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Online Communities. Benefits and Risks: A Literature Review

Online Communities. Benefits and Risks: A Literature Review

1. introduction.

In the 90s, the use of the Internet resulted in a significant change. At first, the Internet was used for information. Internet users were passive users, because the only thing they could do was to read what was written on websites. This was called Web 1.0. Most of users sought ready-made contents, usually created by professionals (Guazzini et al., 2010; Conrad, Bandini, & Vasquez, 2016). Nowadays, it is difficult to imagine a website without at least one comment area. In fact, in 2001, with the development of technology, the Internet has passed from Web 1.0 to Web 2.0 (O’Reilly, 2009). The emphasis has been put on active users, that can comment, interact between each other, write blogs and, in particular, create communities. The most well-known communities are represented by social media, such as Twitter, Facebook and Instagram, where individuals’ names usually appear on their personal page. They allow users to create, share, or exchange information, experiences, photos and videos and to connect people with same or similar interests with one another (Conrad, Bandini, & Vasquez, 2016).

Similarly, many other online communities were created for specific illnesses and they are usually called “online health communities” or, more rarely, “electronic support groups” or “digital health social networks” (Conrad, Bandini, & Vasquez, 2016, p. 3). Around 1990 (Wentzer & Bygholm, 2013) and 2000 (Conrad, Bandini, & Vasquez, 2016) interactions on the Internet became quite common and lots of websites discussed many illnesses, both well-known and unknown. Studies started to research on how being a part of an online self-help/support group and sharing interests and support could have an empowering effect on users (Wentzer & Bygholm, 2013).

Today users can find on Google 13,300,000 diabetes support groups, 636,000 celiac disease support groups, 1,490,000 anorexia support groups, to name but a few (Conrad, Bandini, & Vasquez, 2016). This means that there are many opportunities to get in touch with people who can understand what an individual is going through. This is especially true for people with chronic illnesses rather than people with acute illnesses (Conrad, Bandini, & Vasquez, 2016; Glenn, 2015). But it also means that results are not filtered when searching on the Internet. Moreover, this is a 24/7 service, always available, even when other face-to-face services seem not to be. In fact, users can share and read the content of communities anytime they want and they can discuss with people they may not ever see in their life, thanks to the communication power of the Internet (Malik & Coulson, 2010).

“A mutual help group is defined as a group of people sharing a similar problem, who meet regularly to exchange information and to give and receive psychological support” is the definition of Pistrang, Barker, and Humphreys (2008, p. 110) to explain what self-help groups are. Starting from the first half of the 20th century, self-help groups developed all over the world, with many and different focuses. Participants of self-help groups build new networks and learn how to cope with the situation, in a condition of “warmth, encouragement, and acceptance towards everyone involved” (Brown et al., 2008, p. 106). But stronger needs for privacy and anonymity (Finn, 1999) have brought people to find solutions behind the screen, as the most part of the articles of the present study sustains. In fact, as said above, with the development of Web 2.0 in 2001, individuals had the chance to choose: face-to-face help, virtual help, or both.

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Doing a literature review: Community organizations and nonprofits

literature review online community

This page is a living document -- we welcome community feedback. If you have comments or questions, please contact us: [email protected].

What is a literature review, and why do one?

Literature reviews summarize the existing conversation on a topic. They can accomplish something similar to environmental scans, researching industry best practices, summarizing evidence-based approaches, or laying the groundwork for a new initiative. A literature review can be done as its own complete product, or it can serve as an introduction for the original research you plan to do to add to the conversation in your field. In academic research contexts, such as for theses and dissertations, they provide a grounding for the new work a scholar is presenting to add to this conversation. 

However, most guidance available on conducting literature reviews does not consider how to do a literature review in a nonprofit context, or outside of university settings in general.

What a literature review could do for you

Outside of academia, your motivations for research may be different. For a non-profit, literature reviews might help you:

  • Gather evidence to assess your organization’s best practices
  • Provide evidence for grant proposals
  • Look for new approaches to an issue
  • Provide background or a methodology for your original research
  • Synthesize what’s known on a topic, to share with others working in your area
  • Find out if someone has already studied the topic you are interested in

What are the steps?

What you're looking to create may not be exactly a formal literature review. Most guidance on conducting literature reviews assumes an academic context, with strict guidelines for how a review should be conducted. As a non-profit or NGO worker your resources, needs, and audience may be different from researchers in academic institutions.

Here is a structure to follow based on the literature review process, with questions to consider along the way to help you tailor the process to your context. Each step is described in greater detail below the infographic.

 The process doesn't have to be linear! You can return to each step as needed throughout your research.

literature review online community

 Preparation

Think through your needs, capacity, and resources to plan your work.

What is your motivation for creating a review on your topic?

Do any literature reviews exist on this topic already?

  • Do you have fellow staff or volunteers that could contribute to this project?
  • How much time do you (and others) have to dedicate?
  • Do any staff or volunteers have relevant experience to contribute?

Information and supports:

  • You may have more resources available to you than you realize.
  • See "Where to search" in the "Retrieval" section for more ideas.

Keeping track of sources:

  • To keep track of the sources you intend to use, you can keep a list in your own document, or you may want to consider using citation management software.
  • Citation managers are designed to make it quick and easy to track and cite your sources. You can read more at  Citation management software and tools .

Keeping track of the information you're collecting:

  • What kind of note-taking works well for you?
  • Even if something feels memorable in the moment, it can be difficult to remember where you found a piece of information even the next day.
  • Many citation management tools allow you to add notes or attach documents.

Consider any possible search terms that relate to your topic -- it's useful to try different combinations of words to see what results you get back. Your early searches may help you find relevant terms to add to your list.

You can also consider what kinds of articles will be relevant to your needs, then use search filters to narrow your results to fit those criteria. For example, if you are looking for recent articles, some databases give you the option to filter by publication date.

It's a good idea to keep a record of your searches: a list of what keywords or filters you've used, on what website, and what you were able to find with each search. This can help you locate sources again later, and have a record of what has worked well so you don't repeat work.

Resource links: The collapsed "Where to search section" below describes some options of where you may be able to find information and documents, as well as support services that could help you in your research. "Research strategies" contains more information on research strategies and approaches.

Open web (search engines like Google, Bing, DuckDuckGo ):

  • Tools for searching for Open Access articles ( CORE plug-in , OA button )
  • Advanced Google search tips
  • Grey literature search tips  - grey literature is information produced outside of traditional publishing and distribution channels - things like newsletters, working papers, speeches, reports, and policy literature. It often comes from NGOs , government, industry, and other organizations.

Potentially useful collections:

  • SFU list of Open Access databases
  • Directory of Open Access Journals
  • Academic library databases -- use Open Access filters in search ( SFU guide , UBC guide )
  • Open content on JSTOR  -- a digital library of academic journals, books, and primary sources in the humanities and social sciences
  • Downtown Eastside Research Access Portal  -- contains research and related materials relevant to Vancouver's Downtown Eastside
  • Cochrane  Library  -- a collection of databases with evidence to inform healthcare decision-making, including systematic reviews, controlled trials, etc. (not all Open Access content, but many articles are)
  • Candid. Issue Lab  -- an online collection of free research, evaluations, case studies, toolkits , etc.
  • Frontier Life  -- a digital collection of primary source documents relating to colonialism in North America, Australia, Asia, and Africa

Paid databases:

  • How to effectively search databases for journal articles

There are a few other resources that may assist you in your search or provide you access to additional materials. For example, public libraries may subscribe to databases that would then be free to patrons to access. Academic libraries also sometimes allow guests to visit in person and use university computers to access their electronic resources like databases. Other options include:

  • Paid searching services ( InfoAction  at the Vancouver Public Library, for example)
  • Professional organizations you are a member of may also have their own independent library collections
  • JSTOR free account  - a digital library of academic journals, books, and primary sources in the humanities and social sciences
  • You may qualify for the Community Scholars Program
  • Start your research here -- an overview of the research process
  • Library Research Skills -- interactive Canvas tutorial from the SFU Library that covers understanding assignments (or in your case, your research needs), narrowing your topic, and finding background sources, scholarly books, and articles. Geared towards students but may still be useful
  • Finding articles: Advanced search techniques -- overview video of advanced search techniques that are especially useful when searching databases
  • Search tips for Google, Google Scholar, DuckDuckGo , and other search engines  -- advanced search techniques for web search engines
  • The Beginner’s Guide to Business Research -- from the UBC Small Business Accelerator 
  • How to Conduct Market Research for Nonprofits Like a Pro - Pollfish Resources -- includes suggestions for sources for nonprofit secondary market research

Screen the results you're getting: are they relevant to the topic you've chosen? Do they fit the criteria you've selected for retrieval? You don't need to read the full article at this stage -- you can read the abstract or skim headings. If the article looks relevant, save the full text to read once you reach the synthesis stage.

Evaluating sources:

  • Evaluating Sources - from the University of the Fraser Valley on scholarly vs. popular sources, news sources, images, and the "filter bubble"
  • Evaluating Information Sources - from the University of British Columbia on evaluation frameworks and checklists
  • CASP Checklists - checklists for evaluating methodology and study design

Choosing relevant sources for your topic:

  • Choosing Sources - Sheridan College resource with questions to reflect about the type of information you're seeking
  • Choosing the Best Sources and Evidence - University of Arizona Global Campus resource on selecting strong and relevant evidence
  • How do I choose which sources to use? - Tips from Imperial College London to quickly identify whether information is relevant to your research

You’ll be doing a lot of reading, so keep notes on each source you find. This can be done in the notes section of your citation manager, or your own document.

The other articles your sources are citing can clue you into other important research in the field -- especially if they appear in multiple of your sources.

Recognizing patterns or themes (i.e. in findings, specific aspects of your topic studied, methods of research, conclusions) will be useful when you begin your write-up to help you link articles together or contrast them.

  • Spying on a conversation [video] - tips and tricks on identifying relevant information in a literature review search, 4:43 - 8:54 is particularly relevant for the synthesis step
  • Read & Take Notes - Researching the Literature Review - guide from Oregon State University on strategies for note-taking during a literature review

The form of your finished product may differ based on your audience, needs, and purpose. Should the write-up be thorough or brief? Casual or formal tone? Purely text, or with visuals?

Generally, a literature review should contain:

  • An introduction -- where you explain why you've conducted this research, your context, and give readers a preview what you'll discuss and how that will be structured
  • You don't need to fully summarize each article, and you also don't need to include every article on a topic -- just what's relevant to you!
  • Element of analysis/critique  -- consider which sources you find particularly useful, and the positives or flaws they may have
  • Conclusion -- how does it all add together? Does anything seem to be missing from the scholarship as a whole? Did you learn anything that's useful to your organization and its practices?

There are many possibilities to shape the format to your needs. Your literature review could contain an executive summary to explain your project and call out key findings. It could end with recommendations for action in your organization and beyond. It could take the form of an interactive web page. It could have bulleted summaries, photographs, and graphs.

See below in the "Examples" section to see some possible structures that incorporate some of these elements.

  • Academic writing: What is a literature review? - guide from the SFU Student Learning Commons on what should be included in a literature review and how to organize it
  • Literature Reviews - guide from the University of North Carolina at Chapel Hill on writing a literature review. "Strategies for writing the literature review" and "Begin composing" sections may be most helpful in how to create your write-up

Revisit: who was your original target or imagined audience?

Now that you've conducted your research, are there any other groups (whether internal or external to your organization) who would be interested in what you've created? These could be community members, local leaders, professional organizations, or partner organizations you work closely with.

What methods are available to reach your target audience and other potential groups you've identified?   Trade publications, blogs, email lists, or conferences might be good places to share your work. Internally, newsletters, meetings, and emails could be effective.

 Planning for your project's future

Keeping notes on your process (searches, sources, etc.) throughout your research allows you or others in your organization to pick your work back up later, or to replicate your process on a different topic.

Ensure your notes are kept somewhere secure and reliable, where others in your organization can also access it as needed.

The following links contain literature reviews conducted by and for community groups and nonprofits. They provide an example of the different forms your literature review could take.

  • CityHive - "Enhancing Youth Leadership and Agency - A Toolkit for Successful Leadership Programs"
  • Ontario Nonprofit Network - "Decent Work for Women - A literature review of women working in Ontario's nonprofit sector"
  • Downtown Eastside Women's Centre - "Red Women Rising: Indigenous Women Survivors in Vancouver's Downtown Eastside"
  • The Coalition for Healthy School Food - "The Impact"
  • Canadian Observatory on Homelessness - "Northern, Rural, and Remote Homelessness: A Review of the Literature"

Further resources

For more detailed advice on literature reviews, see our guide on literature reviews for graduate students .

For more information on citation, see this page on citation and style guides , this guide on citing Indigenous Elders and Knowledge Keepers (APA 7), and this piece on citational justice by Neha Kumar and Naveena Karusala.

Acknowledgments

This guide draws on research supported by the Social Sciences and Humanities Research Council. It was developed as part of the Supporting Transparent and open Research Engagement & Exchange ( STOREE ) research project.

Thank you to the Community Scholars and others who reviewed drafts of this page, including Savannah Swann from the Dr. Peter Centre.

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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.

Literature review guide

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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.

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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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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

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Handbook of eHealth Evaluation: An Evidence-based Approach [Internet].

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

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

9.5. Concluding Remarks

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

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

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

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

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

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

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

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

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

What are the parts of a lit review?

