of startups catering to biomedical resources to fulfill the demand that was extant in almost all the markets of the world. In addition, the most prominent entrepreneurial success was witnessed in “digital entrepreneurial enterprises,” which rose quickly due to the widespread digitization of almost all of the world’s economies in the wake of COVID-19. This trend of enterprises surpassed all records of success and they skipped decades in their growth journey.

Proposition: The aftermath of COVID-19 witnessed a global pursuit of resources for translational research encompassing social innovations, fueling a surge in biomedical entrepreneurship and the rapid success of digital enterprises due to widespread digitization surpassing conventional growth timelines .

Starting with the first research question, which aimed to organize the thematic progress of innovation research in entrepreneurship, we applied a text-mining approach of content analysis on the six identified year groups. The results highlight that in recent years digitization and frugal innovations have acted as catalysts for novel business models, termed “Abrupt Circumstantial Business Handling Practices (ACBHP)”. These practices spurred by the COVID-19 pandemic include customized products, increased home deliveries, pop-up shops, and ventures, breaking traditional business norms. This led to the emergence of a “Minimalistic Business Model of Manufacturing” (MBMM), where businesses adapted with minimal resources based on market needs during the pandemic. Such disruptions created uncertainties but also introduced new entrepreneurial ecosystem dynamics. In light of this, we present the findings as follows:

Insight 1: Speciation of innovations and technologies

Innovations, technologies, and strategies are the major drivers of economic growth and development. “Speciation” is one such force and mechanism underlying the business thought process, policy formulation, and practices. It enables the factors and actors facilitating entrepreneurship and entrepreneurial ecosystems to perform business initiation and expansion (Ganzaroli et al., 2014 ), thereby giving rise to newer research factors concerning policy formulations, dynamic capabilities lying latent, and innovative networks. Speciation largely leads to the branching and advancing of technologies (Kantarelis, 2009 ), as was found in the case of the USA, wherein speciation drew attention to the concurrent policy restrictions on commercial and entrepreneurial freedoms. Thereafter, it was witnessed in the most recent case of disruptions during the COVID-19 pandemic, wherein “digitization” was the main source used by almost every new technology as mainstream, and several speciation methods, products, and strategies emanated from that. This magnetized the innovative network and the think pools to leverage assets and strategies at hand and bring out the necessary synergies, leading to required entrepreneurial and policy frameworks to assist in entrepreneurial advancements.

Insight 2: Global outreach of academic knowledge and innovations

The global outreach of entrepreneurship facilitates rapid innovation, leading to knowledge dispersion, inventions, and enhancement of manufacturing capabilities. Moreover, it helps in “nascent opportunity generation” and innovation networks for inventions, leading to augmentation and advancement of technologies. For example, Guerrero et al. ( 2016 ) delineated the soaring need for research in business and economy and further discussed the issue of individual growth and restriction on scientific and commercial freedoms. Collaborative and interactive research has further been facilitated by innovative value co-creation (Mehta et al. 2016 ), along with the extension of new management processes for the extension of processes beyond existing ecosystems. However, at the same time, it poses a concern for damage and serious harm like mishandling, and misuse of dangerous innovative products, which is why it is necessary to foresee and assist scientific and commercial freedoms (Hayter, 2016 ) with precautions that should be taken to prevent scientific inventions and innovations from harming society in general (Roundy, 2016 ).

Insight 3: Government assistance generating synergies for growth

Government assistance by funding innovations leads to better academic research and innovation-centric activities that generate synergies, impacting and enhancing innovative business ecosystems (Harper-Anderson, 2018 ). Even in developing countries, governments have come forward with schemes for payment for ecosystem services (PES), as done in Costa Rica, for biodiversity protection and conservation endeavors (Fischer et al., 2018 ). The heterogeneity among ventures is largely facilitated by knowledge spillovers and dispersion at the global level (Autio et al., 2018 ), corporate research development (Eckhardt et al., 2018 ), and the regional economic development policy agenda of the nations (Crammond et al., 2018 ), which takes up corporate research to bring about regional-level multidimensional economic systems. To further this process, the traditional “Triple Helix Innovation Model,” focusing on the university-industry-government relationship, and the “Quadruple Helix Innovation Systems” can be used to bring about the required synergies (Mirvis and Googins, 2018 ) and ensure success in business ecosystems based on collaboration and competition (Hu, Yu & Chia, 2018 ; Carayannis et al., 2018 ).

Insight 4: Regional transformation and platformization

Regional transformation through open and distributed models of innovation facilitates the pursuit of entrepreneurship. Regional transformation can be hailed as the “basic innovation driver,” disgorging newer approaches toward entrepreneurship (Igwe et al., 2020 ) and helping policymakers and practitioners (Guerrero et al., 2020 ). Moreover, regional transformation together with platformization creates a typology of different ecosystem structures, thereby shaping high-growth entrepreneurship. Furthermore, they help in exploring the dynamics of entrepreneurial ecosystems for rural and urban areas (Huggins and Thompson, 2020 ). To this end, many regions are following the “educate, deregulate, and finance” approach to entrepreneurship, as happened in the case of “Financial and Institutional Reforms for Entrepreneurial Society” in Europe (Lyons et al., 2020 ). Another example is the “Innovation Hub Organizations” in African cities, which have become “Fixtures” (Švarc et al., 2020 ). However, regional transformation is not possible without a proper policy (Jia & Desa, 2022 ) that works on key components and factors influencing entrepreneurial processes (Halbinger, 2020 ).

Insight 5: Management of collective risk for radically innovative products

The management of collective risk by social entrepreneurial ecosystems helps in strengthening institutional environmental and bridges uncertainties to radically innovative products (Khurana and Dutta, 2021 ). Investigating innovation drivers in the informal sector may scrutinize the impact of “complementors” within business owners’ strategies, navigating formal and informal rules (Gifford et al., 2021 ). Further, regional economic ecosystems, influenced by human behavior, culture, and environment, require the measurement and development of skills. Tools like “Entrepreneurship Skill-Building Framework (ESBF)” and “Readiness Inventory for Successful Entrepreneurship (RISE),” based on “communimetrics: theory of measurement,” are crucial (Nthubu, 2021 ). The European Smart Specialization Strategy (S3) reflects the latest entrepreneurial ecosystem developments (Khatami et al., 2022 ).

In addition, addressing systematic inequities involves social innovations and financial models like “blended financing” and “public-private partnerships” (PPP) (Volkmann et al., 2021 ). Other factors include affordable business models for resource settings (Guerrero et al., 2021 ), knowledge economy expansion (Plata et al. 2021 ), and new evaluative approaches to local entrepreneurial ecosystems (Liu et al., 2021 ). Innovation strategies by companies like Apple and Uber, financial technology ecosystem development (Canh et al., 2021 ), growth-oriented entrepreneurship in the African business environment (McDaniel et al., 2021 ), and risk mitigation through public-private ownership (Moraes et al. 2023 contribute to assessing and enhancing the global entrepreneurial climate, including the US (Schaeffer, Guerrero & Fischer, 2021 ).

Insight 6: Discovering latent entrepreneurship for emergent entrepreneurship

Empirical studies underscore the crucial role of entrepreneurial learning and experience in unlocking latent resources and hidden capabilities within social and economic ecosystems. A prime example is the transformative impact observed in the US drone industry (Henrekson et al., 2022 ). Innovative ecosystems, particularly those with a knowledge-intensive focus, foster emergent entrepreneurship, notably when returnee entrepreneurs contribute to local firms, enhancing innovation performance in their home countries (Bakry et al., 2022 ). The “discovery theory” further illuminates how digital applications stimulate entrepreneurial alertness, especially in diverse innovation ecosystems, such as the influence of creative industries on social entrepreneurship (Ho and Yoon, 2022 ). The success of new ventures hinges on navigating multifaceted components within entrepreneurship ecosystems (EE) and the broader business environment (Johnson et al., 2022 ).

