literature review in research methodology pdf

State-of-the-art literature review methodology: A six-step approach for knowledge synthesis

• Original Article
• Open access
• Published: 05 September 2022
• Volume 11 , pages 281–288, ( 2022 )

Cite this article

You have full access to this open access article

• Erin S. Barry   ORCID: orcid.org/0000-0003-0788-7153 1 , 2 ,
• Jerusalem Merkebu   ORCID: orcid.org/0000-0003-3707-8920 3 &
• Lara Varpio   ORCID: orcid.org/0000-0002-1412-4341 3  

27k Accesses

8 Citations

18 Altmetric

Explore all metrics

Introduction

Researchers and practitioners rely on literature reviews to synthesize large bodies of knowledge. Many types of literature reviews have been developed, each targeting a specific purpose. However, these syntheses are hampered if the review type’s paradigmatic roots, methods, and markers of rigor are only vaguely understood. One literature review type whose methodology has yet to be elucidated is the state-of-the-art (SotA) review. If medical educators are to harness SotA reviews to generate knowledge syntheses, we must understand and articulate the paradigmatic roots of, and methods for, conducting SotA reviews.

We reviewed 940 articles published between 2014–2021 labeled as SotA reviews. We (a) identified all SotA methods-related resources, (b) examined the foundational principles and techniques underpinning the reviews, and (c) combined our findings to inductively analyze and articulate the philosophical foundations, process steps, and markers of rigor.

In the 940 articles reviewed, nearly all manuscripts (98%) lacked citations for how to conduct a SotA review. The term “state of the art” was used in 4 different ways. Analysis revealed that SotA articles are grounded in relativism and subjectivism.

This article provides a 6-step approach for conducting SotA reviews. SotA reviews offer an interpretive synthesis that describes: This is where we are now. This is how we got here. This is where we could be going. This chronologically rooted narrative synthesis provides a methodology for reviewing large bodies of literature to explore why and how our current knowledge has developed and to offer new research directions.

Similar content being viewed by others

An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis

Reviewing the literature, how systematic is systematic.

Reading and interpreting reviews for health professionals: a practical review

Avoid common mistakes on your manuscript.

Literature reviews play a foundational role in scientific research; they support knowledge advancement by collecting, describing, analyzing, and integrating large bodies of information and data [ 1 , 2 ]. Indeed, as Snyder [ 3 ] argues, all scientific disciplines require literature reviews grounded in a methodology that is accurate and clearly reported. Many types of literature reviews have been developed, each with a unique purpose, distinct methods, and distinguishing characteristics of quality and rigor [ 4 , 5 ].

Each review type offers valuable insights if rigorously conducted [ 3 , 6 ]. Problematically, this is not consistently the case, and the consequences can be dire. Medical education’s policy makers and institutional leaders rely on knowledge syntheses to inform decision making [ 7 ]. Medical education curricula are shaped by these syntheses. Our accreditation standards are informed by these integrations. Our patient care is guided by these knowledge consolidations [ 8 ]. Clearly, it is important for knowledge syntheses to be held to the highest standards of rigor. And yet, that standard is not always maintained. Sometimes scholars fail to meet the review’s specified standards of rigor; other times the markers of rigor have never been explicitly articulated. While we can do little about the former, we can address the latter. One popular literature review type whose methodology has yet to be fully described, vetted, and justified is the state-of-the-art (SotA) review.

While many types of literature reviews amalgamate bodies of literature, SotA reviews offer something unique. By looking across the historical development of a body of knowledge, SotA reviews delves into questions like: Why did our knowledge evolve in this way? What other directions might our investigations have taken? What turning points in our thinking should we revisit to gain new insights? A SotA review—a form of narrative knowledge synthesis [ 5 , 9 ]—acknowledges that history reflects a series of decisions and then asks what different decisions might have been made.

SotA reviews are frequently used in many fields including the biomedical sciences [ 10 , 11 ], medicine [ 12 , 13 , 14 ], and engineering [ 15 , 16 ]. However, SotA reviews are rarely seen in medical education; indeed, a bibliometrics analysis of literature reviews published in 14 core medical education journals between 1999 and 2019 reported only 5 SotA reviews out of the 963 knowledge syntheses identified [ 17 ]. This is not to say that SotA reviews are absent; we suggest that they are often unlabeled. For instance, Schuwirth and van der Vleuten’s article “A history of assessment in medical education” [ 14 ] offers a temporally organized overview of the field’s evolving thinking about assessment. Similarly, McGaghie et al. published a chronologically structured review of simulation-based medical education research that “reviews and critically evaluates historical and contemporary research on simulation-based medical education” [ 18 , p. 50]. SotA reviews certainly have a place in medical education, even if that place is not explicitly signaled.

This lack of labeling is problematic since it conceals the purpose of, and work involved in, the SotA review synthesis. In a SotA review, the author(s) collects and analyzes the historical development of a field’s knowledge about a phenomenon, deconstructs how that understanding evolved, questions why it unfolded in specific ways, and posits new directions for research. Senior medical education scholars use SotA reviews to share their insights based on decades of work on a topic [ 14 , 18 ]; their junior counterparts use them to critique that history and propose new directions [ 19 ]. And yet, SotA reviews are generally not explicitly signaled in medical education. We suggest that at least two factors contribute to this problem. First, it may be that medical education scholars have yet to fully grasp the unique contributions SotA reviews provide. Second, the methodology and methods of SotA reviews are poorly reported making this form of knowledge synthesis appear to lack rigor. Both factors are rooted in the same foundational problem: insufficient clarity about SotA reviews. In this study, we describe SotA review methodology so that medical educators can explicitly use this form of knowledge synthesis to further advance the field.

We developed a four-step research design to meet this goal, illustrated in Fig.  1 .

Four-step research design process used for developing a State-of-the-Art literature review methodology

Step 1: Collect SotA articles

To build our initial corpus of articles reporting SotA reviews, we searched PubMed using the strategy (″state of the art review″[ti] OR ″state of the art review*″) and limiting our search to English articles published between 2014 and 2021. We strategically focused on PubMed, which includes MEDLINE, and is considered the National Library of Medicine’s premier database of biomedical literature and indexes health professions education and practice literature [ 20 ]. We limited our search to 2014–2021 to capture modern use of SotA reviews. Of the 960 articles identified, nine were excluded because they were duplicates, erratum, or corrigendum records; full text copies were unavailable for 11 records. All articles identified ( n  = 940) constituted the corpus for analysis.

Step 2: Compile all methods-related resources

EB, JM, or LV independently reviewed the 940 full-text articles to identify all references to resources that explained, informed, described, or otherwise supported the methods used for conducting the SotA review. Articles that met our criteria were obtained for analysis.

To ensure comprehensive retrieval, we also searched Scopus and Web of Science. Additionally, to find resources not indexed by these academic databases, we searched Google (see Electronic Supplementary Material [ESM] for the search strategies used for each database). EB also reviewed the first 50 items retrieved from each search looking for additional relevant resources. None were identified. Via these strategies, nine articles were identified and added to the collection of methods-related resources for analysis.

Step 3: Extract data for analysis

In Step 3, we extracted three kinds of information from the 940 articles papers identified in Step 1. First, descriptive data on each article were compiled (i.e., year of publication and the academic domain targeted by the journal). Second, each article was examined and excerpts collected about how the term state-of-the-art review was used (i.e., as a label for a methodology in-and-of itself; as an adjective qualifying another type of literature review; as a term included in the paper’s title only; or in some other way). Finally, we extracted excerpts describing: the purposes and/or aims of the SotA review; the methodology informing and methods processes used to carry out the SotA review; outcomes of analyses; and markers of rigor for the SotA review.

Two researchers (EB and JM) coded 69 articles and an interrater reliability of 94.2% was achieved. Any discrepancies were discussed. Given the high interrater reliability, the two authors split the remaining articles and coded independently.

Step 4: Construct the SotA review methodology

The methods-related resources identified in Step 2 and the data extractions from Step 3 were inductively analyzed by LV and EB to identify statements and research processes that revealed the ontology (i.e., the nature of reality that was reflected) and the epistemology (i.e., the nature of knowledge) underpinning the descriptions of the reviews. These authors studied these data to determine if the synthesis adhered to an objectivist or a subjectivist orientation, and to synthesize the purposes realized in these papers.

To confirm these interpretations, LV and EB compared their ontology, epistemology, and purpose determinations against two expectations commonly required of objectivist synthesis methods (e.g., systematic reviews): an exhaustive search strategy and an appraisal of the quality of the research data. These expectations were considered indicators of a realist ontology and objectivist epistemology [ 21 ] (i.e., that a single correct understanding of the topic can be sought through objective data collection {e.g., systematic reviews [ 22 ]}). Conversely, the inverse of these expectations were considered indicators of a relativist ontology and subjectivist epistemology [ 21 ] (i.e., that no single correct understanding of the topic is available; there are multiple valid understandings that can be generated and so a subjective interpretation of the literature is sought {e.g., narrative reviews [ 9 ]}).

Once these interpretations were confirmed, LV and EB reviewed and consolidated the methods steps described in these data. Markers of rigor were then developed that aligned with the ontology, epistemology, and methods of SotA reviews.

Of the 940 articles identified in Step 1, 98% ( n  = 923) lacked citations or other references to resources that explained, informed, or otherwise supported the SotA review process. Of the 17 articles that included supporting information, 16 cited Grant and Booth’s description [ 4 ] consisting of five sentences describing the overall purpose of SotA reviews, three sentences noting perceived strengths, and four sentences articulating perceived weaknesses. This resource provides no guidance on how to conduct a SotA review methodology nor markers of rigor. The one article not referencing Grant and Booth used “an adapted comparative effectiveness research search strategy that was adapted by a health sciences librarian” [ 23 , p. 381]. One website citation was listed in support of this strategy; however, the page was no longer available in summer 2021. We determined that the corpus was uninformed by a cardinal resource or a publicly available methodology description.

In Step 2 we identified nine resources [ 4 , 5 , 24 , 25 , 26 , 27 , 28 ]; none described the methodology and/or processes of carrying out SotA reviews. Nor did they offer explicit descriptions of the ontology or epistemology underpinning SotA reviews. Instead, these resources provided short overview statements (none longer than one paragraph) about the review type [ 4 , 5 , 24 , 25 , 26 , 27 , 28 ]. Thus, we determined that, to date, there are no available methodology papers describing how to conduct a SotA review.