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

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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Social Network Analysis and Online Learning Communities in Higher Education: A Systematic Literature Review

  • Shazia K. Jan Macquarie University
  • Panos Vlachopoulos Macquarie University
  • Mitch Parsell Macquarie University

This paper presents the results of a systematic literature review which sets out to explore the use of social network analysis (SNA) for investigating online learning communities in higher education. The impetus for such a review originated from an increased interest by researchers in SNA techniques to investigate interactions and learning engagement in various types of online communities. However, the researchers often omit to ground their research and SNA methods in community based learning frameworks such as communities of inquiry (CoI) and communities of practice (CoP). We identified a handful of studies that integrate SNA methods and key constructs from these frameworks and examined: SNA measures and corresponding theoretical constructs used; other analytical techniques used; limitations and; suggestions for further research. We found that while SNA is effective in detecting prominent participants, sub-groups and certain aspects of a CoP, a specific SNA measure cannot be correlated with a particular presence in a CoI. Therefore, SNA needs to be complemented with a qualitative analytical technique. Whether SNA can be used as a stand-alone technique for identifying communities remains to be seen. We also find a lack of consideration to attributional and performance variables in existing studies. In conclusion, we propose the development of a fully integrated research framework for a holistic analysis of online learning and teaching.

Author Biographies

Shazia k. jan, macquarie university, panos vlachopoulos, macquarie university, mitch parsell, macquarie university.

Acharjya, D. P., & Ahmed, K. P. (2016). A survey on big data analytics: Challenges, open research issues and tools. International Journal of Advanced Computer Science and Applications, 7(2), 511-518. http://thesai.org/Publications/ViewPaper?Volume=7&Issue=2&Code=ijacsa&SerialNo=67

Allen, I, E., Seaman, J., Poulin, R. and Straut, T. T. (2016). Online report card: Tracking online education in the United States. Retrieved from http://onlinelearningsurvey.com/reports/onlinereportcard.pdf

Annese, S., & Traetta, M. (2012). Distributed participation in blended learning communities: Actors, contexts and groups. Int. J. Web Based Communities, 8(4), 422-439. doi:10.1504/IJWBC.2012.049558. https://dl.acm.org/citation.cfm?id=2389588

Avella, J. T., Kebritchi, M, Nunn, S. G., & Kanai, T. (2016). Learning analytics methods, benefits, and challenges in higher education: A literature review. Online Learning, 20(2), 13–29. doi:. https://olj.onlinelearningconsortium.org/index.php/olj/article/view/790

Aviv, R., Erlich, Z, Ravid, G., & Geva, A. (2003). Network analysis of knowledge construction in asynchronous learning networks. JALN, 7(3), 1-23. https://onlinelearningconsortium.org/sites/default/files/v7n3_aviv_1.pdf

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De Laat, M., & Prinsen, F. R. (2014). Social learning analytics: Navigating the changing settings of higher education. Research & Practice in Assessment, 9, 51 – 60. http://hdl.handle.net/1820/5870

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Freeman, L. C. (2006). The development of social network analysis. Vancouver, Canada: Empirical Press. Gilbert.

Garrison, D. R., Anderson, T., & Archer, W. (2000). Critical inquiry in a text-based environment: Computer conferencing in higher education. The Internet and Higher Education, 2(2-3), 87-105. doi: 0.1016/S1096-7516(00)00016-6. http://cde.athabascau.ca/coi_site/documents/Garrison_Anderson_Archer_Critical_Inquiry_model.pdf .

Garrison, D. R., Anderson, T., & Archer, W. (2001). Critical thinking, cognitive presence, and computer conferencing in distance education. American Journal of Distance Education, 15(1), 7-23. doi:10.1080/08923640109527071. http://www.tandfonline.com/doi/abs/10.1080/08923640109527071

Garrison, D. R., & Arbaugh, J. B. (2007). Researching the community of inquiry framework: Review, issues, and future directions. Internet and Higher Education, 10, 157 – 172. doi:10.1016/j.iheduc.2007.04.001. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.462.7106&rep=rep1&type=pdf .

Garrison, D. R., & Kanuka, H. (2004). Blended learning: Uncovering its transformative potential in higher education. Internet and Higher Education, 7, 95-105. doi:10.1016/j.iheduc.2004.02.001. https://www.sciencedirect.com/science/article/pii/S1096751604000156

Granovetter, M. (2005). The impact of social structure on economic outcomes. The Journal of Economic Perspectives, 19(1), 33–50. doi:10.1257/0895330053147958. https://pubs.aeaweb.org/doi/pdf/10.1257/0895330053147958

Hamilton, E., & Feenberg, A. (2005). The technical codes of online education. Techné: Research in Philosohy and Technology, 9(1). https://www.sfu.ca/~andrewf/books/hamilton_feenberg_techne.pdf

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Jimoyiannis, A., Tsiotakis, P., & Roussinos, D. (2012). Blogs in higher education: Analysing students' participation and presence in a community of blogging. Paper presented at the Proceedings of the IADIS International Conference e-Learning 2012.

Jimoyiannis, A., & Tsiotakis, P. (2017). Beyond students’ perceptions: investigating learning presence in an educational blogging community. Journal of Applied Research in Higher Education, 9(1), 129-146. doi:10.1108/JARHE-06-2015-0046. http://www.emeraldinsight.com/doi/abs/10.1108/JARHE-06-2015-0046

Jo, I., Park, Y., & Lee, H. (2017). Three interaction patterns on asynchronous online discussion behaviours: A methodological comparison. Journal of Computer Assisted Learning, 33(2), 106-122. doi:10.1111/jcal.12168

Kitchenham, B. (2004). Procedures for performing systematic reviews.

Keele, UK: Keele University. www.inf.ufsc.br/~aldo.vw/kitchenham.pdf

LAK. (2011). 1st International conference on learning analytics and knowledge. Retrieved from https://tekri.athabascau.ca/analytics/

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Palloff, R., & Pratt, K. (1999). Building learning communities in cyberspace. San Francisco: Jossey-Bass.

Picciano, A.G. (2012). The evolution of big data and learning analytics in American higher education. Journal of Asynchronous Learning Networks, 16(3), 9-20. doi:10.24059/olj.v16i3.267. https://www.researchgate.net/publication/258206917_The_Evolution_of_Big_Data_and_Learning_Analytics_in_American_Higher_Education

Pintritch, P. R. (2000). Multiple goals, multiple pathways: The role of goal orientation in learning and achievement. Journal of Educational Psychology, 92(3), 544-555. doi:10.1037/0022-0663.92.3.544

Prior, D. D., Mazanov, J., Meacheam, D. Heaslip, G. & Hanson, J. (2016). Attitude, digital literacy and self-efficacy: Flow-on effects for online learning behaviour. Internet and Higher Education, 29, 91-97. doi:10.1016/j.iheduc.2016.01.001

Rourke, L., & Kanuka, H. (2009). Learning in communities of inquiry: A review of literature. Journal of Distance Education, 23(1), 19-48. www.ijede.ca/index.php/jde/article/view/474/875

Scott, J. (2000). Social network analysis: a handbook. London: Sage.

Senghore, F., Campos-Nanez, E., Fomin, P., & Wasek, J. S. (2014). Using social network analysis to investigate the potential of innovation networks: Lessons learned from NASA’s international space apps challenge. Procedia Computer Science, 28, 380 – 388. doi:10.1016/j.procs.2014.03.047

Shea, P. & Bidjerano, T. (2010). A re-examination of the community of inquiry framework: Social network and content analysis. Internet and Higher Education, 13, 10–21. doi:10.1016/j.iheduc.2009.11.002

Shea, P., Hayes, S., Smith, S. U., Vickers, J., Bidjerano, T, Pickett, A., …, Jian, S. (2012). Learning presence: Additional research on a new conceptual element within the community of inquiry (CoI) framework. Internet and Higher Education, 15(2), 89-95. doi:10.1016/j.iheduc.2011.08.002

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Shea, P., Hayes, S., Uzuner-Smith, S., Gozza-Cohen, M., Vickers, J., & Bidjerano, T. (2014). Reconceptualizing the community of inquiry framework: An exploratory analysis. Internet and Higher Education, 23, 9-17. doi:10.1016/j.iheduc.2014.05.002

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Literature Reviews

  • What is a literature review?
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  • Choose databases and search
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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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Larayne Dallas : Engineering

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Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

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

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

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

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5 literature review tools to ace your research (+2 bonus tools)

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Table of Contents

Your literature review is the lore behind your research paper . It comes in two forms, systematic and scoping , both serving the purpose of rounding up previously published works in your research area that led you to write and finish your own.

A literature review is vital as it provides the reader with a critical overview of the existing body of knowledge, your methodology, and an opportunity for research applications.

Tips-For-Writing-A-Literature-Review

Some steps to follow while writing your review:

  • Pick an accessible topic for your paper
  • Do thorough research and gather evidence surrounding your topic
  • Read and take notes diligently
  • Create a rough structure for your review
  • Synthesis your notes and write the first draft
  • Edit and proofread your literature review

To make your workload a little lighter, there are many literature review AI tools. These tools can help you find academic articles through AI and answer questions about a research paper.  

Best literature review tools to improve research workflow

A literature review is one of the most critical yet tedious stages in composing a research paper. Many students find it an uphill task since it requires extensive reading and careful organization .

Using some of the best literature review tools listed here, you can make your life easier by overcoming some of the existing challenges in literature reviews. From collecting and classifying to analyzing and publishing research outputs, these tools help you with your literature review and improve your productivity without additional effort or expenses.

1. SciSpace

SciSpace is an AI for academic research that will help find research papers and answer questions about a research paper. You can discover, read, and understand research papers with SciSpace making it an excellent platform for literature review. Featuring a repository with over 270 million research papers, it comes with your AI research assistant called Copilot that offers explanations, summaries , and answers as you read.

Get started now:

literature review online community

Find academic articles through AI

SciSpace has a dedicated literature review tool that finds scientific articles when you search for a question. Based on semantic search, it shows all the research papers relevant for your subject. You can then gather quick insights for all the papers displayed in your search results like methodology, dataset, etc., and figure out all the papers relevant for your research.

Identify relevant articles faster

Abstracts are not always enough to determine whether a paper is relevant to your research question. For starters, you can ask questions to your AI research assistant, SciSpace Copilot to explore the content and better understand the article. Additionally, use the summarize feature to quickly review the methodology and results of a paper and decide if it is worth reading in detail.

Quickly skim through the paper and focus on the most relevant information with summarize and brainstorm questions feature on SciSpace Copilot

Learn in your preferred language

A big barrier non-native English speakers face while conducting a literature review is that a significant portion of scientific literature is published in English. But with SciSpace Copilot, you can review, interact, and learn from research papers in any language you prefer — presently, it supports 75+ languages. The AI will answer questions about a research paper in your mother tongue.

Read and understand scientific literature in over 75 languages with SciSpace Copilot

Integrates with Zotero

Many researchers use Zotero to create a library and manage research papers. SciSpace lets you import your scientific articles directly from Zotero into your SciSpace library and use Copilot to comprehend your research papers. You can also highlight key sections, add notes to the PDF as you read, and even turn helpful explanations and answers from Copilot into notes for future review.

Understand math and complex concepts quickly

Come across complex mathematical equations or difficult concepts? Simply highlight the text or select the formula or table, and Copilot will provide an explanation or breakdown of the same in an easy-to-understand manner. You can ask follow-up questions if you need further clarification.

Understand math and tables in research papers

Discover new papers to read without leaving

Highlight phrases or sentences in your research paper to get suggestions for related papers in the field and save time on literature reviews. You can also use the 'Trace' feature to move across and discover connected papers, authors, topics, and more.

Find related papers quickly

SciSpace Copilot is now available as a Chrome extension , allowing you to access its features directly while you browse scientific literature anywhere across the web.

literature review online community

Get citation-backed answers

When you're conducting a literature review, you want credible information with proper references.  Copilot ensures that every piece of information provided by SciSpace Copilot is backed by a direct reference, boosting transparency, accuracy, and trustworthiness.

Ask a question related to the paper you're delving into. Every response from Copilot comes with a clickable citation. This citation leads you straight to the section of the PDF from which the answer was extracted.

By seamlessly integrating answers with citations, SciSpace Copilot assures you of the authenticity and relevance of the information you receive.

2. Mendeley

Mendeley Citation Manager is a free web and desktop application. It helps simplify your citation management workflow significantly. Here are some ways you can speed up your referencing game with Mendeley.

Generate citations and bibliographies

Easily add references from your Mendeley library to your Word document, change your citation style, and create a bibliography, all without leaving your document.

Retrieve references

It allows you to access your references quickly. Search for a term, and it will return results by referencing the year, author, or source.

Add sources to your Mendeley library by dragging PDF to Mendeley Reference Manager. Mendeley will automatically remove the PDF(s) metadata and create a library entry.‌

Read and annotate documents

It helps you highlight and comment across multiple PDFs while keep them all in one place using Mendeley Notebook . Notebook pages are not tied to a reference and let you quote from many PDFs.

A big part of many literature review workflows, Zotero is a free, open-source tool for managing citations that works as a plug-in on your browser. It helps you gather the information you need, cite your sources, lets you attach PDFs, notes, and images to your citations, and create bibliographies.

Import research articles to your database

Search for research articles on a keyword, and add relevant results to your database. Then, select the articles you are most interested in, and import them into Zotero.

Add bibliography in a variety of formats

With Zotero, you don’t have to scramble for different bibliography formats. Simply use the Zotero-Word plug-in to insert in-text citations and generate a bibliography.

Share your research

You can save a paper and sync it with an online library to easily share your research for group projects. Zotero can be used to create your database and decrease the time you spend formatting citations.