To overcome these challenges, entrepreneurs strategically establish complex ecosystems, temporarily gaining monopolistic advantages by eliminating competition during the development phase (Raposo et al., 2022 ). Various factors shape entrepreneurial sustainable innovations (ESIs),” with distinct emphasis on policy, finance, human capital, support, and culture within entrepreneurial ecosystems (Berman et al., 2021 ). While creating new businesses is essential, the establishment of institutions supporting entrepreneurial growth is equally vital. Although “Schumpeterian entrepreneurs play a role, the limitations of “top-down policies” in fostering thriving ecosystems for Schumpeterian entrepreneurship are evident (Henrekson et al., 2022 ). Social entrepreneurship, guided by local actors and social innovators with insights into emerging needs, can lead to profit-oriented innovations (Audretsch et al., 2022 ; Bakry et al., 2022 ). Implementing these strategies demands entrepreneurial ecosystems equipped with tools that address the complex and dynamic aspects of development (Johnson et al., 2022 ; Schmutzler et al., 2022 ).

Model for enhanced entrepreneurial ecosystems

The systematic literature review conducted for the present study has yielded insights that can be utilized to enhance entrepreneurial ecosystems. These insights have been integrated into a model explaining the relationship between various decisive components crucial for achieving improved entrepreneurial ecosystems. The key insights of the model are outlined below.

First, the attainment of enhanced entrepreneurial ecosystems is influenced by several factors that interact and synergize, ultimately resulting in the creation of new ecosystems or the enhancement of existing ones. “Evolutionary Theories,” “Governmental Assistance,” “Global Outreach of Academic Innovations,” “Open and Distributed Models of Innovation,” “Entrepreneurial Learning Experience,” and “Social Entrepreneurship” are identified as decisive components in this research. Alongside underlying factors, these components promote and contribute to the enhancement of entrepreneurial ecosystems.

Figure 7 illustrates that entrepreneurial ecosystems develop unique synergies in all nations and economies in response to different types of economic disturbances arising from individual and collective uncertainties. Although there is a pattern and path with the highest probability of yielding better network creation and rapid development of entrepreneurial ecosystems, it is generally guided by the path of economic turmoil or uncertainty they face. Additionally, government policies play a significant role in influencing the creation, operation, and pace of the progress of entrepreneurial ecosystems. For instance, in countries such as South Korea, where entrepreneurs are provided with free or subsidized space for their ventures, there is a notable boost in entrepreneurial growth, leading to the creation of a higher-quality entrepreneurial ecosystem with better services and growth prospects.

Model for Enhanced Entrepreneurial Ecosystems (bidirectional arrow represents interaction between those factors; unidirectional arrow represents research related to innovation across different domains).

Government assistance and support are crucial components that contribute to the development of entrepreneurial ecosystems. Evolutionary theories from different fields serve as a repository of past initiatives that have proven successful, guiding and enlightening the thought processes of entrepreneurs. These theories often emerge as corrective responses to individual and collective uncertainties or as attempts to rectify anomalies in different ecosystems. Furthermore, government assistance, when integrated into academic research programs, fosters the creation of heterogeneous, innovative models that can be emulated by others. Support for research projects aids in the development of entrepreneurial ecosystem models aligned with market trends and economic turbulence, providing a foundation for theories and fostering entrepreneurial growth.

In addition, the global outreach of academic innovations plays a crucial role in disseminating these innovative models. Through concerted paths, it leads to the development of newer technologies and products. The open and distributed models involved in this process facilitate knowledge spillovers, permeating and transforming the urban and rural economies of nations. Subsequently, this transformative process initiates knowledge spillovers and the diffusion of technology across nations, ushering in uncharted methodologies for addressing challenges and seizing opportunities. This dynamic gives rise to creative industries, fostering a culture of continuous learning and adaptation essential for achieving business sustainability. The enrichment of entrepreneurial learning and experience is evident across diverse nations. Ultimately, this interconnected synergy propels actors and agents of change toward assuming collective responsibilities and championing the cause of social entrepreneurship for greater good and universal growth. The diverse trajectories of entrepreneurial growth invariably encompass these interconnected elements and sequential steps, underscoring the complexity and interdependence inherent in entrepreneurial growth.

Implications, limitations, and future trends

The following section provides implications and limitations.

Theoretical implications

The study underscores crucial theoretical implications, emphasizing that innovation not only introduces novel attributes to business culture but also gives rise to ecosystems capable of developing self-operative and self-corrective mechanisms in response to market disruptions. It asserts that innovation and entrepreneurial ecosystems play pivotal roles in implementing sustainable measures to invigorate global economic systems. An examination of the specified period reveals noteworthy themes that significantly contribute to existing knowledge in business and entrepreneurship. The onset of the pandemic triggered a transformative shift in entrepreneurial ecosystems, leading to “venture mushrooming” driven by dynamic factors (Castellani et al., 2022 ). The disruption prompted a strategic response from entrepreneurial think tanks, showcasing their adept management of unprecedented challenges and highlighting the resilience and adaptability of entrepreneurial ecosystems (Ramezani and Camarinha-Matos, 2020 ). Moreover, the disruptions unveiled opportunities and novel resources, particularly in the digital realm, fostering niche entrepreneurial ecosystems driven by individuals, especially women, responding to COVID-19-related challenges (Cullen & De Angelis, 2021 ). The evolution of these ventures highlighted the self-operative and self-corrective nature of entrepreneurial ecosystems, offering insights into the evolving dynamics of the business environment.

Given the unified global markets and increasing trade transactions, entrepreneurial innovations emerge as essential tools to counter challenges to the global economy. To establish effective progressive and corrective mechanisms for market disruptions, there is a pressing need for innovative speciation that addresses specific market needs and customer bases. Global outreach of innovations is crucial for swift knowledge dissemination, and governments should develop collaborative assistance mechanisms to foster growth. Regional transformation and platformization are equally vital for cultivating novel entrepreneurial tendencies among youth. Creating a catalytic environment requires managers to take initiative in dealing with collective uncertainties, fostering the creation of radically innovative products. Finally, to facilitate the process of creating entrepreneurial ecosystems, emphasis should be placed on recognizing emerging entrepreneurial tendencies at regional, national, and international levels through timely support—technical, economic, and moral—to budding entrepreneurs and “visionpreneurs”.

Practical implications

The study underscores critical policy implications by highlighting the role of entrepreneurial ecosystems in fostering and empowering aspiring entrepreneurs. However, it acknowledges the challenges posed by unprecedented changes, which may prove difficult to address. These situations, whether rooted in knowledge banks or not, often present formidable obstacles that cannot be easily overcome with existing skill sets. The study emphasizes the need for emergent entrepreneurs to draw on their previous exposures, urging them to boldly anticipate and explore future trends, particularly as technologies and skill sets evolve with increasingly shorter product life cycles.

Furthermore, the study advocates for close collaboration between governments and entrepreneurial faculties to mitigate negative economic downturns. Given the interconnected and inseparable nature of international trade indices, this research stresses the importance of collective action to prevent potential cascading effects that could lead to significant economic damage in a short period. The research contributes practical policy implications by proposing a model for entrepreneurial ecosystems with self-operative and self-corrective mechanisms. It suggests that governments support the strengths inherent in their ecosystems, providing subsidies, incentives for growth, and specialized incubation center facilities. These facilities, collaboratively developed with university research outcomes, aim to build new infrastructures for entrepreneurial development, ensuring both present and future entrepreneurial growth.

Limitations

This study presents a comprehensive review of collected papers utilizing text mining and content analysis to delve into the dynamics of entrepreneurial ecosystems. However, it acknowledges certain limitations that could impact the breadth and clarity of perspectives. The review focused exclusively on papers matching specific keywords like “Innovation,” “Business Entrepreneurship,” “Entrepreneurial Ecosystem,” and “Entrepreneurial Networks.” Notably, the exclusion of other keywords such as “academic entrepreneurship,” “spillover effects,” and “speciation” might have yielded different insights not covered in this analysis.