Step 3 revealed that “state of the art” was used in 4 different ways across the 940 articles (see Fig.  2 for the frequency with which each was used). In 71% ( n  = 665 articles), the phrase was used only in the title, abstract, and/or purpose statement of the article; the phrase did not appear elsewhere in the paper and no SotA methodology was discussed. Nine percent ( n  = 84) used the phrase as an adjective to qualify another literature review type and so relied entirely on the methodology of a different knowledge synthesis approach (e.g., “a state of the art systematic review [ 29 ]”). In 5% ( n  = 52) of the articles, the phrase was not used anywhere within the article; instead, “state of the art” was the type of article within a journal. In the remaining 15% ( n  = 139), the phrase denoted a specific methodology (see ESM for all methodology articles). Via Step 4’s inductive analysis, the following foundational principles of SotA reviews were developed: (1) the ontology, (2) epistemology, and (3) purpose of SotA reviews.

Four ways the term “state of the art” is used in the corpus and how frequently each is used

Ontology of SotA reviews: Relativism

SotA reviews rest on four propositions:

The literature addressing a phenomenon offers multiple perspectives on that topic (i.e., different groups of researchers may hold differing opinions and/or interpretations of data about a phenomenon).

The reality of the phenomenon itself cannot be completely perceived or understood (i.e., due to limitations [e.g., the capabilities of current technologies, a research team’s disciplinary orientation] we can only perceive a limited part of the phenomenon).

The reality of the phenomenon is a subjective and inter-subjective construction (i.e., what we understand about a phenomenon is built by individuals and so their individual subjectivities shape that understanding).

The context in which the review was conducted informs the review (e.g., a SotA review of literature about gender identity and sexual function will be synthesized differently by researchers in the domain of gender studies than by scholars working in sex reassignment surgery).

As these propositions suggest, SotA scholars bring their experiences, expectations, research purposes, and social (including academic) orientations to bear on the synthesis work. In other words, a SotA review synthesizes the literature based on a specific orientation to the topic being addressed. For instance, a SotA review written by senior scholars who are experts in the field of medical education may reflect on the turning points that have shaped the way our field has evolved the modern practices of learner assessment, noting how the nature of the problem of assessment has moved: it was first a measurement problem, then a problem that embraced human judgment but needed assessment expertise, and now a whole system problem that is to be addressed from an integrated—not a reductionist—perspective [ 12 ]. However, if other scholars were to examine this same history from a technological orientation, learner assessment could be framed as historically constricted by the media available through which to conduct assessment, pointing to how artificial intelligence is laying the foundation for the next wave of assessment in medical education [ 30 ].

Given these foundational propositions, SotA reviews are steeped in a relativist ontology—i.e., reality is socially and experientially informed and constructed, and so no single objective truth exists. Researchers’ interpretations reflect their conceptualization of the literature—a conceptualization that could change over time and that could conflict with the understandings of others.

Epistemology of SotA reviews: Subjectivism

SotA reviews embrace subjectivism. The knowledge generated through the review is value-dependent, growing out of the subjective interpretations of the researcher(s) who conducted the synthesis. The SotA review generates an interpretation of the data that is informed by the expertise, experiences, and social contexts of the researcher(s). Furthermore, the knowledge developed through SotA reviews is shaped by the historical point in time when the review was conducted. SotA reviews are thus steeped in the perspective that knowledge is shaped by individuals and their community, and is a synthesis that will change over time.

Purpose of SotA reviews

SotA reviews create a subjectively informed summary of modern thinking about a topic. As a chronologically ordered synthesis, SotA reviews describe the history of turning points in researchers’ understanding of a phenomenon to contextualize a description of modern scientific thinking on the topic. The review presents an argument about how the literature could be interpreted; it is not a definitive statement about how the literature should or must be interpreted. A SotA review explores: the pivotal points shaping the historical development of a topic, the factors that informed those changes in understanding, and the ways of thinking about and studying the topic that could inform the generation of further insights. In other words, the purpose of SotA reviews is to create a three-part argument: This is where we are now in our understanding of this topic. This is how we got here. This is where we could go next.

The SotA methodology

Based on study findings and analyses, we constructed a six-stage SotA review methodology. This six-stage approach is summarized and guiding questions are offered in Tab.  1 .

Stage 1: Determine initial research question and field of inquiry

In Stage 1, the researcher(s) creates an initial description of the topic to be summarized and so must determine what field of knowledge (and/or practice) the search will address. Knowledge developed through the SotA review process is shaped by the context informing it; thus, knowing the domain in which the review will be conducted is part of the review’s foundational work.

Stage 2: Determine timeframe

This stage involves determining the period of time that will be defined as SotA for the topic being summarized. The researcher(s) should engage in a broad-scope overview of the literature, reading across the range of literature available to develop insights into the historical development of knowledge on the topic, including the turning points that shape the current ways of thinking about a topic. Understanding the full body of literature is required to decide the dates or events that demarcate the timeframe of now in the first of the SotA’s three-part argument: where we are now . Stage 2 is complete when the researcher(s) can explicitly justify why a specific year or event is the right moment to mark the beginning of state-of-the-art thinking about the topic being summarized.

Stage 3: Finalize research question(s) to reflect timeframe

Based on the insights developed in Stage 2, the researcher(s) will likely need to revise their initial description of the topic to be summarized. The formal research question(s) framing the SotA review are finalized in Stage 3. The revised description of the topic, the research question(s), and the justification for the timeline start year must be reported in the review article. These are markers of rigor and prerequisites for moving to Stage 4.

Stage 4: Develop search strategy to find relevant articles

In Stage 4, the researcher(s) develops a search strategy to identify the literature that will be included in the SotA review. The researcher(s) needs to determine which literature databases contain articles from the domain of interest. Because the review describes how we got here , the review must include literature that predates the state-of-the-art timeframe, determined in Stage 2, to offer this historical perspective.

Developing the search strategy will be an iterative process of testing and revising the search strategy to enable the researcher(s) to capture the breadth of literature required to meet the SotA review purposes. A librarian should be consulted since their expertise can expedite the search processes and ensure that relevant resources are identified. The search strategy must be reported (e.g., in the manuscript itself or in a supplemental file) so that others may replicate the process if they so choose (e.g., to construct a different SotA review [and possible different interpretations] of the same literature). This too is a marker of rigor for SotA reviews: the search strategies informing the identification of literature must be reported.

Stage 5: Analyses

The literature analysis undertaken will reflect the subjective insights of the researcher(s); however, the foundational premises of inductive research should inform the analysis process. Therefore, the researcher(s) should begin by reading the articles in the corpus to become familiar with the literature. This familiarization work includes: noting similarities across articles, observing ways-of-thinking that have shaped current understandings of the topic, remarking on assumptions underpinning changes in understandings, identifying important decision points in the evolution of understanding, and taking notice of gaps and assumptions in current knowledge.

The researcher(s) can then generate premises for the state-of-the-art understanding of the history that gave rise to modern thinking, of the current body of knowledge, and of potential future directions for research. In this stage of the analysis, the researcher(s) should document the articles that support or contradict their premises, noting any collections of authors or schools of thinking that have dominated the literature, searching for marginalized points of view, and studying the factors that contributed to the dominance of particular ways of thinking. The researcher(s) should also observe historical decision points that could be revisited. Theory can be incorporated at this stage to help shape insights and understandings. It should be highlighted that not all corpus articles will be used in the SotA review; instead, the researcher(s) will sample across the corpus to construct a timeline that represents the seminal moments of the historical development of knowledge.

Next, the researcher(s) should verify the thoroughness and strength of their interpretations. To do this, the researcher(s) can select different articles included in the corpus and examine if those articles reflect the premises the researcher(s) set out. The researcher(s) may also seek out contradictory interpretations in the literature to be sure their summary refutes these positions. The goal of this verification work is not to engage in a triangulation process to ensure objectivity; instead, this process helps the researcher(s) ensure the interpretations made in the SotA review represent the articles being synthesized and respond to the interpretations offered by others. This is another marker of rigor for SotA reviews: the authors should engage in and report how they considered and accounted for differing interpretations of the literature, and how they verified the thoroughness of their interpretations.

Stage 6: Reflexivity

Given the relativist subjectivism of a SotA review, it is important that the manuscript offer insights into the subjectivity of the researcher(s). This reflexivity description should articulate how the subjectivity of the researcher(s) informed interpretations of the data. These reflections will also influence the suggested directions offered in the last part of the SotA three-part argument: where we could go next. This is the last marker of rigor for SotA reviews: researcher reflexivity must be considered and reported.

SotA reviews have much to offer our field since they provide information on the historical progression of medical education’s understanding of a topic, the turning points that guided that understanding, and the potential next directions for future research. Those future directions may question the soundness of turning points and prior decisions, and thereby offer new paths of investigation. Since we were unable to find a description of the SotA review methodology, we inductively developed a description of the methodology—including its paradigmatic roots, the processes to be followed, and the markers of rigor—so that scholars can harness the unique affordances of this type of knowledge synthesis.

Given their chronology- and turning point-based orientation, SotA reviews are inherently different from other types of knowledge synthesis. For example, systematic reviews focus on specific research questions that are narrow in scope [ 32 , 33 ]; in contrast, SotA reviews present a broader historical overview of knowledge development and the decisions that gave rise to our modern understandings. Scoping reviews focus on mapping the present state of knowledge about a phenomenon including, for example, the data that are currently available, the nature of that data, and the gaps in knowledge [ 34 , 35 ]; conversely, SotA reviews offer interpretations of the historical progression of knowledge relating to a phenomenon centered on significant shifts that occurred during that history. SotA reviews focus on the turning points in the history of knowledge development to suggest how different decisions could give rise to new insights. Critical reviews draw on literature outside of the domain of focus to see if external literature can offer new ways of thinking about the phenomenon of interest (e.g., drawing on insights from insects’ swarm intelligence to better understand healthcare team adaptation [ 36 ]). SotA reviews focus on one domain’s body of literature to construct a timeline of knowledge development, demarcating where we are now, demonstrating how this understanding came to be via different turning points, and offering new research directions. Certainly, SotA reviews offer a unique kind of knowledge synthesis.

Our six-stage process for conducting these reviews reflects the subjectivist relativism that underpins the methodology. It aligns with the requirements proposed by others [ 24 , 25 , 26 , 27 ], what has been written about SotA reviews [ 4 , 5 ], and the current body of published SotA reviews. In contrast to existing guidance [ 4 , 5 , 20 , 21 , 22 , 23 ], our description offers a detailed reporting of the ontology, epistemology, and methodology processes for conducting the SotA review.