Sysrev is an AI too for article review that facilitates screening, collaboration, and data extraction from academic publications, abstracts, and PDF documents using machine learning. The platform is free and supports public and Open Access projects only.

Some of the features of Sysrev include:

Group labels

Group labels can be a powerful concept for creating database tables from documents. When exported and re-imported, each group label creates a new table. To make labels for a project, go into the manage -> labels section of the project.

Group labels enable project managers to pull table information from documents. It makes it easier to communicate review results for specific articles.

Track reviewer performance

Sysrev's label counting tool provides filtering and visualization options for keeping track of the distribution of labels throughout the project's progress. Project managers can check their projects at any point to track progress and the reviewer's performance.

Tool for concordance

The Sysrev tool for concordance allows project administrators and reviewers to perform analysis on their labels. Concordance is measured by calculating the number of times users agree on the labels they have extracted.

Colandr is a free, open-source, internet-based analysis and screening software used as an AI for academic research. It was designed to ease collaboration across various stages of the systematic review procedure. The tool can be a little complex to use. So, here are the steps involved in working with Colandr.

Create a review

The first step to using Colandr is setting up an organized review project. This is helpful to librarians who are assisting researchers with systematic reviews.

The planning stage is setting the review's objectives along with research queries. Any reviewer can review the details of the planning stage. However, they can only be modified by the author for the review.

Citation screening/import

In this phase, users can upload their results from database searches. Colandr also offers an automated deduplication system.

Full-text screening

The system in Colandr will discover the combination of terms and expressions that are most useful for the reader. If an article is selected, it will be moved to the final step.

Data extraction/export

Colandr data extraction is more efficient than the manual method. It creates the form fields for data extraction during the planning stage of the review procedure. Users can decide to revisit or modify the form for data extraction after completing the initial screening.

Bonus literature review tools

SRDR+ is a web-based tool for extracting and managing systematic review or meta-analysis data. It is open and has a searchable archive of systematic reviews and their data.

7. Plot Digitizer

Plot Digitizer is an efficient tool for extracting information from graphs and images, equipped with many features that facilitate data extraction. The program comes with a free online application, which is adequate to extract data quickly.

Final thoughts

Writing a literature review is not easy. It’s a time-consuming process, which can become tiring at times. The literature review tools mentioned in this blog do an excellent job of maximizing your efforts and helping you write literature reviews much more efficiently. With them, you can breathe a sigh of relief and give more time to your research.

As you dive into your literature review, don’t forget to use SciSpace ResearchGPT to streamline the process. It facilitates your research and helps you explore key findings, summary, and other components of the paper easily.

Frequently Asked Questions (FAQs)

1. what is rrl in research.

RRL stands for Review of Related Literature and sometimes interchanged with ‘Literature Review.’ RRL is a body of studies relevant to the topic being researched. These studies may be in the form of journal articles, books, reports, and other similar documents. Review of related literature is used to support an argument or theory being made by the researcher, as well as to provide information on how others have approached the same topic.

2. What are few softwares and tools available for literature review?

• SciSpace Discover

• Mendeley

• Zotero

• Sysrev

• Colandr

• SRDR+

3. How to generate an online literature review?

The Scispace Discover tool, which offers an excellent repository of millions of peer-reviewed articles and resources, will help you generate or create a literature review easily. You may find relevant information by utilizing the filter option, checking its credibility, tracing related topics and articles, and citing in widely accepted formats with a single click.

4. What does it mean to synthesize literature?

To synthesize literature is to take the main points and ideas from a number of sources and present them in a new way. The goal is to create a new piece of writing that pulls together the most important elements of all the sources you read. Make recommendations based on them, and connect them to the research.

5. Should we write abstract for literature review?

Abstracts, particularly for the literature review section, are not required. However, an abstract for the research paper, on the whole, is useful for summarizing the paper and letting readers know what to expect from it. It can also be used to summarize the main points of the paper so that readers have a better understanding of the paper's content before they read it.

6. How do you evaluate the quality of a literature review?

• Whether it is clear and well-written.

• Whether Information is current and up to date.

• Does it cover all of the relevant sources on the topic.

• Does it provide enough evidence to support its conclusions.

7. Is literature review mandatory?

Yes. Literature review is a mandatory part of any research project. It is a critical step in the process that allows you to establish the scope of your research and provide a background for the rest of your work.

8. What are the sources for a literature review?

• Reports

• Theses

• Conference proceedings

• Company reports

• Some government publications

• Journals

• Books

• Newspapers

• Articles by professional associations

• Indexes

• Databases

• Catalogues

• Encyclopaedias

• Dictionaries

• Bibliographies

• Citation indexes

• Statistical data from government websites

9. What is the difference between a systematic review and a literature review?

A systematic review is a form of research that uses a rigorous method to generate knowledge from both published and unpublished data. A literature review, on the other hand, is a critical summary of an area of research within the context of what has already been published.

literature review online community

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MAXQDA is the best choice for a comprehensive literature review. It works with a wide range of data types and offers powerful tools for literature review, such as reference management, qualitative, vocabulary, text analysis tools, and more.

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Literature Review Software MAXQDA Interface

As your all-in-one literature review software, MAXQDA can be used to manage your entire research project. Easily import data from texts, interviews, focus groups, PDFs, web pages, spreadsheets, articles, e-books, and even social media data. Connect the reference management system of your choice with MAXQDA to easily import bibliographic data. Organize your data in groups, link relevant quotes to each other, keep track of your literature summaries, and share and compare work with your team members. Your project file stays flexible and you can expand and refine your category system as you go to suit your research.

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Having used several qualitative data analysis software programs, there is no doubt in my mind that MAXQDA has advantages over all the others. In addition to its remarkable analytical features for harnessing data, MAXQDA’s stellar customer service, online tutorials, and global learning community make it a user friendly and top-notch product.

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All-in-one Literature Review Software MAXQDA: Import of documents

Easily import your literature review data

With a literature review software like MAXQDA, you can easily import bibliographic data from reference management programs for your literature review. MAXQDA can work with all reference management programs that can export their databases in RIS-format which is a standard format for bibliographic information. Like MAXQDA, these reference managers use project files, containing all collected bibliographic information, such as author, title, links to websites, keywords, abstracts, and other information. In addition, you can easily import the corresponding full texts. Upon import, all documents will be automatically pre-coded to facilitate your literature review at a later stage.

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Great ideas will often occur to you while you’re doing your literature review. Using MAXQDA as your literature review software, you can create memos to store your ideas, such as research questions and objectives, or you can use memos for paraphrasing passages into your own words. By attaching memos like post-it notes to text passages, texts, document groups, images, audio/video clips, and of course codes, you can easily retrieve them at a later stage. Particularly useful for literature reviews are free memos written during the course of work from which passages can be copied and inserted into the final text.

Using Literature Review Software MAXQDA to Organize Your Qualitative Data: Memo Tools

Find concepts important to your generated literature review

When generating a literature review you might need to analyze a large amount of text. Luckily MAXQDA as the #1 literature review software offers Text Search tools that allow you to explore your documents without reading or coding them first. Automatically search for keywords (or dictionaries of keywords), such as important concepts for your literature review, and automatically code them with just a few clicks. Document variables that were automatically created during the import of your bibliographic information can be used for searching and retrieving certain text segments. MAXQDA’s powerful Coding Query allows you to analyze the combination of activated codes in different ways.

Aggregate your literature review

When conducting a literature review you can easily get lost. But with MAXQDA as your literature review software, you will never lose track of the bigger picture. Among other tools, MAXQDA’s overview and summary tables are especially useful for aggregating your literature review results. MAXQDA offers overview tables for almost everything, codes, memos, coded segments, links, and so on. With MAXQDA literature review tools you can create compressed summaries of sources that can be effectively compared and represented, and with just one click you can easily export your overview and summary tables and integrate them into your literature review report.

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Powerful and easy-to-use literature review tools

Quantitative aspects can also be relevant when conducting a literature review analysis. Using MAXQDA as your literature review software enables you to employ a vast range of procedures for the quantitative evaluation of your material. You can sort sources according to document variables, compare amounts with frequency tables and charts, and much more. Make sure you don’t miss the word frequency tools of MAXQDA’s add-on module for quantitative content analysis. Included are tools for visual text exploration, content analysis, vocabulary analysis, dictionary-based analysis, and more that facilitate the quantitative analysis of terms and their semantic contexts.

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As an all-in-one literature review software, MAXQDA offers a variety of visual tools that are tailor-made for qualitative research and literature reviews. Create stunning visualizations to analyze your material. Of course, you can export your visualizations in various formats to enrich your literature review analysis report. Work with word clouds to explore the central themes of a text and key terms that are used, create charts to easily compare the occurrences of concepts and important keywords, or make use of the graphical representation possibilities of MAXMaps, which in particular permit the creation of concept maps. Thanks to the interactive connection between your visualizations with your MAXQDA data, you’ll never lose sight of the big picture.

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AI Assist – your virtual research assistant – supports your literature review with various tools. AI Assist simplifies your work by automatically analyzing and summarizing elements of your research project and by generating suggestions for subcodes. No matter which AI tool you use – you can customize your results to suit your needs.

Free tutorials and guides on literature review

MAXQDA offers a variety of free learning resources for literature review, making it easy for both beginners and advanced users to learn how to use the software. From free video tutorials and webinars to step-by-step guides and sample projects, these resources provide a wealth of information to help you understand the features and functionality of MAXQDA for literature review. For beginners, the software’s user-friendly interface and comprehensive help center make it easy to get started with your data analysis, while advanced users will appreciate the detailed guides and tutorials that cover more complex features and techniques. Whether you’re just starting out or are an experienced researcher, MAXQDA’s free learning resources will help you get the most out of your literature review.

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Get your maxqda license, compare the features of maxqda and maxqda analytics pro, faq: literature review software.

Literature review software is a tool designed to help researchers efficiently manage and analyze the existing body of literature relevant to their research topic. MAXQDA, a versatile qualitative data analysis tool, can be instrumental in this process.

Literature review software, like MAXQDA, typically includes features such as data import and organization, coding and categorization, advanced search capabilities, data visualization tools, and collaboration features. These features facilitate the systematic review and analysis of relevant literature.

Literature review software, including MAXQDA, can assist in qualitative data interpretation by enabling researchers to organize, code, and categorize relevant literature. This organized data can then be analyzed to identify trends, patterns, and themes, helping researchers draw meaningful insights from the literature they’ve reviewed.

Yes, literature review software like MAXQDA is suitable for researchers of all levels of experience. It offers user-friendly interfaces and extensive support resources, making it accessible to beginners while providing advanced features that cater to the needs of experienced researchers.

Getting started with literature review software, such as MAXQDA, typically involves downloading and installing the software, importing your relevant literature, and exploring the available features. Many software providers offer tutorials and documentation to help users get started quickly.

For students, MAXQDA can be an excellent literature review software choice. Its user-friendly interface, comprehensive feature set, and educational discounts make it a valuable tool for students conducting literature reviews as part of their academic research.

MAXQDA is available for both Windows and Mac users, making it a suitable choice for Mac users looking for literature review software. It offers a consistent and feature-rich experience on Mac operating systems.

When it comes to literature review software, MAXQDA is widely regarded as one of the best choices. Its robust feature set, user-friendly interface, and versatility make it a top pick for researchers conducting literature reviews.

Yes, literature reviews can be conducted without software. However, using literature review software like MAXQDA can significantly streamline and enhance the process by providing tools for efficient data management, analysis, and visualization.

literature review online community

Prevention & Community Health: Literature Review

  • Find Articles
  • Maternal & Child Health
  • Literature Review
  • Test/Survey/Measurement Tools
  • Peer-Reviewed Tips
  • Types of Studies
  • Systematic Review

Good Place to Start: Citation Databases

Interdisciplinary Citation Databases:

A good place to start your research  is to search a research citation database to view the scope of literature available on your topic.

TIP #1: SEED ARTICLE Begin your research with a "seed article" - an article that strongly supports your research topic.  Then use a citation database to follow the studies published by finding articles which have cited that article, either because they support it or because they disagree with it.

TIP #2: SNOWBALLING Snowballing is the process where researchers will begin with a select number of articles they have identified relevant/strongly supports their topic and then search each articles' references reviewing the studies cited to determine if they are relevant to your research.

BONUS POINTS: This process also helps identify key highly cited authors within a topic to help establish the "experts" in the field.

Begin by constructing a focused research question to help you then convert it into an effective search strategy.

  • Identify keywords or synonyms
  • Type of study/resources
  • Which database(s) to search
  • Asking a Good Question (PICO)
  • PICO - AHRQ
  • PICO - Worksheet
  • What Is a PICOT Question?

Web Resources

What is a literature review?

A literature review is a comprehensive and up-to-date overview of published information on a subject area. Conducting a literature review demands a careful examination of a body of literature that has been published that helps answer your research question (See PICO). Literature reviewed includes scholarly journals, scholarly books, authoritative databases, primary sources and grey literature.

A literature review attempts to answer the following:

  • What is known about the subject?
  • What is the chronology of knowledge about my subject?
  • Are there any gaps in the literature?
  • Is there a consensus/debate on issues?
  • Create a clear research question/statement
  • Define the scope of the review include limitations (i.e. gender, age, location, nationality...)
  • Search existing literature including classic works on your topic and grey literature
  • Evaluate results and the evidence (Avoid discounting information that contradicts your research)
  • Track and organize references
  • How to conduct an effective literature search.
  • Social Work Literature Review Guidelines (OWL Purdue Online Writing Lab)

What is PICO?