Additionally, the choice of the Scopus database as the sole source for article extraction poses another limitation, as utilizing different databases could have resulted in a diverse set of research articles, potentially altering the domain and theme structures. The study’s methodology is also recognized as a limiting factor, as alternative approaches could have produced varied results. Furthermore, the consideration of a nearly two-decade timeframe raises concerns about the relevance of earlier reviews in the rapidly evolving landscape of entrepreneurial needs and trends.

Despite these limitations, the paper makes a noteworthy contribution by providing a general outline and direction for the development of enhanced entrepreneurial ecosystems. It acknowledges the lack of first-hand exposure to entrepreneurial ecosystems, which could have enriched the output. Nevertheless, the study’s significant contribution lies in its comprehensive analysis of entrepreneurial ecosystems and their interplay, aiming for greater output generation, improved growth for the collective good, and the overall welfare of economies, beyond mere economic gains.

In conclusion, while innovations and entrepreneurial ecosystems have been extensively explored in research, a collaborative effort between governments and the intelligentsia is essential to reshape policies. Addressing the identified gap in the literature, the research emphasizes that entrepreneurial ecosystems are not confined to traditional business circles but have evolved through the ingenuity of individuals facing job losses or career shifts. Therefore, this paper aims to provide the thematic improvement that happens in literature and based on that, present the enhanced entrepreneurial ecosystems. This study’s result indicates the necessity of global outreach for swift knowledge dissemination and emphasizes collaborative efforts between governments and entrepreneurial entities to foster growth. Regional transformation and platformization are identified as pivotal in nurturing novel entrepreneurial tendencies, particularly among youth.

This study elucidates critical theoretical implications, highlighting the transformative power of innovation in shaping not only novel attributes within business culture but also the creation of adaptive entrepreneurial ecosystems. The study underscores the need for proactive policymaking and infrastructure support to empower these ecosystems to navigate the evolving landscape. The collaboration between governments and the intelligentsia is highlighted as crucial for ensuring that entrepreneurial ventures thrive and contribute significantly to the broader economic context. This integrated approach aligns policy measures with the dynamic needs of entrepreneurial ecosystems, fostering resilience, adaptability, and sustained success in the face of emerging global challenges. In essence, this research not only contributes to the existing knowledge but also fills a crucial gap by shedding light on the dynamic nature of entrepreneurial ecosystems in the face of unprecedented challenges, providing valuable insights for future research and practical applications.

Data availability

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

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Kumar, R.K., Pasumarti, S.S., Figueiredo, R.J. et al. Innovation dynamics within the entrepreneurial ecosystem: a content analysis-based literature review. Humanit Soc Sci Commun 11 , 366 (2024). https://doi.org/10.1057/s41599-024-02817-9

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A Content-Analysis Based Literature Review in Blockchain Adoption within Food Supply Chain

1 Blockchain Research Center of China, Southwestern University of Finance and Economics, Chengdu 611130, China; nc.ude.efuws@t_jnaud

2 Southampton Business School, University of Southampton, Highfield, Southampton SO17 1BJ, UK; [email protected] (Y.G.); [email protected] (S.B.)

Steve Brown

3 School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China; moc.liamxof@ilsreip

According to the World Health Organization (WHO), one out of 10 people get sick from eating contaminated food. Complex food production process and globalization make food supply chain more delicate. Many technologies have been investigated in recent years to address food insecurity and achieve efficiency in dealing with food recalls. One of the most promising technologies is Blockchain, which has already been used successfully in financial aspects, such as bitcoin, and it is attracting interests from food supply chain organizations. As blockchain has characteristics, such as decentralization, security, immutability, smart contract, it is therefore expected to improve sustainable food supply chain management and food traceability. This paper applies a content-analysis based literature review in blockchain adoption within food supply chain. We propose four benefits. Blockchain can help to improve food traceability, information transparency, and recall efficiency; it can also be combined with Internet of things (IoT) to achieve better efficiency. We also propose five potential challenges, including lack of deeper understanding of blockchain, technology difficulties, raw data manipulation, difficulties of getting all stakeholders on board, and the deficiency of regulations.

1. Introduction

Food systems are complex and keep changing over time [ 1 , 2 ] Nowadays, customers have an increasing demand for food quality, safety, and nutrition, rather than just quantity. Although hunger might seem not to be an issue for most people anymore, food crisis is still ranked as the seventh risk in terms of impact by the World Economic Forum in 2018 [ 3 ]. Moreover, globalisation and outsourcing make the food system even more complex with more suppliers and companies involved [ 4 , 5 , 6 , 7 ]. Every continent has suffered serious foodborne disease outbreaks and they have been amplified by globalisation in the past decade [ 7 ]. The longer geographical distance between the producers and consumers of food supply chains has also created a challenge in maintaining food quality and achieving fast food recall when necessary.

According to the World Health Organization [ 8 ], almost one out of 10 people globally suffer sickness due to foodborne disease each year. Food hazards can cause over 200 diseases by bacteria, chemical, and other contaminations; and, the foodborne and waterborne diarrhoeal diseases can kill about two-million people annually [ 8 ]. Some of the most well-known food scandals in history include Sanlu milk scandal in China (2008), the Enterohemorrhagic Escherichia coli outbreak in Germany due to contaminated fenugreek sprouts (2011), the horse meat scandal in the UK (2013), and the outbreak of E. coli of Romaine lettuce in America (2018). More recently, several foodborne disease outbreaks were reported. For example, an outbreak of Salmonella Newport illnesses that was linked to frozen ground tuna in America caused 13 people to fell ill [ 9 ], Salmonella-infected British eggs poisoned 45 people [ 10 ], in the Netherlands, and 12 people felt sick due to the Listeria monocytogenes infected meat [ 11 ].

In America, approximately 48 million people get sick and 3,000 of them die annually due to foodborne diseases [ 12 ]. In 2018, there were 1,935 food recalls reported according to US Food and Drug Administration [ 9 ]. More than half of the food recalls were due to operational mistakes, including contamination, mislabelling, undeclared ingredient, biological causes, etc. [ 13 ]. Customers have growing concerns of food security and quality. From the food safety survey conducted in 2018, more than two-thirds (68.3%) of participants were worried about food fraud problems [ 14 ]. A meat inspection petition that was signed by more than 216,000 people was submitted to the UK food standards Agency [ 15 ]. Food security is considered to be a shared responsibility for all of the stakeholders, including food producers, food retailers, related governments, and customers [ 7 , 16 ].

Supply chain management is a key vehicle for helping to address food insecurity and contribute to public health issues. Within a complex food supply chain, the efficient traceability system can make significant contribution in food recall and public health. It can help to isolate certain products and ingredients from the root of the problem in a faster speed to prevent further loss. Traditionally, the traceability system largely relied upon paper-based systems or internal computer systems [ 16 ]. Paper recording can be time consuming and cause errors. Internal traceability can be unusable for other companies and cause difficulties for stakeholders’ integration. Technologies recently showed popular trends, such as Radio Frequency Identification (RFID), barcodes, smart tags, Wireless Sensor Network (WSN), and DNA based techniques. Technological innovations can provide a more efficient way to record and exchange information. Most recently, blockchain has drawn significant attention and presents a promising solution to the food traceability issues [ 17 ].

Blockchain technology is one of the promising technologies, which is believed to revolutionise the modern food supply chain [ 18 , 19 ]. It is a decentralized platform that not only allows peer-to-peer direct transaction that eliminates middlemen, but also validates information by cryptography and records history permanently. A few researchers suggest that it can improve supply chain efficiency and address certain issues, such as information inequality and food recall inefficiency, etc. [ 19 , 20 , 21 ].