This explicit methodology description is essential since many academic journals list SotA reviews as an accepted type of literature review. For instance, Educational Research Review [ 24 ], the American Academy of Pediatrics [ 25 ], and Thorax all lists SotA reviews as one of the types of knowledge syntheses they accept [ 27 ]. However, while SotA reviews are valued by academia, guidelines or specific methodology descriptions for researchers to follow when conducting this type of knowledge synthesis are conspicuously absent. If academics in general, and medical education more specifically, are to take advantage of the insights that SotA reviews can offer, we need to rigorously engage in this synthesis work; to do that, we need clear descriptions of the methodology underpinning this review. This article offers such a description. We hope that more medical educators will conduct SotA reviews to generate insights that will contribute to further advancing our field’s research and scholarship.

Cooper HM. Organizing knowledge syntheses: a taxonomy of literature reviews. Knowl Soc. 1988;1:104.

Google Scholar  

Badger D, Nursten J, Williams P, Woodward M. Should all literature reviews be systematic? Eval Res Educ. 2000;14:220–30.

Article   Google Scholar  

Snyder H. Literature review as a research methodology: an overview and guidelines. J Bus Res. 2019;104:333–9.

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

Sutton A, Clowes M, Preston L, Booth A. Meeting the review family: exploring review types and associated information retrieval requirements. Health Info Libr J. 2019;36:202–22.

Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

Tricco AC, Langlois E, Straus SE, World Health Organization, Alliance for Health Policy and Systems Research. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva: World Health Organization; 2017.

Jackson R, Feder G. Guidelines for clinical guidelines: a simple, pragmatic strategy for guideline development. Br Med J. 1998;317:427–8.

Greenhalgh T, Thorne S, Malterud K. Time to challenge the spurious hierarchy of systematic over narrative reviews? Eur J Clin Invest. 2018;48:e12931.

Bach QV, Chen WH. Pyrolysis characteristics and kinetics of microalgae via thermogravimetric analysis (TGA): a state-of-the-art review. Bioresour Technol. 2017;246:88–100.

Garofalo C, Milanović V, Cardinali F, Aquilanti L, Clementi F, Osimani A. Current knowledge on the microbiota of edible insects intended for human consumption: a state-of-the-art review. Food Res Int. 2019;125:108527.

Carbone S, Dixon DL, Buckley LF, Abbate A. Glucose-lowering therapies for cardiovascular risk reduction in type 2 diabetes mellitus: state-of-the-art review. Mayo Clin Proc. 2018;93:1629–47.

Hofkens PJ, Verrijcken A, Merveille K, et al. Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review. Anaesthesiol Intensive Ther. 2015;47:89–116.

Schuwirth LW, van der Vleuten CP. A history of assessment in medical education. Adv Health Sci Educ Theory Pract. 2020;25:1045–56.

Arena A, Prete F, Rambaldi E, et al. Nanostructured zirconia-based ceramics and composites in dentistry: a state-of-the-art review. Nanomaterials. 2019;9:1393.

Bahraminasab M, Farahmand F. State of the art review on design and manufacture of hybrid biomedical materials: hip and knee prostheses. Proc Inst Mech Eng H. 2017;231:785–813.

Maggio LA, Costello JA, Norton C, Driessen EW, Artino AR Jr. Knowledge syntheses in medical education: a bibliometric analysis. Perspect Med Educ. 2021;10:79–87.

McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003–2009. Med Educ. 2010;44:50–63.

Krishnan DG, Keloth AV, Ubedulla S. Pros and cons of simulation in medical education: a review. Education. 2017;3:84–7.

National Library of Medicine. MEDLINE: overview. 2021. https://www.nlm.nih.gov/medline/medline_overview.html . Accessed 17 Dec 2021.

Bergman E, de Feijter J, Frambach J, et al. AM last page: a guide to research paradigms relevant to medical education. Acad Med. 2012;87:545.

Maggio LA, Samuel A, Stellrecht E. Systematic reviews in medical education. J Grad Med Educ. 2022;14:171–5.

Bandari J, Wessel CB, Jacobs BL. Comparative effectiveness in urology: a state of the art review utilizing a systematic approach. Curr Opin Urol. 2017;27:380–94.

Elsevier. A guide for writing scholarly articles or reviews for the educational research review. 2010. https://www.elsevier.com/__data/promis_misc/edurevReviewPaperWriting.pdf . Accessed 3 Mar 2020.

American Academy of Pediatrics. Pediatrics author guidelines. 2020. https://pediatrics.aappublications.org/page/author-guidelines . Accessed 3 Mar 2020.

Journal of the American College of Cardiology. JACC instructions for authors. 2020. https://www.jacc.org/pb-assets/documents/author-instructions-jacc-1598995793940.pdf . Accessed 3 Mar 2020.

Thorax. Authors. 2020. https://thorax.bmj.com/pages/authors/ . Accessed 3 Mar 2020.

Berven S, Carl A. State of the art review. Spine Deform. 2019;7:381.

Ilardi CR, Chieffi S, Iachini T, Iavarone A. Neuropsychology of posteromedial parietal cortex and conversion factors from mild cognitive impairment to Alzheimer’s disease: systematic search and state-of-the-art review. Aging Clin Exp Res. 2022;34:289–307.

Chan KS, Zary N. Applications and challenges of implementing artificial intelligence in medical education: integrative review. JMIR Med Educ. 2019;5:e13930.

World Health Organization. Framework for action on interprofessional education and collaborative practice. 2010. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice . Accessed July 1 2021.

Hammersley M. On ‘systematic’ reviews of research literatures: a ‘narrative’ response to Evans & Benefield. Br Educ Res J. 2001;27:543–54.

Chen F, Lui AM, Martinelli SM. A systematic review of the effectiveness of flipped classrooms in medical education. Med Educ. 2017;51:585–97.

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

Matsas B, Goralnick E, Bass M, Barnett E, Nagle B, Sullivan E. Leadership development in US undergraduate medical education: a scoping review of curricular content and competency frameworks. Acad Med. 2022;97:899–908.

Cristancho SM. On collective self-healing and traces: How can swarm intelligence help us think differently about team adaptation? Med Educ. 2021;55:441–7.

Download references

Acknowledgements

We thank Rhonda Allard for her help with the literature review and compiling all available articles. We also want to thank the PME editors who offered excellent development and refinement suggestions that greatly improved this manuscript.

Author information

Authors and affiliations.

Department of Anesthesiology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA

Erin S. Barry

School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands

Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA

Jerusalem Merkebu & Lara Varpio

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Erin S. Barry .

Ethics declarations

Conflict of interest.

E.S. Barry, J. Merkebu and L. Varpio declare that they have no competing interests.

Additional information

The opinions and assertions contained in this article are solely those of the authors and are not to be construed as reflecting the views of the Uniformed Services University of the Health Sciences, the Department of Defense, or the Henry M. Jackson Foundation for the Advancement of Military Medicine.

Supplementary Information

40037_2022_725_moesm1_esm.docx.

For information regarding the search strategy to develop the corpus and search strategy for confirming capture of any available State of the Art review methodology descriptions. Additionally, a list of the methodology articles found through the search strategy/corpus is included

Rights and permissions

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

Reprints and permissions

About this article

Barry, E.S., Merkebu, J. & Varpio, L. State-of-the-art literature review methodology: A six-step approach for knowledge synthesis. Perspect Med Educ 11 , 281–288 (2022). https://doi.org/10.1007/s40037-022-00725-9

Download citation

Received : 03 December 2021

Revised : 25 July 2022

Accepted : 27 July 2022

Published : 05 September 2022

Issue Date : October 2022

DOI : https://doi.org/10.1007/s40037-022-00725-9

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• State-of-the-art literature review
• Literature review
• Literature review methodology
• Find a journal
• Publish with us
• Track your research

• Methodology
• Open access
• Published: 11 October 2016

Reviewing the research methods literature: principles and strategies illustrated by a systematic overview of sampling in qualitative research

• Stephen J. Gentles 1 , 4 ,
• Cathy Charles 1 ,
• David B. Nicholas 2 ,
• Jenny Ploeg 3 &
• K. Ann McKibbon 1  

Systematic Reviews volume  5 , Article number:  172 ( 2016 ) Cite this article

52k Accesses

26 Citations

13 Altmetric

Metrics details

Overviews of methods are potentially useful means to increase clarity and enhance collective understanding of specific methods topics that may be characterized by ambiguity, inconsistency, or a lack of comprehensiveness. This type of review represents a distinct literature synthesis method, although to date, its methodology remains relatively undeveloped despite several aspects that demand unique review procedures. The purpose of this paper is to initiate discussion about what a rigorous systematic approach to reviews of methods, referred to here as systematic methods overviews , might look like by providing tentative suggestions for approaching specific challenges likely to be encountered. The guidance offered here was derived from experience conducting a systematic methods overview on the topic of sampling in qualitative research.

The guidance is organized into several principles that highlight specific objectives for this type of review given the common challenges that must be overcome to achieve them. Optional strategies for achieving each principle are also proposed, along with discussion of how they were successfully implemented in the overview on sampling. We describe seven paired principles and strategies that address the following aspects: delimiting the initial set of publications to consider, searching beyond standard bibliographic databases, searching without the availability of relevant metadata, selecting publications on purposeful conceptual grounds, defining concepts and other information to abstract iteratively, accounting for inconsistent terminology used to describe specific methods topics, and generating rigorous verifiable analytic interpretations. Since a broad aim in systematic methods overviews is to describe and interpret the relevant literature in qualitative terms, we suggest that iterative decision making at various stages of the review process, and a rigorous qualitative approach to analysis are necessary features of this review type.

Conclusions

We believe that the principles and strategies provided here will be useful to anyone choosing to undertake a systematic methods overview. This paper represents an initial effort to promote high quality critical evaluations of the literature regarding problematic methods topics, which have the potential to promote clearer, shared understandings, and accelerate advances in research methods. Further work is warranted to develop more definitive guidance.