The PICO model can help you formulate a good clinical question. Sometimes it's referred to as PICO-T, containing an optional 5th factor. 

Seminal Works: Search Key Indexing/Citation Databases

  • Google Scholar
  • Web of Science

TIP – How to Locate Seminal Works

  • DO NOT: Limit by date range or you might overlook the seminal works
  • DO: Look at highly cited references (Seminal articles are frequently referred to “cited” in the research)
  • DO: Search citation databases like Scopus, Web of Science and Google Scholar

Search Example

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Form and Structure of the Literature

Use of Online Communities among People with Type 2 Diabetes: A Scoping Review

  • Open access
  • Published: 08 March 2024

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  • Arantxa Bujanda-Sainz de Murieta   ORCID: orcid.org/0000-0002-4645-5751 1 , 2 ,
  • Nelia Soto-Ruiz   ORCID: orcid.org/0000-0002-5161-2272 1 , 2 ,
  • Cristina García-Vivar   ORCID: orcid.org/0000-0002-6022-559X 1 , 2 ,
  • Leticia San Martín-Rodríguez   ORCID: orcid.org/0000-0002-9097-7493 1 , 2 &
  • Paula Escalada-Hernández   ORCID: orcid.org/0000-0003-2263-156X 1 , 2  

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Purpose of Review

People with diabetes require continuous self-monitoring and face numerous decisions in their day-to-day lives. Therefore, on many occasions, they need more support than that provided by health professionals. In this context, peer support in online diabetes communities could be a useful tool. The purpose of the review is to describe, analyze and synthesize the available evidence on the use and health out-comes of online communities for people with type 2 diabetes mellitus. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were performed PubMed, Web of Science, CINHAL, Scopus and Cochrane databases.

Recent Findings

From 1821 identified documents, 6 articles were included. These studies explored the characteristics of diabetes online communities and the population features. Besides, the results were classified according to whether they were clinical, psychosocial, or addressed people's experiences with the online community. The analysis underscores their value in facilitating communication, improving diabetes management, and enhancing psychosocial well-being. Future investigations should prioritize longitudinal assessments to elucidate the sustained impact of community engagement and optimize user participation for enhanced patient outcomes.

The growing relevance of new technologies has led to a significant number of individuals with chronic illnesses seeking peer support. Online health communities have emerged as virtual spaces where individuals with shared health interests interact and form relationships. Within these digital spaces, individuals can engage in peer interaction, observe behaviors, and mutually benefit, potentially leading to improved attitudes toward the disease.

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Introduction

Diabetes mellitus (DM) is considered a public health problem of the twenty-first century due to its high incidence and prevalence worldwide, which continues to increase. In 2021, 537 million people had diabetes and it is estimated to reach 643 million people by 2030 [ 1 ]. The management of this disease is not straightforward due to the different factors that influence its control. Adherence to drug treatment, dietary control, regular physical exercise, lifestyle changes and continuous glucose measurements, inter alia, are necessary to maintain glucose levels in the appropriate range [ 2 •].

Although people with diabetes have to make many decisions about their disease throughout their lives, they spend no more than 1% of their time in contact with healthcare professionals. Therefore, the self-management of their diabetes is carried out outside the healthcare environment and it is the patients themselves who have to assume control and management of their own treatment [ 3 ]. In this sense, both diabetes education and the support provided to them are essential [ 4 ]. For this reason, it seems necessary for people with DM to have continuous support beyond the usual check-ups with healthcare professionals.

In this way, peer support can be a promising tool. Peer support is defined as “the giving of assistance and encouragement by an individual considered equal” [ 5 ]. People with chronic illnesses often feel more comfortable sharing their experiences and challenges with others with whom they can talk based on their own reality [ 6 ]. In addition, sharing experiences can enhance understanding and support learning [ 7 ].

In this effort to connect patients with each other, the use of new technologies is becoming increasingly relevant. In fact, according to the Pew Research Center [ 8 ], one in four Internet users living with a chronic illness seeks out other people with a similar health condition online. Peer support by using digital tools allows knowledge to be expanded beyond the network of contacts, increasing the possibility of satisfying the needs of the participants [ 7 ].

As part of this trend, online health communities have emerged as virtual spaces where a group of people who share a common interest related to health form relationships and interact online [ 9 , 10 ]. These communities allow users to interact with their peers, observing each other´s behavior and seeking mutual benefit. They also have the potential to improve patients´ attitudes towards their disease, since they could be used as a forum to educate [ 11 ].

In the specific field of ​​diabetes, online activity has also grown exponentially. Diabetes discussions began in the 1980s by telephone helpline services, and later, web-based discussion forums and social networks gained prominence. The term “diabetes online communities” (DOC) was first used in 2005 on the blog Six Until Me to refer to online forums and content for people with diabetes and their families [ 6 ]. Currently, a DOC is an online community developed to share knowledge and provide support based on the user experience of living with diabetes. It is a tool for people to learn self-care practices from peers, discuss diabetes issues, and connect with others in a similar situation. These communities facilitate open communication and help patients take an active role in their health. In this way, they can be a source of confidence, inspiration, motivation and encouragement [ 12 , 13 ] ​​. Communities are hosted on “social media platforms”, which are defined as any Internet-based system for the creation, exchange, or distribution of any user-generated content for information, advertising, or any other purpose [ 14 ].

Although efforts in the use of technologies have been directed more to people with type 1 diabetes mellitus, possibly due to the characteristics of the population, there are increasingly more patients with type 2 diabetes (T2D) using these tools, so it seems interesting to be able to analyze the existing knowledge to date.

The aim of this study is to describe, analyze and synthesize the available evidence on the use and clinical and psychosocial results of online communities for people with type 2 diabetes mellitus.

Material and Method

A scoping review was performed, as it was considered the most appropriate methodology to fulfill the purpose of this study. Scoping reviews reach broad objectives and identify areas for further synthesis of results and map the evidence in a currently understudied area. Consequently, it is the ideal format to deepen the use of online communities among people with T2D [ 15 , 16 ].

The scoping review was established according to the guidelines of the Joanna Briggs Institute [ 16 ]. As proposed by Arksey & O'Malley [ 17 ], will consist of 5 phases. The results are presented according to the PRISMA- ScR (Preferred reporting items for Systematic reviews and Meta- Analyses extension for Scoping Reviews) [ 18 ].

Phase I: Development of the Research Question

Considering the objective of this review, the research questions are two:

What are the characteristics of online communities of people with type 2 diabetes?

What is the evidence for the use of online communities for people with type 2 diabetes?

These questions correspond to PCC-type, a framework that is considered appropriate when developing research questions in scoping reviews [ 16 ]. The acronym corresponds to the initials: (P) for Population, (C) for Concept and (C) for Context. The population in this case are people diagnosed with T2D with any type of treatment. And the concept corresponds to online communities. The context is not explicitly stated, as any setting would be eligible [ 19 ].

Phase II: Determination of Inclusion and Exclusion Criteria and Systematic Search

Regarding the inclusion criteria, we included studies that analyzed the use of online diabetes communities in which communication groups could be created (social networks, blogs, online communities, forums…), which had evaluated effects or changes at a clinical or psychosocial level in patients regarding peer support and whose population were people with T2D. The search filtered those articles published from 2012 to February 7, 2024.

Furthermore, we excluded literature reviews, interventions that did not have a digital component, and studies in which the intervention did not have a peer-to-peer interaction, as they did not match our initial definition of online diabetes communities. Studies that did not evaluate results derived from the interaction between peers (evaluation of educational programs, assessment of medical records by health professionals…) were also excluded.

Search Strategy

Finally, regarding the search strategy, we used Pubmed, Web of Science, CINHAL, Scopus and Cochrane databases with the following keywords: diabetes mellitus type 2, diabetes type 2, type 2 diabetes, social media, social networking, online social network, patient portal, social medium, web 2.0, patient web portal, patient internet portal, online community, online peer support community, forum, blog, online. The search was limited to those articles that contained the aforementioned terms in their title or abstract. They were combined using the Boolean operators “AND” and “OR”. Annex 1 shows the search strategy in detail. The Zotero application v.6.0.19 (Zotero.org) was used to manage the references.

Phase III: Review and Selection of Studies

Two reviewers participated in the study selection process. Discrepancies were resolved by consensus or by the intervention of a third reviewer.

Firstly, duplicate studies were identified and removed. Next, the titles and abstracts of the articles were reviewed, and a second elimination round was performed using the inclusion and exclusion criteria discussed above. Finally, the full texts of the studies were retrieved and the selection was made applying the aforementioned criteria. For those articles included in the analysis, a search of the reference lists was performed to detect relevant studies that were not captured in the first database search. A flow chart detailing the reasons for exclusion of the articles selected for full-text reading is included in Fig.  1 [ 18 ].

figure 1

PRISMA 2020 flowchart. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71

Phase IV. Data Extraction

In the data extraction process, a specific table was created according to the needs of the review: name of the first author, year and country of publication, objective, design, sample and inclusion/exclusion criteria, intervention and duration. In addition, the main results were analyzed.

Phase V. Analysis and Reporting of Results

The aim of the scoping review was to present an overview of the selected studies. For this purpose, a narrative account was conducted. A scoping study does not seek to assess the quality of the evidence and, therefore, cannot determine whether particular studies provide robust or generalizable findings [ 17 ].

A description of the general characteristics of the studies included in the review was made, followed by a synthesis of the main characteristics of the online diabetes communities and the results reached in these investigations.

Five databases were used in the search, through which 1821 results were obtained. Once duplicate articles were removed, 964 studies were screened for relevancy. After reading the title and abstract, 157 were read completely. Of these articles, 151 were excluded for the following reasons: 54 of them were educational programs without peer interaction, 50 dealt with the importance of social support from friends and family and not between patients, 9 had no digital component, 19 evaluated a patient portal where they uploaded their medical records and communicated with healthcare professionals, 14 articles did not yield clinical or psychological outcomes and 5 were removed for other reasons (they did not talk about T2D, were communications of already selected articles, etc.) (Fig.  1 ). The remaining 6 studies were considered eligible for this review. The main characteristics of the studies are shown in Table  1 [ 20 ].

The results of the analysis of the studies are presented below, structured into the following sections: characteristics of the DOC, clinical outcomes, psychosocial outcomes and experiences of people with diabetes in using online communities.

Regarding the country of the studies, 50% ( n  = 3) came from the United States, and the remaining three studies were from South Korea, India and Spain.

Characteristics of Online Diabetes Communities

In this section we will explain the general aspects of the online communities analyzed, how they are dynamized and which members are in charge of moderating them and, finally, how people with T2D evaluate them.

General Features

Online diabetes communities can be set up on specific platforms or use available social networks. Related to this issue, both studies by Litchman et al. [ 25 •, 26 ] and Herrero et al. [ 21 •] used a diabetes-specific online community created on a web domain, while the other authors studied communities created on broader social networks such as Facebook [ 21 •, 24 ]; Never Cafe [ 23 •] or Second Life [ 22 ]. All of them still active.

Once we analyzed in more detail the characteristics of online communities, we found that the studies led by Litchman [ 25 •, 26 ] used Beyond Type 2 [ https://community.beyondtype2.org/ ), an online community created in 2009 by the non-profit organization Beyond Type 1. This community requires pre-registration for people with T2D to share their stories, connect with each other, and find resources on topics ranging from daily management to mental health management. The community has a group exclusively for Spanish-speaking people, tailored to the culture, customs and traditions. In addition, an email with new posts or news is sent monthly.

Nevertheless, in two of the articles, specific Facebook groups previously created are used [ 21 •, 24 ]. As it is widely known, Facebook is a social network that requires the creation of a user to access. Facebook groups, which can be public or private, are small groups that allow quick and easy organization of people with similar interests or characteristics, who can share messages, images, and material on the group's wall. Both “Diabetes support” ( https://www.facebook.com/groups/MyDiabetes/about ) and “Diabetes contact group” ( https://www.facebook.com/groups/1169185889761308 ) were created in 2016, to provide support and information about diabetes in addition to connecting people living with diabetes or their family and friends. The LCHF group ( https://www.facebook.com/groups/LCHF4LIFE ) originated in 2014 and focuses on learning and discussing the low-carbohydrate diet [ 24 ]. All of them are still active.

Never Café ( https://cafe.naver.com/ ) is one of the most popular social networks in South Korea, very similar to the previous one. On this platform, the authors developed the community “Diabetes, my companion” with four main activities: diabetes information, action planning in everyday life, patients´ chat room and questions and answers [ 23 •].

Johnson et al. [ 22 ] created SLIDES (Second Life Impacts Diabetes Education & Self-Management), an ad-hoc community within Second Life social network ( https://secondlife.com/ ), a virtual world founded in 2003, in which, unlike the previous ones, you can interact with other people through a personalized avatar and exchange virtual products. The SLIDES community provided self-care education and support based on social cognitive theory according to the user´s characteristics. It contained different resources such as a bookstore with links to buy books and links to web pages. In addition, there were restaurants with nutritional information, a gym with exercise videos, and a community center with a classroom, a slide projector, and a forum that allowed participants to share information and personal experiences. Training classes on diabetes were also offered in this virtual center.

The description of the online communities used by the selected studies is summarized in Table  2 .

Dynamization of Online Diabetes Communities

In online communities, patients support each other. However, sometimes a figure to moderate the group is necessary. The details of the dynamization are shown in Table  3 .