Previous researches have introduced a few integrations of blockchain and food supply chain, with the application of Internet of Things (IoT) [ 17 , 22 ], by applying case studies [ 23 ], or Survey methods [ 24 ]. These studies presented some benefits, such as improving traceability efficiency, improving supply chain transparency, while there are also challenges, including scalability, lack of legislation, and immature technology [ 21 ]. However, few literature reviews have been carried out to explore this topic in a systematic manner, especially with a management focus. Therefore, this paper aims to fill this gap. Thus, the primary aim of this paper is to investigate how blockchain has been used in the food supply chain area, and how it can help to address food security issues. Therefore, this paper answers the following research questions:

• Question 1: What research has been carried out on blockchain adoption in food supply chain management?
• Question 2: What benefits can blockchain bring to the food supply chain?
• Question 3: What are the challenges of blockchain adoption in food supply chain management?

In order to answer these questions and enable achieve the aim of the study, we will collect and summarise related papers, and provide a deeper analysis of the literature. More specifically, this paper applies the content-analysis based literature review methodology to support this analysis.

The remainder of this paper is organized, as follows. We first introduce literature review to provide some background information about the key concepts followed by our research methodology. We then present and discuss the findings and, finally, conclude and discuss future research direction.

2. Literature Review

This section provides a brief review of the relevant concepts, including food supply chain, Blockchain, and traceability, to provide some background information as the basis for this study.

2.1. Food Supply Chain

Food supply chain is defined by Folkerts and Koehorse [ 25 ] (p. 11), as “a set of interdependent companies that work closely together to manage the flow of goods and services along the value-added chain of agricultural and food products, in order to realize superior customer value at the lowest possible costs”. When compared to other industries, food production takes place in more vulnerable value chains, which requires more attention over handling processes, such as producing and storing [ 16 , 26 , 27 ]. In addition, food has the natural feature of changing in quality all the time, which makes ensuring food safety and quality a challenge [ 16 ]. Outer environments, such as temperature and transport, can also affect food products’ quality and freshness. Processed food with longer shelf lives might have significantly complex producing procedures with a mixture of multiple ingredients. The complex food production also means higher risks of product failure and requires extra attention on the raw material quality and production process [ 6 , 26 , 28 ]. Food products failure includes food borne disease, food poisoning, low quality food, counterfeit products, or mislabelling and undeclared ingredients after production. Every step and every supplier in a food supply chain matters to the final food products. Therefore, food supply chain requires higher efficiency and closer partner collaboration to maintain the value chain and eliminate products failure.

Modern food supply chain is centralized, which heavily relies on the central powers to control information flow. The centralization can threaten the supply chain transparency, which causes information inequality and trust issues [ 17 , 22 ]. Companies can choose to open up selected information that is beneficial to its own brand image [ 29 ]. On the other side, companies can also hide information, so that customers can only know what food companies and governments want them to know. Centralized supply chain also means the vulnerability for being a target of bribery [ 17 ]. Therefore, a single failure can lead to the disruption of the whole supply chain network [ 17 ]. For certain products, such as organic, kosher products, vegan food or green products, it is even harder for consumers to know the authenticity if there is no evidence of customers becoming sick as a result of consuming the products. Therefore, customers feel more threatened by the food scandals and demand more knowledge of the products before purchasing. Deeper concerns and lack of trust in the food industry and food quality still remain, even where laws and policies have been published.

2.2. Blockchain

Blockchain has recently gained considerable research attention for addressing food supply chain issues. Nakamoto introduced the concept of the decentralized peer-to-peer ledger in 2008. It has been successfully applied in financial areas, such as Bitcoin, and it now triggers huge interest in multiple areas, including food supply chain, property, voting, etc. Blockchain technology can be defined as “a shared, immutable ledger for recording transactions, tracking assets and building trust” [ 30 ]. The fundamental technology of blockchain has a few main features that can bring significant benefits once used properly: decentralization, immutability, security, and smart contract.

2.2.1. Decentralization

Different from traditional transactions that need to be approved by central authorities, decentralization eliminates the central powers and addresses information inequality by allowing for direct transaction between the users. It ensures that every authorized user has equal power within a network. Users help each other to validate transactions, to keep copies of records, and have the same power to access history anytime [ 19 , 31 , 32 ]. In the food supply chain, from the raw material suppliers to customers, products information can be recorded along the whole supply chain. Multiple stakeholders save the copies of records, which can be retrieved on demand anytime [ 33 ]. For example, the end users, consumers, can obtain the detailed information on the products include authenticity and origins, etc. Producers can also monitor their suppliers to make sure that raw material quality meet requirements. Therefore, a decentralised supply chain can help to eliminate information inequality and build trust.

2.2.2. Security

The blockchain consensus algorithm can achieve data security. One of the consensus mechanisms is Proof of Work (PoW), which requires that all transactions, and is validated by other users [ 34 ]. Users have to define computer calculation to approve a transaction and add data into the database. When decentralization eliminates central power on the network, it also prevents a supply chain from breaking down, because a single point failure will not lead to the failure of the whole network, which can reduce the chance of hacking. Technically, hacking can only be achieved when the majority of the users are taken over, which will take a considerable amount of energy/time [ 34 ]. Therefore, the more complicated blockchain network is with more users, the more difficult it is for the hacking behaviour to happen. When applied to the food supply chain, blockchain can keep records and data safe, and eliminates the risks of hacking and data stealing.

2.2.3. Immutability

After allowing authorized users to have the same power to upload and check information, blockchain also ensures the records’ originality and authenticity. This means historic data cannot be altered without warning other users. Therefore the immutability feature can minimize the human intervention on records. This feature is especially useful during food recall, which can prevent any related stakeholders change history and escape from responsibilities [ 19 , 33 ]. It is powerful proof for investigating the possibilities of food crisis. It allows companies to trace back along the supply chain and isolate certain ingredients from specific suppliers more efficiently [ 23 , 35 ]. It also acts as evidence for containing products, such as organic food, halal food, fair trade food, etc., which allows for customers to buy with confidence. However, immutability cannot always guarantee the raw information authenticity, and the initial data has to be correct from the beginning. With the increase of transactions, blockchain can be considered as a strategic tool to encourage food supply chain stakeholders to take responsibilities and provide/record quality information [ 20 , 23 ].

2.2.4. Smart Contract

Smart contract is another important feature of blockchain, which is a digitalized contract and operates automatically once certain agreements are met [ 34 ]. The use of smart contact can significantly speed up the transactions and enhance trust [ 35 , 36 , 37 ]. For instance, payment can automatically be sent to producers once products arrive at the warehouse. The programmed contract can save paperwork, accelerate processing time, and minimize human labor efforts when compared to the traditional supply chain [ 21 , 23 ]. For example, in 2014, Maersk found that over 30 people and organizations got involved when shipping a container of roses and avocado from Kenya to Netherlands [ 38 ]. It also took 34 days, including 10 days of documents processing to complete a whole shipping activity, not considering missing papers causing delays and time extension into account [ 38 ]. No single users can make changes on smart contract as it is based on the agreement of all partners. In other words, it can replace “the letter of credit” and protect the partnerships.

Combining all of these features, blockchain can eliminate the risks of transactions in a lack of trust environment, increase supply chain visibility and transparency, improve efficiency, and protect every stakeholder’s benefits. In this case, blockchain can achieve maximum digitalization, save processing time, increase efficiency, and reduce unnecessary costs [ 39 ].

2.3. Traceability

Traceability has many definitions so far, the earliest definition was by International Organization for standardization in 1994 [ 40 ]: “the ability to trace the history, application or location of an entity by means of recorded identifications”. The Codex Alimentarius Commission defines Traceability as “the ability to follow the movement of a food through specified stage(s) of production, processing and distribution” [ 41 ]. Bosona and Gebresenbet [ 42 ] (p. 35) proposed the definition as: “food traceability is part of logistics management that capture, store, and transmit adequate information about a food, feed, food-producing is correct animal or substance at all stages in the food supply chain so that the product can be checked for safety and quality control, traced upward, and tracked downward at any time required”.

Many researchers have proposed few benefits on food traceability [ 16 , 43 , 44 ], which can be summarized into four types: improve efficiencies (increasing food safety, improving operational efficiencies, enhancing brand reputation); meet stakeholder demand (meeting stakeholder requirements and ensuring food authenticity); meet regulations requirements (meeting legal requirements); and, achieve global alignment (supporting global standardization and conservation of natural resources).

Good traceability provides precise recording of products movements, which allows companies to have a clearer view of the supply chain, make better decisions, and avoid potential quality risks [ 44 ]. The ability of tracing products backward and forward along the supply chain can improve the speed of isolating and finding certain products from certain suppliers, which makes quality checks and product recalls more efficient. By demonstrating the resources and products flow, customers have better knowledge and trust in the buying products.

Therefore, traceability is considered as an added value to the food products [ 43 , 45 ]. In addition, the traceability system can be a marketing tool to attract more customers and enhance customer loyalty. The records keeping are also a point of verifications for companies to ensure their suppliers provide quality products [ 16 ]. Therefore, an efficient traceability system can be used as a strategic tool to build trust between partners [ 43 ]. Following the food hazards and customer demand, governments and non-government organizations have also published policies to encourage and pressure food companies to develop their traceability systems for food safety and quality purposes. For example, European Commission (EC) Food Law Regulation 178/2002 was developed to ensure the food traceability requirements and stated that food must be traceable at all stages [ 44 ].

Many government departments or non-profit organizations were also built to help with food safety, such as FDA in America, Food Standards Agency in the UK, State Food and Drug Administration in China, etc. The global supply chains are more complex with different policies to adapt in different areas, and give global companies more pressure for traceability. By applying blockchain, globalized standardization can be adaptable for all countries and regions, and they can save companies from duplicative works [ 44 ]. For sustainability purposes, traceability is also a way to monitor environmental impacts, therefore, encouraging companies to be more sustainable.

Although traceability is found to be important and necessary, it can differentiate food companies from success and failure during food recall, by accelerating the recall speed and saving unnecessary costs [ 43 ]. Traditionally, product recall can take up to weeks or months due to the complicated and inefficient procedures, especially for processed food. According to FDA, it takes, on average, 57 days for a recall, sometimes it can take up to 10 months [ 46 , 47 ]. The current traceability systems are largely paper-based or by private databases [ 16 ], which is even harder to achieve efficient target recall [ 34 ]. The slower the products recall, the more likely the harm to public health [ 34 ]. It can also lead to deep concerns of food safety and damage a company’s brand image. Therefore, an efficiency traceability system can be a “life saver” for both customers and companies.

Blockchain was found to be a choice of solution for achieving efficient traceability in the food supply chain [ 22 ] utilized one of the earliest researches of blockchain in food traceability. In this paper, the author proposed a conceptual framework that integrates blockchain and IoT, and analyses the benefits, including improving efficiency and transparency. There are also many pilot studies that provide the practical implication. One of the well-known blockchain pilot examples was run by Walmart and IBM to trace mango [ 32 ]. When compared with the traditional traceability system, mango reduced the tracing time from nearly seven days to 2.2 s by using blockchain.

3. Methodology

This research adopts a literature review method in order to answer the research questions. There are several review papers on blockchain and supply chain management; however, none of them have a specific focus on food supply chain with a management focus [ 19 , 21 , 31 , 35 , 48 , 49 ]. These papers provide the foundation for this research.

Fink [ 50 ] (p. 3) defined literature review as “a systematic, explicit, and reproducible design for identifying, evaluating, and interpreting the existing body of recorded documents”. Tranfield et al. [ 51 ] (p. 208) also suggested that literature review could be used “to map and assess the existing intellectual territory, and to specify a research question to develop the existing body of knowledge further”. This paper adopts a content-analysis based literature review method to analyze the literature on the application of blockchain in food supply chain management. Systematic review, according to Tranfield et al. [ 51 ] (p. 209, p. 220), aims to identify “key scientific contributions”, to reduce bias and “provide collective insight” to a field. Content analysis, as Seuring and Gold [ 52 ] suggested, can be used to generate reliable findings due to the structured and consistent procedure. A few researchers have conducted a content-based literature review method in the field of supply chain management [ 52 , 53 ]. This paper not only thoroughly reviews blockchain, but also considers practical applications in food supply chain management. It aims to provide a more precise and integrated understanding of blockchain and its influences in food supply chain management.

We apply a six-stage refinement process that was suggested by Durach et al. [ 54 ]: define research question, set inclusion and exclusion criteria, determine searching databases, apply criteria, synthesize relevant literatures, and report findings. Research questions were provided in the introduction. In order to have a wide coverage, the research keywords are: blockchain, food supply chain. Therefore, the journal articles and conference papers about blockchain applications in the food supply chain can be found and reviewed. Web of science, Scopus, and Ebsco are the three online databases that were applied to search for relevant academic literature, as the three databases have a wide range of resources, and they have been extensively used in supply chain management research. Peer-reviewed journal articles are seen as a way of high-quality communication between research fellows. However, in this paper, other resources, such as conference papers, grey papers, such as consulting reports, and third party reports that can provide more updated information, are also considered due to the early stage of blockchain and the limited published articles. The initial search came out with 57 results in the three databases.

Removing the duplicated papers and applying inclusion and exclusion criteria ( Table 1 ), the number of useful papers was reduced to 26 in the final process ( Figure 1 ). The final 26 papers were categorized and evaluated by the content analysis method, which is a systematic and objective research method that have been used to quantify phenomena, documents, or communications [ 52 ].

Paper selection process.

Inclusion and Exclusion Criteria.

Descriptive analysis is the first insight into all of the papers, to provide basic information of the selected papers. Among the selected papers, the earliest paper (one out of 26) was released in 2016, and nine papers in 2017, and 16 papers were from 2018, due to the young age of technology. The time trend shows that blockchain is gaining increasing attention and interest in the supply chain area. This also explains why 13 out of 26 papers are technology and innovation related conference papers. Although all of the papers are focused on the food supply chain, the food categories are slightly different. Most of the papers focused on agri-food supply chain in general [ 17 , 22 , 28 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. A few papers used more specific food supply chains, such as Halal supply chain [ 62 ], tilapia supply chain [ 63 ], and rice supply chain [ 64 ]. Papers mainly introduced blockchain and demonstrate its potential by using conceptual framework (13 out of 26), and then pilot cases (seven out of 26), three theory papers (three out of 26), one survey (one out of 26), and two systematic literature analyses (two out of 26), respectively.

All of the papers were read thoroughly and highlighted by the different categories of benefits and challenges ( Table 2 ). The benefits can be divided into four categories: transparency, information authenticity, efficiency, and sustainability; the challenges are: lack of understanding, immature technology, stakeholder cooperation, trade secrets, and raw data manipulation. By listing and dividing papers, as in Table 2 , the brief content and highlights of every paper can be shown more clearly.

List of papers by content analysis.

4. Finding and Discussion

Many studies pointed out the problems in current food supply chain, including inefficient traceability, information asymmetry, information fraud, poor supply chain management, etc. In this case, blockchain is supposed to be a feasible solution for the problems that are mentioned above. The following parts are the five benefits that have been summarized from the 26 papers (details in Table 2 ).

4.1. Benefits

4.1.1. blockchain improves food traceability.

Different food companies have different traceability systems, either by paper or by computer system. However, food supply chain can be very complicated with multiple supplies horizontally and vertically due to the complex feature of the food products [ 72 ]. Therefore, manual traceability system, such as paper records, can be very time consuming or easily cause errors. While some companies’ traceability database can be too private to be applicable for the other stakeholders, which can cause lack of stakeholder cooperation or a lack of supervision within a supply chain [ 59 ]. The complex food supply chain also means higher risks of recall (mislabelling, chemical contamination, low quality of raw material, and food additives) and higher requirements on stakeholders’ collaboration, single ingredient caused food recall can take up to many months to address [ 28 , 32 ]. According to Yiannas [ 32 ] it can cost up to $93 billion to recall products, due to an inability to trace the root cause of outbreak. Blockchain is believed to improve the traceability efficiency and enhance trust during food recall.