Peer Review reports

While reviews of methods are not new, they represent a distinct review type whose methodology remains relatively under-addressed in the literature despite the clear implications for unique review procedures. One of few examples to describe it is a chapter containing reflections of two contributing authors in a book of 21 reviews on methodological topics compiled for the British National Health Service, Health Technology Assessment Program [ 1 ]. Notable is their observation of how the differences between the methods reviews and conventional quantitative systematic reviews, specifically attributable to their varying content and purpose, have implications for defining what qualifies as systematic. While the authors describe general aspects of “systematicity” (including rigorous application of a methodical search, abstraction, and analysis), they also describe a high degree of variation within the category of methods reviews itself and so offer little in the way of concrete guidance. In this paper, we present tentative concrete guidance, in the form of a preliminary set of proposed principles and optional strategies, for a rigorous systematic approach to reviewing and evaluating the literature on quantitative or qualitative methods topics. For purposes of this article, we have used the term systematic methods overview to emphasize the notion of a systematic approach to such reviews.

The conventional focus of rigorous literature reviews (i.e., review types for which systematic methods have been codified, including the various approaches to quantitative systematic reviews [ 2 – 4 ], and the numerous forms of qualitative and mixed methods literature synthesis [ 5 – 10 ]) is to synthesize empirical research findings from multiple studies. By contrast, the focus of overviews of methods, including the systematic approach we advocate, is to synthesize guidance on methods topics. The literature consulted for such reviews may include the methods literature, methods-relevant sections of empirical research reports, or both. Thus, this paper adds to previous work published in this journal—namely, recent preliminary guidance for conducting reviews of theory [ 11 ]—that has extended the application of systematic review methods to novel review types that are concerned with subject matter other than empirical research findings.

Published examples of methods overviews illustrate the varying objectives they can have. One objective is to establish methodological standards for appraisal purposes. For example, reviews of existing quality appraisal standards have been used to propose universal standards for appraising the quality of primary qualitative research [ 12 ] or evaluating qualitative research reports [ 13 ]. A second objective is to survey the methods-relevant sections of empirical research reports to establish current practices on methods use and reporting practices, which Moher and colleagues [ 14 ] recommend as a means for establishing the needs to be addressed in reporting guidelines (see, for example [ 15 , 16 ]). A third objective for a methods review is to offer clarity and enhance collective understanding regarding a specific methods topic that may be characterized by ambiguity, inconsistency, or a lack of comprehensiveness within the available methods literature. An example of this is a overview whose objective was to review the inconsistent definitions of intention-to-treat analysis (the methodologically preferred approach to analyze randomized controlled trial data) that have been offered in the methods literature and propose a solution for improving conceptual clarity [ 17 ]. Such reviews are warranted because students and researchers who must learn or apply research methods typically lack the time to systematically search, retrieve, review, and compare the available literature to develop a thorough and critical sense of the varied approaches regarding certain controversial or ambiguous methods topics.

While systematic methods overviews , as a review type, include both reviews of the methods literature and reviews of methods-relevant sections from empirical study reports, the guidance provided here is primarily applicable to reviews of the methods literature since it was derived from the experience of conducting such a review [ 18 ], described below. To our knowledge, there are no well-developed proposals on how to rigorously conduct such reviews. Such guidance would have the potential to improve the thoroughness and credibility of critical evaluations of the methods literature, which could increase their utility as a tool for generating understandings that advance research methods, both qualitative and quantitative. Our aim in this paper is thus to initiate discussion about what might constitute a rigorous approach to systematic methods overviews. While we hope to promote rigor in the conduct of systematic methods overviews wherever possible, we do not wish to suggest that all methods overviews need be conducted to the same standard. Rather, we believe that the level of rigor may need to be tailored pragmatically to the specific review objectives, which may not always justify the resource requirements of an intensive review process.

The example systematic methods overview on sampling in qualitative research

The principles and strategies we propose in this paper are derived from experience conducting a systematic methods overview on the topic of sampling in qualitative research [ 18 ]. The main objective of that methods overview was to bring clarity and deeper understanding of the prominent concepts related to sampling in qualitative research (purposeful sampling strategies, saturation, etc.). Specifically, we interpreted the available guidance, commenting on areas lacking clarity, consistency, or comprehensiveness (without proposing any recommendations on how to do sampling). This was achieved by a comparative and critical analysis of publications representing the most influential (i.e., highly cited) guidance across several methodological traditions in qualitative research.

The specific methods and procedures for the overview on sampling [ 18 ] from which our proposals are derived were developed both after soliciting initial input from local experts in qualitative research and an expert health librarian (KAM) and through ongoing careful deliberation throughout the review process. To summarize, in that review, we employed a transparent and rigorous approach to search the methods literature, selected publications for inclusion according to a purposeful and iterative process, abstracted textual data using structured abstraction forms, and analyzed (synthesized) the data using a systematic multi-step approach featuring abstraction of text, summary of information in matrices, and analytic comparisons.

For this article, we reflected on both the problems and challenges encountered at different stages of the review and our means for selecting justifiable procedures to deal with them. Several principles were then derived by considering the generic nature of these problems, while the generalizable aspects of the procedures used to address them formed the basis of optional strategies. Further details of the specific methods and procedures used in the overview on qualitative sampling are provided below to illustrate both the types of objectives and challenges that reviewers will likely need to consider and our approach to implementing each of the principles and strategies.

Organization of the guidance into principles and strategies

For the purposes of this article, principles are general statements outlining what we propose are important aims or considerations within a particular review process, given the unique objectives or challenges to be overcome with this type of review. These statements follow the general format, “considering the objective or challenge of X, we propose Y to be an important aim or consideration.” Strategies are optional and flexible approaches for implementing the previous principle outlined. Thus, generic challenges give rise to principles, which in turn give rise to strategies.

We organize the principles and strategies below into three sections corresponding to processes characteristic of most systematic literature synthesis approaches: literature identification and selection ; data abstraction from the publications selected for inclusion; and analysis , including critical appraisal and synthesis of the abstracted data. Within each section, we also describe the specific methodological decisions and procedures used in the overview on sampling in qualitative research [ 18 ] to illustrate how the principles and strategies for each review process were applied and implemented in a specific case. We expect this guidance and accompanying illustrations will be useful for anyone considering engaging in a methods overview, particularly those who may be familiar with conventional systematic review methods but may not yet appreciate some of the challenges specific to reviewing the methods literature.

Results and discussion

Literature identification and selection.

The identification and selection process includes search and retrieval of publications and the development and application of inclusion and exclusion criteria to select the publications that will be abstracted and analyzed in the final review. Literature identification and selection for overviews of the methods literature is challenging and potentially more resource-intensive than for most reviews of empirical research. This is true for several reasons that we describe below, alongside discussion of the potential solutions. Additionally, we suggest in this section how the selection procedures can be chosen to match the specific analytic approach used in methods overviews.

Delimiting a manageable set of publications

One aspect of methods overviews that can make identification and selection challenging is the fact that the universe of literature containing potentially relevant information regarding most methods-related topics is expansive and often unmanageably so. Reviewers are faced with two large categories of literature: the methods literature , where the possible publication types include journal articles, books, and book chapters; and the methods-relevant sections of empirical study reports , where the possible publication types include journal articles, monographs, books, theses, and conference proceedings. In our systematic overview of sampling in qualitative research, exhaustively searching (including retrieval and first-pass screening) all publication types across both categories of literature for information on a single methods-related topic was too burdensome to be feasible. The following proposed principle follows from the need to delimit a manageable set of literature for the review.

Principle #1:

Considering the broad universe of potentially relevant literature, we propose that an important objective early in the identification and selection stage is to delimit a manageable set of methods-relevant publications in accordance with the objectives of the methods overview.

Strategy #1:

To limit the set of methods-relevant publications that must be managed in the selection process, reviewers have the option to initially review only the methods literature, and exclude the methods-relevant sections of empirical study reports, provided this aligns with the review’s particular objectives.

We propose that reviewers are justified in choosing to select only the methods literature when the objective is to map out the range of recognized concepts relevant to a methods topic, to summarize the most authoritative or influential definitions or meanings for methods-related concepts, or to demonstrate a problematic lack of clarity regarding a widely established methods-related concept and potentially make recommendations for a preferred approach to the methods topic in question. For example, in the case of the methods overview on sampling [ 18 ], the primary aim was to define areas lacking in clarity for multiple widely established sampling-related topics. In the review on intention-to-treat in the context of missing outcome data [ 17 ], the authors identified a lack of clarity based on multiple inconsistent definitions in the literature and went on to recommend separating the issue of how to handle missing outcome data from the issue of whether an intention-to-treat analysis can be claimed.

In contrast to strategy #1, it may be appropriate to select the methods-relevant sections of empirical study reports when the objective is to illustrate how a methods concept is operationalized in research practice or reported by authors. For example, one could review all the publications in 2 years’ worth of issues of five high-impact field-related journals to answer questions about how researchers describe implementing a particular method or approach, or to quantify how consistently they define or report using it. Such reviews are often used to highlight gaps in the reporting practices regarding specific methods, which may be used to justify items to address in reporting guidelines (for example, [ 14 – 16 ]).

It is worth recognizing that other authors have advocated broader positions regarding the scope of literature to be considered in a review, expanding on our perspective. Suri [ 10 ] (who, like us, emphasizes how different sampling strategies are suitable for different literature synthesis objectives) has, for example, described a two-stage literature sampling procedure (pp. 96–97). First, reviewers use an initial approach to conduct a broad overview of the field—for reviews of methods topics, this would entail an initial review of the research methods literature. This is followed by a second more focused stage in which practical examples are purposefully selected—for methods reviews, this would involve sampling the empirical literature to illustrate key themes and variations. While this approach is seductive in its capacity to generate more in depth and interpretive analytic findings, some reviewers may consider it too resource-intensive to include the second step no matter how selective the purposeful sampling. In the overview on sampling where we stopped after the first stage [ 18 ], we discussed our selective focus on the methods literature as a limitation that left opportunities for further analysis of the literature. We explicitly recommended, for example, that theoretical sampling was a topic for which a future review of the methods sections of empirical reports was justified to answer specific questions identified in the primary review.

Ultimately, reviewers must make pragmatic decisions that balance resource considerations, combined with informed predictions about the depth and complexity of literature available on their topic, with the stated objectives of their review. The remaining principles and strategies apply primarily to overviews that include the methods literature, although some aspects may be relevant to reviews that include empirical study reports.