Use of Online Communities by People with T2D

Regarding the use of online communities, three of them reported different metrics to measure the degree of use [ 22 , 23 •, 25 •]. Johnson et al. [ 22 ] tracked engagement rates and use. Participants logged in to the community an average of 38 times, with an average of 43 min per session, during the 6 months they participated in the study. 75% of logins occurred within the first three months and the majority within the first month. 75% of items such as food, books, menus, web pages, videos, and pharmacy items were "handled" by 19 of the participants while in the community. Participants interacted with these items a total of 1,180 times.

In order to assess participation, Kim et al. [ 23 •] used the summary statistical report of the platform Never Café. The average number of monthly visits of each person to the platform was 8.53. Eighty-four of participants revisited the site within 12 months. And within the different sections of the website, 69.7% returned to search for information on diabetes, 67% to action planning, 45% to the questions and answers section, and 73.3% to the chat. In addition, all verbal and text communications were continuously recorded for the duration of the study. Regarding communication, the members used their voice most of the time when they were with other people and spent most of the time in the classroom (48.6%) where classes were held twice a week.

Litchman, Ng, et al. [ 25 •] analyzed the engagement rate, defined as 3 or more daily messages per participant. The highest rate was 61.5%, with 13 active participants in the forum. They also received a daily e-mail with a summary of new messages, but it was not possible to check their reading.

In both Litchman studies [ 25 •, 26 ], although they were encouraged to participate 3 times a week, they did not specify if they complied or not. Herrero et al. [ 21 •] only asked if they were members or not and since when, and did not measure the degree of participation. Verma et al. [ 24 ] indicated that they interviewed people who were actively involved in the DOC, but did not define what active participation was indeed.

Evidence in the Use of Online Diabetes Communities

The following sections describe the main clinical and psychosocial results addressed in the selected studies about online diabetes communities.

Clinical Results

In the studies analyzed, different clinical data were collected from patients, both directly related to diabetes and to general health condition, to assess the influence of the use of online communities on them (Table  4 ).

In order to analyze the improvement in glycemic control, changes in glycosylated hemoglobin (HbA1c), fasting blood glucose, and time in range were measured. Johnson et al. [ 22 ] observed a decrease in HbA1c of 0.59%, although it was not significant, while in the study by Kim et al. [ 23 •] the intervention group presented a significantly lower level than the control group, for non-insulin users, at 3 (6.38; SD (Standard Deviation) = 0.34 vs. 7.25; SD = 0.24, p  = 0.040) and 6 months (6.31; SD = 0.37 vs. 7.28; SD = 0.26, p  = 0.036). With the same objective, they recorded fasting blood glucose, in which there were significant improvements in insulin-dependent people who participated in the intervention group at 6 months (135.80; SD = 12.37 vs. 175.82; SD = 15.34, p  = 0.049). Also Litchman, Ng, et al. [ 25 •] demonstrated that nine participants (37.5%) had a decrease of more than 0.5% HbA1c at 12 weeks, five (20.8%) had an increase of more than 0.5%, and 10 (41, 6%) had no significant changes. They used the time in range (between 70 and 180 mg/dl) in the same way, in which there were no statistically significant improvements either. However, there was an increase in glycemic variability (Z =  − 2.172, p  = 0.03).

Kim et al. [ 23 •] found significant differences in the reduction of triglycerides (206.85, SD = 38.26 vs. 387.50, SD = 56.19, p  = 0.013). However, there were no differences in the other measured outcomes such as blood pressure, weight, Body Mass Index or total cholesterol.

Nevertheless, Herrero et al. [ 21 •] reported a greater number of complications derived from diabetes in people who used the DOC. There were differences between groups M = 1.95, SD = 1.28, for people with T2D not belonging to DOC and M = 4.77, SD = 0.72, for DOC users.

Psychosocial outcomes

Psychosocial data related to participants´ perceptions such as self-efficacy, self-care, social support, perceived presence and co-presence, quality of life, and knowledge about diabetes were collected in all studies (Table  5 ).

Regarding self-efficacy, Johnson et al. [ 22 ] used the Diabetes Empowerment Scale -Short Form (DES-SF). In a range from 1 to 5, at baseline of the study it was 3.89 points on average (SD = 0.81); however, it improved at 3 months (4.45, SD = 0.67, p  = 0.036) and at 6 months (4.64, SD = 0.39, p  = 0.02). While Litchman, Ng, et al. [ 25 •] used the Self-efficacy Scale, whose score significantly improved after 12 weeks of community participation (68.6, SD = 18.3 vs. 82.7, SD = 14.5; p  < 0.01).

Self-care was evaluated in three studies. Herrero et al. [ 21 •] were based on the DSMQ (Diabetes Self -Management Questionnaire) by four subscales: glucose control, dietary control, physical activity, and use of the healthcare system; as well as a global score of all of them. People with T2D not belonging to online communities (32% of the sample) had a significantly higher score for diabetes self-management in all subscales: glucose control (4.34 vs. 2.51; p  = 0.000), diet control (4.03 vs. 2.17; p  = 0.000), healthcare (4.35 vs. 2.58; p  = 0.000), physical activity (3.91 vs. 1.89; p  = 0.000), diabetes care (4.05 vs. 2.90; p  = 0.000); being 0 the minimum score and 10 being the maximum score. Both Johnson et al. [ 22 ] and Kim et al. [ 23 •] assessed self-care using the Diabetes Self-Care Activities Scale (SDSCA), made up of 17 items that measure the number of days per week on which the indicated behavior is performed. It presents six subscales on a scale from 0 to 7: general diet, specific diet, physical activity and exercise, blood sugar testing, foot care, and medication. In the first of them, participants only showed a statistically significant improvement in the number of days per week spent to foot care. At baseline 3.68 days on average (SD = 2.08) and at 6 months 6.17 days (SD = 2.08) ( p  = 0.03). In contrast, in the study by Kim [ 23 •] the only significant difference was in the improvement in medication behavior for insulin users in the intervention group at 3 and 6 months. (6.79, SD = 0.34 vs. 5.03, SD = 0.49, p  = 0.004; 6.37, SD = 0.52 vs. 4.68, SD = 0.65, p  = 0.047; respectively) [ 23 •].

The aim of this study was to describe, analyze and synthesize the available evidence on the use and health outcomes of online communities for people with T2D. A scoping review was performed to this end, in which six primary studies were identified that addressed the evidence on the use of online communities and its influence on health outcomes for people with T2D between 2012 and 2023. These findings showed a paucity of research regarding these types of resources and interventions in T2D.

In recent years, there has been a growing interest in this type of intervention, specifically for people with diabetes. Thus, our review complements the synthesis of evidence already offered by previous reviews in this area. The systematic review by Elnaggar et al. [ 27 ] seeks to describe the use of peer-to-peer social networks to manage diabetes and cardiovascular disease, in addition to evaluating clinical outcomes, behavioral outcomes, quality of life, and patient self-efficacy as a result of the use of peer-to-peer social networks until 2019. However, they do not analyze any intervention specifically in T2D, as is the focus of the present review. Litchman, Walker et al. [ 3 ] performed a scoping review focusing on variations in study design, platform and user characteristics of DOC, and potential or actual benefits and consequences. The search was carried out until 2018, while the communities have been growing rapidly and steadily. In order to update their previous research, they used a rapid review in 2021 [ 28 •]. Although they aim to highlight the clinical impact of participation in DOCs and provide guidance to healthcare professionals in navigating and recommending these communities, they only analyze one of the selected studies in this review, as four of them are conducted after 2021 and do not study the interventions of Johnson et al. [ 22 ] and Verma et al. [ 24 ].

In this study, the concept of online communities was understood as virtual places where peer support is given. Therefore, other types of communities that were based on communication with health professionals or those focused exclusively on diabetes education were not taken into account.

Lewinski et al. [ 29 ], in their integrative review, concluded that an ideal community includes a large and diverse sample, a moderator that promotes interaction, synchronous and asynchronous communication, self-management information, and a dynamic learning environment. Despite the fact that the evaluated communities were heterogeneous, they meet these characteristics, except for the role of moderator which does not appear in the study by Verma et al. [ 24 ] nor in the study by Herrero et al. [ 21 •]. On the contrary, all communities were included in broader social networks or platforms with an established structure.

Regarding the recruitment of people who participated in the studies, a convenience sampling was carried out in all of them, so it is important to take this limitation into account. The average age of the samples, which varies from 49 to 55 years, coincides with the profile of people with T2D, since the highest prevalence occurs for people between 50 and 59 years [ 1 ]. However, the range age of the people who participated in the studies is very wide (from 19 to 81 years) and the results divided into age intervals are not specified. This aspect could be relevant to the results, since older people have to make a greater effort to adapt to the use of information and communication technologies, which have considerably increased since the year 2000 [ 30 ]. Although social networks are becoming increasingly important in mitigating loneliness for elderly people, further research is needed to adapt existing technology and incorporate emerging technology into care therapies. In fact, these tools could transform the way people with diabetes are supported to improve their self-management [ 31 ].

This review analyzes clinical results, psychosocial outcomes and/or experiences with online diabetes communities (use, satisfaction, difficulties…). Regarding the clinical repercussion, it has been verified that people with diabetes have from 2 to 4 times increased risk of stroke and death from heart disease [ 32 ]. Elevated HbA1c level has been identified as a significant risk factor for cardiovascular disease and stroke. In fact, a 1% increase in HbA1c concentration was associated with an increase in mortality of about 30–40%. Whereas reducing the HbA1c level by 0.2% could reduce mortality by 10% [ 33 ]. In the analyzed studies that evaluated HbA1c, an improvement greater than 0.5% was observed [ 2 •, 22 , 26 ]. However, the improvement is only significant in the study by Kim [ 34 ], possibly due to the sample size. It is also noteworthy that, in a 12-week intervention, such as that of Litchman, Ng, et al. [ 25 •], it is not easy to see changes in glycosylated hemoglobin, which measures the average level of glucose over three months. Similarly, in the study by Kim et al. [ 23 •], there is a significant drop in triglyceride levels, also associated with cardiovascular risk. These clinical findings correspond with the results of other online communities for people with type 1 diabetes mellitus, where they demonstrate improvements in HbA1c [ 35 , 36 , 37 ] and cholesterol levels [ 38 ].

In the same way, psychosocial improvements in a chronic disease such as diabetes are of the utmost importance. Although the concepts of self-care and self-management have different nuances, in the analyzed articles they are used interchangeably [ 39 ]. In the studies by Johnson et al. [ 22 ] and Kim et al. [ 23 •] they used the SDSCA scale, indicating significant improvements in the subscales of foot care and medication taking, respectively. However, in the intervention by Herrero et al. [ 21 •] the level of self-care, measured by the DSMQ questionnaire, was lower in those people who used the DOCs.

Regarding self-efficacy, understood as an individual's confidence in their ability to carry out specific self-management behaviors, it significantly increased in all the studies in which it was evaluated. Johnson et al. [ 22 ] used the DES-SF questionnaire, while Litchman, Ng, et al. [ 25 •] do not specify the scale. According to Bandura's self-efficacy theory [ 40 ], people who are confident in their abilities are more consistent in maintaining their daily tasks. Similarly, Karimy et al. [ 41 ] indicated that self-efficacy is the most important predictor of self-care behaviors in patients with diabetes. Social support also facilitates healthy behaviors and has a direct connection to self-care behaviors of people with diabetes [ 42 ]. However, further research is needed to recognize whether these results are a cause or a consequence of participation in DOC. These results are consistent with other support groups in other diseases, such as cancer or mental health, where positive but inconclusive results are shown for the time being [ 43 , 44 , 45 ].

Other reviews carried out on online communities in people with T2D, discussed above, also conclude that results are positive and negative consequences are few, but further research should be carried out on the subject, since its use is incipient [ 3 , 29 , 30 ].

Furthermore, although the aim of this review is not to perform a quality analysis, the results should be interpreted with caution, since there are certain limitations in the analyzed studies, such as the participants recruitment, the sample size or the use of self-reported scales.

The present study is not without limitations. One of them is the heterogeneity in the diabetes online communities, making it difficult to draw conclusive conclusions. In addition, the review is limited to scientific articles, being aware that there will be many online communities in which results can be reported by surveys, but no evidence is recorded. Due to the different perceptions about what an online community is, it could be that we have missed some specific virtual place where support is given among patients.

Conclusions

The analysis of online communities for individuals with type 2 diabetes mellitus (T2D) reveals a variety of features and outcomes across the studies reviewed. Despite the diversity, these communities consistently offer a valuable space for synchronous and asynchronous communication among patients, contributing to improved diabetes management and psychosocial well-being.

Psychosocial outcomes also demonstrated the beneficial impact of online communities on participants' self-efficacy, self-care behaviors, and social support networks. Moreover, the sense of community and support provided by peers and moderators contributed to enhanced well-being and quality of life for participants. Engagement metrics indicated active participation among users, with frequent logins and interactions observed in various online communities. However, improvements in glycemic control were not consistently significant across all studies.

While the findings are promising, it is essential to acknowledge the limitations of the existing research, including small sample sizes and methodological variations. Therefore, future studies should aim to address these limitations and conduct more comprehensive assessments of the effectiveness of online peer support interventions for individuals with T2D. Additionally, exploring the long-term effects of community engagement and identifying strategies to optimize user participation are crucial areas for further investigation.

Given the prevalence of T2D and the proliferation of technology and its influence on social interaction, further investigation into online peer support interventions targeting people with this disease is needed.

Future research should focus on analyzing patient outcomes based on participation in online communities and conduct correlational studies based on this.

Papers of particular interest, published recently, have been highlighted as: • Of importance

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A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia

  • Bianca E. Kavanagh   ORCID: orcid.org/0000-0002-1656-2775 1 ,
  • Kayla B. Corney 2 ,
  • Hannah Beks   ORCID: orcid.org/0000-0002-2851-6450 1 ,
  • Lana J. Williams   ORCID: orcid.org/0000-0002-1377-1272 2 ,
  • Shae E. Quirk 2 , 3 , 4 &
  • Vincent L. Versace   ORCID: orcid.org/0000-0002-8514-1763 1  

BMC Health Services Research volume  23 , Article number:  1060 ( 2023 ) Cite this article

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Inadequate healthcare access and utilisation are implicated in the mental health burden experienced by those living in regional, rural, and remote Australia. Facilitators that better enable access and utilisation are also reported in the literature. To date, a synthesis on both the barriers and facilitators to accessing and utilising mental health services within the rural Australian context has not been undertaken. This scoping review aims to (1) synthesise the barriers and facilitators to accessing and utilising mental health services in regional, rural, and remote Australia, as identified using the Modified Monash Model; and (2) better understand the relationship between barriers and facilitators and their geographical context.

A systematic search of Medline Complete, EMBASE, PsycINFO, Scopus, and CINAHL was undertaken to identify peer-reviewed literature. Grey literature was collated from relevant websites. Study characteristics, including barriers and facilitators, and location were extracted. A descriptive synthesis of results was conducted.

Fifty-three articles were included in this scoping review. Prominent barriers to access and utilisation included: limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators included person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy and culturally-sensitive practice. The variability of the included studies precluded the geographical analysis from being completed.

Both healthcare providers and service users considered a number of barriers and facilitators to mental health service access and utilisation in the regional, rural, and remote Australian context. Barriers and facilitators should be considered when re-designing services, particularly in light of the findings and recommendations from the Royal Commission into Victoria’s Mental Health System, which may be relevant to other areas of Australia. Additional research generated from rural Australia is needed to better understand the geographical context in which specific barriers and facilitators occur.

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Introduction

The mental health of Australians who live in regional, rural, and remote Australia is an ongoing concern [ 1 ]. Poor healthcare access is one of the key determinants of adverse mental health outcomes, with access issues being more pronounced in regional, rural, and remote Australia (hereafter referred to as rural , in line with the Australian Government’s definition under the Rural Health Multidisciplinary Training [RHMT] Program [ 2 ]), compared to metropolitan Australia [ 3 ]. People living in rural Australia often face difficulties in obtaining healthcare, and this care is often delayed and more expensive for the patient [ 4 ]. These difficulties in accessing and utilising healthcare are implicated in the higher mental disorder burden experienced by those living in rural Australia, shown by the higher rates of suicide, compared with major cities [ 5 ]. Moreover, this group is less likely than those living in major cities to take-up and complete mental health treatment [ 6 ]. Workforce maldistribution plays a role in these health inequalities [ 7 , 8 , 9 , 10 ], with more clinical full time equivalent (FTE) mental health professionals working in major cities, compared with rural areas (i.e., 92 vs. 30–80 mental health nurses, 15 vs. 2–6 psychiatrists, and 90 vs. 15–55 psychologists per 100,000/population) [ 3 ]. Other areas of the health workforce are similarly maldistributed across the country (i.e., 403 vs. 223–309 clinical FTE medical practitioners and 531 vs. 382–469 clinical FTE allied health professionals per 100,000/population in major cities versus rural areas) [ 11 ].

There are a number of factors that are implicated — both directly and indirectly — in the access and utilisation of mental health services, and these factors may be pertinent to the level of remoteness experienced. This includes particular aspatial (i.e., social) and spatial (i.e., geographical) dimensions [ 12 , 13 ]. Aspatial dimensions consist of the factors that affect the affordability , acceptability , accommodation , and awareness of healthcare access. In the rural context of Australia, this tends to relate to social matters [ 14 , 15 ] including stoicism, low help-seeking behaviours, and confidentiality concerns [ 16 ]. Spatial dimensions are concerned with the availability and accessibility of service access, including geographical isolation [ 14 ], service delivery capacity [ 17 ] [ 18 ], and dual-roles [ 14 ] (i.e., the intersection of professional and personal relationships) in rural areas. While here we define access as factors that pertain to the attributes/expectations of the individual and their alignment with the provider/services [ 12 ], other models conceptualise access as the opportunity to identify healthcare needs, seek services, reach resources, obtain or use services, and have the need for services fulfilled [ 19 ]. Utilisation refers to the generation of a healthcare plan throughout a healthcare encounter, as well as its implementation and follow-through [ 20 ].

Conceivably, mitigating the barriers and augmenting the facilitators to the utilisation of mental health services may be particularly important when considering the obstacles that people from rural areas face when accessing services. One previous study on rurally-based Australian adolescents suggested that barriers to accessing services, such as social exclusion and ostracism by members of their community, also likely prevented the continued utilisation of services and negatively affected treatment outcomes [ 21 ]. Cheesmond et al. [ 22 ], in a review of residents in rural Australia, Canada, and the United States of America, highlighted a link between sociocultural rurality, rural identity, and help-seeking behaviour. Cheesmond et al. [ 22 ] suggested that specific place-sensitive approaches are needed to overcome barriers to help-seeking, and that a greater understanding of help-seeking in the rural context is required. This includes further exploration of rurality as a concept, conducting research within diverse environments, allowing participants to contextualise barriers to help-seeking, and exploring the co-existence of multiple help-seeking barriers. Parallel to this, a paucity of research has focussed on the facilitators to accessing and utilising mental health services in rural Australia.

To the authors’ knowledge, no previous reviews have specifically focussed on understanding the barriers and facilitators to accessing and utilising mental health services within the rural Australian context. A scoping review was chosen as the preferred approach to this work because of the emerging and cross-disciplined nature of the research. The aim of this scoping review is to: (1) explore the barriers and facilitators to accessing and utilising mental health services for Australians living in rural areas; and (2) better understand the relationship between barriers and facilitators and their geographical context.

This scoping review conforms to the guidelines put forward by Arksey and O’Malley [ 23 ], follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) [ 24 ], and a published protocol [ 25 ].

Eligibility criteria

The scope of this review was intentionally broad to allow explanation of the nature and extent of the literature describing the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. Articles were eligible for inclusion if they met the following criteria:

Included individuals with a diagnosed mental disorder, experienced mental health issues, or were part of a mental health community service; or included healthcare providers that provided diagnostic, assessment, or treatment services for mental health issues.

Explained obstacles that impeded the uptake, quality, or level of mental health services being accessed or described facilitators that allowed the uptake, quality, or level of mental health services being received.

Included service users, healthcare providers, or services that were based in regional, rural, or remote Australia according to the Modified Monash Model (MMM) 2–7 ( regional centres to very remote communities ) [ 4 ] (i.e. the current RHMT definition of rural).

The population/concept/context (PCC) framework was used to generate the eligibility criteria for this scoping review and is described in Table  1 . The eligibility criteria for this review varied slightly from the published protocol [ 25 ]. In this review, we included pharmacists as healthcare providers, as it was identified that pharmacists play a key role in mental health services in some rural areas. We excluded mental health programs and health promotion activities that were considered to be a “structured activity” delivered by a service, reviews, viewpoints, declarations, tailpieces, frameworks, and commentaries. We also excluded articles that did not provide sufficient detail to describe the barriers or facilitators to accessing or utilising services, as well as articles that pooled results across participants from metropolitan and regional/rural/remote areas. The only exception to this was when authors referred to the study setting as regional/rural/remote, but upon further investigation using the health workforce locator [ 26 ] (see Sect.  2.8 Geographical analysis ), the location was deemed to be metropolitan according to the MMM [ 4 ] — this exception was allowed due to the differences in geographical models applied to Australian health research [ 27 , 28 ]. Separately, we decided to include articles that reported on the barriers and/or facilitators of a specific rural mental health service implementation activity or service model, as we felt that these articles offered important insights that may be translated to new service initiatives or research activities.

Information sources

The following databases were systematically searched: Medline Complete, EMBASE, PsycINFO, Scopus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). Websites of the Australian federal and state government’s Department of Health, Primary Health Network (PHN), key rural and remote peak bodies/agencies known to the authors from their collective experience on the topic, and Google were also searched to ascertain grey literature. The search was performed on 11th January 2022 and a 2012-current date filter was employed using the ‘start’ and ‘end’ publication year functions. Additional sources were identified through ‘snowball’ searching of included studies. Where needed, additional location information was obtained via a study’s first or corresponding author.

The search strategy was developed in consultation with two scholarly services librarians (JS and BK) to identify peer-reviewed studies and grey literature records. Relevant keywords, search terms, and wildcard symbols were applied to each database. An adapted search string was searched in Google using the advanced search function. The “all these words” and “any of these words” search options were engaged, and PDF files were requested. All (n = 11) pages of the search results were assessed for eligibility by one reviewer (BEK), and the research term agreed on their inclusion.

The full search strategy and grey literature sources are presented in Additional Table  1 .

Selection of sources of evidence

One reviewer (BEK) applied the search strategy to the databases and websites. Two reviewers (BEK and KBC) independently screened all articles using Covidence [ 29 ]. Where discrepancies concerning the eligibility of an article occurred, a meeting was held to determine consensus; if consensus could not be reached, a third reviewer (LJW) was consulted to make the final decision.

Data charting process

To ensure that the data charting process was consistent with the research question, a charting form was developed and piloted by two authors (BEK and KBC). One author (BEK) then charted the data for each of the eligible articles, using Microsoft Excel.

The following data items were extracted from eligible studies: author and year, study objective, study design, location, sample size, characteristics of participants, mental health diagnosis/issue and assessment method, healthcare provider type/role, barriers, facilitators, mental health service, regional/rural/remote area of Australia, and summary of findings (Additional Table  2 ). For literature that included participants from both metropolitan and regional/rural/remote areas, only information that pertained to those from regional/rural/remote areas was extracted, except for instances where statistical differences between groups were reported for comparison. Likewise, in instances where articles included participants who were eligible (e.g., healthcare providers) as well as participants who were ineligible (e.g., no evidence of mental health diagnosis/engagement with services), only information from eligible participants was extracted. First or corresponding authors of studies that did not specifically state where the study was conducted were contacted to provide additional location information.

Synthesis of results

A descriptive synthesis was conducted by providing an overview of the included study characteristics, setting and target groups, and barries and facilitators. Links to aspatial and spatial access factors were also described, where relevant. The study characteristics are presented in Table  2 and the barriers and facilitators pertaining to each included study are presented in Additional Table  3 . A quality appraisal of the included studies was not undertaken as scoping reviews aim to offer an overview or map of the pertinent evidence [ 30 ].

Geographical analysis

Geographical coordinates provided by the health workforce locator [ 26 ] were used to determine the remoteness of the study locations according to the MMM categories. These data were inputted into STATA to determine the number and proportion of each of the MMM categories.

The database search yielded 1,278 articles, of which 555 articles were removed due to duplication. Subsequently, 723 titles and abstracts were screened, and 441 were excluded due to ineligibility. At the full text stage, 282 articles were screened, with 181 studies being excluded, resulting in 47 articles meeting the eligibility criteria. The grey literature search yielded 128 potentially relevant sources, of which six were eligible after removing three for duplication. In total, 53 articles were included in this scoping review. A snowball search of the references of included records was also conducted and two additional records were identified but were deemed ineligible as they reported on studies/samples that were already included in the review. Figure  1 displays the PRISMA flow throughout each screening stage.

figure 1

PRISMA flow diagram of studies considered in this review

Study characteristics

Of the 53 included studies, 25 articles described barriers and/or facilitators from the healthcare provider perspective, 13 were from the point of view of the service user, eight reported on combined perspectives of both the healthcare provider and service user, and seven reported on barriers/facilitators from neither the healthcare provider nor service user perspective directly but did consider the barriers/facilitators of the service environment (e.g., service evaluations).

Most studies (n = 29, 54.7%) employed qualitative methods, including interviews and/or focus groups; 12 studies utilised quantitative cross-sectional or longitudinal methods, seven were mixed-methods research designs, and two were service description and classification studies.

The highest proportion of studies were conducted in New South Wales (NSW) (n = 13) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], followed by Australia broadly (n = 12) [ 33 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ], South Australia (SA) (n = 10) [ 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ], Victoria (VIC) (n = 6) [ 65 , 66 , 67 , 68 , 69 , 70 ], Queensland (QLD) (n = 5) [ 71 , 72 , 73 , 74 , 75 ], Western Australia (WA) (n = 3) [ 76 , 77 , 78 ], Tasmania (TAS) (n = 2) [ 79 , 80 ], and Northern Territory (NT) (n = 1) [ 81 ]. One study pertained to areas within NSW, QLD, and VIC [ 82 ], and another study concerned NSW and WA [ 83 ]. No studies were centred on Australian Capital Territory (ACT). Table  2 depicts the characteristics of the included studies.

Setting and target groups

Mental health service setting.

Fourteen studies reported on general or community-based mental health services [ 18 , 33 , 43 , 48 , 53 , 54 , 57 , 64 , 72 , 74 , 77 , 78 , 83 ]. Four studies described mental health services provided within emergency departments (EDs) and/or urgent care centres (UCCs) [ 40 , 41 , 46 , 65 ]. The remaining studies described mental health services provided by counsellors and GPs [ 38 ], nurses, peer-workers [ 71 ], personal helpers and mentors [ 35 ], pharmacists [ 47 ], and a combination of several healthcare providers [ 59 ]. Seven studies reported on technology-based or -enhanced mental health services [ 51 , 60 , 61 , 62 , 63 , 75 , 76 ].