Galvez et al. [ 67 ], who analysed the potential of its uses in food traceability and authenticity, also suggested that blockchain is a powerful tool to avoid food fraud and improve traceability efficiency, including time and costs saving, risks reducing, and increasing trust. Similarly, Caro et al. [ 55 ] built two traceability systems that were based on combination of blockchain and IoT on Ethereum and Hyperleger Sawtooth, respectively, and confirmed the ability of blockchain on providing transparency and auditability. Walmart and IBM conducted a pilot study of the blockchain based traceability system in 2016. The two companies worked together to trace mangoes from a store to the farm. By current traceability system, it took almost seven days to collect all of the information of mango movements, which required every stakeholder to contact each other to get to know the required details [ 32 ]. By blockchain, the time to contact and wait for response from other stakeholders can be eliminated. The movements of mangoes are recorded by each stakeholder along the supply chain, and are ready to be checked anytime. The trace time reduced from nearly seven days to 2.2 s by blockchain [ 32 ]. AgriDigital and CBH group also carried out a pilot study in the Australian grain industry and found that the blockchain network allowed for better traceability [ 56 ].

4.1.2. Blockchain Improves Food Supply Chain Transparency

In the current supply chain, big food brands normally choose to open partially selected information to the public and aim to benefit the companies themselves, which can cause customers to not have enough knowledge of products and company details of their suppliers [ 27 ]. As Reyna et al. [ 34 ] proposed that, insufficient information could impact food security. For certain products that have specific requirements, such as halal food, transparency of the supply chain is significantly necessary to ensure products quality and keep customer trust [ 62 ]. Although government and other authorities have published policies and make regular checks on food quality in many cases, the authority’s power can be the target of bribery, and contribute to cover up for big brand companies. For example, the Sanlu milk scandal did not become exposed in the first place because the company managers and local authorities hid the scandal [ 73 ]. Even though companies can release certain information based on requirements, it is easy to change information or erase history to escape from responsibilities or hide the truth [ 17 , 22 , 55 , 74 ]. Thus, information credibility and trust are hard to achieve by centralized supply chains, where transparency and visibility remain low [ 59 ].

Therefore, one of the main features of blockchain is decentralization, which allows for authorized users to make transactions and to access history directly without central power intervention. Every registered valid user has the same power to examine a transaction, and have a copy of history [ 19 ]. This feature can eliminate any large powers over the information flow, address information asymmetry between stakeholders, and provide transparency along the supply chain. Meanwhile, once data are updated onto the blockchain, the recordings become permanent. The immutability feature can be achieved by running the blockchain mining process [ 17 ]. Once the majority of miners/users vote to validate certain transactions, the transaction data stay stored, and they can never be changed without notifying all of the users [ 17 ]. Thus, the history of the products movements in a supply chain can be retrieved and checked any time whenever needed without worrying its being tempered. In addition, product information includes its movement and certain certification can be digitalized and updated, which allows for permissioned users to access anytime [ 32 ]. For food products, the verifications are necessary for proving companies’ eligibility for producing or selling. The digitalization of records and documents not only can save time from manual paper check, but also eliminate the risks from data manipulation and errors [ 56 ]. In 2016, Walmart and Tsinghua University tracked pork in China from-farm-to-fork [ 32 ]. The finding showed the ability of blockchain on improving information authenticity, reducing information errors, and gaining trust.

4.1.3. Blockchain Can Be Combined with IoT Devices

IoT includes RFID (Radio-Frequency Identification), GPS (Global Positioning system), GIS (Geographic Information System), WSN (Wireless sensor network), etc., is an intelligent, reliable, and high-speed information network that connects objects. Instead of manual recording, information, such as temperature and humidity, can be automatically captured by IoT sensors. This real-time information capturing ability is especially important for frozen and fresh food products, as the quality is closely related to the external environment [ 22 , 65 ]. The automation by IoT can increase the efficiency of monitoring and capturing information, and reduce the manual errors [ 17 , 22 , 28 , 75 ]. However, there are also a few challenges of IoT deployments including data confidentiality, vulnerability, data integrity, and stakeholder’s privacy [ 34 , 55 , 75 , 76 , 77 ]. Therefore, protection and security are important when using IoT devices in supply chains, which can be developed by combining with blockchain protocol [ 19 , 34 , 35 , 39 , 75 , 76 ].

Many studies have combined blockchain technology with IoT and suggested that blockchain can help to manage IoT and make supply chain more efficient [ 17 , 22 , 28 , 63 , 67 , 68 , 75 ]. Rejeb [ 75 ] made six propositions on the combination of blockchain and IoT, the scalability, security, auditing, efficiency, interoperability, and the quality of IoT solutions can be improved. Tian [ 17 , 22 ] built an agri-food traceability system based on RFID tags and blockchain to deliver real-time information of food products. Lin et al. [ 28 ] also proposed a blockchain and IoT based agriculture system and agreed that the new system is trusted and self-organized without human intervention.

In practice, the Accenture traceability report listed a few blockchain pilot studies that have been incorporated with IoT, such as WWF while using smart tagging combined with blockchain to prevent illegal tuna fishing in Fiji; Belagricola uses IoT and smart contact to track grains and ensure the quality [ 68 ]. By combining with smart contract, once anything goes wrong, such as losing temperature control, the digitalized program can be automatically triggered and send registered users warnings, which can prevent further damage [ 17 , 55 , 65 ]. From the production to retailing, the integration of the two technologies allows for data collection and transferring without human intervention and ensures food quality and safety.

4.1.4. Blockchain Can Improve the Efficiency of Food Recall

By using blockchain, the food supply chain is found to be more sustainable by operating more efficiently and targeted food recall. When products information is updated on blockchain in near real-time speed, stakeholders can have more knowledge of products flow and react to situations quicker. For instance, Walmart realized that fresh import products, such as mangoes, could wait to be checked up to four days in the country border [ 32 ]. In this case, Walmart can follow up the products movements, accelerate the products checking process, and give products greater shelf-live. The improvement of information transparency can improve the supply chain efficiency and eliminate unnecessary products wastes.

Meanwhile, the untargeted food recall is also one of the major causes of food wastes. Food products tend to be complicated with mixture of many ingredients. Single ingredient contamination caused food recall to be complicated and time consuming, which requires the traceability system to be extremely efficient. By blockchain-based traceability, it is possible to retrieve needed information, isolate products from certain suppliers, and narrow down the products recall range. Meanwhile, companies can also make more accurate customer demand forecasting based on the point of sales data, depending on the information [ 78 ]. Zhao et al. [ 21 ] also pointed out that applying blockchain technology could lead to sustainable water management by recordkeeping in blockchain platform based water trading.

4.2. Challenges

Blockchain sounds like a promising technology that might revolutionize food supply chain, improve efficiency, and eliminate risks. More pilot studies have been tested and received positive feedbacks [ 32 , 56 ]. However, it is an undeniable fact that blockchain is still at its infancy stage and it has a long way to go before it can be widely put in use. There are few challenges that have been raised by multiple researchers based on our review that need to be addressed. Some of these are discussed a little bit, being detailed in the following paragraphs below.

4.2.1. Lack of Deep Understanding and Knowledge of the Blockchain Technology by Companies

The first challenge is to introduce the concept to the public, studies show that many people working on supply chain management are still having troubles to fully understand blockchain potentials [ 19 , 21 , 24 , 60 , 67 ]. The level of understanding of the technology can significantly impact the participants’ attitudes. According to the survey by Hackius and Petersen [ 24 ], participants who are more familiar with the concept and more experienced, tend to hold a more positive attitude to blockchain adoption. After analyzing some most recent pilot studies, Verhoeven et al. [ 23 ] also suggested that there is still lack of deep understanding of blockchain potential, as many companies tend to choose blockchain as solution before diagnosing company issues. For instance, Verhoeven et al. [ 23 ] suggested that, in Walmart’s pilot study of tracing mangoes, the tracing speed increased by blockchain should have been due to the elimination of the manual validation process rather than a change to an efficient platform. The mango pilot study also failed to present the importance of the immutability feature, as the records can be very important for fresh food quality. For example, the immutable records that include temperature and humidity can be the evidence for keeping food. Leong et al. [ 68 ] also suggested that different stages of the supply chain might have different requirements of technology adoption. Therefore, it is always necessary to have a comprehensive understanding of both costs and benefits of the technology to provide the right “remedy” to company problems; sometimes, other existing technologies can be better solutions [ 23 , 68 ].

4.2.2. Technology Scalability Issue

The second challenge is blockchain scalability, which is also called “scalability trilemma” by the founder of Ethereum—Vitalik Buterin [ 69 ]. According to him, it is hard to achieve decentralization, scalability, and security at the same time; only two out of the three can be achieved at a point in time [ 69 , 79 ]. Bitcoin, for example, was designed to be decentralized and security with a compromising scalability.

Scalability determines how large the capacity the network can be. Currently, the smart contract platform—Ethereum, for example, can process 15 transactions per second, while other platforms, such as Visa, can process 45,000 transactions per second [ 80 ]. By operating the complicated mining process to validate transactions and keep all transaction copies in each node, blockchain can achieve high degree of decentralization and security; however, it can also cause a slow speed of validations, especially when a large number of transactions are happening. This means that high scalability can increase the security risks, while low scalability can cause transaction crowds and slow down the network.

Food supply chain tends to be vast with a large number of users exist in one transaction, the global food supply chain scale can reach approximately Petabyte per year by assumption according to [ 72 ]. Therefore, developers are still working to find a better solution to expend blockchain scalability while keeping high security and decentralization. Pearson et al. [ 72 ] assumed that blockchain is more likely to happen in niche areas in a food supply chain, where the blockchain potentials are necessarily needed, such as organic products, etc., due to the scalability issues. Leong et al. [ 68 ] also suggested that the different stages of the food supply chain might have different requirements for blockchain adoption, where the balance of the three features can be different.

4.2.3. Possibilities of Raw Data Manipulation before Uploading to Blockchain

Although blockchain can provide a robust way to keep records, many studies have concerned raw data manipulation, for example by tempering with IoT sensors, it is hard to know whether the raw data in the first place are authentic [ 65 , 67 ]. It is also possible to make damage on products on purpose without notifying blockchain users [ 39 ]. Targeting on potential raw data manipulation, third parties, such as governments and certifications, can get involved in the blockchain network by making regular checks to ensure raw data authenticity [ 17 , 68 ]. Meanwhile, the immutable recording can be used as strategic tool to encourage suppliers to take responsibilities for their products and provide authentic information in the first place.

4.2.4. It Is Hard to Require All Stakeholders within a Food Supply Chain to Adopt Blockchain

Rather than paper recording, blockchain requires all of the stakeholders to get involved, from raw material suppliers to customers along the multiple tiers of the supply chain. Stakeholders can register themselves as authorised users, which will allow them to upload information, to verify transactions, and to access past records. Customers as the end users will also have rights to require and check products’ history. Bringing all of the stakeholders on board can be beneficial for improving information transparency and efficiency; however, it also can be an obstacle due to the different level of awareness and infrastructures. For small and medium enterprises (SME) and developing countries, the blockchain implementing and infrastructure mentioning fee can be the barriers for adopting new innovations [ 60 , 68 , 69 , 72 ]. Kamilaris et al. [ 60 ] also found that most of the blockchain projects are located in developed counties. Therefore, it is important to make blockchain “SME friendly” which means easy to use, easy to deploy with low initial costs [ 68 , 72 ]. Perboli et al. [ 69 ] developed a blockchain model that was based on Hyperledger Fabric for SMEs and came to the conclusion that the implementation fee of blockchain can be highly sustainable and be paid back by saving on costs. They also suggested that replacing the system partially by blockchain is more reasonable than replacing the whole system.

4.2.5. Regulations/Laws Need to Be Updated

Policies will be needed to protect users’ rights and trading secrets, as blockchain is an open database. Tse et al. [ 66 ] applied PEST analysis to examine the uncontrollable external environment, which includes political, economic, social, and technological factors for blockchain implementation. The paper suggested that governments could obtain supply chain information and reduce food risks by using blockchain. A few countries and authorities also showed their interests and supports on blockchain development [ 66 ]: China, for example, has published Blockchain White book and launched blockchain related projects [ 66 ]. ISO Blockchain (TC307) was also working on developing global blockchain standards [ 72 ]. There is still no strict blockchain policy in the food supply chain area so far. Leong et al. [ 68 ] and Pearson et al. [ 72 ] suggested that policies and rules need to be developed to protect users, including what data should be uploaded, who own the data, how to use and store the data, etc. Kamilaris et al. [ 60 ] proposed that a lack of policy could be the barrier for blockchain wide adoption. Therefore, from protecting users’ rights point of the view, it is difficult to invite all companies or people to use blockchain before some completed standards and policies are being launched.

5. Conclusions and Limitations

This paper presents a comprehensive review of blockchain based food supply chain. Most of the reviewed paper agreed on the promising benefits that blockchain may bring to the food supply chain. From building conceptual frameworks or analysing case studies, blockchain is found to be able to bring transparency, enhance information authenticity, and speed up food recall. Combining with current IoT technology, such as RFID, blockchain can further improve the efficiency of supply chain management and traceability system. Nevertheless, despite it drawing increasing attention from researchers, blockchain is in its infancy stage with many challenges. The challenges are waiting to be addressed before the technology can be put in use publicly. For technology adopters, such as food suppliers, there is a lack of deep understanding of the technology, which can compromise the benefits of blockchain. In another words, technology should be chosen for the issues rather than another way around. For technology developers, the low scalability is also an issue, which can cause a transaction crowd due to a large number of users and transactions in one food supply chain. For third parties, such as governments and organizations, there is no common admitted standard on blockchain adoption in food supply chain thus far. The development of policies can give protection to companies on their trading secrets and data storage. In this case, third parties are suggested to be more supportive in technology adoption, including technology education to the public, the development of certain policies and rules, and engagement with blockchain by pilot projects. In total, blockchain shows a significant potential that might address food crisis and bring a more trusted future on food security and quality.

This paper is one of the first to investigate how blockchain influences food supply chain specifically. The paper provides a fundamental and comprehensive understanding of blockchain and its potential impacts, which will not only be a useful guide for new researcher in relevant area, but can also provide some deeper insights for practitioners, such as company decision-makers. By identifying and analysing the most related papers, this work lays a solid ground for future research on this area and points out some research directions. This paper also gives technology adopters a better understanding of blockchain and explains to them some possible adoption challenges and reminds them to use blockchain wisely.

Despite the contributions put forth by this paper, we would like to point out some limitations and future research areas. First of all, the paper is based on 26 papers review, which might not be enough to prevent research bias. This is due the immaturity of blockchain technology; only several pilot studies with most of the theory-based articles are included. As there was big success of blockchain application in financial sector, the “hype” of blockchain is increasing and it gains a lot of attention. This can lead to potentially positive perspectives of blockchain rather than questioning the technology. In this case, future research can focus on blockchain implementation in the real world and provide more empirical evidence rather than theories. Secondly, food supply chain is vast and complicated. Different food products, such as fresh food, frozen food, agri-food, processed food, etc., may require difference supply chain. However, this review collects 26 food supply chain related papers without identifying particular products. Future research is possible to focus on specific food products, and present more precise findings.

Author Contributions

Conceptualization, Y.G. and J.D.; methodology, C.Z. and Y.G.; formal analysis, C.Z.; writing—original draft preparation, C.Z. and Y.G.; writing—review and editing, J.D., S.B. and Z.L.; visualization, Y.G.; supervision, Y.G. and S.B.; funding acquisition, J.D. and Y.G. All authors have read and agree to the published version of the manuscript.

The APC was funded by Southwestern University of Finance and Economics.

Conflicts of Interest

The authors declare no conflict of interest.

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• Inappropriate use of proton pump inhibitors in clinical practice globally: a systematic review and meta-analysis
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• http://orcid.org/0000-0002-5111-7861 Amit K Dutta 1 ,
• http://orcid.org/0000-0003-2472-3409 Vishal Sharma 2 ,
• Abhinav Jain 3 ,
• Anshuman Elhence 4 ,
• Manas K Panigrahi 5 ,
• Srikant Mohta 6 ,
• Richard Kirubakaran 7 ,
• Mathew Philip 8 ,
• http://orcid.org/0000-0003-1700-7543 Mahesh Goenka 9 ,
• Shobna Bhatia 10 ,
• http://orcid.org/0000-0002-9435-3557 Usha Dutta 2 ,
• D Nageshwar Reddy 11 ,
• Rakesh Kochhar 12 ,
• http://orcid.org/0000-0002-1305-189X Govind K Makharia 4
• 1 Gastroenterology , Christian Medical College and Hospital Vellore , Vellore , India
• 2 Gastroenterology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
• 3 Gastroenterology , Gastro 1 Hospital , Ahmedabad , India
• 4 Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
• 5 Gastroenterology , All India Institute of Medical Sciences - Bhubaneswar , Bhubaneswar , India
• 6 Department of Gastroenterology , Narayana Superspeciality Hospital , Kolkata , India
• 7 Center of Biostatistics and Evidence Based Medicine , Vellore , India
• 8 Lisie Hospital , Cochin , India
• 9 Apollo Gleneagles Hospital , Kolkata , India
• 10 Gastroenterology , National Institute of Medical Science , Jaipur , India
• 11 Asian Institute of Gastroenterology , Hyderabad , India
• 12 Gastroenterology , Paras Hospitals, Panchkula , Chandigarh , India
• Correspondence to Dr Amit K Dutta, Gastroenterology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India; akdutta1995{at}gmail.com

https://doi.org/10.1136/gutjnl-2024-332154

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• PROTON PUMP INHIBITION
• META-ANALYSIS

We read with interest the population-based cohort studies by Abrahami et al on proton pump inhibitors (PPI) and the risk of gastric and colon cancers. 1 2 PPI are used at all levels of healthcare and across different subspecialties for various indications. 3 4 A recent systematic review on the global trends and practices of PPI recognised 28 million PPI users from 23 countries, suggesting that 23.4% of the adults were using PPI. 5 Inappropriate use of PPI appears to be frequent, although there is a lack of compiled information on the prevalence of inappropriate overuse of PPI. Hence, we conducted a systematic review and meta-analysis on the inappropriate overuse of PPI globally.

Supplemental material

Overall, 79 studies, including 20 050 patients, reported on the inappropriate overuse of PPI and were included in this meta-analysis. The pooled proportion of inappropriate overuse of PPI was 0.60 (95% CI 0.55 to 0.65, I 2 97%, figure 1 ). The proportion of inappropriate overuse by dose was 0.17 (0.08 to 0.33) and by duration of use was 0.17 (0.07 to 0.35). Subgroup analysis was done to assess for heterogeneity ( figure 2A ). No significant differences in the pooled proportion of inappropriate overuse were noted based on the study design, setting (inpatient or outpatient), data source, human development index of the country, indication for use, sample size estimation, year of publication and study quality. However, regional differences were noted (p<0.01): Australia—40%, North America—56%, Europe—61%, Asia—62% and Africa—91% ( figure 2B ). The quality of studies was good in 27.8%, fair in 62.03% and low in 10.12%. 6

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Forest plot showing inappropriate overuse of proton pump inhibitors.

(A) Subgroup analysis of inappropriate overuse of proton pump inhibitors (PPI). (B) Prevalence of inappropriate overuse of PPI across different countries of the world. NA, data not available.

This is the first systematic review and meta-analysis on global prescribing inappropriateness of PPI. The results of this meta-analysis are concerning and suggest that about 60% of PPI prescriptions in clinical practice do not have a valid indication. The overuse of PPI appears to be a global problem and across all age groups including geriatric subjects (63%). Overprescription increases the patient’s cost, pill burden and risk of adverse effects. 7–9 The heterogeneity in the outcome data persisted after subgroup analysis. Hence, this may be inherent to the practice of PPI use rather than related to factors such as study design, setting or study quality.

Several factors (both physician and patient-related) may contribute to the high magnitude of PPI overuse. These include a long list of indications for use, availability of the drug ‘over the counter’, an exaggerated sense of safety, and lack of awareness about the correct indications, dose and duration of therapy. A recently published guideline makes detailed recommendations on the accepted indications for the use of PPI, including the dose and duration, and further such documents may help to promote its rational use. 3 Overall, there is a need for urgent adoption of PPI stewardship practices, as is done for antibiotics. Apart from avoiding prescription when there is no indication, effective deprescription strategies are also required. 10 We hope the result of the present systematic review and meta-analysis will create awareness about the current situation and translate into a change in clinical practice globally.

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Supplementary materials

Supplementary data.

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Contributors AKD: concept, study design, data acquisition and interpretation, drafting the manuscript and approval of the manuscript. VS: study design, data acquisition, analysis and interpretation, drafting the manuscript and approval of the manuscript. AJ, AE, MKP, SM: data acquisition and interpretation, critical revision of the manuscript, and approval of the manuscript. RK: study design, data analysis and interpretation, critical revision of the manuscript and approval of the manuscript. MP, MG, SB, UD, DNR, RK: data interpretation, critical revision of the manuscript and approval of the manuscript. GKM: concept, study design, data interpretation, drafting the manuscript, critical revision and approval of the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

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

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SYSTEMATIC REVIEW article

Correlation analysis between low birth weight and impaired glucose tolerance in children: a systematic review and meta-analysis provisionally accepted.

• 1 Heping Hospital Affiliated to Changzhi Medical College, China
• 2 Guangzhou Red Cross Hospital, China

The final, formatted version of the article will be published soon.

Background: A potential association between the onset of diabetes and normal birth weight (NBW) has been discovered. Diverse conclusions and study methodologies exist regarding the connection between low birth weight (LBW) and impaired glucose tolerance in children, underscoring the need for further robust research. Our institution is embarking on this study to thoroughly examine the association between LBW and impaired glucose tolerance in children.We conducted searches on Cochrane Library, ScienceDirect, EMBASE, PubMed, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature data (CBM) online database, VIP full-text Database, and Wanfang Database to identify correlation analyses or case-control studies investigating the relationship between LBW and abnormal glucose tolerance in children. The search spanned from January 2010 to September 2023. The quality of observational studies was evaluated using the Newcastle-Ottawa Scale (NOS) tool. Data synthesis was performed using the statistical software RevMan 5.3 for meta-analysis.Results: Based on the preferred reporting items for systematic reviews and metaanalysis (PRISMA) guidelines, we finally included 10 clinical control studies consisting of a total of 2971 cases. There wasn't considerably change in blood sugar levels among LBW, NBW and high birth weight (HBW) infants (P>0.05). There was no significant difference in insulin levels between LBW infants and NBW infants (P>0.05). The HOMA-IR of LBW infants was considerably higher than that of NBW infants (P<0.05). The risk of abnormal glucose tolerance in LBW infants was 0.42 times higher than that in NBW and HBW infants [Fisher's Z = 0.42, 95% CI = (0.09,0.75), P=0.01].LBW is associated with an increased risk of abnormal glucose tolerance, as indicated by elevated HOMA-IR level in LBW infants compared to NBW and HBW pediatric population. Further research is needed to confirm and expand upon these findings to better understand the complex relationship between LBW and impaired glucose tolerance in children.

Keywords: Newborn, low birth weight, Abnormal glucose tolerance, diabetes, Meta-analysis

Received: 27 Dec 2023; Accepted: 23 Apr 2024.

Copyright: © 2024 Ma, Lian, Mo and Wang. 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) or licensor 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: Mx. Youfang Wang, Guangzhou Red Cross Hospital, Guangzhou, China

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