Searching beyond standard bibliographic databases

An important reality affecting identification and selection in overviews of the methods literature is the increased likelihood for relevant publications to be located in sources other than journal articles (which is usually not the case for overviews of empirical research, where journal articles generally represent the primary publication type). In the overview on sampling [ 18 ], out of 41 full-text publications retrieved and reviewed, only 4 were journal articles, while 37 were books or book chapters. Since many books and book chapters did not exist electronically, their full text had to be physically retrieved in hardcopy, while 11 publications were retrievable only through interlibrary loan or purchase request. The tasks associated with such retrieval are substantially more time-consuming than electronic retrieval. Since a substantial proportion of methods-related guidance may be located in publication types that are less comprehensively indexed in standard bibliographic databases, identification and retrieval thus become complicated processes.

Principle #2:

Considering that important sources of methods guidance can be located in non-journal publication types (e.g., books, book chapters) that tend to be poorly indexed in standard bibliographic databases, it is important to consider alternative search methods for identifying relevant publications to be further screened for inclusion.

Strategy #2:

To identify books, book chapters, and other non-journal publication types not thoroughly indexed in standard bibliographic databases, reviewers may choose to consult one or more of the following less standard sources: Google Scholar, publisher web sites, or expert opinion.

In the case of the overview on sampling in qualitative research [ 18 ], Google Scholar had two advantages over other standard bibliographic databases: it indexes and returns records of books and book chapters likely to contain guidance on qualitative research methods topics; and it has been validated as providing higher citation counts than ISI Web of Science (a producer of numerous bibliographic databases accessible through institutional subscription) for several non-biomedical disciplines including the social sciences where qualitative research methods are prominently used [ 19 – 21 ]. While we identified numerous useful publications by consulting experts, the author publication lists generated through Google Scholar searches were uniquely useful to identify more recent editions of methods books identified by experts.

Searching without relevant metadata

Determining what publications to select for inclusion in the overview on sampling [ 18 ] could only rarely be accomplished by reviewing the publication’s metadata. This was because for the many books and other non-journal type publications we identified as possibly relevant, the potential content of interest would be located in only a subsection of the publication. In this common scenario for reviews of the methods literature (as opposed to methods overviews that include empirical study reports), reviewers will often be unable to employ standard title, abstract, and keyword database searching or screening as a means for selecting publications.

Principle #3:

Considering that the presence of information about the topic of interest may not be indicated in the metadata for books and similar publication types, it is important to consider other means of identifying potentially useful publications for further screening.

Strategy #3:

One approach to identifying potentially useful books and similar publication types is to consider what classes of such publications (e.g., all methods manuals for a certain research approach) are likely to contain relevant content, then identify, retrieve, and review the full text of corresponding publications to determine whether they contain information on the topic of interest.

In the example of the overview on sampling in qualitative research [ 18 ], the topic of interest (sampling) was one of numerous topics covered in the general qualitative research methods manuals. Consequently, examples from this class of publications first had to be identified for retrieval according to non-keyword-dependent criteria. Thus, all methods manuals within the three research traditions reviewed (grounded theory, phenomenology, and case study) that might contain discussion of sampling were sought through Google Scholar and expert opinion, their full text obtained, and hand-searched for relevant content to determine eligibility. We used tables of contents and index sections of books to aid this hand searching.

Purposefully selecting literature on conceptual grounds

A final consideration in methods overviews relates to the type of analysis used to generate the review findings. Unlike quantitative systematic reviews where reviewers aim for accurate or unbiased quantitative estimates—something that requires identifying and selecting the literature exhaustively to obtain all relevant data available (i.e., a complete sample)—in methods overviews, reviewers must describe and interpret the relevant literature in qualitative terms to achieve review objectives. In other words, the aim in methods overviews is to seek coverage of the qualitative concepts relevant to the methods topic at hand. For example, in the overview of sampling in qualitative research [ 18 ], achieving review objectives entailed providing conceptual coverage of eight sampling-related topics that emerged as key domains. The following principle recognizes that literature sampling should therefore support generating qualitative conceptual data as the input to analysis.

Principle #4:

Since the analytic findings of a systematic methods overview are generated through qualitative description and interpretation of the literature on a specified topic, selection of the literature should be guided by a purposeful strategy designed to achieve adequate conceptual coverage (i.e., representing an appropriate degree of variation in relevant ideas) of the topic according to objectives of the review.

Strategy #4:

One strategy for choosing the purposeful approach to use in selecting the literature according to the review objectives is to consider whether those objectives imply exploring concepts either at a broad overview level, in which case combining maximum variation selection with a strategy that limits yield (e.g., critical case, politically important, or sampling for influence—described below) may be appropriate; or in depth, in which case purposeful approaches aimed at revealing innovative cases will likely be necessary.

In the methods overview on sampling, the implied scope was broad since we set out to review publications on sampling across three divergent qualitative research traditions—grounded theory, phenomenology, and case study—to facilitate making informative conceptual comparisons. Such an approach would be analogous to maximum variation sampling.

At the same time, the purpose of that review was to critically interrogate the clarity, consistency, and comprehensiveness of literature from these traditions that was “most likely to have widely influenced students’ and researchers’ ideas about sampling” (p. 1774) [ 18 ]. In other words, we explicitly set out to review and critique the most established and influential (and therefore dominant) literature, since this represents a common basis of knowledge among students and researchers seeking understanding or practical guidance on sampling in qualitative research. To achieve this objective, we purposefully sampled publications according to the criterion of influence , which we operationalized as how often an author or publication has been referenced in print or informal discourse. This second sampling approach also limited the literature we needed to consider within our broad scope review to a manageable amount.

To operationalize this strategy of sampling for influence , we sought to identify both the most influential authors within a qualitative research tradition (all of whose citations were subsequently screened) and the most influential publications on the topic of interest by non-influential authors. This involved a flexible approach that combined multiple indicators of influence to avoid the dilemma that any single indicator might provide inadequate coverage. These indicators included bibliometric data (h-index for author influence [ 22 ]; number of cites for publication influence), expert opinion, and cross-references in the literature (i.e., snowball sampling). As a final selection criterion, a publication was included only if it made an original contribution in terms of novel guidance regarding sampling or a related concept; thus, purely secondary sources were excluded. Publish or Perish software (Anne-Wil Harzing; available at http://www.harzing.com/resources/publish-or-perish ) was used to generate bibliometric data via the Google Scholar database. Figure  1 illustrates how identification and selection in the methods overview on sampling was a multi-faceted and iterative process. The authors selected as influential, and the publications selected for inclusion or exclusion are listed in Additional file 1 (Matrices 1, 2a, 2b).

Literature identification and selection process used in the methods overview on sampling [ 18 ]

In summary, the strategies of seeking maximum variation and sampling for influence were employed in the sampling overview to meet the specific review objectives described. Reviewers will need to consider the full range of purposeful literature sampling approaches at their disposal in deciding what best matches the specific aims of their own reviews. Suri [ 10 ] has recently retooled Patton’s well-known typology of purposeful sampling strategies (originally intended for primary research) for application to literature synthesis, providing a useful resource in this respect.

Data abstraction

The purpose of data abstraction in rigorous literature reviews is to locate and record all data relevant to the topic of interest from the full text of included publications, making them available for subsequent analysis. Conventionally, a data abstraction form—consisting of numerous distinct conceptually defined fields to which corresponding information from the source publication is recorded—is developed and employed. There are several challenges, however, to the processes of developing the abstraction form and abstracting the data itself when conducting methods overviews, which we address here. Some of these problems and their solutions may be familiar to those who have conducted qualitative literature syntheses, which are similarly conceptual.

Iteratively defining conceptual information to abstract

In the overview on sampling [ 18 ], while we surveyed multiple sources beforehand to develop a list of concepts relevant for abstraction (e.g., purposeful sampling strategies, saturation, sample size), there was no way for us to anticipate some concepts prior to encountering them in the review process. Indeed, in many cases, reviewers are unable to determine the complete set of methods-related concepts that will be the focus of the final review a priori without having systematically reviewed the publications to be included. Thus, defining what information to abstract beforehand may not be feasible.

Principle #5:

Considering the potential impracticality of defining a complete set of relevant methods-related concepts from a body of literature one has not yet systematically read, selecting and defining fields for data abstraction must often be undertaken iteratively. Thus, concepts to be abstracted can be expected to grow and change as data abstraction proceeds.

Strategy #5:

Reviewers can develop an initial form or set of concepts for abstraction purposes according to standard methods (e.g., incorporating expert feedback, pilot testing) and remain attentive to the need to iteratively revise it as concepts are added or modified during the review. Reviewers should document revisions and return to re-abstract data from previously abstracted publications as the new data requirements are determined.

In the sampling overview [ 18 ], we developed and maintained the abstraction form in Microsoft Word. We derived the initial set of abstraction fields from our own knowledge of relevant sampling-related concepts, consultation with local experts, and reviewing a pilot sample of publications. Since the publications in this review included a large proportion of books, the abstraction process often began by flagging the broad sections within a publication containing topic-relevant information for detailed review to identify text to abstract. When reviewing flagged text, the reviewer occasionally encountered an unanticipated concept significant enough to warrant being added as a new field to the abstraction form. For example, a field was added to capture how authors described the timing of sampling decisions, whether before (a priori) or after (ongoing) starting data collection, or whether this was unclear. In these cases, we systematically documented the modification to the form and returned to previously abstracted publications to abstract any information that might be relevant to the new field.

The logic of this strategy is analogous to the logic used in a form of research synthesis called best fit framework synthesis (BFFS) [ 23 – 25 ]. In that method, reviewers initially code evidence using an a priori framework they have selected. When evidence cannot be accommodated by the selected framework, reviewers then develop new themes or concepts from which they construct a new expanded framework. Both the strategy proposed and the BFFS approach to research synthesis are notable for their rigorous and transparent means to adapt a final set of concepts to the content under review.

Accounting for inconsistent terminology

An important complication affecting the abstraction process in methods overviews is that the language used by authors to describe methods-related concepts can easily vary across publications. For example, authors from different qualitative research traditions often use different terms for similar methods-related concepts. Furthermore, as we found in the sampling overview [ 18 ], there may be cases where no identifiable term, phrase, or label for a methods-related concept is used at all, and a description of it is given instead. This can make searching the text for relevant concepts based on keywords unreliable.

Principle #6:

Since accepted terms may not be used consistently to refer to methods concepts, it is necessary to rely on the definitions for concepts, rather than keywords, to identify relevant information in the publication to abstract.

Strategy #6:

An effective means to systematically identify relevant information is to develop and iteratively adjust written definitions for key concepts (corresponding to abstraction fields) that are consistent with and as inclusive of as much of the literature reviewed as possible. Reviewers then seek information that matches these definitions (rather than keywords) when scanning a publication for relevant data to abstract.