Target groups

The population group focus of studies varied. Of the studies that commented on, or specified that they targeted specific subpopulations, four studies discussed care pertinent to Indigenous or Aboriginal and/or Torres Strait Islander Peoples [ 66 , 67 , 68 , 81 ]. Four studies discussed mental health services for young people [ 55 , 63 , 73 , 82 ]. Three studies specifically included at least a proportion of service users who were under the age of 18 years old [ 55 , 61 , 79 ]. Two studies reported on mental health services for older people [ 50 , 58 ]. Other studies described barriers and or facilitators specific to sex workers [ 80 ], medical doctors [ 45 ], LGBTIQA + people [ 51 ], immigrants [ 49 ], and women [ 39 ] or men [ 70 ] with specific mental health issues. Three studies described mental health services that were specific for supporting people with depression [ 34 , 39 , 55 ]; two studies were focussed on suicide [ 68 , 70 ]; two studies described care for people with eating disorders [ 42 , 52 ]; and one study was centred on perinatal and infant support [ 75 ].

Barriers and facilitators

The included studies varied significantly. This included differences in the purpose and type of study, participant sample, and methodology, and reporting of findings. Barriers and facilitators were grouped into prominent concepts based on terminology used by the relevant literature and are presented in Table  3 . Barriers related to limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators related to person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy; and culturally-sensitive practice.

Prominent barrier concepts

Barriers affecting healthcare providers and service users.

Limited resources. Across the studies, the most considerable barrier was limited resources [ 18 , 33 , 34 , 35 , 36 , 38 , 39 , 42 , 45 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 71 , 74 , 75 , 78 , 79 , 80 , 82 ]. This key concept considered limited resources at the healthcare provider and service user level. Notably, lack of available general and specialist services, limited service capacity, workforce shortages, difficulty attracting and retaining staff, and staff turnover were frequently reported as considerable spatial barriers to service delivery, hampering access to services. Moreover, financial costs, disadvantage, or appointment fees [ 34 , 37 , 52 , 53 , 61 , 62 , 78 ], and lack of transport [ 34 , 50 , 52 , 53 , 58 , 62 , 71 , 78 ] restricted access to mental health services for the service user. These issues reflect the lower relative socio-economic advantage seen in rural areas of Australia [ 2 ].

System complexity and navigation. The complexity in using and navigating the system was a common aspatial barrier [ 18 , 33 , 36 , 40 , 41 , 42 , 45 , 46 , 51 , 52 , 53 , 57 , 58 , 59 , 61 , 63 , 65 , 66 , 69 , 73 , 74 , 78 , 80 ], which affected healthcare providers in coordinating patient care and service users in utilising such care. These issues were most frequently reflected in reports on extended wait times and delays in assessment and diagnosis [ 34 , 40 , 46 , 53 , 55 , 57 , 58 , 62 , 66 , 78 , 80 ].

Attitudinal or social matters. Many studies reported that attitudinal or social matters were a barrier for the service user [ 34 , 35 , 36 , 38 , 39 , 43 , 50 , 51 , 52 , 60 , 61 , 64 , 66 , 67 , 68 , 70 , 78 , 80 , 81 ], particularily concerning privacy or confidentiality concerns [ 39 , 51 , 60 , 61 , 62 , 63 , 66 , 67 , 78 ], affecting aspatial access to care. The need to be stoic was reported as a barrier to seeking psychological help among regional medical doctors, relating to their perceptions of regional practitioner identity [ 45 ], and among service users [ 50 , 67 , 70 ].

Technological limitations. Several studies cited limitations to services delivered via technological means [ 51 , 53 , 60 , 61 , 62 , 64 , 78 ]. Some studies acknowledged that technology can enhance physical mental health services, but cannot replace them [ 62 , 64 ], particularly for specific client groups, including the older population and Aboriginal and Torres Strait Islander people, who reportedly prefer face-to-face service delivery [ 78 ]. In addition, poor connectivity and high costs of technology use were reported as aspatial barriers to accessing technology-delivered mental health services and may also affect their utilisation [ 53 , 62 , 78 ].

Lack of awareness. Lack of awareness about mental health issues, needs, or services available was reported as an aspatial barrier in the current review [ 43 , 50 , 52 , 67 , 78 ]. This lack of awareness was reported at the healthcare provider level in one study, and was described as the healthcare provider having a limited understanding of the mental health needs in older people, resulting in a lack of referral to appropriate services [ 50 ]. At the service user level, a lack of awareness precluded individuals from recognising mental health problems [ 67 ], while a lack of awareness of services was a barrier to seeking help [ 52 , 78 ].

Barriers affecting service users

Distance to services. The spatial distance required to travel to physical services is a considerable issue for people residing in rural localities, and this distance has been shown to reduce service access and utilisation in the current review [ 52 , 62 , 63 , 64 , 67 , 71 , 78 ]. There is also an additional burden experienced by those with physical disability, or those who don’t have a support person to assist them [ 53 ].

Insufficient culturally-sensitive practice. A limited capacity to meet the needs of culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander communities was reported, affecting aspatial access and utilisation of services. This tended to be a result of service users not feeling culturally safe within the service environment, perceptions that health professionals had cultural assumptions about the service user, and inappropriate assessment tools [ 48 , 49 , 58 , 73 , 78 ].

Prominent facilitator concepts

Facilitators affecting healthcare providers and service users .

Person-centred and collaborative care. Many studies reported that person- (or client-) centred care that is non-judgemental and permits collaboration to be an important aspatial facilitator to mental health service access and utilisation [ 31 , 34 , 35 , 36 , 41 , 42 , 56 , 57 , 58 , 59 , 61 , 63 , 64 , 65 , 72 , 74 , 81 ]. It is noteworthy that person centred care was specifically reported in studies pertaining to the service user [ 61 ] and healthcare provider [ 63 , 64 ] in the current review, suggesting that this approach is recognised as important by both those delivering and using the service. Care that is regular and non-intrusive was seen as a way to facilitate service utilisation [ 34 , 57 ].

Technological facilitation. Technology-based services, including integrated mental health services, telehealth, live chat, SMS appointment reminders and coordination, and mental health web-pages, were reported to be useful in filling spatial and aspatial gaps in service delivery for physical services [ 51 , 53 , 58 , 60 , 61 , 62 , 63 , 75 , 76 , 78 ]. These services were reported to facilitate connection and information sharing [ 62 ], clinical supervision, contact with specialists [ 60 ], workforce upskilling, and security [ 75 ] for the healthcare provider. For the service user, technology-based services facilitated immediacy of consultations, cost savings, and anonymity, and reduced mental health hospitalisations and admissions, additional client appointments, the need to travel, stigma, and family stress [ 60 ].

Environment and ease of access. The mental health service environment and the ease of which one may access services — granted that all other access issues are overcome — were frequently reported as spatial facilitators [ 31 , 49 , 65 , 73 , 80 , 81 ]. Specifically, services that permitted a non-clinical and comfortable environment were deemed as important aspatial factors for young people [ 61 , 73 ]. Co-located services were also considered important for access, as this allows service integration and facilitated information sharing [ 31 , 41 , 63 ].

Community supports. The community was considered to be an important aspatial facilitator. This included healthcare providers being involved and connected with the community [ 56 , 65 , 66 ], as well as having a sense of community [ 59 ], as a way to facilitate care via information sharing, collaboration, and knowing community members and local issues. For the service user, community and place was seen as a source of strength as noted by one study [ 39 ].

Facilitators affecting service users

Mental health literacy. Several studies reported that having awareness of mental health issues and being confident in using services were aspatial facilitators to mental health service access and utilisation [ 52 , 57 , 59 , 66 , 70 ]. These factors are generally referred to as mental health literacy within the wider literature, which is a crucial component of healthcare [ 84 ].

Culturally-sensitive practice. Of the studies that reported on cultural elements of mental health service provision, it was noted that Indigenous and other culturally appropriate staff (i.e., a Koori Mental Health Liaison Officer or Aboriginal Mental Health Worker), as well as the involvement of Community Elders and spiritual healers [ 48 ] assisted with service access and utilisation [ 48 , 66 ]. Further, culturally appropriate décor and flexibility in meeting places [ 66 ], and the use of culturally acceptable models of mental health [ 48 ] were also seen as important aspatial dimensions.

Overall, thirty studies were described as being relevant to rural areas [ 18 , 31 , 33 , 34 , 35 , 36 , 38 , 39 , 42 , 43 , 48 , 49 , 50 , 53 , 57 , 58 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 73 , 76 , 78 , 83 ], three studies were pertinent to regional areas [ 39 , 56 , 79 ], two studies were concerned with remote areas [ 77 , 81 ], and the remaining studies involved combinations of regional/rural/remote populations of Australia [ 37 , 40 , 41 , 44 , 45 , 46 , 47 , 51 , 52 , 54 , 55 , 59 , 60 , 71 , 74 , 75 , 80 , 82 ]. Over one third of the studies (n = 21, 39.6%) reported or provided specific spatial data, which allowed the MMM [ 4 ] to be applied directly to the study location; n = 10 (47.6%) of these studies included multiple locations, resulting in a total of 41 MMM categories. Studies were conducted most frequently in MM5 small rural towns (n = 10, 24.4%) and MM3 large rural towns (n = 9, 22.0%) and least frequently in MM6 remote communities (n = 3, 7.3%). The first author’s location was used as a proxy location for 28 studies (52.8%). Of these studies, the most frequent location was MM1 metropolitan settings (n = 16, 57.1%), likely due to the high proportion of study locations being taken from the first author’s location, and that many universities and research centres are located in major cities. There were no studies conducted in MM5 small rural towns (n = 0, 0%). Three author locations (5.7%) could not be determined due to limited information provided. Table  4 displays details of the MMM categories according to spatial data reported or obtained and proxy locations. Due to the heterogeneity and lack of mutual exclusivity of the data, an analysis of the association between geographical area and specific barriers and facilitators was unable to be completed.

Discussion and implications

This scoping review identified the barriers and facilitators experienced by healthcare providers delivering mental health services and individuals accessing, or attempting to access mental health services in rural Australia. Prominent barriers included: limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators included person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy and culturally-sensitive practice. We also aimed to understand these barriers and facilitators in relation to their geographical context; however, the variability in the data precluded the geographical analysis from being completed.

This study revealed a paucity of research conducted in MM6 remote and MM7 very remote communities in Australia when specific spatial data are considered, as well as in the ACT — however, it is noted that the majority of the ACT is classified as metropolitan, with 99.83% (387,887 residents) of the population residing in MM1 at the time of the 2016 census [ 2 ]. Moreover, when proxy study locations are used, many studies are conducted by researchers located in metropolitan areas. Only three studies specifically included service users who were under the age of 18 years old, representing a significant gap in understanding the mental health service needs of the younger population. Although it is acknowledged that there are considerable research ethics restrictions in place to protect children and young people, the onset of many mental health issues tends to occur between 14.5 and 18 years of age [ 85 ], highlighting the importance of understanding barriers and facilitators to accessing mental health services amongst the younger cohort. Due to the heterogeneity of the findings, the following discussion considers the most prominent barriers and facilitator concepts identified across the studies.

Review findings support limited resources as being one of the biggest restrictors of mental health service access and utilisation within rural Australia. Thes findings echo reports at the national scale, which show the mental health workforce is heavily concentrated in metropolitan areas compared to other remoteness areas, relative to the population [ 86 ]. Considerable efforts need to be made to reduce the resource inequalities, including the dearth of mental health professionals practicing outside of metropolitan cities. Recently, the National Mental Health Workforce Strategy Taskforce (the Strategy) was established to deliberate the quality, supply, distribution, structure, and methods to improve attracting, training, and retaining Australia’s mental health workforce [ 87 ]. The Consultation Draft of the Strategy highlights six objectives, including (1) careers in mental health are recognised as, attractive; (2) data underpins workforce planning; (3) the entire mental health workforce is utilised; (4) the mental health workforce is appropriately skilled; (5) the mental health workforce is retained in the sector; and (6) the mental health workforce is distributed to deliver support and treatment when and where consumers need it [ 88 ]. These objectives reflect the systemic resource issues cited in the current scoping review and emphasise the importance of a contemporary approach to increasing resources for mental health services in rural Australia. This contemporary approach is important, as it has previously been acknowledged that increasing graduates has not resolved workforce maldistribution in other areas of healthcare (i.e., medical physicians), but rather, an improved distribution of both human and other resources is needed [ 89 , 90 ].

For the service user, resource issues spanned both aspatial and spatial dimensions and include the affordability (i.e., perceived worth relative to cost) and accessibility of the service (i.e., the location of the service and ease of getting to that location) [ 12 , 13 ]. Transport issues were commonly reported to be a resource issue within the current review and the wider literature. Limited transport compounds access issues for specific subpopulations, such the elderly, particularly when they do not have personal transport and when there is no public transport available [ 50 ]. This issue is likely compounded by resource limitations, including the cost of travel, and is specifically related to spatial distance to services. Distance to services is a significant barrier to accessing healthcare. Wood et al. [ 91 ] in a systematic review, identified that there is a lack of research which measures spatial access specific to mental health services in Australia, and highlighted a need for consensus on what is reasonable access to healthcare services. Further, reports have noted that while distance alone is a significant barrier to accessing healthcare, accommodation may sometimes need to be sought depending on the time of the appointment, adding to the cost of attending the appointment [ 92 ] and further perpetuating the resource issues experienced by those living in rural areas of Australia. In addition, although not specifically reported in the current review, it is likely that the time required for traveling to and attending such appointments may require the individual to choose between tending to work or family needs or receiving the help needed.

Transport and other resource issues, as well as distance to services, may be mitigated through telehealth appointments, which have been central to the provision of healthcare since the beginning of the COVID-19 pandemic. However, the utilisation of telehealth requires many patients to have had a face-to-face consultation with their GP in the previous 12 months [ 93 ], which may preclude some Australians from rural areas from its use, considering the significant workforce maldistribution previously discussed. Moreover, rural areas of Australia also experience digital disadvantage as a result of lower internet connectivity — brought about by the high costs of installing internet infrastructure in rural and remote areas — and the socio-economic disadvantage experienced by those who live outside of metropolitan areas [ 94 ]. These issues are compounded by an ageing population, lower educational levels, a larger primary industry sector, a higher unemployment rate, and a higher Indigenous population in rural and remote Australia [ 94 ]. High cost, connectivity issues, and suitability for specific client groups should be key considerations in the delivery of technology-based mental health services. Notwithstanding these issues, the current review identified that technology-based services may be a useful adjunct to physical services, particularly in relation to reducing the need to travel, consultation immediacy, and clinician upskilling. This finding partially supports a recent systematic review, which found that youth located in rural and remote areas of Australia and Canada prefer to see mental health professionals in person, with telehealth provided as an additional option [ 95 ]. As such, the benefits and limitations to technology-based mental health services needs to be carefully considered by those designing services.

A key barrier to both access and utilisation in the current review was the complexity of using and navigating the mental health system. These issues typically occur at the system and organisation level and affect the way a service operates and its culture, making it challenging for service users to receive effective care. A complex mental health system and service fragmentation has been previously reported to lead to confusion and a lengthy amount time spent trying to navigate the system, with these issues being even greater amongst those who are younger, less autonomous, or who have less experience navigating the system [ 96 ]. System navigation initiatives may address this gap and have previously been implemented via the Partners in Recovery (PIR) program — established to facilitate care coordination for people with severe and persistent mental illness — with positive impacts for those who used the program [ 97 ]. However, the introduction of the National Disability Insurance Scheme has superseded the PIR program, and has rendered many former PIR program participants ineligible for support [ 98 , 99 ], representing a significant gap in mental health service navigation and care coordination support. Isaacs et al. [ 100 ], identified that it is more cost effective to support people with severe and persistent mental illness to access PIR supports than to not provide this support, due to the potential increased need for other services (e.g., hospital admissions, homelessness supports, residential supports). Indeed, the Australian Government’s Productivity Commission (Productivity Commission) recommended that life insurers should have greater flexibility to fund approved mental health services to reduce the likelihood of hospitalisation for mental health issues [ 101 ]. In addition, Isaacs et al. [ 100 ] reported that co-located services — which were reported as a facilitator in the current review — and the increased need of non-clinical support through mental health community support services, offered via non-governmental and not-for-profit organisations, were demonstrated to be important considerations for cost effective mental health care.

Attitudinal or social matters are frequently reported to be key barriers for rural Australians to accessing care and are considered to be an aspatial dimension [ 12 , 13 ]. These matters which include stigma, fear of judgement, stoicism, lack of trust, preference for keeping to oneself, and reluctance to seek help have been reported on the global scale as impacting upon help-seeking in rural areas in relation to rural identity [ 22 ]. Stoicism, in particular, is ordinarily viewed as a positive trait, with rural participants of a global review contextualising stoicism as an inflexible element to their core identity, however, this trait has repeatedly been reported as a barrier to the uptake of mental health services in this review [ 45 , 50 , 67 , 70 ] and in the wider literature [ 22 ]. In terms of addressing attitudinal and social matters, previous Australian research [ 16 ] has identified that intentions to seek help for a mental or emotional issue decreased with a higher classification of remoteness. Moreover, stoicism and attitudes towards seeking professional help were predictive of help-seeking intentions for participants from both rural and metropolitan areas, but sex, suicidality, and previous engagement with a mental health professional were additionally predictive of help-seeking intentions for rural Australians [ 16 ]. The current scoping review identified few studies that specifically reported on these issues in relation to barriers to accessing services [ 37 , 55 , 68 , 70 ], suggesting a need to increase research focus on these issues. Interestingly, Kaukiainen and Kõlves [ 16 ] study, found that attitudes towards seeking professional help mediated the relationship between stoicism and help-seeking intentions for participants from both rural and metropolitan locations, suggesting that attitudes towards seeking professional help may be a fruitful avenue to target to increase help-seeking intentions for all Australians [ 16 ]. Education programs delivered in secondary school or tertiary settings have been suggested as a way to improve attitudes towards help-seeking and stigma [ 102 ]. These avenues may also be useful to increase mental health literacy (i.e., the public knowledge and recognition of mental disorders and knowing where and how to seek help) [ 84 ] in the community, given that lack of awareness was a barrier and mental health literacy was a facilitator in the current review.

Providing person-centred and collaborative care was reported as a key facilitator in the current review. Person-centred care is generally defined as care that is holistic and incorporates the person’s context, individual expression, beliefs, and preferences, and includes families and caregivers, as well as prevention and promotion activities [ 103 ]. Indeed, person-centred care is a prominent practice model in mental health care, and this model of care may be particularly beneficial in rural Australia, given that it aims to decrease barriers between health service providers via shared knowledge. This model of care is collaborative by nature, although it should be noted that collaborative care is a distinct, though related model of care. Collaborative care refers to health professionals and patients working together to overcome a mental health problem [ 104 ]. This model of care has been shown to improve depression and anxiety outcomes across the short to long term (i.e., 0–24 months), and has benefits on medication use, patient satisfaction, and mental health quality of life [ 104 ]. The Productivity Commission recommended the trial of innovation funds to diffuse best practice in mental health service delivery and to eliminate practices that are no longer supported by evidence [ 101 ]. Such innovation funds may allow healthcare providers to maintain currency on practices such as person-centred and collaborative care. Importantly, the Royal Commission into Victoria’s Mental Health System (the Royal Commission) [ 90 ] identified person-centred care as a way to promote inclusion and prevent inequalities, and was specifically linked to providing culturally safe mental health care — which was noted as a facilitator to access and utilisation in the current review and has been highlighted as an important approach to eliminate health inequalities [ 105 ]. Moreover, the Royal Commission recommended the use of an integrated service approach — where service providers can work together to provide care [ 90 ]. This approach to care may mitigate service fragmentation and system complexity and navigation barriers, and also permit environments that are comfortable and allow ease of use — as identified as facilitators in the current review.

Community support, both in the sense of individuals feeling connected to the community and healthcare providers being seen within the community, was a key concept in the current review. For the service user, Johnson et al. [ 39 ] reported that accessing services under the scrutiny of the community was seen as a challenge, but that the community was also seen a source of strength. Crotty et al. [ 56 ] noted the duality for healthcare providers being involved with the community in both a social and professional sense, leading to both challenges and a feeling of togetherness. This sense of togetherness reflects the historical view that rural and remote communities have been connected over several generations [ 106 ]. Notably, in the current review, one study on healthcare provider perspectives on workforce retention reported that personal connections and a ‘natural’ connection to the community were key factors in the decision for staff working in remote areas to stay [ 33 ], suggesting the importance of embedded relationships in this setting. Preferences to stay in rural and remote towns have been associated with a sense of belonging and the quality of diverse and interesting activities, particularly for younger people [ 107 ], and these factors should be strengthened to permit the retention of the rural mental health workforce.

It is noteworthy that many of the studies were undertaken at metropolitan locations, suggesting that much of the research completed on rural locations was not necessarily conducted within this setting. However, it is acknowledged that many university locations are affiliated with major campuses, which are often located in metropolitan areas. Simultaneously, many rurally-based health and community services do not have the resources to undertake locally-generated research, and this consequently limits the evidence available for policymakers to make informed decisions regarding the health of the rural population — noting that place-based approaches are gaining traction [ 108 , 109 , 110 ]. This area is a key focus of the RHMT program [ 111 ]. The RHMT program aims to maximise investment in of Australia via academic networks, developing an evidence-base, and providing training in rural areas for health professionals. To date the RHMT program has seen that health graduates who undertook clinical placements in the most rural settings are working more in rural locations [ 112 ], and this is likely to have flow-on effects for healthcare providers to build connections to these areas, retain the workforce, and increase health outcomes for the community.

This review highlights the need for a contemporary approach to mental health services in rural Australia. This includes encouraging and educating the public about mental health issues and how to seek and engage in timely mental health care that is appropriate to one’s needs. Simultaneously, this review suggests a need to reconsider how the public navigates mental health services, and to redesign services that are easy to engage with, culturally safe, comfortable to use, and have technological capabilities. This may be more accurately achieved when services are designed with local issues and the community in mind via the integration of bottom-up place-based strategies and top-down place-sensitive approaches, particularly given that a one-size-fits-all approach to policy — and thus mental health service design — does not favour regions and localities [ 113 ]. It is critical that rural mental health services are invested in to remove barriers and improve health equity. The fiscal implications of such investment may be offset using this integrated approach, which leverages local and external assets, encourages workforce retention, and may reduce costs in other areas healthcare service delivery.

Strengths and limitations

The strengths of this scoping review include the use of peer-reviewed and grey literature, the full-span of the child-adult age range, and the wide variety of included studies. In addition, this scoping review applied a consistent approach to applying remoteness categories, albeit this application was not without issues. For example, Wand et al. [ 40 ] and Wand et al. [ 41 ] reports on work done in Maitland (MM1) and Dubbo (MM3). Maitland (NSW) is of particular interest in the context of remoteness settings as it has historically been described as a regional area. In the early 2000s when the Australian Bureau of Statistics was defining the most accessible category of the Accessibility/Remoteness Index of Australia (ARIA), Maitland (as well as other locations such as Wollongong, NSW and Geelong, Victoria) was included in the most accessible category [ 114 ].

Several limitations must also be considered. Firstly, many sources — particularly grey literature sources — included potentially relevant information; however, a lack of clear evidence that the data specifically pertained to those living in regional/rural/remote areas prevented many of these sources from being included. In addition, findings were limited by the available literature, especially among community service organisations, which have limited resources to generate research outputs. The search strategy was limited to 2012–2022 and did not include search terms specific to certain subgroups of the population who have been known to experience barriers to mental health services in rural areas (e.g., farmers and people from CALD backgrounds), and some search results may have been omitted as a result of this. It was not possible to discern whether findings related specifically to access or utilisation in many studies, and as such, a nuanced discussion of these dimensions is not provided. Further, the data were heterogeneous and results tended to be grouped across regional, rural, and/or remote contexts, precluding an analysis of the association between geographical area and barriers and facilitators from taking place. Future research may consider completing a comprehensive geographical analysis once additional data on the topic becomes available. Lastly, although data screening was completed by two reviewers, only one reviewer coded the extracted data into key concepts, and this may have introduced bias into the results, however the key concepts were agreed upon by the research team.

This scoping review found a number of barriers to accessing and utilising mental health services that may be overcome through initiatives that have been implemented or suggested by the government. Importantly, many of the spatial barriers associated with access and utilisation may be mitigated through innovative solutions, such as a combination of face-to-face and technology-based service provision, provided that careful consideration is given to the technological and resource limitations seen in the rural context of Australia. Parallel with this, several facilitators to accessing and utilising mental health services were noted, some of which may already be prominent in the provision of services, but could be further strengthened through additional training, service re-design, and community initiatives.

The included studies varied in their aim, setting, and study design, and many studies were grouped across MMM categories, disallowing a nuanced understanding of how barriers and facilitators operate within specific geographical contexts. This, paired with the finding that many studies were conducted at a metropolitan location, highlights the importance of conducting research within the rural setting. Additional research generated from rural areas, as well as consideration for how remoteness is measured, would assist in providing a more comprehensive understanding of the barriers and facilitators to mental health services within the geographic contexts they occur.

Data Availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Australian Capital Territory

Accessibility/Remoteness Index of Australia

Culturally and linguistically diverse

Cumulative Index of Nursing and Allied Health Literature

Emergency department

Full time equivalent

General practitioner

Lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual

Modified Monash Model

Population/concept/context

Primary Health Network

Partners in Recovery

Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews

New South Wales

Northern Territory

Rural Health Multidisciplinary Training

South Australia

Urgent care centre

Western Australia

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Acknowledgements

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BEK, HB, and VLV are funded by the Rural Health Multidisciplinary Training (RHMT) program. LJW is supported by a National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship [1174060].

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Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia

Bianca E. Kavanagh, Hannah Beks & Vincent L. Versace

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Kayla B. Corney, Lana J. Williams & Shae E. Quirk

Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland

Shae E. Quirk

Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland

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BEK conceptualised the research question; completed the search, data screening, extraction, and analysis; and wrote the original draft of this manuscript. KBC contributed to data screening and extraction. HB and VLV assisted with the geographical analysis. All authors edited and approved the final version of this manuscript.

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Additional Table 1: Search strategy for Medline Complete via EBSCO

Additional table 2: charting form used for data extraction, 12913_2023_10034_moesm3_esm.docx.

Additional Table 3: Barriers and/or facilitators of access and/or utilisation factors in regional, rural, and remote Australia

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Kavanagh, B.E., Corney, K.B., Beks, H. et al. A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. BMC Health Serv Res 23 , 1060 (2023). https://doi.org/10.1186/s12913-023-10034-4

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