literature review in goal

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

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How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

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

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

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

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

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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Literature Review - what is a Literature Review, why it is important and how it is done

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 What is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries. " - Quote from Taylor, D. (n.d) "The literature review: A few tips on conducting it"

Source NC State University Libraries. This video is published under a Creative Commons 3.0 BY-NC-SA US license.

What are the goals of creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

- Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what have been written about your research topic and to point out how your own research will shed a new light into these body of scholarship.

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature reviews look at a topic from a historical perspective to see how the understanding of the topic have change through time.

What kinds of literature reviews are written?

• Narrative Review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : This is a type of review that focus on a small set of research books on a particular topic " to locate these books within current scholarship, critical methodologies, and approaches" in the field. - LARR
• Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L.K. (2013). Research in Communication Sciences and Disorders . San Diego, CA: Plural Publishing.
• Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M.C. & Ilardi, S.S. (2003). Handbook of Research Methods in Clinical Psychology . Malden, MA: Blackwell Pub.
• Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). "Qualitative meta-synthesis: A question of dialoguing with texts," Journal of Advanced Nursing , 53(3), 311-318.

Guide adapted from "Literature Review" , a guide developed by Marisol Ramos used under CC BY 4.0 /modified from original.

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Keeping these goals in mind throughout your project will help you stay organized and focused.

A literature review helps the author:

• Understand the scope, history, and present state of knowledge in a specific topic
• Understand application of research concepts such as statistical tests and methodological choices
• Create a research project that complements the existing research or fills in gaps

A literature review helps the reader:

• Understand how your research project fits into the existing knowledge and research in a field
• Understand that a topic is important/relevant to the world and persuade them to keep reading your project
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How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts. 

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

• Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
• Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
• Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly. 

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences. 

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

• Abstract - Brief summary of the contents of the article
• Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
• Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
• Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
• Results - What was found in the course of the study
• Discussion - What do the results mean
• Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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What is a Literature Review?

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

A literature review should: 

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

From  S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

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For help, please contact the librarian for your subject area.  We have a guide to library specialists by subject .

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Ten Simple Rules for Writing a Literature Review

Marco pautasso.

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

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

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

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

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

Rule 1: Define a Topic and Audience

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

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

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

Rule 2: Search and Re-search the Literature

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

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

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

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

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

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

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

Rule 3: Take Notes While Reading

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

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

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

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

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

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

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

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

Rule 6: Be Critical and Consistent

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

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

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

Rule 7: Find a Logical Structure

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

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

Rule 8: Make Use of Feedback

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

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

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

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

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

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

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

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

Acknowledgments

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

Funding Statement

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

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

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

What is a Literature Review?

So, what is a literature review .

"A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

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

What kinds of literature reviews are written?

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

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

What are the Goals of Creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 
• Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

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

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

Where to Find Standalone Literature Reviews

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

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

Social Sciences

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

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
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Tom Brady on the Art of Leading Teammates

• Nitin Nohria

When our society talks about leaders, we focus on formal roles, such as the CEO. This view undervalues the role of informal leaders—team members who influence outcomes by the tone they set, how they conduct themselves, and how they interact with their peers. Their job title doesn’t include the word “manager,” but they play an outsize role in how teams perform.

In this article, NFL great Tom Brady and Nitin Nohria, of Harvard Business School, present a set of principles that people in any realm can apply to help teams successfully work together toward common goals.

The NFL great explains how he motivated himself and fellow players.

When our society talks about success, we tend to focus on individual success. We obsess about who is the “greatest of all time,” who is most responsible for a win, or what players or coaches a team might add next season to become even better.

• Tom Brady achieved great success in his 23-year NFL career, winning seven world championships. He is also an entrepreneur, a New York Times best-selling author, and a business adviser.
• Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

Partner Center

• Open access
• Published: 21 August 2024

Financing pandemic prevention, preparedness and response: lessons learned and perspectives for future

• Nicaise Ndembi 1 ,
• Nebiyu Dereje 1 ,
• Justice Nonvignon 1 ,
• Merawi Aragaw 1 ,
• Tajudeen Raji 1 ,
• Mosoka Papa Fallah 1 ,
• Mohammed Abdulaziz 1 ,
• Benjamin Djoudalbaye 1 ,
• Aggrey Aluso 2 ,
• Yap Boum II 3 ,
• Gwen Mwaba 4 ,
• Olive Shisana 5 ,
• Ngashi Ngongo 1 &
• Jean Kaseya 1  

Globalization and Health volume  20 , Article number:  65 ( 2024 ) Cite this article

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The attainment of global health security goals and universal health coverage will remain a mirage unless African health systems are adequately funded to improve resilience to public health emergencies. The COVID-19 pandemic exposed the global inequity in accessing medical countermeasures, leaving African countries far behind. As we anticipate the next pandemic, improving investments in health systems to adequately finance pandemic prevention, preparedness, and response (PPPR) promptly, ensuring equity and access to medical countermeasures, is crucial. In this article, we analyze the African and global pandemic financing initiatives and put ways forward for policymakers and the global health community to consider.

This article is based on a rapid literature review and desk review of various PPPR financing mechanisms in Africa and globally. Consultation of leaders and experts in the area and scrutinization of various related meeting reports and decisions have been carried out.

The African Union (AU) has demonstrated various innovative financing mechanisms to mitigate the impacts of public health emergencies in the continent. To improve equal access to the COVID-19 medical countermeasures, the AU launched Africa Medical Supplies Platform (AMSP) and Africa Vaccine Acquisition Trust (AVAT). These financing initiatives were instrumental in mitigating the impacts of COVID-19 and their lessons can be capitalized as we make efforts for PPPR. The COVID-19 Response Fund, subsequently converted into the African Epidemics Fund (AEF), is another innovative financing mechanism to ensure sustainable and self-reliant PPPR efforts. The global initiatives for financing PPPR include the Pandemic Emergency Financing Facility (PEF) and the Pandemic Fund. The PEF was criticized for its inadequacy in building resilient health systems, primarily because the fund ignored the prevention and preparedness items. The Pandemic Fund is also being criticized for its suboptimal emphasis on the response aspect of the pandemic and non-inclusive governance structure.

Conclusions

To ensure optimal financing for PPPR, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems.

The health systems in Africa, already limited in capability and capacity, face the daunting challenge of addressing emerging and reemerging public health emergencies [ 1 ]. This challenge is set against a backdrop of economic vulnerabilities, including significant debts and populations with generally low socioeconomic status and health literacy. Infectious diseases still have a severe impact on the African continent, accounting for over 227 million years of healthy life lost every year and producing an annual productivity loss of over $800 billion [ 1 ]. Compounding this situation are the disproportionate impacts of climate change on public health and the ongoing wars and conflicts in various regions of the continent [ 2 ]. Such circumstances severely impede Africa’s ability to effectively engage in pandemic prevention, preparedness, and response (PPPR).

Building strong, resilient health systems in Africa that can adequately handle public health emergencies is crucial. However, the severe underfunding of health systems, as evidenced by the low domestic investments of African governments, contrary to the commitments of the Abuja declaration, specifically on spending 15% of the budget on health, could further worsen the already weak health systems [ 3 ]. The attainment of global health security (GHS) goals and universal health coverage (UHC) will remain a mirage unless African health systems are adequately and efficiently funded to improve resilience to emerging and reemerging public health emergencies. GHS agenda mainly targets infectious disease prevention and control while the UHC prioritizes universal, timely, and quality access to essential healthcare services for everyone [ 4 , 5 ]. However, both initiatives have impacts on strengthening one another. A strong health system built by the UHC can significantly contribute to the success of the GHS agenda and vice-versa [ 4 , 6 , 7 ]. To ensure this, various scholars indicated the need for integration (building capacity for GHS within the comprehensive UHC framework), investment (unified financing to strengthen the overall health system), building a resilient health system, and addressing the inequity gaps [ 4 , 5 , 6 , 7 , 8 , 9 ]. This is critical in Africa where the infectious disease burden is high and resources are limited.

As we anticipate the next pandemic, improving investments in health systems and building a solid buffer to adequately finance PPPR promptly, ensuring equity and access to medical counter-measures is crucial, and mechanisms must be placed in the ongoing Pandemic Agreement negotiations [ 10 , 11 ]. The pandemic financing system is a fundamental element to ensure the realization of the envisioned safe and equitable world for everyone by the Pandemic Agreement [ 11 ]. In this article, we analyzed the African and global pandemic financing initiatives and put ways forward for the consideration of policymakers and the global health community.

This article is based on a rapid literature review and desk review of financial mechanisms implemented to address the pandemic prevention preparedness and response in Africa and globally. We used Google, Google Scholar, PubMed Central, and Web of Sciences to search for relevant documents, reports, and published journal articles stating PPPR financial mechanisms. We also made consultations with prominent experts and leaders of various institutions such as the Africa Union, Africa CDC, World Bank, Afriexim Bank, and Pandemic Action Network to get their perspectives and insights into the financing mechanisms. Moreover, we searched various institutions’ websites that are relevant to our topic of inquiry such as the World Bank website for PPPR financial initiatives including the Pandemic Fund, the Africa Union website for the COVID-19 Response Fund, and the Epidemic Intelligence Fund. We scrutinized various meeting reports and decisions to support our analysis of the financial mechanisms.

African Union initiatives to Finance the PPPR

With the challenges presented by public health emergencies such as the West African Ebola outbreak and the COVID-19 pandemic, the African continent has learned important lessons that need to be translated into policy and action as part of PPPR. The West African Ebola outbreak exposed African health systems’ fragility and reliance on international expertise and support to respond to the outbreak – underscoring the overwhelming urgent need for building local capacity to effectively mobilize domestic resources (health workforce, finance, and leadership) [ 12 ].

The recent COVID-19 response unveiled serious global inequities regarding access to medical countermeasures (vaccines, diagnostics, and therapeutics), and Africa was left far behind. The global financing systems utterly failed to fulfill the demands of the countries as evidenced by an alarmingly more than 100-day gap between the first COVID-19 vaccination in low-income countries (LICs) and high-income countries (HICs) [ 13 ], and an average daily testing capacity of 6.07 tests per 1000 people in HICs as compared to 0.08 tests per 1000 people in LICs [ 14 ]. The African Union (AU) initially dealt with the COVAX (COVID-19 Vaccine Global Access) - Access to COVID-19 Tools Accelerator (ACT-A) to address the vaccine access gap. However, the COVAX facility is said to have been severely delayed in ensuring that vaccines are optionally supplied to Africa and other LMICs [ 15 ]. ACT-A was an unprecedented global coordination mechanism co-chaired by South Africa and Norway, which raised 24 billion dollars, distributed over vaccines, diagnostics, therapeutics and other essential medical products. Notwithstanding its phenomenal success, there were serious and life-costing pitfalls: it took too long to raise the financing, vaccine deployment was delayed by issues of export bans and other geopolitical tensions, the diagnostics and therapeutics pillars did not meet their targets, and the health systems connector pillar did not operationalize adequately and failed to meet its mandate, compromising critical last mile capabilities (Table  1 ). As a result, the ACT-A fell short of delivering equity, as evidenced by the fact that today, the world average for vaccination is 67%, while low-income countries only average 27%[ 16 ]. According to the ACT-A external evaluation, a similar platform for future pandemics should have, inter alia, better coordination on R&D, that there should be available contingent funding on Day Zero of the next pandemic, that there should be a ‘strong representation of regional actors’ in the governance structure, and a stronger emphasis on technology transfer [ 17 ].

During the pandemic, the African Union acted swiftly to mitigate inequities, including by creating a pooled vaccine and medical supplies procurement platforms, Africa Vaccine Acquisition Trust (AVAT) and Africa Medical Supplies Platform (AMSP) – successfully delivering medical countermeasures to the AU Member States (Table  1 ).

The AMSP is a digital platform that unlocks immediate access to an African and global base of vetted manufacturers and enables AU Member States to purchase certified medical equipment and clinical management devices with increased cost-effectiveness and transparency. The platform is a unique interface enabling volume aggregation, payment facilitation, and logistics and transportation to ensure equitable and efficient access to critical supplies for African governments. The AVAT is a special-purpose vehicle created to facilitate the pooled procurement mechanism and act as the interface between AU member states and vaccine manufacturers. The procurement of COVID-19 vaccines through AVAT was supported by a $2 billion financial guarantee issued by the African Export-Import Bank (Afreximbank). AVAT negotiated and executed a vaccine supply contract with Johnson & Johnson (J&J) for 220 million vaccine doses on a committed basis (at a cost of $7.5 per dose for a total of USD 1.65 billion) with an option to trigger an additional 180 million vaccine doses subject to demand from AU Member States. With the backing of a payment guarantee from Afreximbank, AVAT was able to meet all its financial obligations to the vaccine manufacturer J&J. All J&J invoices for supplies made by J&J were settled by AVAT on behalf of AU Member States. As of 8th May 2024, 158.3 million doses have been shipped to the participating countries (42 African countries plus 6 Caribbean Community and Common Market (CARICOM) countries). A further quantity of 30.3 million doses has been accepted by the countries and in the process of being prepared for shipment. Strong strategic partnerships and collaborations with institutions and organizations like the World Bank, Mastercard Foundation, Africa CDC, UNICEF, and MTN amongst others who worked with AVAT’s pooled procurement mechanism initiative a success.

This guarantee provided payment assurance to the vaccine manufacturers [ 18 ]. However, financial constraints and reduced vaccine uptake in Member States after the end of the declaration of COVID-19 as a Public Health Emergency of International Concern (PHEIC) challenged the initiatives.

The COVID-19 Response Fund was another significant AU initiative, that demonstrated the role of public-private partnership (PPP) in strengthening domestic capacity to mitigate the impact of the pandemic. The partnership aimed to raise an initial $150 million for immediate needs to prevent the spread and up to $400 million to support sustainable medical response to the COVID-19 pandemic by pooling the resources required for the procurement of medical supplies and commodities, supporting the deployment of rapid responders across the continent as well as providing socio-economic support to the most vulnerable populations in Africa.

Capitalizing on lessons learned from this initiative, heads of state of the AU member states converted the fund into the African Epidemics Fund (AEF), which was envisioned to support the African continent’s sustainable and self-reliant PPPR efforts. The AEF is set to be mobilized from various sources, including contributions from the Member States, private sectors, philanthropies, and international stakeholders. Unlike other ear-marked and vertical funding, this fund received through the AEF shall be used flexibly to accommodate the continent’s evolving needs, thereby continually strengthening Member States’ capability towards effective and timely PPPR efforts.

The other AU initiative, the African Risk Capacity (ARC), aims to support AU Member States in improving their capacities to better plan, prepare, and respond to weather-induced events and disease outbreaks [ 19 ]. ARC is the parametric sovereign insurance policy that is contributed by Member States so that the insurance supports outbreak response efforts of Member States by providing predictable funding at the early response phase of the outbreak or epidemic. To date, 39 AU Member States have ratified the APC treaty and signed membership, and 62 policies have been signed by the Member States for cumulative insurance coverage of US $720 million to protect 72 million vulnerable populations in participating countries [ 20 ]. Strengthening these domestic financing mechanisms is essential for creating a sense of ownership in the countries and ensuring sustainable funds for PPPR.

The global financing initiatives for PPPR

As diseases do not respect international borders, it is a must for global communities to make concerted and collaborative efforts to ensure global health security. The COVID-19 pandemic has practically demonstrated that ‘no one is safe until everyone is safe’. Under this premise, several global initiatives, including the Pandemic Fund, have been established to finance the PPPR. The Pandemic Fund seeks to channel critical investments to strengthen PPPR capacities at national, regional, and global levels, particularly in low- and middle-income countries – envisioning a resilient world. The Pandemic Fund has been contributed by donor countries, co-investors, and foundations, and hosted by the World Bank as a trustee [ 21 ].

The World Bank has been indeed engaged in various initiatives to support pandemic response, such as the response to the 2014–16 Ebola outbreak in West Africa and the establishment of the Pandemic Emergency Financing Facility (PEF) to fund outbreak responses (started in 2016 but now ceased operation in April 2021). These initiatives of the World Bank were instrumental in providing the required support for the response to the outbreaks, although they were criticized for their inadequacy in building resilient health systems that can go beyond the emergency period. Particularly, the prevention and preparedness items were ignored in these initiatives [ 22 ]. The PEF comes to its end following the recommendation of the International Working Group of the World Bank, underscoring the need to strengthen and scale up investments in global health security as an urgent priority [ 23 ].

To address the gaps in financing PPPR in countries, the World Bank established an International Working Group in Financing Pandemic Preparedness in 2016, with a mandate to propose how national governments and partners can ensure optimal and sustainable financing for actions to strengthen PPPR [ 23 ]. In May 2017, the World Bank International Working Group in Financing Pandemic Preparedness proposed strategies to finance preparedness and response capacities for pandemics and other health emergencies, particularly underscoring the need for national governments to increase domestic finances, development partners to capitalize on the existing bi-lateral and multilateral collaborations to finance preparedness and response, and the World Bank and International Monitory Fund (IMF) to place strategies to incentivize countries to invest in preparedness [ 23 ]. In 2019, the Center for Strategic and International Studies (CSIS) recommended new multilateral PPR financing, underscoring the need for the U.S. government to establish a Pandemic Preparedness Challenge at the World Bank to incentivize countries to invest in their preparedness. These initiatives and recommendations were critical in shaping the global financing architecture for PPPR [ 24 ]. Following the declaration of COVID-19 as a Public Health Emergency of International Concern (PHEIC) in 2020 by the World Health Organization (WHO), global leaders realized the vitality of having a strong and sustainable financing mechanism for PPPR to ensure global health security. In January 2021, G20 nations established a High-Level Independent Panel (HLIP) to recommend financing the global commons for PPPR. The HLIP strongly recommended countries make substantial investments, more than ever committed, to avoid the next pandemic – further pronouncing the critical need for increased domestic financing (up to an additional 1% of the GDP), increased additional international financing of up to $15 billion per year, and addressing the critical gap in global health governance architecture by integrating key actors, both from the global health and financing systems [ 25 , 26 ].

Drawing from these evolving outbreak response lessons and consultations, the Pandemic Fund has come to its realization (Fig.  1 ). The Pandemic Fund has adopted a multilateral common goods financing approach to address persistent global health challenges, as demonstrated by the establishment of the Global Fund to combat HIV/AIDS, Tuberculosis and Malaria, and GAVI, the Vaccine Alliance [ 27 ].

Prominent global milestones in the journey to support PPPR

The global PPPR requires an estimated $31.1 billion annual investment. Considering the existing and potential international and domestic financing for PPPR, it is estimated that at least an additional $10.5 billion per year in international financing will be needed to fund a fit-for-purpose PPPR, with a substantial gap in the LICs [ 26 ]. However, only $1.9 billion was pledged for the Pandemic Fund by donors and partners as of May 2023, and only $300 million was disbursed in the first round of pandemic funding – which was too far from the demand from LMICs that exceeded $7 billion [ 28 ]. This demand for funds requested from LMICs, with aims to strengthen their disease surveillance and early warning systems, laboratory systems, and health workforce development, implies their commitment and intense desire to prepare for the next pandemic. However, only five African countries were funded in the first round of the fund, and there was no consideration of regional entities from Africa. Moreover, the Pandemic Fund has been criticized for its suboptimal emphasis on the response aspect of public health emergencies [ 29 ]. More importantly, the governance structure of the Pandemic Fund needs to be all-inclusive, whether in high-income or low-income countries, rich or resource-constrained settings [ 25 , 26 , 27 , 29 ]. Surge financing from Day Zero has been proposed by the G7 countries, to ensure the immediate release of pre-arranged finance for countermeasures at the onset of the next pandemic [ 30 ]. Notably, 60–75% of the delay in COVID-19 vaccine access to LMICs was attributable to their signing procurement agreements later than high-income countries, which placed them further behind in the delivery line [ 17 ]. While supporting the cruciality of availing pre-arranged funds for immediate release, we also advocate that the initiative must be designed to ensure timely and equitable access to countermeasures to all countries.

Other remarkable initiatives such as the Global Health Initiatives (Global Fund, PEPFAR, World Bank and GAVI), established in 2002 to raise and disburse funds to address infectious diseases, immunization and strengthen the health systems in LMICs, have made several strides to support global health security and universal health coverage. However, due to the changes in global health needs, financing and governance, reshaping global health architecture is critical to building a more robust and resilient health system that can cope with emerging public health threats while enhancing everyone’s access to essential healthcare services [ 31 ].

Under these premises, delegates from multi-sectoral organizations (funders, governments, global health organizations, civil society, and the research and learning community) had 14 months of engagements to develop strategic shifts on GHIs to address the challenges of UHC and global health security sustainably. These engagements resulted in the “Lusaka Agenda” which proposes five strategic shifts – make a more substantial contribution to primary health care (PHC) by effectively strengthening systems for health; play a catalytic role towards sustainable, domestically-financed health services and public health functions; strengthen joint approaches for achieving equity in health outcomes; achieve strategic and operational coherence; coordinate approaches to products, research and development (R&D), and regional manufacturing to address market and policy failures in global health. To realize this strategic shift, a more inclusive and transparent governance system, monitoring the impacts of the initiatives, and working closely with government systems are required [ 31 ].

A call to action

As we are in the season where pandemics emerge and reemerge more frequently and spread more quickly, it is imperative to place mechanisms that ensure effective and sustainable financing for PPPR. As such, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR. The proliferation of (multiple) financing mechanisms for pandemics does not focus efforts but diverts attention and resources. Moreover, fragmented multiple financing mechanisms make financial and programmatic monitoring complex and challenging [ 32 ]. Thus, it is critical to make financial investments harmonized in a way that contributes to building comprehensive and resilient health systems to address current and future public health emergencies.

There is an urgent need to make regional financing mechanisms central to global PPPR financing efforts. The inequity we experienced with the COVID-19 response can only be addressed with regional financing that can optimally support PPPR initiatives such as geographically diversified and sustainable production of countermeasures. So, for equity in access and flexibility, AEF and other regional efforts need to be the focus and perhaps entrenched in global PPPR financing discussions. AEF can serve as a financing entity to support African Union member states in their efforts for pandemic PPR. The global entities, funders, partners, and philanthropies can provide direct financial support to this initiative. Notably, countries have easier access and a sense of ownership to regional mechanisms than global ones.

It is a must for the local and global financing mechanisms to adequately and proportionally align to support the public health threats, and the international finance governance systems ensure the inclusivity of all the key actors, irrespective of their development status to ensure global health security. The engagement of private sectors and philanthropies in the financing efforts must be considered.

We need to fortify our defenses against future pandemics by investing in comprehensive Pandemic Prevention, Preparedness, and Response strategies. Financial support is crucial to developing robust health systems, advancing research for rapid diagnostics, vaccines, and treatments, and establishing resilient supply chains for critical medical supplies. We must build a safer world by being part of the shield protecting humanity from the next health crisis.

As we are in the season with enormous emerging and reemerging public health threats, it is imperative to place mechanisms that ensure equity, and effective and sustainable financing for PPPR. Lessons learned from the continental and global financing initiatives, particularly during the COVID-19 pandemic, must be translated as we prepare for the next pandemic. Therefore, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems. This can be realized through provisions that can be included in the Pandemic Agreement.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Africa Epidemic Fund

Africa Medical Supplies Platform

Africa Vaccine Acquisition Trust

African Union

Coronavirus Disease

High-income Countries

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Pandemic Emergency Financing Facility

Pandemic Prevention, Preparedness and Response

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The write-up of this manuscript is supported by Africa Centres for Disease Control and Prevention (Africa CDC) through funding from the Mastercard Foundation.

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Ndembi, N., Dereje, N., Nonvignon, J. et al. Financing pandemic prevention, preparedness and response: lessons learned and perspectives for future. Global Health 20 , 65 (2024). https://doi.org/10.1186/s12992-024-01066-4

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Research Article

A scoping review of Deaf awareness programs in Health professional education

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Medicine Health and Life Science, Swansea University, Swansea, Wales, United Kingdom

Roles Conceptualization, Methodology, Writing – review & editing

Affiliation Faculty of Science and Engineering, Swansea University, Swansea, Wales, United Kingdom

• Julia Terry, 
• Rhian Meara

• Published: August 19, 2024
• https://doi.org/10.1371/journal.pgph.0002818
• Peer Review
• Reader Comments

Deaf awareness aims to promote understanding about Deaf and hard of hearing people, with the goal of reducing barriers between Deaf and hearing populations; and is particularly pertinent for health professional students as they need to learn to communicate effectively with a range of population groups. This scoping review aims to provide an overview of literature examining Deaf awareness programs provided to health professional students during their initial training. We searched four medical and public health databases and registers using terms related to Deaf awareness. We used the PRISMA-ScR reporting standards checklist for scoping reviews. We identified 10,198 citations, with 15 studies included in the final review. Searches were performed during August to September 2022, and April 2023. Studies were included provided they examined Deaf awareness content or programs within health professional education. Data were extracted by two independent reviewers who screened all abstracts using Rayyan software, followed by discussion to achieve knowledge synthesis and agreement. In all, a total of 15 articles from six countries were identified across health professional student disciplines including pharmacy, nursing, audiology, inter-professional and medical programs. The review found sparse evidence of research into Deaf awareness programs delivered to health professional students, with delivery often solely to small groups of students, indicating why so few students can access information about how to communicate effectively with Deaf and hard of hearing patients during their initial training programs. This scoping reviewed showed evidence of promising benefits for health professional students undertaking Deaf awareness programs during their undergraduate education. The importance of communicating with Deaf and hard of hearing patients and attaining Deaf cultural competencies for health professional students should be investigated in future research.

Citation: Terry J, Meara R (2024) A scoping review of Deaf awareness programs in Health professional education. PLOS Glob Public Health 4(8): e0002818. https://doi.org/10.1371/journal.pgph.0002818

Editor: Julia Robinson, PLOS: Public Library of Science, UNITED STATES OF AMERICA

Received: December 21, 2023; Accepted: July 9, 2024; Published: August 19, 2024

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

Data Availability: Submitted as Supporting Information files.

Funding: This work was supported by the Burdett Trust for Nursing, grant number 101010662\737073 – JT. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Introduction

Deaf awareness training aims to promote understanding about Deaf and hard of hearing people, with the goal of reducing barriers and increasing accessibility between Deaf and hearing populations and combating discrimination. In this paper the terms Deaf and hard of hearing people will be used throughout. The heterogeneity of Deaf and hard of hearing people are often not fully known to health staff [ 1 ] and that a person-centred approach is required according to individual communication needs. People who identify as culturally and profoundly Deaf may be referred to using a capital D for Deaf, with a lower case ‘d’ for deaf, more commonly used for people who are hard of hearing.

Despite the numbers of Deaf and hard of hearing people increasing globally from around 466 million people currently, to 900 million by 2050 [ 2 ], there is limited preparation and training for health professionals and health professional students to communicate and work with Deaf patients [ 3 – 5 ]. Health professionals themselves have reported that their communication skills and knowledge of working with Deaf and hard of hearing people could be greatly improved [ 6 ], as they lack tailored communication skills in caring for Deaf and hard of hearing populations [ 7 ]. There is a dearth of evidence about the effectiveness of provider-oriented disability programs, specifically those relating to sensory loss, and those in existence tend to be focused on general disability awareness [ 8 ] or about attitudes and behaviours towards specific population groups [ 9 , 10 ].

Challenges for Deaf and hard of hearing patients are many and are often not known to health professional groups with whom they engage. Difficulties for Deaf and hard of hearing people often relate to a lack of accessible services and provision in education [ 11 ], in society [ 12 ], and in disaster response [ 13 ] as well as difficulties accessing health services [ 14 , 15 ]. It is also acknowledged that health professional students need to be trained in Deaf cultural competencies [ 1 ] so they develop relevant knowledge and skills about Deaf and hard of hearing culture. For example, a person may use a Signed language as their preferred communication method, whilst others may prefer information literature in written form. However, literacy levels in Deaf and hard of hearing people are often lower than in hearing populations [ 16 ], so it is essential that health workers learn to ask about preferred communication methods for each individual. Students may demonstrate attitudes to Deaf people stemming from their own lack of knowledge that results in a negative stigma toward anyone who is Deaf (referred to as audism) [ 17 ], particularly if they lack experience of working with Deaf and hard of hearing patients [ 18 ].

Further challenges are reported by Deaf and hard of hearing patients who note they do not understand health providers instructions in nearly half of appointments, with few clinicians checking patient understanding [ 19 ] suggesting potential risk of misunderstanding and resultant health risks. Difficulties often result when a Sign language interpreter is required as health staff have little notion how to book or how to work with a Deaf patient and a Sign language interpreter [ 20 ]. Similarly, few health professional staff have used remote video interpreting services during health consultations [ 21 ], which involves either the health facility or the patient using a sign language interpreter via an app or remote video interpreting service (either in a booked capacity or on-demand). Few health professionals or students know the challenges members of Deaf and hard of hearing communities experience accessing health services, and specifically care routes that may or may not be open to them [ 22 ].

Notably in healthcare settings few staff have Deaf awareness training which leads to persistent health inequalities for Deaf and hard of hearing patients who often have poor experiences and outcomes in healthcare settings [ 23 ]. These negative experiences can relate to discrimination around booking procedures and face to face appointments, as well as assessments and testing visits [ 24 , 25 ], often due to limited accessibility for communication options [ 26 ], with services unprepared and ill-equipped to meet the needs of Deaf and hard of hearing people [ 27 ]. It is imperative that health service experiences improve for this population group. It has been described as a silent epidemic with global efforts needed to address the unmet needs of Deaf and hard of hearing adults and children who experience poorer health and care [ 28 ].

The Deaf awareness knowledge gap is likely unknown by health workers, who may have had limited exposure to this population group, and consequently do not appreciate the healthcare barriers Deaf and hard of hearing people experience [ 29 ]. Furthermore, there is increasing evidence that Deaf and hard of hearing people experience poorer health, with increased risk of preventable ill-health with chronic illness often undiagnosed and untreated, such as diabetes and cardiac disease [ 22 ]. Many diverse groups are disadvantaged because of assumptions around health literacy that may relate to English not being a first language, and ability to read and write, which in turn impacts on a person’s ability to understand healthcare and pharmacy directions and information [ 30 ]. Deaf people are aware health information is often not in accessible formats, so consequently they may rarely seek health material and be disadvantaged as a result by not being aware of common risks or solutions within their own control.

Knowledge of Signed language and the use of telecommunication equipment, such as Sign language relay services is not prevalent in health providers [ 31 ]. Deaf awareness programs highlight the different forms of communication that Deaf and hard of hearing people may use [ 32 ], including sign language, lip reading, note taking and oral methods, but few health workers are aware of this. Individual education providers may offer opportunities for students that challenge their knowledge about diversity, increase knowledge and communication, and break down stereotypes [ 33 ]. Certainly, there is a need for increased disability training in health professional education [ 34 ], with the most effective programs noted to be those that include people with disabilities themselves.

The aim of this scoping review was to report on the published evidence of Deaf awareness programs experienced by health professional students during their initial training. Given the health inequalities that Deaf and hard of hearing people experience, we wanted to explore the range of interventions and approaches used with health professional students to understand the current evidence about Deaf awareness programs.

Methods and analysis

Ethics statement.

As this study only included published data, ethics approval was not sought. The methods and results are reported according to the relevant items of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist [ 35 ]. According to Verdejo et al. [ 36 ] the main aim of a scoping review is to identify and map the available evidence for a specific topic area. The approach to the review was based on Arksey and O’Malley’s framework [ 37 ] which consists of the following stages: i) identifying the research question; ii) identifying relevant studies; iii) selecting studies; iv) charting the data; and v) collating, summarising, and reporting the results.

Search strategy

A scoping review seeks to present an overview of a potentially large and diverse body of literature pertaining to a broad topic, whereas a systematic review attempts to collate empirical evidence from a relatively smaller number of studies [ 38 ]. This scoping review is not intended as a conclusive synthesis of evidence but does provide an overview of the evidence of Deaf awareness programs that exist, primarily for health professional students. The study has been funded by the Burdett Trust for Nursing and was conducted in Wales, UK. It was not registered online. The overall project had a steering group which included lay members, Deaf and hearing professionals. The focus of the steering group was on the empirical aspects of our study and building a Deaf awareness course for Wales, UK, with this scoping review discussed at early meetings, and members contributing ideas for search terms.

Identifying the research question.

The core aim of this scoping review was to find out ‘what is the existing evidence on Deaf awareness programs that are included in health professional education training?’. Deaf and hard of hearing people’s experiences in health services and poor health literacy are frequently linked to the poor knowledge of health professionals about how to communicate with Deaf and hard of hearing people; including a lack of training for medical and nursing students, and students studying to become allied health professionals [ 1 , 39 , 40 ].

Identifying relevant studies.

The scoping review research question was left intentionally broad. The evidence was searched using four electronic databases (CINAHL, MEDLINE, ASSIA and Proquest Central), registers and key journals and repositories (such as PROSPERO), and contact made with key authors; as well as internet site searches for policies and reports. An experienced information specialist’s help was sought in reviewing the search strategy tool (PICO framework), which included students (P- population), Deaf awareness (I- intervention), health professional education (C–context); and learning (O–outcome). Search terms used included: Deaf OR hard of hearing or DHH or sensory loss; combining "deaf aware*" OR "deaf culture*") AND ("learn*" OR "educat*" OR "train*" OR "course*" OR "program*" OR "teach*". The databases included were CINAHL, Medline, ASSIA and Proquest Central, as well as Cochrane registers, with searches conducted between August and September 2022; and again in April 2023 (an example of the search strategy for one database is provided as an additional file). Different techniques and terms were used to expand and narrow searches, including tools such as medical subject headings (MESH), Boolean operators and Truncation. Single and combined search terms included key subject areas on: Deaf, hard of hearing, and Deaf awareness. Education related search terms included learning, education, training, course, program and teaching. Limitations were set to include papers in the English Language and research since 2000. Initial searches found papers in languages other than English did not relate to Deaf awareness programs but to Deaf students. Papers not in English language were excluded to reduce volume, and this remains a common decision for researchers [ 41 ]. In addition, key journals, professional organisation websites and reference lists of key studies were searched to identify further relevant documents. The final search strategy and terms were agreed and verified by a health librarian.

Inclusion criteria were: published research articles specific to: a) a focus on Deaf awareness, training on Deaf awareness/Deaf culture and b) were published in the English Language between 2000–2023. Exclusion criteria were: papers published before 2000, not in English language, papers without a focus on Deaf awareness, training/courses/understanding Deaf and hard of hearing patient experience for health professional students.

Study selection.

The initial search produced a total of 10,159 from database searches and 39 from registers. Once duplicates were removed (n = 5804), a further 4049 records were excluded that did not meet the inclusion criteria, 345 publications remained, and titles and abstracts were screened. All 345 records were screened by two separate reviewers independently using Rayyan software [ 42 ] and annotated spreadsheets of retrieved papers. We began by excluding sources that did not describe empirical studies of Deaf awareness courses for health professional students, such as opinion articles, newspaper reports, and papers without a Deaf awareness focus. Inter-rater discrepancies were resolved by discussion. 26 records were then removed in line with the eligibility criteria, and the remaining 15 publications are included in this review (see Fig 1 ).

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https://doi.org/10.1371/journal.pgph.0002818.g001

Charting the data.

A data-charting form was developed by one reviewer, and then updated iteratively through discussion with a second reviewer. The 15 included sources were charted initially to examine authors, year of publication and country of origin, study design, sample population, study aim and main findings, which was piloted and found to be effective. Through this process sources were all identified as primary research studies. Papers related to the following health professional student disciplines: Pharmacy (n = 2), Nursing (n = 2), Audiology (n = 2), Inter-professional (n = 1), and Medicine (n = 8).

Collating, summarising and reporting results.

In the final scoping review, six individual countries were represented. Most publications came out of the USA, which may be due to greater funding or interest in this area of research compared to other nations. Due to the heterogeneity of the range of study contexts, a narrative synthesis was a reasonable way to approach the reporting of retrieved studies which included: four pre and post intervention surveys; eight cross-sectional studies; two comparative studies and one evaluation of experiential role play.

After summarising the information from sources, then studies were sorted into categories regarding Deaf and hard of hearing awareness courses for specific health professional education program by discipline, as follows: i) pharmacy students; ii) nursing students; iii) audiology students; iv) inter-professional students and v) medical students; and also regarding methodological approach. In addition, main findings of the sources are presented in Table 1 . Context from the grey literature is included in this paper’s introduction as this clinical wisdom provides additional information and context.

https://doi.org/10.1371/journal.pgph.0002818.t001

Identification of studies

The 15 papers included in this scoping review were carried out geographically in the USA (n = 8), Canada (n = 2), the UK including Ireland (n = 3), with one study each from Germany and Puerto Rico. All studies’ samples were university students undertaking undergraduate study, and included pharmacy students (n = 3), nursing students (n = 2), medical students (n = 7), and other/mixed groups (n = 5), accounting for some overlap of participant groups.

Findings are reported under four deductive themes: i) provision of Deaf awareness training ii) Deaf awareness: reflections iii) Deaf awareness: examining knowledge and iv) Deaf awareness: exploring confidence and communication.

i) Provision of Deaf awareness training

One article examined the provision of Deaf awareness training across medical schools in the UK and Ireland and was the only paper retrieved [ 43 ] to survey education providers and to ask about Deaf awareness provision. Medical schools in the UK (n = 38) were asked to complete a survey as to whether they included Deaf and hard of hearing awareness training in their curriculum, with 23 respondents [ 43 ]. 7/23 medical schools reported they did not provide any Deaf and hard of hearing awareness training, and of the 16 medical schools who said they provided training, 8 made it compulsory. 6/16 provided a formal qualification in Sign Language or Deaf and hard of hearing awareness. Time spent training varied from 1–2 hours to six weeks, and 13/16 involved a Deaf and hard of hearing tutor in teaching delivery [ 43 ]. No other papers have been retrieved that have enquired about provider provision of Deaf awareness training for health professional programs.

ii) Deaf awareness: Reflections

As seen in Table 1 , among the 15 studies reporting Deaf awareness training, five studies delivered a workshop and undertook either a post training reflection or evaluation to enquire about participants’ experiences [ 3 , 44 – 47 ] (there was no pre-testing or baseline knowledge enquiry for these studies), and all involved training delivery with members of local Deaf and hard of hearing communities. Of these evaluation studies, one involved pharmacy students [ 47 ], one further paper discussed Deaf awareness introduced across ten health professional disciplines [ 3 ], and the remaining three were conducted solely with medical students [ 44 – 46 ].

One study [ 3 ], led as a medical student project, was run as a collaboration with students and hard of hearing people, with general evaluations very positive, and one of the ten professional student groups who attended (occupational therapy students) completing reflective journals post workshop. The authors, who reported their interest in the logistics of delivery with patients and community partners, strongly recommend delivery of Deaf awareness training in using Deaf people as mentors to students, initially as a panel, which was replaced for subsequent sessions with mentors and students in small groups for more informal interactions.

Another study to use reflections to understand students’ (pharmacy) experience of a Deaf awareness session [ 47 ], engaged participants in a different learning style with members from a nearby centre for Deaf and hard of hearing people and participation in a role-reversal exercise as students ‘became’ Deaf patients. Members of the Deaf and hard of hearing community wrote scenarios for student learning, and prior to the exercise students had basic lessons in American Sign Language (ASL) and reading materials about Deaf and hard of hearing culture. Students then experienced the patient perspective and different parts of a mock hospital experience as they communicated symptoms without using their voices and moved through processes of asking for interpreters, consenting to treatment, and giving symptom information. The session included debriefing, reflection on the experience and students learned the frustrating experiences in healthcare that Deaf and hard of hearing people experience [ 47 ]. 65 pharmacy students agreed the experience would positively impact their attitudes and future behaviour towards Deaf and hard of hearing patients [ 47 ]. As part of course requirements students wrote two-page reflections on the experience. In terms of feasibility the authors [ 47 ] note the nearness of the centre for Deaf people being close by helped. Authors note a small number of students were involved with requirement for heavy resource, for example 12 faculty members were involved [ 47 ].

Three further studies, that included an evaluation only type design, were focused solely on medical students [ 44 – 46 ]. The first of these also involved a role reversal experience for students, as well as involvement from 40 local Deaf individuals [ 45 ]. Medical students in their new ‘Deaf’ role interacted across four stations/types of clinical setting and were given instruction cards and waited for their ‘appointment turn’ as a Deaf receptionist finger-spelled their names. The program evaluated positively and at a later time point over 12 months later, 97% recalled participating and reported finding it a valuable experience [ 45 ].

The final two evaluation only studies [ 44 , 46 ] involved a one-off Deaf awareness workshop and both studies involved participation from Deaf community trainers, with evaluations showing that students had highly rated the activities. Time lengths of the Deaf awareness workshops varied depending on content, from one three-hour workshop run in the evening [ 46 ] to a 72-hour activity which included a short series of workshops for learning British Sign Language [ 44 ]. In response to initial positive evaluations from medical students on a Sensory awareness Day, a special study module was developed including a short Sign language course taught by a Deaf and hard of hearing tutor and self-directed material to gain insight into Deaf and hard of hearing awareness [ 44 ]. The course included a written report, British Sign Language (BSL) tutorials and classes, a BSL objective structured clinical examination (OSCE) assessed by a certified BSL examiner, all totalling 72 hours of study activity [ 44 ]. To date 54 medical students have undertaken the course, and out of 52 completed evaluations 98% students found the sign language manageable and the content appropriate for clinical practice, although 19% would have liked more medical vocabulary [ 44 ].

iii) Deaf awareness: Examining knowledge

Four papers reported in this section focused on examining student knowledge after a Deaf awareness session with two studies involving a control group [ 48 , 49 ], and two studies seeking knowledge about students existing knowledge without participation in any Deaf awareness program [ 50 , 51 ].

First, two studies of medical students that sought to discover if students who attend Deaf and hard of hearing culture training demonstrated greater knowledge of Deaf and hard of hearing culture and Deaf and hard of hearing patients than medical students not given a Deaf and hard of hearing awareness educational opportunity (control group), one UK study [ 48 ] and one from USA [ 49 ]. A significant difference was noted on survey questionnaires to measure attitudes to and knowledge of Deafness in those taking an optional Deaf and hard of hearing awareness course (n = 29) and control group, who could perceive patient mannerisms as rude [ 48 ]. Students reported that without encountering Deaf and hard of hearing people it may be difficult to understand the issues they face [ 48 ]. For the USA study, students were asked to list up to five problems they thought a Deaf and hard of hearing person might experience on hospitalisation, with students who had attended Deaf and hard of hearing cultural training showing awareness about understanding terms and medical language as the number one difficulty, but also acknowledging awareness about maltreatment and mistreatment being a possibility, which others in control group did not show awareness about [ 49 ].

For the two studies that sought to know students’ existing knowledge about Deaf awareness without participation in a Deaf awareness program, surveys were undertaken with nursing students in the USA [ 50 ] and with medical students in Puerto Rico [ 51 ]. For nursing students [ 50 ], the survey included multiple choice questions then true/false statements [ 50 ]. Out of 131 respondents [ 50 ], 18 had taken an entry level sign language course previously. Only 17% (n = 22) answered more than half the questions correctly indicating that overall there were low levels of Deaf awareness across the cohort and low Deaf cultural competence. For the medical students’ study [ 51 ] (n = 158) were asked about their knowledge of Deaf culture and community in Puerto Rico, without any intervention [ 51 ], 21% of respondents had attended a sign language class, and generally students in more senior years reported more likelihood of working with a Deaf or hard of hearing patient and showed an increased understanding of Deaf culture in comparison to junior students. Studies that indicate low baseline knowledge about a particular patient group without preparation are to be expected, but also highlight the need to increase Deaf awareness in those student populations.

iv) Deaf awareness: Exploring confidence and communication

In this section of the scoping review findings, we report on five studies that involved a pre and post test for student groups before and after their participation in a Deaf awareness program [ 4 , 5 , 52 – 54 ].

The first example of a study in this review that involved USA pharmacy students [ 52 ], involved them embarking on a co-curricular course that consisted of four 90-minute sessions including Deaf and hard of hearing cultural competence and sign language words and phrases [ 52 ], with students who completed the course reporting significantly improved knowledge and feelings of confidence in relation to communicating with people who are Deaf and hard of hearing [ 52 ]. Initially the six-hour course had a cost of $50, reduced to $12 for each student by university sponsorship. As an external agency provided and co-ordinated the courses, it is noted that the workload was not additional for course staff.

Another university applied Deaf culture to an anatomy session

With US Medical students [ 5 ], while they studied the ear and hearing [ 5 ]. Deaf and hard of hearing panellists attended this 90-minute session and discussed their healthcare experiences, additionally a further 90-minute session on Deaf and hard of hearing culture was provided, with students given pre and post session questions. Students gave positive feedback about the cultural competencies relating directly to the anatomy and neuroscience session, with students recognising their previous low knowledge levels in relation to Deaf and hard of hearing communities

Medical students in Germany [ 4 ] were invited to attend an online workshop held on three consecutive occasions, and to engage in pre and post evaluations (n = 95) [ 47 ]. 65.3% of students had not been in contact with a Deaf and hard of hearing or person before. Students reported feeling substantially more confident working with Deaf and hard of hearing people after engaging in the online Deaf and hard of hearing awareness program. Students reported finding the Deaf awareness workshop particularly helpful from a personal and from a professional point of view. The workshop was elective and the only Deaf awareness intervention that was delivered online, out of the 15 papers found in this scoping review.

Similarly, osteopathic medical students in the USA [ 53 ] participated in a pre-test, a four-hour workshop, then post-test study two weeks later with significantly improved scores at post-test following workshop attendance [ 53 ]. Students reported the contact with Deaf and hard of hearing people as part of the workshop to be the most beneficial aspect of learning, and also commended the opportunities to practice their newly learned skills.

The final study included participating nursing students in the USA using newly acquired Deaf awareness knowledge to ‘assess’ a ‘deaf patient’ after a Deaf awareness lecture [ 54 ]. This study involved students interacting directly with Deaf and hard of hearing people acting as standardised patients [ 54 ]. On starting an initial history taking exercise students were unaware patients would be Deaf and hard of hearing, mirroring real-life practice situations. Initially several students were reported to have turned away, preventing lip-reading, or left the room without saying they were going in search of interpreters. Students then received further input about communicating with Deaf communities and several positive changes were noted in the second exercise. This study [ 54 ] is another good example of how local Deaf and hard of hearing communities can be directly involved in providing students with a meaningful learning experience, which Deaf and hard of hearing participating tutors reported benefits in contributing to nurse education and improving care for others [ 54 ].

Overall papers retrieved in this scoping review suggest that health professional students who have the opportunity to engage in Deaf and hard of hearing awareness education courses during their undergraduate training find it beneficial as an opportunity to increase their knowledge about Deaf and hard of hearing people, as well as increasing their confidence and competence when communicating with Deaf and hard of hearing patients.

This scoping review describes the extent and characterises existing research on Deaf awareness training in health professional programs. We found that there is significant variability in how Deaf awareness training and programs exist for health professional students as well as how the learning may be assessed and examined. Generally, health professional training does not include significant content about learning how to communicate with Deaf and hard of hearing people and few opportunities to develop Deaf and hard of hearing cultural competencies. The lack of content regarding the care of Deaf and hard of hearing people during education of all health professional students may be one of the explanations for the difficulty of interaction between professionals and the dissatisfaction Deaf and hard of hearing users of health services experience [ 55 , 56 ]. Evidence retrieved usually involved small samples, and providers were often supported by external agencies in terms of delivery of Deaf awareness training initiatives.

Several of the retrieved studies reported on one-off interventions with small participant numbers, some of which required heavy resource from either education faculties, local Deaf and hard of hearing centres or both [ 47 , 50 , 52 ]. Whilst direct involvement from Deaf and hard of hearing communities is admirable and probably the best experience for student learning, it may not be feasible for health professional programs to aspire to such learning opportunities due to high numbers of students. Providing the opportunities to a select few is not in the spirit of equity, and Deaf awareness knowledge and cultural competence surely need to be known to all undertaking a health professional program. Education providers with large student populations simply cannot over-burden local Deaf and hard of hearing communities to come on-site and provide teaching and practice opportunities, and the logistics of organising this for large cohorts are challenging, with providers aware of competing topics, and limited program time. One solution would be for the development of Deaf awareness eLearning packages that have been Deaf-led and include the development of knowledge about types of Deafness, best ways to communicate, what to avoid, as well as promoting positivity around Deaf and hard of hearing population, so that Deaf culture is not only learned about, but embraced.

In terms of approaches, it is unsurprising that Deaf awareness interventions increased student knowledge and cultural competence about working with Deaf and hard of hearing people. Collecting pre and post knowledge information would certainly demonstrate a more robust approach and supply feedback about the impact of interventions, as well as the opportunity for students to apply their Deaf awareness as evidence-informed practice [ 57 ].

A solution by some providers in terms of navigating competing timetable demands is to provide Deaf awareness as optional [ 48 ] resulting in probably the most motivated students attending, and again resulting in the student majority not having the opportunity for Deaf and hard of hearing awareness skill and knowledge development. Yet health professional comfort levels at communicating with Deaf and hard of hearing patients increase when they have more contact with Deaf and hard of hearing patients [ 58 ].

As with most skills workshops, and several of the studies in this review included a student opportunity to learn basic signed language, it is acknowledged that unless learners have the opportunity to regularly practice a skill it may soon be lost [ 58 ], so a thorough approach with regularity and informal practice time would be essential for success.

A scarcity of evidence was found from allied health professional programs regarding Deaf awareness content. This is notable in terms of audiology student programs, although anecdotally many claim to include a session on the topic. Regarding qualified audiologists, two studies examined audiologists’ current cultural competency [ 59 ] and the need for audiologists to have clinically relevant sign language [ 60 ]. There is a need for audiologists to increase their knowledge of Deaf awareness and proficiency in sign language starting during their professional training is clear, as well as their knowledge regarding how to work with sign language interpreters [ 59 ], which applies to all healthcare professionals. Similarly, others who work with patient groups, such as genetic counselling graduates [ 61 ], with over a quarter reporting no Deaf and hard of hearing awareness training and 51% reported limited training of just 1–2 hours during their initial training programs.

There may be certain professional groups who are viewed as more likely to encounter contact directly with a Deaf and hard of hearing person. For example in a study of emergency medical practitioners [ 62 ], out of 148 respondents, 109 reported having responded to an emergency call from a Deaf and hard of hearing person. In the same study, participants who attended training said it expanded their knowledge of Deaf and hard of hearing culture; and at 3 months all respondents reported the training to still be helpful and clinically relevant.

Any facilitators of Deaf awareness programs need to ensure accuracy in terms of context and relevant country/regional Sign language. Assumptions are often made, for example a study about Deaf awareness training for support staff with people with intellectual disabilities [ 63 ] talked about using signs but people are not always aware that sign for communication support differ considerably a recognised Signed language. For example, Makaton is not a recognised language but is a communication tool [ 64 ].

Health professional students themselves have noted that workshops similar to Deaf awareness would help considerably in increasing their knowledge and skills of how best to communication and work with under-served populations [ 51 ]. Despite moves to progress accessible standards in health services, we continue to know that populations continue to have poor experiences in healthcare which mostly relate to the limited knowledge and preparedness of those working in such professions.

Recommendations

Involving Deaf and hard of hearing individuals in the planning and delivery of activities at the outset will ensure content is accurate, relevant and may provide the opportunity for immediate feedback if practical exercises are included. Deaf awareness training during health professional training programs can serve as a timely introduction to the topic and ensure students thoughtfully evaluate their approach to communication and engagement with all individuals. At the very minimum all health professional programs need to provide basic Deaf awareness information that can be accessed on their student learning platforms, along with information about local Deaf communities and Sign Language training providers.

Strengths and limitations of this study

• Using the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), this study provides a detailed view of the evidence of Deaf and hard of hearing awareness content that feature in health professional student programs
• Literature from four electronic databases and registers were screened to comprehensively source and describe the literature.
• Only published peer-reviewed research articles in English were included (although initial searches for papers in other languages did take place with none located)
• Despite a systematic approach, there is a risk that further evidence may have been overlooked.

As Deaf and hard of hearing communities frequently report negative experiences in healthcare largely due to a lack of Deaf awareness knowledge in staff, it is important to understand more about the delivery of Deaf awareness programmes available to health workers. This scoping review outlined the available evidence regarding health professional programs that include Deaf awareness content aimed to increase students’ knowledge skills and Deaf cultural competencies as they move forwards in their careers. There is a lack of rigorous research in this field, although there is emerging evidence of benefits and increased Deaf awareness knowledge for student populations. All development of Deaf awareness education needs full involvement from Deaf and hard of hearing communities to ensure relevance and success. Programme regulators and providers have an important role here in reviewing program content to ensure disadvantaged communities do not remain under-served. There is potential to ensure that students emerge from health professional education with good knowledge about how to work with Deaf and hard of hearing patients.

Our review offers a starting point to educators and health and care providers to consider potential benefits to both health professional students and staff about increasing knowledge, confidence and competence about Deaf awareness, as well as modes of delivery. Further research on the acceptability of, and implementation of Deaf awareness programs on health professional students is needed. Knowledge gaps exist around the type of Deaf awareness programs, how such training might be accessed, length of course, content and device delivery. Knowing ultimately what communication approaches impact positively on Deaf people in healthcare services is the ultimate goal.

Supporting information

S1 checklist. prisma checklist..

https://doi.org/10.1371/journal.pgph.0002818.s001

S1 Text. Cinahl search.

https://doi.org/10.1371/journal.pgph.0002818.s002

Acknowledgments

The authors thank the project steering group, particularly Deaf and hard of hearing communities in Wales for their support and interest with the project.

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