In the abstraction process for the sampling overview [ 18 ], we noted the several concepts of interest to the review for which abstraction by keyword was particularly problematic due to inconsistent terminology across publications: sampling , purposeful sampling , sampling strategy , and saturation (for examples, see Additional file 1 , Matrices 3a, 3b, 4). We iteratively developed definitions for these concepts by abstracting text from publications that either provided an explicit definition or from which an implicit definition could be derived, which was recorded in fields dedicated to the concept’s definition. Using a method of constant comparison, we used text from definition fields to inform and modify a centrally maintained definition of the corresponding concept to optimize its fit and inclusiveness with the literature reviewed. Table  1 shows, as an example, the final definition constructed in this way for one of the central concepts of the review, qualitative sampling .

We applied iteratively developed definitions when making decisions about what specific text to abstract for an existing field, which allowed us to abstract concept-relevant data even if no recognized keyword was used. For example, this was the case for the sampling-related concept, saturation , where the relevant text available for abstraction in one publication [ 26 ]—“to continue to collect data until nothing new was being observed or recorded, no matter how long that takes”—was not accompanied by any term or label whatsoever.

This comparative analytic strategy (and our approach to analysis more broadly as described in strategy #7, below) is analogous to the process of reciprocal translation —a technique first introduced for meta-ethnography by Noblit and Hare [ 27 ] that has since been recognized as a common element in a variety of qualitative metasynthesis approaches [ 28 ]. Reciprocal translation, taken broadly, involves making sense of a study’s findings in terms of the findings of the other studies included in the review. In practice, it has been operationalized in different ways. Melendez-Torres and colleagues developed a typology from their review of the metasynthesis literature, describing four overlapping categories of specific operations undertaken in reciprocal translation: visual representation, key paper integration, data reduction and thematic extraction, and line-by-line coding [ 28 ]. The approaches suggested in both strategies #6 and #7, with their emphasis on constant comparison, appear to fall within the line-by-line coding category.

Generating credible and verifiable analytic interpretations

The analysis in a systematic methods overview must support its more general objective, which we suggested above is often to offer clarity and enhance collective understanding regarding a chosen methods topic. In our experience, this involves describing and interpreting the relevant literature in qualitative terms. Furthermore, any interpretative analysis required may entail reaching different levels of abstraction, depending on the more specific objectives of the review. For example, in the overview on sampling [ 18 ], we aimed to produce a comparative analysis of how multiple sampling-related topics were treated differently within and among different qualitative research traditions. To promote credibility of the review, however, not only should one seek a qualitative analytic approach that facilitates reaching varying levels of abstraction but that approach must also ensure that abstract interpretations are supported and justified by the source data and not solely the product of the analyst’s speculative thinking.

Principle #7:

Considering the qualitative nature of the analysis required in systematic methods overviews, it is important to select an analytic method whose interpretations can be verified as being consistent with the literature selected, regardless of the level of abstraction reached.

Strategy #7:

We suggest employing the constant comparative method of analysis [ 29 ] because it supports developing and verifying analytic links to the source data throughout progressively interpretive or abstract levels. In applying this approach, we advise a rigorous approach, documenting how supportive quotes or references to the original texts are carried forward in the successive steps of analysis to allow for easy verification.

The analytic approach used in the methods overview on sampling [ 18 ] comprised four explicit steps, progressing in level of abstraction—data abstraction, matrices, narrative summaries, and final analytic conclusions (Fig.  2 ). While we have positioned data abstraction as the second stage of the generic review process (prior to Analysis), above, we also considered it as an initial step of analysis in the sampling overview for several reasons. First, it involved a process of constant comparisons and iterative decision-making about the fields to add or define during development and modification of the abstraction form, through which we established the range of concepts to be addressed in the review. At the same time, abstraction involved continuous analytic decisions about what textual quotes (ranging in size from short phrases to numerous paragraphs) to record in the fields thus created. This constant comparative process was analogous to open coding in which textual data from publications was compared to conceptual fields (equivalent to codes) or to other instances of data previously abstracted when constructing definitions to optimize their fit with the overall literature as described in strategy #6. Finally, in the data abstraction step, we also recorded our first interpretive thoughts in dedicated fields, providing initial material for the more abstract analytic steps.

Summary of progressive steps of analysis used in the methods overview on sampling [ 18 ]

In the second step of the analysis, we constructed topic-specific matrices , or tables, by copying relevant quotes from abstraction forms into the appropriate cells of matrices (for the complete set of analytic matrices developed in the sampling review, see Additional file 1 (matrices 3 to 10)). Each matrix ranged from one to five pages; row headings, nested three-deep, identified the methodological tradition, author, and publication, respectively; and column headings identified the concepts, which corresponded to abstraction fields. Matrices thus allowed us to make further comparisons across methodological traditions, and between authors within a tradition. In the third step of analysis, we recorded our comparative observations as narrative summaries , in which we used illustrative quotes more sparingly. In the final step, we developed analytic conclusions based on the narrative summaries about the sampling-related concepts within each methodological tradition for which clarity, consistency, or comprehensiveness of the available guidance appeared to be lacking. Higher levels of analysis thus built logically from the lower levels, enabling us to easily verify analytic conclusions by tracing the support for claims by comparing the original text of publications reviewed.

Integrative versus interpretive methods overviews

The analytic product of systematic methods overviews is comparable to qualitative evidence syntheses, since both involve describing and interpreting the relevant literature in qualitative terms. Most qualitative synthesis approaches strive to produce new conceptual understandings that vary in level of interpretation. Dixon-Woods and colleagues [ 30 ] elaborate on a useful distinction, originating from Noblit and Hare [ 27 ], between integrative and interpretive reviews. Integrative reviews focus on summarizing available primary data and involve using largely secure and well defined concepts to do so; definitions are used from an early stage to specify categories for abstraction (or coding) of data, which in turn supports their aggregation; they do not seek as their primary focus to develop or specify new concepts, although they may achieve some theoretical or interpretive functions. For interpretive reviews, meanwhile, the main focus is to develop new concepts and theories that integrate them, with the implication that the concepts developed become fully defined towards the end of the analysis. These two forms are not completely distinct, and “every integrative synthesis will include elements of interpretation, and every interpretive synthesis will include elements of aggregation of data” [ 30 ].

The example methods overview on sampling [ 18 ] could be classified as predominantly integrative because its primary goal was to aggregate influential authors’ ideas on sampling-related concepts; there were also, however, elements of interpretive synthesis since it aimed to develop new ideas about where clarity in guidance on certain sampling-related topics is lacking, and definitions for some concepts were flexible and not fixed until late in the review. We suggest that most systematic methods overviews will be classifiable as predominantly integrative (aggregative). Nevertheless, more highly interpretive methods overviews are also quite possible—for example, when the review objective is to provide a highly critical analysis for the purpose of generating new methodological guidance. In such cases, reviewers may need to sample more deeply (see strategy #4), specifically by selecting empirical research reports (i.e., to go beyond dominant or influential ideas in the methods literature) that are likely to feature innovations or instructive lessons in employing a given method.

In this paper, we have outlined tentative guidance in the form of seven principles and strategies on how to conduct systematic methods overviews, a review type in which methods-relevant literature is systematically analyzed with the aim of offering clarity and enhancing collective understanding regarding a specific methods topic. Our proposals include strategies for delimiting the set of publications to consider, searching beyond standard bibliographic databases, searching without the availability of relevant metadata, selecting publications on purposeful conceptual grounds, defining concepts and other information to abstract iteratively, accounting for inconsistent terminology, and generating credible and verifiable analytic interpretations. We hope the suggestions proposed will be useful to others undertaking reviews on methods topics in future.

As far as we are aware, this is the first published source of concrete guidance for conducting this type of review. It is important to note that our primary objective was to initiate methodological discussion by stimulating reflection on what rigorous methods for this type of review should look like, leaving the development of more complete guidance to future work. While derived from the experience of reviewing a single qualitative methods topic, we believe the principles and strategies provided are generalizable to overviews of both qualitative and quantitative methods topics alike. However, it is expected that additional challenges and insights for conducting such reviews have yet to be defined. Thus, we propose that next steps for developing more definitive guidance should involve an attempt to collect and integrate other reviewers’ perspectives and experiences in conducting systematic methods overviews on a broad range of qualitative and quantitative methods topics. Formalized guidance and standards would improve the quality of future methods overviews, something we believe has important implications for advancing qualitative and quantitative methodology. When undertaken to a high standard, rigorous critical evaluations of the available methods guidance have significant potential to make implicit controversies explicit, and improve the clarity and precision of our understandings of problematic qualitative or quantitative methods issues.

A review process central to most types of rigorous reviews of empirical studies, which we did not explicitly address in a separate review step above, is quality appraisal . The reason we have not treated this as a separate step stems from the different objectives of the primary publications included in overviews of the methods literature (i.e., providing methodological guidance) compared to the primary publications included in the other established review types (i.e., reporting findings from single empirical studies). This is not to say that appraising quality of the methods literature is not an important concern for systematic methods overviews. Rather, appraisal is much more integral to (and difficult to separate from) the analysis step, in which we advocate appraising clarity, consistency, and comprehensiveness—the quality appraisal criteria that we suggest are appropriate for the methods literature. As a second important difference regarding appraisal, we currently advocate appraising the aforementioned aspects at the level of the literature in aggregate rather than at the level of individual publications. One reason for this is that methods guidance from individual publications generally builds on previous literature, and thus we feel that ahistorical judgments about comprehensiveness of single publications lack relevance and utility. Additionally, while different methods authors may express themselves less clearly than others, their guidance can nonetheless be highly influential and useful, and should therefore not be downgraded or ignored based on considerations of clarity—which raises questions about the alternative uses that quality appraisals of individual publications might have. Finally, legitimate variability in the perspectives that methods authors wish to emphasize, and the levels of generality at which they write about methods, makes critiquing individual publications based on the criterion of clarity a complex and potentially problematic endeavor that is beyond the scope of this paper to address. By appraising the current state of the literature at a holistic level, reviewers stand to identify important gaps in understanding that represent valuable opportunities for further methodological development.

To summarize, the principles and strategies provided here may be useful to those seeking to undertake their own systematic methods overview. Additional work is needed, however, to establish guidance that is comprehensive by comparing the experiences from conducting a variety of methods overviews on a range of methods topics. Efforts that further advance standards for systematic methods overviews have the potential to promote high-quality critical evaluations that produce conceptually clear and unified understandings of problematic methods topics, thereby accelerating the advance of research methodology.

Hutton JL, Ashcroft R. What does “systematic” mean for reviews of methods? In: Black N, Brazier J, Fitzpatrick R, Reeves B, editors. Health services research methods: a guide to best practice. London: BMJ Publishing Group; 1998. p. 249–54.

Google Scholar  

Cochrane handbook for systematic reviews of interventions. In. Edited by Higgins JPT, Green S, Version 5.1.0 edn: The Cochrane Collaboration; 2011.

Centre for Reviews and Dissemination: Systematic reviews: CRD’s guidance for undertaking reviews in health care . York: Centre for Reviews and Dissemination; 2009.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700–0.

Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9(1):59.

Article   PubMed   PubMed Central   Google Scholar  

Kastner M, Tricco AC, Soobiah C, Lillie E, Perrier L, Horsley T, Welch V, Cogo E, Antony J, Straus SE. What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Med Res Methodol. 2012;12(1):1–1.

Article   Google Scholar  

Booth A, Noyes J, Flemming K, Gerhardus A. Guidance on choosing qualitative evidence synthesis methods for use in health technology assessments of complex interventions. In: Integrate-HTA. 2016.

Booth A, Sutton A, Papaioannou D. Systematic approaches to successful literature review. 2nd ed. London: Sage; 2016.

Hannes K, Lockwood C. Synthesizing qualitative research: choosing the right approach. Chichester: Wiley-Blackwell; 2012.

Suri H. Towards methodologically inclusive research syntheses: expanding possibilities. New York: Routledge; 2014.

Campbell M, Egan M, Lorenc T, Bond L, Popham F, Fenton C, Benzeval M. Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health. Syst Rev. 2014;3(1):1–11.

Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med. 2008;6(4):331–9.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reportingqualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.

Article   PubMed   Google Scholar  

Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med. 2010;7(2):e1000217.

Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG. Epidemiology and reporting characteristics of systematic reviews. PLoS Med. 2007;4(3):e78.

Chan AW, Altman DG. Epidemiology and reporting of randomised trials published in PubMed journals. Lancet. 2005;365(9465):1159–62.

Alshurafa M, Briel M, Akl EA, Haines T, Moayyedi P, Gentles SJ, Rios L, Tran C, Bhatnagar N, Lamontagne F, et al. Inconsistent definitions for intention-to-treat in relation to missing outcome data: systematic review of the methods literature. PLoS One. 2012;7(11):e49163.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Gentles SJ, Charles C, Ploeg J, McKibbon KA. Sampling in qualitative research: insights from an overview of the methods literature. Qual Rep. 2015;20(11):1772–89.

Harzing A-W, Alakangas S. Google Scholar, Scopus and the Web of Science: a longitudinal and cross-disciplinary comparison. Scientometrics. 2016;106(2):787–804.

Harzing A-WK, van der Wal R. Google Scholar as a new source for citation analysis. Ethics Sci Environ Polit. 2008;8(1):61–73.

Kousha K, Thelwall M. Google Scholar citations and Google Web/URL citations: a multi‐discipline exploratory analysis. J Assoc Inf Sci Technol. 2007;58(7):1055–65.

Hirsch JE. An index to quantify an individual’s scientific research output. Proc Natl Acad Sci U S A. 2005;102(46):16569–72.

Booth A, Carroll C. How to build up the actionable knowledge base: the role of ‘best fit’ framework synthesis for studies of improvement in healthcare. BMJ Quality Safety. 2015;24(11):700–8.

Carroll C, Booth A, Leaviss J, Rick J. “Best fit” framework synthesis: refining the method. BMC Med Res Methodol. 2013;13(1):37.

Carroll C, Booth A, Cooper K. A worked example of “best fit” framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2011;11(1):29.

Cohen MZ, Kahn DL, Steeves DL. Hermeneutic phenomenological research: a practical guide for nurse researchers. Thousand Oaks: Sage; 2000.

Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. Newbury Park: Sage; 1988.

Book   Google Scholar  

Melendez-Torres GJ, Grant S, Bonell C. A systematic review and critical appraisal of qualitative metasynthetic practice in public health to develop a taxonomy of operations of reciprocal translation. Res Synthesis Methods. 2015;6(4):357–71.

Article   CAS   Google Scholar  

Glaser BG, Strauss A. The discovery of grounded theory. Chicago: Aldine; 1967.

Dixon-Woods M, Agarwal S, Young B, Jones D, Sutton A. Integrative approaches to qualitative and quantitative evidence. In: UK National Health Service. 2004. p. 1–44.

Download references

Acknowledgements

Not applicable.

There was no funding for this work.

Availability of data and materials

The systematic methods overview used as a worked example in this article (Gentles SJ, Charles C, Ploeg J, McKibbon KA: Sampling in qualitative research: insights from an overview of the methods literature. The Qual Rep 2015, 20(11):1772-1789) is available from http://nsuworks.nova.edu/tqr/vol20/iss11/5 .

Authors’ contributions

SJG wrote the first draft of this article, with CC contributing to drafting. All authors contributed to revising the manuscript. All authors except CC (deceased) approved the final draft. SJG, CC, KAB, and JP were involved in developing methods for the systematic methods overview on sampling.

Authors’ information

Competing interests.

The authors declare that they have no competing interests.

Consent for publication

Ethics approval and consent to participate, author information, authors and affiliations.

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Stephen J. Gentles, Cathy Charles & K. Ann McKibbon

Faculty of Social Work, University of Calgary, Alberta, Canada

David B. Nicholas

School of Nursing, McMaster University, Hamilton, Ontario, Canada

Jenny Ploeg

CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main Street West, IAHS 408, Hamilton, ON, L8S 1C7, Canada

Stephen J. Gentles

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Stephen J. Gentles .

Additional information

Cathy Charles is deceased

Additional file

Additional file 1:.

Submitted: Analysis_matrices. (DOC 330 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Gentles, S.J., Charles, C., Nicholas, D.B. et al. Reviewing the research methods literature: principles and strategies illustrated by a systematic overview of sampling in qualitative research. Syst Rev 5 , 172 (2016). https://doi.org/10.1186/s13643-016-0343-0

Download citation

Received : 06 June 2016

Accepted : 14 September 2016

Published : 11 October 2016

DOI : https://doi.org/10.1186/s13643-016-0343-0

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Systematic review
• Literature selection
• Research methods
• Research methodology
• Overview of methods
• Systematic methods overview
• Review methods

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• For authors
• Browse by collection
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 14, Issue 4
• Use of headphones for the delivery of music programs for people with dementia in long-term care homes: a scoping review protocol
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Lillian Hung 1 ,
• http://orcid.org/0000-0002-4079-9123 Karen Lok Yi Wong 1 ,
• Kitty Huang 2 ,
• Daphne Sze Ki Cheung 2 ,
• Myung Sun Yeo 3 ,
• Soo JI Kim 3
• 1 The University of British Columbia , Vancouver , British Columbia , Canada
• 2 School of Nursing , The Hong Kong Polytechnic University , Kowloon City , Kowloon , Hong Kong
• 3 Music Therapy Education , Ewha Womans University , Seoul , Korea (the Republic of)
• Correspondence to Ms Karen Lok Yi Wong; klywong1{at}mail.ubc.ca

Introduction Dementia affects the quality of life. Excessive noise in care environments can exacerbate stress and related symptoms. Headphone-based music interventions may help improve the quality of life for people with dementia in long-term care homes. This review aims to explore and synthesise research on headphone-based music interventions for people with dementia in long-term care homes, focusing on enablers and barriers to implementing headphone-based music interventions.

Methods and analysis Joanna Briggs Institute guidance for scoping review and Preferred Reporting Items for Scoping Reviews and Meta-analyses extension for Scoping Reviews will guide the review and report process. CINAHL, MEDLINE, Embase, Web of Science, Scopus, AgeLine, PsycINFO and ProQuest databases will be searched for relevant literature from June 2010 to January 2024, supplemented by hand searches and Google for grey literature. Two research assistants will independently screen citations, followed by a full-text review. Data will be extracted using a data extraction tool. We will present the data in a table with narratives that answer the questions of the scoping review.

Ethics and dissemination This scoping review does not require ethics approval and participation consent, as all data will be publicly available. The scoping review results will be disseminated through conference presentations and an open-access publication in a peer-reviewed journal. The findings will provide practical insights into the adoption and efficacy of headphone-based music programmes for dementia in long-term care homes, contributing to education, practice, policy and future research.

• Nursing Care
• GERIATRIC MEDICINE

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-082892

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

STRENGTHS AND LIMITATIONS OF THIS STUDY

The scoping review will consider diverse types of sources and study designs.

The scoping review will involve patient and family partners with lived experiences.

Since we will follow the Joanna Briggs Institute Scoping Review Guidelines, we will not do a methodological appraisal of the quality of studies.

Literature in languages other than English will not be considered.

Introduction

More than 55 million people have dementia worldwide. Every year, there are nearly 10 million new cases. Dementia results from a variety of diseases and injuries that affect the brain. Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally. 1 Symptoms associated with dementia, such as stress and anxiety, significantly impact the quality of life for patients and caregivers. 2 According to a systematic review by Janus et al , 3 noise such as human voices and electronic devices in nursing homes was associated with decreased nighttime sleep and increased symptoms such as agitation in dementia. A systematic meta-analysis by Meng et al 4 showed that noise exposure may be a specific risk factor for dementia. Therefore, managing environmental noise is crucial to enhancing the quality of life for people with dementia. 3

Headphones can be a tool for people with dementia to engage with their choice of music to avoid unwanted sounds. 5 In this review, we focus on headphones as a non-pharmacological music intervention. A pharmacological approach such as antipsychotic drugs involves a dangerous risk of cerebrovascular issues, falls, drowsiness, agitation and mortality rate, especially in long-term care homes. 6 Hung et al 7 showed that music delivered by silent disco headphones in an older adult mental health unit is acceptable and feasible for patients. Findings showed that music delivered by silent disco headphones provides a personalised and immersive experience that helps people focus better and minimise distractions. 8

There are some literature reviews indicating the positive effect of music therapy on cognitive and psychological functions in patients with dementia. Ueda et al 6 revealed that music therapy had moderate effects on behavioural symptoms and anxiety and that interventions lasting more than 3 months were associated with greater decreases in anxiety. A meta-analysis by Pederson et al 9 suggests that music intervention can reduce agitation in persons with dementia. Also, a systematic review by Gómez-Romero et al 10 reported that music therapy improves behavioural symptoms, anxiety and agitation in people with dementia. Garrido et al 11 revealed that prerecorded music could be effective in reducing a variety of affective and behavioural symptoms, in particular agitation, even where a trained music therapist is not present. A recent literature review by Notis Paraskevopoulos 12 reported that using personalised music playlists and headphones results in mood improvement and a significant reduction in behavioural disturbance in people with dementia.

While some studies have shown the positive effects and the increased popularity of headphones for the delivery of music interventions, comprehensive analyses of their reach, delivery methods, effectiveness and associated challenges remain sparse. Taiwan researchers reported the drop-out rate in the intervention group could be up to 61.5%. 13 Moreover, older participants from a qualitative study complained about their discomfort with the use of headphones, and residential aged-care staff also expressed concern about the accessibility of music equipment. 14 In view of this, a thorough review of the literature on headphone-based music programmes is warranted.

This scoping review will examine the use of headphones in music programmes for people with dementia, aiming to identify both enablers and barriers to their implementation in long-term care homes. The findings are intended to serve as a useful resource for researchers, staff, policy-makers and other people involved in caring for people with dementia in long-term care homes. The objective is to find key strategies for advancing the implementation of headphone-based music programmes.

We conducted a preliminary search of MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports on 15 June 2023 and found no systematic review examining enablers and barriers to implementing headphone-based music programmes for people with dementia in long-term care homes. A scoping review is useful to systematically identify and synthesise the current knowledge on a research topic that is new and has not been fully explored, as suggested by JBI. 15 Moreover, the scoping review is appropriate for this work because the objective is to collate and map how headphones have been used to implement music programmes for people with dementia in long-term care homes and to identify implementation enablers and barriers. The findings will be presented in tabular and narrative formats using a structured approach outlined by the JBI methodology for rigorous scoping review. 15

Review questions

What evidence exists regarding the methods and effectiveness of delivering and receiving music programmes through headphones?

What are the barriers to implementing headphone-based music programmes for people with dementia living in long-term care homes?

What are the enablers and strategies for overcoming barriers to headphone-based music programmes for people with dementia living in long-term care homes?

Eligibility criteria

Participants.

Residents of long-term care homes who have been diagnosed with dementia and participated in a headphone-based music programme will be included in this scoping review.

This scoping review aims to summarise the research on the implementation and outcomes of headphone-based music programmes for people with dementia in long-term care homes and identify the enablers and barriers to implementing these programmes. The core concept is headphone-based music programmes.

Headphones are audio devices designed to be worn over the ears or inserted into the ear canals to listen to audio content, such as music. Headphones can be wireless, eliminating the need for cables and offering greater freedom of movement. Headphones let a single user listen to an audio source privately, in contrast to a loudspeaker , which emits sound into the open air that may disturb others. 16 Modern headphones incorporate features like noise cancellation to create an immersive listening experience.

Long-term care provides support for people with chronic health and/or mental health conditions. 17–19 This scoping review focuses on headphone-based music programmes provided in long-term care homes, either publicly or privately funded. There are two types of long-term care homes: institutional and community-based. Institutional facilities offer 24-hour round-the-clock nursing care, personal care and other allied health services. Examples include nursing homes, rehabilitation facilities, intermediate care facilities, mental health facilities, hospices and hospital palliative care units. Community-based long-term care homes, on the other hand, offer care supervision and personal care from trained staff, allowing residents to live as independently as possible, for instance, in personal care apartments and group homes.

Types of sources

Original articles, conference abstracts and student theses or dissertations published in English will be considered. We will consider an extensive range of study designs. Both experimental and quasi-experimental study designs will be considered, including randomised controlled trials, non-randomised controlled trials, before and after studies and interrupted time-series studies. In addition, descriptive and analytical observational studies, including prospective and retrospective cohort studies, case-control studies and cross-sectional studies, will be considered for inclusion. The scoping review will also include qualitative studies, such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. Mixed-methods studies, case series, text and opinion papers will also be considered for inclusion in this scoping review.

To enhance reliability, we will adopt the JBI methodology for scoping reviews. 20 This methodology has clear steps for conducting a scoping review, as well as broad popularity among international scientists. This scoping study will take place between 1 June 2010 and 31 January 2024. We framed our search parameters to span 13 years because our preliminary search identified limited studies before 2010. Also, we will include review articles that mentioned studies before 2010.

Search strategy

The planned start and end dates of the scoping review will be 1 March 2024 to August 2024. The three-step search strategy will be adopted as suggested in the JBI review guidelines. 20 The first step is an initial limited search of MEDLINE (via PubMed), CINAHL (via EBSCO) and the JBI Database of Systematic Reviews and Implementation Reports databases to identify articles relevant to the topic. In the second step, text words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a full search strategy for Embase, Web of Science, Scopus, AgeLine, PsycINFO (via ProQuest) and ProQuest. The search strategy will be adopted for each included database. Please see the full search strategy for MEDLINE and CINAHL (see online supplemental appendix 1 ). The third step will be screening the reference lists of all included literature for additional literature. Google Scholar will also be searched by using combining terms for headphone-based music programmes: ‘Headphone music’ OR ‘music’ OR ‘music therapy’ OR ‘music intervention’ OR ‘individualized music’ OR ‘personalized music’, terms for dementia: ‘Dementia’ OR ‘Alzheimer’ and terms for long-term care homes: ‘long-term care’ OR ‘nursing home‘ OR ‘residential care ‘ OR ‘care settings’ OR ‘hospital’ OR ‘assisted living’ OR ‘group homes’ OR ‘halfway houses’ OR ‘homes for the aged’. We have been collaborating with a university medical librarian to further refine the search strategy so that we can make sure that we capture the key literature. The academic professor (LH) in the team is familiar with key literature and will provide guidance for specific reference searches throughout the process.

Supplemental material

Study/source of evidence selection.

Following the search, all identified citations will be collected and imported into the Covidence, which will automatically delete the duplicates. Two research assistants will then independently screen the titles and abstracts for assessment by referring to the inclusion criteria. Potentially the relevant literature will be retrieved in full, and their citation details will be uploaded into the JBI System for Unified Management, Assessment and Review of Information. 21 Two researchers will assess the full text of the selected literature in detail by referring to the inclusion criteria. The first author (LH) will check with the medical librarian and refine the searching and selecting process. We will record and report the reasons for the exclusion of full-text studies that do not meet the inclusion criteria. If there are any disagreements between the reviewers at any stage of the literature selection process, reviewers will resolve them through discussion. The academic professor (LH) will make a decision if a consensus cannot be reached. We will report the results of the search in full in the final report. We will also present them in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews flow diagram.

Data extraction

Two researchers will use a data extraction tool to extract data from the literature included in the review. We will extract the following details: author, year and country of publication, publication source and name, long-term care settings, type of articles, participants, inclusion criteria, exclusion criteria, study design, intervention, comparator, outcomes, measurements and key findings (including enablers, barriers and impacts (eg, behavioural, psychological, neurological and cognitive impacts)) of music delivered by headphones for people with dementia in long-term care homes.

Please see the data extraction tool (see online supplemental appendix 2 ). We will do a pilot test with the data extraction tool. Two researchers will do the extraction from three studies independently and compare the results. We will adjust the data extraction tool and revise it during the process of data extraction if needed. We will describe the adjustments in the scoping review report. Depending on the discussion in the study team meeting, if necessary, we will go back to any included literature to further explore and present results that are not in the extracted data. If there are any disagreements between the reviewers, the reviewers will resolve them through discussion. The academic professor (LH) will make decisions in case consensus cannot be achieved.

Data analysis and presentation

Extracted data will be reviewed and discussed by the review team. We will note the range of headphone-based music programmes, the benefits and disadvantages of using headphones in these programmes, and the geographical differences in the adoption of such programmes. We will use a table to present the extracted data. We will also include a table that summarises the study type and the country where the study took place. Following the table, there will be a narrative summary to describe the enablers and barriers to implementation. We will adopt a content analysis approach to analyse our data from the literature on the enablers and barriers, assisted by qualitative data analysis software NVivo. We will conduct a thematic analysis by coding the data, grouping codes into categories and grouping categories into themes, referring to our research questions. The findings of the scoping review will be evidence to inform future practice, policy and research.

Patient and public involvement

We will involve patient and family partners (ie, people living with dementia or caring for a family member with dementia) in the scoping review. They collaborated with the first author (LH) on research, including a few scoping reviews. Patient and family partners will help review the full texts of selected items of their choice. We expect that each partner will review one to two items. Regular meetings through Zoom will be held with patient and family partners. They will also help with data analysis as a team by giving feedback on the synthesised findings. They will support the dissemination of the findings, for example, by delivering presentations at conferences.

Ethics statements

Patient consent for publication.

Not applicable.

Acknowledgments

The authors thank the Medical Research Librarian, Katherine Miller, at the University of British Columbia for her assistance. We would like to thank Dr Mahdiyeh Sarraf-Razavi, who was involved in preparing parts of the first draft.

• World Health Organization (WHO)
• Johannesen M ,
• LoGiudice D
• Janus SIM ,
• Kosters J ,
• van den Bosch KA , et al
• Zhang S , et al
• Suzukamo Y ,
• Sato M , et al
• Hung PhD Rn L ,
• Dahl Bmt K ,
• Peake G , et al
• Cabrera IN ,
• Pedersen SKA ,
• Andersen PN ,
• Lugo RG , et al
• Gómez-Romero M ,
• Jiménez-Palomares M ,
• Rodríguez-Mansilla J , et al
• Garrido S ,
• Chang E , et al
• Paraskevopoulos N
• Yang Y-H , et al
• Gaviola MA ,
• Higgins I ,
• Dilworth S , et al
• Godfrey C , et al
• JBL Headphones
• National Institute of Aging
• Godfrey C ,
• Khalil H , et al

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

X @karenwonglokyi2, @odrose

Contributors LH and KLYW were involved in the scoping review design. MSY and SJK reviewed and analyzed the background literature. LH, KLYW, KH, MSY and SJK constructed and edited the protocol. DSKC was involved in critically reviewing the protocol and giving feedback. All authors approved the latest version of the protocol.

Funding The Canada Research Chair in Senior Care (Grant number: GR021222) will support the funding of this scoping review.

Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; externally 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.

Read the full text or download the PDF: