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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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  • 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.

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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.

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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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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

  • Review the abstracts carefully.  
  • Keep careful notes so that you may track your thought processes during the research process.
  • Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

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Literature review

A general guide on how to conduct and write a literature review.

Please check course or programme information and materials provided by teaching staff , including your project supervisor, for subject-specific guidance.

What is a literature review?

A literature review is a piece of academic writing demonstrating knowledge and understanding of the academic literature on a specific topic placed in context.  A literature review also includes a critical evaluation of the material; this is why it is called a literature review rather than a literature report. It is a process of reviewing the literature, as well as a form of writing.

To illustrate the difference between reporting and reviewing, think about television or film review articles.  These articles include content such as a brief synopsis or the key points of the film or programme plus the critic’s own evaluation.  Similarly the two main objectives of a literature review are firstly the content covering existing research, theories and evidence, and secondly your own critical evaluation and discussion of this content. 

Usually a literature review forms a section or part of a dissertation, research project or long essay.  However, it can also be set and assessed as a standalone piece of work.

What is the purpose of a literature review?

…your task is to build an argument, not a library. Rudestam, K.E. and Newton, R.R. (1992) Surviving your dissertation: A comprehensive guide to content and process. California: Sage, p49.

In a larger piece of written work, such as a dissertation or project, a literature review is usually one of the first tasks carried out after deciding on a topic.  Reading combined with critical analysis can help to refine a topic and frame research questions.  Conducting a literature review establishes your familiarity with and understanding of current research in a particular field before carrying out a new investigation.  After doing a literature review, you should know what research has already been done and be able to identify what is unknown within your topic.

When doing and writing a literature review, it is good practice to:

  • summarise and analyse previous research and theories;
  • identify areas of controversy and contested claims;
  • highlight any gaps that may exist in research to date.

Conducting a literature review

Focusing on different aspects of your literature review can be useful to help plan, develop, refine and write it.  You can use and adapt the prompt questions in our worksheet below at different points in the process of researching and writing your review.  These are suggestions to get you thinking and writing.

Developing and refining your literature review (pdf)

Developing and refining your literature review (Word)

Developing and refining your literature review (Word rtf)

Writing a literature review has a lot in common with other assignment tasks.  There is advice on our other pages about thinking critically, reading strategies and academic writing.  Our literature review top tips suggest some specific things you can do to help you submit a successful review.

Literature review top tips (pdf)

Literature review top tips (Word rtf)

Our reading page includes strategies and advice on using books and articles and a notes record sheet grid you can use.

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The Academic writing page suggests ways to organise and structure information from a range of sources and how you can develop your argument as you read and write.

Academic writing

The Critical thinking page has advice on how to be a more critical researcher and a form you can use to help you think and break down the stages of developing your argument.

Critical thinking

As with other forms of academic writing, your literature review needs to demonstrate good academic practice by following the Code of Student Conduct and acknowledging the work of others through citing and referencing your sources.  

Good academic practice

As with any writing task, you will need to review, edit and rewrite sections of your literature review.  The Editing and proofreading page includes tips on how to do this and strategies for standing back and thinking about your structure and checking the flow of your argument.

Editing and proofreading

Guidance on literature searching from the University Library

The Academic Support Librarians have developed LibSmart I and II, Learn courses to help you develop and enhance your digital research skills and capabilities; from getting started with the Library to managing data for your dissertation.

Searching using the library’s DiscoverEd tool: DiscoverEd

Finding resources in your subject: Subject guides

The Academic Support Librarians also provide one-to-one appointments to help you develop your research strategies.

1 to 1 support for literature searching and systematic reviews

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A referencing management tool can help you to collect and organise and your source material to produce a bibliography or reference list. 

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Information Services provide access to Cite them right online which is a guide to the main referencing systems and tells you how to reference just about any source (EASE log-in may be required).

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There are a number of scholarship skills books and guides available which can help with writing a literature review.  Our Resource List of study skills guides includes sections on Referencing, Dissertation and project writing and Literature reviews.

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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . Fourth edition. Thousand Oaks, CA: SAGE, 2014.

Importance of a Good Literature Review

A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

  • Give a new interpretation of old material or combine new with old interpretations,
  • Trace the intellectual progression of the field, including major debates,
  • Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
  • Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.

Given this, the purpose of a literature review is to:

  • Place each work in the context of its contribution to understanding the research problem being studied.
  • Describe the relationship of each work to the others under consideration.
  • Identify new ways to interpret prior research.
  • Reveal any gaps that exist in the literature.
  • Resolve conflicts amongst seemingly contradictory previous studies.
  • Identify areas of prior scholarship to prevent duplication of effort.
  • Point the way in fulfilling a need for additional research.
  • Locate your own research within the context of existing literature [very important].

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper. 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . Los Angeles, CA: SAGE, 2011; Knopf, Jeffrey W. "Doing a Literature Review." PS: Political Science and Politics 39 (January 2006): 127-132; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012.

Types of Literature Reviews

It is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the primary studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally among scholars that become part of the body of epistemological traditions within the field.

In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews. Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are a number of approaches you could adopt depending upon the type of analysis underpinning your study.

Argumentative Review This form examines literature selectively in order to support or refute an argument, deeply embedded assumption, or philosophical problem already established in the literature. The purpose is to develop a body of literature that establishes a contrarian viewpoint. Given the value-laden nature of some social science research [e.g., educational reform; immigration control], argumentative approaches to analyzing the literature can be a legitimate and important form of discourse. However, note that they can also introduce problems of bias when they are used to make summary claims of the sort found in systematic reviews [see below].

Integrative Review Considered a form of research that reviews, critiques, and synthesizes representative literature on a topic in an integrated way such that new frameworks and perspectives on the topic are generated. The body of literature includes all studies that address related or identical hypotheses or research problems. A well-done integrative review meets the same standards as primary research in regard to clarity, rigor, and replication. This is the most common form of review in the social sciences.

Historical Review Few things rest in isolation from historical precedent. Historical literature reviews focus on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.

Methodological Review A review does not always focus on what someone said [findings], but how they came about saying what they say [method of analysis]. Reviewing methods of analysis provides a framework of understanding at different levels [i.e. those of theory, substantive fields, research approaches, and data collection and analysis techniques], how researchers draw upon a wide variety of knowledge ranging from the conceptual level to practical documents for use in fieldwork in the areas of ontological and epistemological consideration, quantitative and qualitative integration, sampling, interviewing, data collection, and data analysis. This approach helps highlight ethical issues which you should be aware of and consider as you go through your own study.

Systematic Review This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyze data from the studies that are included in the review. The goal is to deliberately document, critically evaluate, and summarize scientifically all of the research about a clearly defined research problem . Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?" This type of literature review is primarily applied to examining prior research studies in clinical medicine and allied health fields, but it is increasingly being used in the social sciences.

Theoretical Review The purpose of this form is to examine the corpus of theory that has accumulated in regard to an issue, concept, theory, phenomena. The theoretical literature review helps to establish what theories already exist, the relationships between them, to what degree the existing theories have been investigated, and to develop new hypotheses to be tested. Often this form is used to help establish a lack of appropriate theories or reveal that current theories are inadequate for explaining new or emerging research problems. The unit of analysis can focus on a theoretical concept or a whole theory or framework.

NOTE : Most often the literature review will incorporate some combination of types. For example, a review that examines literature supporting or refuting an argument, assumption, or philosophical problem related to the research problem will also need to include writing supported by sources that establish the history of these arguments in the literature.

Baumeister, Roy F. and Mark R. Leary. "Writing Narrative Literature Reviews."  Review of General Psychology 1 (September 1997): 311-320; Mark R. Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Kennedy, Mary M. "Defining a Literature." Educational Researcher 36 (April 2007): 139-147; Petticrew, Mark and Helen Roberts. Systematic Reviews in the Social Sciences: A Practical Guide . Malden, MA: Blackwell Publishers, 2006; Torracro, Richard. "Writing Integrative Literature Reviews: Guidelines and Examples." Human Resource Development Review 4 (September 2005): 356-367; Rocco, Tonette S. and Maria S. Plakhotnik. "Literature Reviews, Conceptual Frameworks, and Theoretical Frameworks: Terms, Functions, and Distinctions." Human Ressource Development Review 8 (March 2008): 120-130; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

Structure and Writing Style

I.  Thinking About Your Literature Review

The structure of a literature review should include the following in support of understanding the research problem :

  • An overview of the subject, issue, or theory under consideration, along with the objectives of the literature review,
  • Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
  • An explanation of how each work is similar to and how it varies from the others,
  • Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research.

The critical evaluation of each work should consider :

  • Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
  • Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
  • Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
  • Persuasiveness -- which of the author's theses are most convincing or least convincing?
  • Validity -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

II.  Development of the Literature Review

Four Basic Stages of Writing 1.  Problem formulation -- which topic or field is being examined and what are its component issues? 2.  Literature search -- finding materials relevant to the subject being explored. 3.  Data evaluation -- determining which literature makes a significant contribution to the understanding of the topic. 4.  Analysis and interpretation -- discussing the findings and conclusions of pertinent literature.

Consider the following issues before writing the literature review: Clarify If your assignment is not specific about what form your literature review should take, seek clarification from your professor by asking these questions: 1.  Roughly how many sources would be appropriate to include? 2.  What types of sources should I review (books, journal articles, websites; scholarly versus popular sources)? 3.  Should I summarize, synthesize, or critique sources by discussing a common theme or issue? 4.  Should I evaluate the sources in any way beyond evaluating how they relate to understanding the research problem? 5.  Should I provide subheadings and other background information, such as definitions and/or a history? Find Models Use the exercise of reviewing the literature to examine how authors in your discipline or area of interest have composed their literature review sections. Read them to get a sense of the types of themes you might want to look for in your own research or to identify ways to organize your final review. The bibliography or reference section of sources you've already read, such as required readings in the course syllabus, are also excellent entry points into your own research. Narrow the Topic The narrower your topic, the easier it will be to limit the number of sources you need to read in order to obtain a good survey of relevant resources. Your professor will probably not expect you to read everything that's available about the topic, but you'll make the act of reviewing easier if you first limit scope of the research problem. A good strategy is to begin by searching the USC Libraries Catalog for recent books about the topic and review the table of contents for chapters that focuses on specific issues. You can also review the indexes of books to find references to specific issues that can serve as the focus of your research. For example, a book surveying the history of the Israeli-Palestinian conflict may include a chapter on the role Egypt has played in mediating the conflict, or look in the index for the pages where Egypt is mentioned in the text. Consider Whether Your Sources are Current Some disciplines require that you use information that is as current as possible. This is particularly true in disciplines in medicine and the sciences where research conducted becomes obsolete very quickly as new discoveries are made. However, when writing a review in the social sciences, a survey of the history of the literature may be required. In other words, a complete understanding the research problem requires you to deliberately examine how knowledge and perspectives have changed over time. Sort through other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to explore what is considered by scholars to be a "hot topic" and what is not.

III.  Ways to Organize Your Literature Review

Chronology of Events If your review follows the chronological method, you could write about the materials according to when they were published. This approach should only be followed if a clear path of research building on previous research can be identified and that these trends follow a clear chronological order of development. For example, a literature review that focuses on continuing research about the emergence of German economic power after the fall of the Soviet Union. By Publication Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on environmental studies of brown fields if the progression revealed, for example, a change in the soil collection practices of the researchers who wrote and/or conducted the studies. Thematic [“conceptual categories”] A thematic literature review is the most common approach to summarizing prior research in the social and behavioral sciences. Thematic reviews are organized around a topic or issue, rather than the progression of time, although the progression of time may still be incorporated into a thematic review. For example, a review of the Internet’s impact on American presidential politics could focus on the development of online political satire. While the study focuses on one topic, the Internet’s impact on American presidential politics, it would still be organized chronologically reflecting technological developments in media. The difference in this example between a "chronological" and a "thematic" approach is what is emphasized the most: themes related to the role of the Internet in presidential politics. Note that more authentic thematic reviews tend to break away from chronological order. A review organized in this manner would shift between time periods within each section according to the point being made. Methodological A methodological approach focuses on the methods utilized by the researcher. For the Internet in American presidential politics project, one methodological approach would be to look at cultural differences between the portrayal of American presidents on American, British, and French websites. Or the review might focus on the fundraising impact of the Internet on a particular political party. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Other Sections of Your Literature Review Once you've decided on the organizational method for your literature review, the sections you need to include in the paper should be easy to figure out because they arise from your organizational strategy. In other words, a chronological review would have subsections for each vital time period; a thematic review would have subtopics based upon factors that relate to the theme or issue. However, sometimes you may need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. However, only include what is necessary for the reader to locate your study within the larger scholarship about the research problem.

Here are examples of other sections, usually in the form of a single paragraph, you may need to include depending on the type of review you write:

  • Current Situation : Information necessary to understand the current topic or focus of the literature review.
  • Sources Used : Describes the methods and resources [e.g., databases] you used to identify the literature you reviewed.
  • History : The chronological progression of the field, the research literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
  • Selection Methods : Criteria you used to select (and perhaps exclude) sources in your literature review. For instance, you might explain that your review includes only peer-reviewed [i.e., scholarly] sources.
  • Standards : Description of the way in which you present your information.
  • Questions for Further Research : What questions about the field has the review sparked? How will you further your research as a result of the review?

IV.  Writing Your Literature Review

Once you've settled on how to organize your literature review, you're ready to write each section. When writing your review, keep in mind these issues.

Use Evidence A literature review section is, in this sense, just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence [citations] that demonstrates that what you are saying is valid. Be Selective Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the research problem, whether it is thematic, methodological, or chronological. Related items that provide additional information, but that are not key to understanding the research problem, can be included in a list of further readings . Use Quotes Sparingly Some short quotes are appropriate if you want to emphasize a point, or if what an author stated cannot be easily paraphrased. Sometimes you may need to quote certain terminology that was coined by the author, is not common knowledge, or taken directly from the study. Do not use extensive quotes as a substitute for using your own words in reviewing the literature. Summarize and Synthesize Remember to summarize and synthesize your sources within each thematic paragraph as well as throughout the review. Recapitulate important features of a research study, but then synthesize it by rephrasing the study's significance and relating it to your own work and the work of others. Keep Your Own Voice While the literature review presents others' ideas, your voice [the writer's] should remain front and center. For example, weave references to other sources into what you are writing but maintain your own voice by starting and ending the paragraph with your own ideas and wording. Use Caution When Paraphrasing When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. Even when paraphrasing an author’s work, you still must provide a citation to that work.

V.  Common Mistakes to Avoid

These are the most common mistakes made in reviewing social science research literature.

  • Sources in your literature review do not clearly relate to the research problem;
  • You do not take sufficient time to define and identify the most relevant sources to use in the literature review related to the research problem;
  • Relies exclusively on secondary analytical sources rather than including relevant primary research studies or data;
  • Uncritically accepts another researcher's findings and interpretations as valid, rather than examining critically all aspects of the research design and analysis;
  • Does not describe the search procedures that were used in identifying the literature to review;
  • Reports isolated statistical results rather than synthesizing them in chi-squared or meta-analytic methods; and,
  • Only includes research that validates assumptions and does not consider contrary findings and alternative interpretations found in the literature.

Cook, Kathleen E. and Elise Murowchick. “Do Literature Review Skills Transfer from One Course to Another?” Psychology Learning and Teaching 13 (March 2014): 3-11; Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . London: SAGE, 2011; Literature Review Handout. Online Writing Center. Liberty University; Literature Reviews. The Writing Center. University of North Carolina; Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: SAGE, 2016; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012; Randolph, Justus J. “A Guide to Writing the Dissertation Literature Review." Practical Assessment, Research, and Evaluation. vol. 14, June 2009; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016; Taylor, Dena. The Literature Review: A Few Tips On Conducting It. University College Writing Centre. University of Toronto; Writing a Literature Review. Academic Skills Centre. University of Canberra.

Writing Tip

Break Out of Your Disciplinary Box!

Thinking interdisciplinarily about a research problem can be a rewarding exercise in applying new ideas, theories, or concepts to an old problem. For example, what might cultural anthropologists say about the continuing conflict in the Middle East? In what ways might geographers view the need for better distribution of social service agencies in large cities than how social workers might study the issue? You don’t want to substitute a thorough review of core research literature in your discipline for studies conducted in other fields of study. However, particularly in the social sciences, thinking about research problems from multiple vectors is a key strategy for finding new solutions to a problem or gaining a new perspective. Consult with a librarian about identifying research databases in other disciplines; almost every field of study has at least one comprehensive database devoted to indexing its research literature.

Frodeman, Robert. The Oxford Handbook of Interdisciplinarity . New York: Oxford University Press, 2010.

Another Writing Tip

Don't Just Review for Content!

While conducting a review of the literature, maximize the time you devote to writing this part of your paper by thinking broadly about what you should be looking for and evaluating. Review not just what scholars are saying, but how are they saying it. Some questions to ask:

  • How are they organizing their ideas?
  • What methods have they used to study the problem?
  • What theories have been used to explain, predict, or understand their research problem?
  • What sources have they cited to support their conclusions?
  • How have they used non-textual elements [e.g., charts, graphs, figures, etc.] to illustrate key points?

When you begin to write your literature review section, you'll be glad you dug deeper into how the research was designed and constructed because it establishes a means for developing more substantial analysis and interpretation of the research problem.

Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1 998.

Yet Another Writing Tip

When Do I Know I Can Stop Looking and Move On?

Here are several strategies you can utilize to assess whether you've thoroughly reviewed the literature:

  • Look for repeating patterns in the research findings . If the same thing is being said, just by different people, then this likely demonstrates that the research problem has hit a conceptual dead end. At this point consider: Does your study extend current research?  Does it forge a new path? Or, does is merely add more of the same thing being said?
  • Look at sources the authors cite to in their work . If you begin to see the same researchers cited again and again, then this is often an indication that no new ideas have been generated to address the research problem.
  • Search Google Scholar to identify who has subsequently cited leading scholars already identified in your literature review [see next sub-tab]. This is called citation tracking and there are a number of sources that can help you identify who has cited whom, particularly scholars from outside of your discipline. Here again, if the same authors are being cited again and again, this may indicate no new literature has been written on the topic.

Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: Sage, 2016; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

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What is a Literature Review?

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

A literature review should: 

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

From  S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

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For help 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.

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  • Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

You can also search for this author in PubMed   Google Scholar

Literature reviews are important resources for scientists. They provide historical context for a field while offering opinions on its future trajectory. Creating them can provide inspiration for one’s own research, as well as some practice in writing. But few scientists are trained in how to write a review — or in what constitutes an excellent one. Even picking the appropriate software to use can be an involved decision (see ‘Tools and techniques’). So Nature asked editors and working scientists with well-cited reviews for their tips.

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Correction 09 December 2020 : An earlier version of the tables in this article included some incorrect details about the programs Zotero, Endnote and Manubot. These have now been corrected.

Hsing, I.-M., Xu, Y. & Zhao, W. Electroanalysis 19 , 755–768 (2007).

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Ledesma, H. A. et al. Nature Nanotechnol. 14 , 645–657 (2019).

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Brahlek, M., Koirala, N., Bansal, N. & Oh, S. Solid State Commun. 215–216 , 54–62 (2015).

Choi, Y. & Lee, S. Y. Nature Rev. Chem . https://doi.org/10.1038/s41570-020-00221-w (2020).

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Determine Your Research Question

Refine your research topic to an answerable question that is innovative, clearly defined, and focused on problem resolution. Your question should include distinct concepts for analysis and not be too broad or too narrow in scope. Learn more about frameworks that help refine evidence-based clinical questions in " Formulating Answerable Questions: Question Negotiation in Evidence-based Practice .”

Evidence-based frameworks can help map your medical research question. Segment the topic into concepts, and then assign associated terms to each concept. Combine each concept into a literature search strategy for database entry.

PICO (Population/Patient, Intervention, Comparison, Outcome) is a popular framework for research in medicine.

PICO Example :  What are the effects of low sodium diet on preeclampsia and hypertensive disorders in pregnant women?

Population/Patient : pregnant women

Intervention/Indicator : low sodium diet

Comparison/Control : routine care or minimal interventions

Outcome : preeclampsia, hypertensive disorders

Learn more about PICO and other models for framing the research question in related disciplines in “ Formulating the Evidence Based Practice Question: A Review of the Frameworks .”

Once you have established an answerable research question, determine your question’s research need. Does your question address a "gap" within the literature? Does it address a larger societal impact or importance? If not, you may have to formulate a new or modified question.

To assess your topic’s research need, conduct a preliminary literature search in at least one appropriate database. Based on search results, refine your topic by either addressing a related unanswered question, choosing another population, or shifting to another topic altogether.

To master formulating a clinical question using PICO, as well as review how to search for and appraise evidence to answer the question, visit the Maguire Medical Library's  PICO: Form a Focused Clinical Question subject guide.

Conduct a Preliminary Literature Review

A literature review is an overview that may range from an informal survey of the literature to a comprehensive review published for clinical decision support.  

Select a Database

Consider your topic’s discipline (medicine, nursing, biology, public health, interdisciplinary, etc.), typical publication format (journals, books, conference proceedings, images, etc.), as well as the publication years and indexed journals included in each database. 

Subject-specific Databases for the Health Sciences

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Interdisciplinary Databases on Multiple Subjects

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Find more subject-specific and interdisciplinary databases

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Learn Advanced Literature Searching Techniques

  • Advanced Literature Searching in the Health Sciences Learn the fundamental components of advanced literature searches for professionals and researchers in the health sciences. This course will help you improve the quality and reporting of literature searches for projects that rely on past research. Developed by the Taubman Health Sciences Library, University of Michigan

Type of Research Articles

  • Original Scientific Research Articles
  • Case Reports
  • Narrative Reviews
  • Rapid Reviews
  • Systematic Reviews
  • Meta-analyses
  • New England Journal of Medicine Author Center: Article Types Example of how journals define their publication criteria, including types of articles and their specifications.
  • A typology of reviews: an analysis of 14 review types and associated methodologies Can help researchers decide on the type of review to publish before initiating the literature search process; presents options other than systematic reviews that may be appropriate for a researcher's schedule and resources.
  • The CRAAP Test From the Meriam Library, CSU, Chico; list of questions to evaluate information for currency, relevance, authority, accuracy and purpose.

Manage Your References

Reference management tools can help you keep track of, share and organize articles, books, and other references as you conduct research for your paper or other publication. These tools also give you the ability to format your references according to the style required by the publisher.

The FSU College of Medicine supports the reference management tool EndNote for its students, staff and faculty.

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Covidence is a systematic review management tool, but it can be used for any type of literature review. Covidence users can collect references from multiple databases and invite team members to screen titles, abstracts, and full text articles for a literature review. 

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Annotated Bibliographies

An annotated bibliography is a list of proposed references and evaluative summaries on a specific topic, usually created as a precursor to preparing a presentation or writing a paper.

Reading and evaluating reference sources, such as journal articles, will help you choose which references to include in your annotated bibliography. Ideally, the chosen references will fully address your topic.

To create the bibliography, provide a description of approximately 150 words on the content of each reference. The goal is to give your readers enough information of the relevance, accuracy, and quality of the sources you have cited.

  • Annotated Bibliography Examples Written by FSU medical students and used with their permission
  • How to Prepare an Annotated Bibliography From Cornell University Library; includes details about the process of creating an annotated bibliography, as well as two samples
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Q. What is a scholarly literature review? How can I find one?

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Answered By: APUS Librarians Last Updated: Sep 21, 2022     Views: 67879

What is a literature Review?  

A literature review is a  written summary of the existing published research  on a topic.    A literature review can be brief (a section in a larger article) or it can be an entire article unto itself.   The purpose of a literature review is to provide an overview of the current knowledge on a topic, and/or to provide a context for new research.

Click here to see a table that lists the various kinds of literature reviews  that you may encounter in your research. (From Grant, M. J. and Booth, A. (2009),  A typology of reviews: an analysis of 14 review types and associated methodologies .  Health Information & Libraries Journal , 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x)

To find the literature review section in a scholarly article:

  • Scholarly publications (especially peer reviewed articles) will always include at least a brief literature review in their introduction and discussion sections.  Click here to learn how to find scholarly or peer reviewed articles.
  • Introduction
  • Literature Review
  • Survey of the Literature
  • Review of the Literature
  • Use keywords to narrow your search to literature reviews.  For example:
  • motor learning AND literature review
  • motor learning AND systematic review
  • A few databases will let you limit your search to literature reviews only . You'll typically find this "document type" or "publication type" option in the database's advanced search options.

Here are examples from two popular databases (EBSCO and ProQuest):

See also:  

  • What's the difference between a research article (or research study) and a review article?
  • How do I write a literature review?
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ENGL 127 Research Writing: Social Sciences

What is scholarly literature.

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Features of Scholarly Literature

  • Written by scholars and subject experts
  • Written for other scholars, professionals. and policy makers. Also read by student researchers
  • It reflects a specific discipline or interdisciplinary field, such as sociology, history, gender studies, etc.
  • Literature reviews, for example, give an overview of the body of research on a specific topic.
  • Original research studies, on the other hand, present original research findings in a field.
  • Theoretical articles offer original analysis.
  • Research studies aim to be transparent. They outline the purpose of the study, the methodology, findings, and conclusions. One of the goals of a research study is that it be reproduceable so that its conclusions may be verified.
  • Scholarship is usually, though not always, lengthy, and it engages with issues at a more substantial level than magazine articles.
  • Scholarship in the social sciences will include an extensive list of References at the end of the work, and comprehensive in-text citations throughout for all claims made in the body of the article.
  • Scholarship is published in scholarly journals and in books generally from university presses.
  • The purpose of a body of scholarship on a subject is to advance our knowledge and understanding in that field.

What can you ask to determine if a source is scholarly?

When you are determining whether or not the article you found is a peer-reviewed article, you should consider the following.

(Click on image to enlarge) 

This is an image showing parts of a scholarly journal highlighted, such as the authors and their credentials, the serious tone and in-depth coverage of the topic and various sections like an abstract, data, methods, discussions, and references

Also consider...

  • Is the journal in which you found the article published or sponsored by a professional scholarly society, professional association, or university academic department? Does it describe itself as a peer-reviewed publication? (To know that, check the journal's website). 
  • Did you find a citation for it in one of the  databases that includes scholarly publications? (Academic Search Complete, PsycINFO, etc.)?  Read the database description to see if it includes scholarly publications.
  • In the database, did you limit your search to scholarly or peer-reviewed publications? (See video tutorial below for a demonstration.)
  • Is the topic of the article narrowly focused and explored in depth?
  • Is the article based on either original research or authorities in the field (as opposed to personal opinion)?
  • Is the article written for readers with some prior knowledge of the subject?
  • Introduction
  • Theory or Background
  • Literature review

What is the peer review process?

In academic publishing, the goal of peer review is to assess the quality of articles submitted for publication in a scholarly journal. Before an article is deemed appropriate to be published in a peer-reviewed journal, it must undergo the following process:

  • The author of the article must submit it to the journal editor who forwards the article to experts in the field. Because the reviewers specialize in the same scholarly area as the author, they are considered the author’s peers (hence “peer review”).
  • These impartial reviewers are charged with carefully evaluating the quality of the submitted manuscript.
  • The peer reviewers check the manuscript for accuracy and assess the validity of the research methodology and procedures.
  • If appropriate, they suggest revisions. If they find the article lacking in scholarly validity and rigor, they reject it.

Because a peer-reviewed journal will not publish articles that fail to meet the standards established for a given discipline, peer-reviewed articles that are accepted for publication exemplify the best research practices in a field.

Attribution: Much of the information about the  the peer-review process  was used with permission from the awesome librarians at the  Lloyd Sealy Library at the John Jay College of Criminal Justice .

Source: "Peer Review in 3 Minutes" by libncsu , is licensed under a Standard YouTube License.

Identifying common elements in a journal article

Look through the images and notes below to learn more about the various parts common to a scholarly article

The Citation information: Authors, Article title, Journal information and Abstract

  • As shown in the image below, much of the citation information about the article appears on the first page. Here we see the title of journal, page numbers, and the publication date.
  • Multiple authors are common in search and they usually include academic affiliations that are listed just near the authors' names, as shown in this image, or as a footnote at the bottom of the page. 
  • Also on the first page, you can often see the abstract to the article, which is common.

The Abstract:

Read the abstract to determine if an article will be relevant, helpful, and comprehensible.

The abstract is more than a summary. It maps out the article with a brief overview of each section. The abstract may present the article's claim, purpose, methodology, and conclusions. 

review of scholarly literature

In-Text Citations

  • As show in the image of the article text below, you can see that in-text citations are common. This article also shows the contact information for the main author. 

(click on image to enlarge)

review of scholarly literature

The Methodology:

If the article is a research study, the article will include the methodology and findings. 

The methodology lays out how the study was done. Check to see if the study was conducted with many or few subjects, over a long or short period of time, if subjects represent a broad or narrow cross-section of stakeholders, and if controls make results reliable.

review of scholarly literature

The Results:

The results section presents the raw data gathered in the study. Seeing the data helps one determine if the conclusions are supported by the data.

review of scholarly literature

Data set up for comparison - Tables and Charts:

review of scholarly literature

The Discussion & Conclusion:

review of scholarly literature

The References:

The references section of scholarly articles (and books) document the works upon, and sometimes against, which the current study was conducted. 

Use the references section as a research tool and "mine it" for relevant works you might look for.

review of scholarly literature

Click on images to enlarge

Open the full articles linked below for a hands-on exploration of differences between popular and scholarly texts.

  • A Balanced Life: How One Mom Finds Time for Work and Life Learning Magazine article by Vanessa Sheets, Natural Life, May/June 2009
  • Well-balanced families?: A gendered analysis of work-life balance policies and work family practices

Video: How Library Stuff Works: Scholarly vs Popular Sources

Source: "How Library Stuff Works: Scholarly vs. Popular Sources" by McMaster Libraries , is licensed under a Standard YouTube License.

Video: What is Peer-Review?

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" Literature reviews survey research on a particular area or topic in [a field of study]. Their main purpose is to knit together theories and results from multiple studies to give an overview of a field of research ."

Published literature reviews are called review articles, however, research articles contain brief literature reviews at the beginning to give context to the study within that article. A literature review's purpose is two-fold: to describe and compare studies in an area of research and to evaluate those studies. You will need both in a well-done literature review understanding that the ability to understand and compare the current research is necessary before you can evaluate it.

At the heart of any thorough literature review lies the engagement with diverse source materials. Beyond simply absorbing the content, meticulous and organized note-taking emerges as a critical skill, enabling the synthesis of key insights, the formulation of probing questions, the evaluation of each source's merit, and the ability to create correct citations to avoid plagiarism. Executed effectively, this note-taking practice becomes the cornerstone of a streamlined and efficient research process.

By mastering this note-taking technique, you can significantly streamline the research process, fostering a clear and well-organized framework for your literature review.

The Literature Review matrix is a great resource. You can download the PDF or use the Excel spreadsheet to capture all of the necessary information and organize your notes (and thinking).

[Literature Review Matrix created by: McLean, Lindsey. "Literature Review." CORA (Community of Online Research Assignments), 2015. https://www.projectcora.org/assignment/literature-review.]

  • Literature Review Matrix Excel
  • Literature Review Matrix PDF

Literature : a collection of materials on your topic.  (does not mean “literature” in the sense of “language and literature”  (To Kill a Mockingbird, Jane Eyre, etc.)    —means understanding the difference between primary, secondary and tertiary literature  Primary—peer reviewed, scholarly, original, review articles—secondary

Review : to look again at what has been written. (does not mean giving your personal opinion or whether or not you liked the sources.) 

Research : to search again.  

The narrower the topic the easier it will be to limit the number of sources you need to read.

 A Literature Review is a select list of available resources covering the topic in question accompanied by a short description AND a critical comparative evaluation/analysis of the works included  http://www.library.arizona.edu/help/tutorials/litreviews/whatis.html  

  • an integral part of the scientific process
  • reveals whether or not a research question has been answered by someone else

Major points to consider

  • Thematic -- defined by a guiding question or concept
  • Descriptive
  • Directly relevant
  • Highly selective, narrowly focused
  • May include all scholarly formats including government documents; book reviews; films; selected websites; scholarly open source journals
  • Usually includes a thesis statement/narrowly focused research question, summary and/or synthesis of the ideas encountered. (synthesis=reorganization of information of what is known, what is yet to be discovered  

*Expect that your work will be traced by readers.

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Issue Cover

Article Contents

Introduction, changes in global population: patterns of fertility, infertility prevalence and determinants, infertility awareness and prevention, access to fertility care, working toward equitable access to fertility care, conclusions, call to action, data availability, acknowledgements, authors’ roles, conflict of interest.

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Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature

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Bart C.J.M. Fauser and G. David Adamson are co-first authors.

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Bart C J M Fauser, G David Adamson, Jacky Boivin, Georgina M Chambers, Christian de Geyter, Silke Dyer, Marcia C Inhorn, Lone Schmidt, Gamal I Serour, Basil Tarlatzis, Fernando Zegers-Hochschild, Contributors and members of the IFFS Demographics and Access to Care Review Board , Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature, Human Reproduction Update , Volume 30, Issue 2, March-April 2024, Pages 153–173, https://doi.org/10.1093/humupd/dmad028

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Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature.

The concept of family building , the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies.

A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached.

Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society.

Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.

Declining fertility rates globally focus attention on the human right to build a family and the need for family-friendly policies and more accessible fertility care. LBGTQ, lesbian, gay, bisexual, transgender, queer, asexual, questioning.

Declining fertility rates globally focus attention on the human right to build a family and the need for family-friendly policies and more accessible fertility care. LBGTQ, lesbian, gay, bisexual, transgender, queer, asexual, questioning.

For over half a century, family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone desired pregnancies and, in some countries, terminate unwanted pregnancies. Additionally, many policies were driven by the goal to reduce population growth because of concerns that overpopulation would result in overcrowding, poor sanitation, disease epidemics, famine, war, massive migrations, increasing human inequality, and environmental damage that would bring about human apocalypse ( Scott, 2022 ). This approach to family planning has contributed significantly to slowing population growth in many parts of the world. The global population is anticipated to peak at 9.7 billion around the year 2064, followed by a steady decline ( Bongaarts, 1994 ; Vollset et al. , 2020 ). Family planning has also facilitated economic development, increasing levels of education, the empowerment of women to pursue educational and career opportunities and has helped alleviate environmental consequences of an increasing global population. And while most would agree that draconian forced sterilization and other measures that occurred in many countries are no longer necessary, there are still legitimate and compelling arguments that human population growth creates existential risks to humanity ( Van Bavel, 2013 ; Lidicker, 2020 ; Wilmoth et al. , 2022 ).

Within this context, it is now recognized that the total fertility rate (TFR), defined as the number of children born per woman living to the end of childbearing years (15–49 years), has been decreasing dramatically for decades in many countries. By 2050 and 2100, respectively, 77% of predominantly high-income countries and 93% of all countries will have a TFR below the replacement level of 2.1 children per woman. Not including the effects of migration, many countries are predicted to have a population decline of more than 50% from 2017 to 2100 ( Vollset et al. , 2020 ; Dao et al. , 2021 ). This evolution of the world population will cause demographic changes with profound societal implications. The dramatically increasing ratio between elderly people and young adults already affects historical social norms concerning education, marriage, and care of the elderly, with major economic ramifications ( Mester, 2018 ). The ongoing trend of having fewer children may be irreversible and even accelerating ( Aitken, 2022 ).

The decreasing TFR can potentially impact societies in multiple ways, some advantageous, and some disadvantageous ( Qiao et al. , 2021 ). Population growth magnifies the harmful impact of economic processes on the environment; yet the rise in per capita income has been more important than population growth in driving increased production and consumption ( Götmark et al., 2018 ; Dodson et al. , 2020 ; Wilmoth et al., 2022 ). Increased resources for improving maternal and child health care can be offset by the impact of delayed childbearing on fertility, maternal health, and poorer pregnancy outcomes ( Balasch and Gratacos, 2012 ; Schmidt et al. , 2012 ). Maternal and child health can be improved if each child has access to more resources and parental time, but potentially negatively if many children have no siblings ( Fall et al. , 2015 ). Smaller families and delayed parenting will impact many social norms and activities ( Canning and Schultz, 2012 ; Schmidt et al. , 2012 ). Aging populations will require increased healthcare and pension costs at the same time there are fewer workers producing the wealth to support them, let alone provide the taxes to sustain other social welfare systems—including their own retirement funds—and grow economies. Countries will have to consider policies that address work-life balance, affordable childcare, and parental leave. Different TFRs among countries will promote immigration and emigration with important consequences for all countries, including increased political and social friction ( Vollset et al. , 2020 ). All these changes will create changing attitudes and ethical challenges with respect to cultural and societal values and norms of parenthood, gender roles, and gender equality. Different age groups will likely disagree on their proportionate contributions to society. The declining TFR will also raise questions about an individual’s reproductive rights relative to the needs of society ( Mburu et al. , 2023 ).

The optimal number of children per woman may be perceived differently in various countries, depending on cultural norms, economic status, existing TFR, population demographic distribution, and migration (Organization for Economic Cooperation and Development, OECD Family Database, SF2.2, 2016). Regardless of these differences, the overall decreasing fertility rate worldwide is of growing concern. In attempts to address these trends, an increasing number of countries have implemented child-friendly policies: mainly financial incentives, such as compensation for extended pregnancy leave, financial benefits related to childbirth, maternity and paternity leave, child tax deduction or credit strategies, and compensation for childcare.

Despite this entirely changed paradigm of population growth, the concept of family building (the process by which individuals or couples create or expand their families) has, until recently, been largely ignored in family-planning paradigms ( Ziebe and Devroey, 2008 ; Seifer et al. , 2015 ; Bakkensen and Goldman, 2022 ). Not only the general public but also health care professionals could benefit from (inter)national education programs for young adults to increase family-building awareness and improve reproductive life decisions.

While the global decline in fertility rate is due to multiple societal and environmental changes, it is important to emphasize that globally between 48 million couples and 186 million individuals of reproductive age live with infertility ( World Health Organization, 2020 ; Cox et al. , 2022 ). Infertility is a common chronic disease affecting many reproductive-age women and men and represents a major life burden, causing anxiety, depression, relationship dysfunction, and social marginalization ( World Health Organization, 2020 ). Major advances in infertility care, especially through ART, have dramatically improved family-building opportunities for infertile and fertile people over the last three decades in both developed and developing countries. Although up to 10% of all children are born as a result of infertility therapies in some wealthy countries, great variation in access to care can be observed ( DeWeerdt, 2020 ; Chiware et al. , 2021 ; Choi et al. , 2022 ). The high cost to patients of infertility treatment renders it unaffordable for most, particularly those in low- and middle-income countries (LMICs) ( Karaga et al. , 2023 ). Therefore, access to fertility care remains a major challenge and disproportionately impacts opportunities for family building globally. Currently, the overall contribution of fertility care to the global TFR is relatively small because access to fertility care globally is very limited.

Public funding of fertility treatment has occurred in a limited number of countries with the aim to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country ( Fig. 1 ), and many barriers remain for the inclusion of fertility care in reproductive health policies, especially in LMICs (Organization for Economic Cooperation and Development, OECD Social Expenditure Database; Ethics Committee of the American Society for Reproductive Medicine, 2021; Afferri et al. , 2022 ). Moreover, distinct inconsistencies in regulations, the availability and funding of infertility treatment options and the involvement of patients have recently been described by the patient organization ‘Fertility Europe’ for various European countries ( Fig. 2 ) ( Atlas of Fertility Treatment Policies in Europe, 2021 ).

Public spending on child benefits by type of expenditure as percentage of GDP, 2017. GDP, gross domestic product; EU, European Union. Reprinted with permission from Organization for Economic Cooperation and Development. http://www.oecd.org/social/expenditure.htm.

Public spending on child benefits by type of expenditure as percentage of GDP, 2017. GDP, gross domestic product; EU, European Union. Reprinted with permission from Organization for Economic Cooperation and Development. http://www.oecd.org/social/expenditure.htm .

Infertility friendly treatment policies vary among countries in Europe. Published online at Atlas of fertility treatment policies in Europe—Fertility Europe. Reprinted with permission, Atlas of Fertility Treatment Policies in Europe. EFP, European Parliament Forum. https://fertilityeurope.eu/atlas/#:∼:text=Fertility%20Europe%20in%20conjunction%20with%20the%20European%20Parliamentary,The%20Atlas%20describes%20the%20current%20situation%20in%202021.

Infertility friendly treatment policies vary among countries in Europe. Published online at Atlas of fertility treatment policies in Europe—Fertility Europe. Reprinted with permission, Atlas of Fertility Treatment Policies in Europe. EFP, European Parliament Forum. https://fertilityeurope.eu/atlas/#:∼:text=Fertility%20Europe%20in%20conjunction%20with%20the%20European%20Parliamentary,The%20Atlas%20describes%20the%20current%20situation%20in%202021 .

Infertility has historically been defined as the inability to become pregnant within at least 1 year of regular unprotected intercourse in heterosexual couples who desire to have a child. For the past half-century concerns regarding global overpopulation have frequently led to the contention that infertility treatments should have a low priority because they promote population growth and, as a result, support for fertility care has often been opposed. Such perspectives and actions give rise to inequality, injustice, and discrimination ( Pennings, 2008 ; Gerrits et al. , 2017 ; Ombelet and Goossens, 2017 ). Such a view requires that couples or individuals who wish to have a child—who already suffer from the distinct burden of the disease—bear a disproportionate responsibility for reducing world population growth. Social policy should be equitable for all members of society, and any approach to population growth that places undue responsibility on people who wish to establish a family contravenes the principle of social justice. The same infertility treatments initially developed to treat infertile heterosexual couples are now also increasingly used to help single persons and lesbian, gay, bisexual, transgender, intersex, queer/questioning (LGBTQ+) persons so they can realize their desire to have a child. In this context, these broader scope interventions, which include fertility awareness, support, and fertility management with an intention to assist individuals and couples to realize their desires associated with reproduction and/or to build a family, are defined as fertility care ( Zegers-Hochschild et al. , 2017 ). Infertility treatment is a subset of fertility care.

In addition to the need to improve access to fertility care to mitigate the personal burden of this disease, social justice mandates that people wanting to found a family have a right to do so (United Nations (UN), https://www.ohchr.org/en/human-rights/universal-declaration/translations/english ). This right applies to couples or individuals who wish to have a first or subsequent child. Fertility is an important component of strong societal trends regarding the need to address diversity, equity, inclusion and social determinants of health. The inability to access fertility care disproportionately affects women and minorities ( World Health Organization, 2020 ). Societal trends in many countries encourage access for those in the LGBTQ+ community, single people, and those needing to use third-party reproduction (donor sperm, eggs, embryos, or surrogacy). Thus, providing access to fertility care is important for social justice. Furthermore, preliminary studies point to the increasing contribution of fertility care to the overall population and the economic benefits for society that result from every new person born from fertility care ( Connolly et al. , 2008 , 2009 , 2021 ; Leridon and Slama, 2008 ; Habbema et al. , 2009 ; Faddy et al. , 2018 ).

This article aims to provide global perspectives that support the need to harmonize family planning with family building: comparing patterns and determinants of TFR, societal and economic implications of a decreasing population, the prevalence and burden of infertility, societal trends impacting fertility care, fertility awareness and infertility prevention, economic and social justice aspects of access to fertility care, and policy recommendations that will benefit both individuals and society. More than ever, today the implementation of public policies needs to balance both the need of the individual and society.

Recommendations are provided, and important knowledge gaps identified, to provide professionals, the public, and policymakers a comprehensive understanding of the role of child friendly policies, including fertility care, in the context of the global trend of decreasing fertility rates. Hopefully, this will facilitate the formulation, now and in the future, of more effective family-building policies that are harmonized with family planning.

This article presents the IFFS consensus after a narrative review of the existing literature performed by global leaders who themselves have contributed significantly to the research in this field. These peers were selected by IFFS based on their scholarly publications, academic accomplishments, professional leadership roles, and reputation in respective areas of interest. Each section of the review was prepared by two to three of these experts, each of whom searched the published literature (PubMed), drawing upon decades of professional expertise, and academic accomplishment. Only peer reviewed full papers and reviews were included (if useful, we also refer to website of relevant global organizations), and searches were performed and updated until September 2023. The following keywords were used: world population growth, underpopulation, family planning, family building, fertility, infertility, fertility care, ART, LGBTQ (Introduction and Conclusion sections); world population, TFR, fecundity, fertility, maternal age, childbirth (global population paragraph section); infertility, infertility prevalence, population-based studies, reviews (infertility prevalence section); age-related fertility decline, fertility awareness, education, infertility risk (infertility awareness section); access to care, ART, ART utilization, fertility care (access to fertility care section), fertility care, access to care, affordability, health economics, and gender equality (equitable access section).

Multiple drafts were circulated electronically among each section’s team members for comment and editing. All sections were discussed monthly by all authors (January 2021–July 2022) and quarterly by the review board (July 2021–July 2022). Text was modified and distributed where needed based on these discussions until full agreement was reached by all participants. Repeated discussion also involved the overall scope of the paper, and the order in which the various topics were presented. The final document was prepared following discussions among all team members during a hybrid invitational 2-day meeting organized in Amsterdam, May 2022, where full consensus was reached. The final document was approved by all authors and members of the review board.

Assuming no net migration and unchanged mortality, a TFR of around 2.1 children per woman is the replacement level often cited for broad population stability (UN, Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, 2011). Between 1990 and 2021, global TFR dropped from 3.3 to 2.3 ( Table 1 ) ( United Nations, 2022 ). Factors affecting the TFR decline include changes in lifestyle choices, education levels, discrimination against women, and inadequate support of working parents ( D’Addio and d’Ercole, 2005 ). The declining global fertility rate has not been uniformly distributed ( United Nations, 2022 ) ( Table 2 ).

Trends in total fertility rate 1975–2021. a

United Nations (2022) .

More developed regions comprise Europe, Northern America, Australia/New Zealand, and Japan.

Less developed regions comprise all regions of Africa, Asia (excluding Japan), Latin America and the Caribbean plus Melanesia, Micronesia, and Polynesia.

The least developed countries (n = 48): 33 in Africa, 9 in Asia, 5 in Oceania; 1 in Latin America and the Caribbean. Total fertility rate (TFR) is also negatively correlated with the capacity of women to make their own reproductive decisions. It is difficult to isolate the freedom to exercise reproductive choice from other largely accepted cultural and religious reasons whereby women ‘voluntarily’ refrain from using contraceptives and place enormous value on having many children. Economic circumstances can modulate the desire to have children in different ways. For example, the TFR in some low- and middle-income countries that are economically restricted (e.g. Cuba) or emerging economies (e.g. Chile, Uruguay) has decreased to around 1.6; in Latin America, TFR decreased from 5.86 in 1950–1955 to 2.04 in 2022. Similar declines have taken place in most African countries. However, in most countries in Eastern, Western, and Central Africa the TFR remains extremely high (> 4.5) ( Table 2 ) ( Central Intelligence Agency, The World Factbook: Field Listing—Total Fertility Rate, 2022 ). Some high-income countries have experienced a slight rebound in their TFR, partly because of childcare friendly policies ( Organization for Economic Cooperation and Development, 2009 ; De Geyter et al. , 2020 ; UNFPA, 2022 ).

High total fertility rate in selected African countries (estimates, 2022). a

Central Intelligence Agency The World Factbook: Field Listing—Total Fertility Rate 2022 .

TFR, total fertility rate.

TFR refers to the average number of births per woman. Men’s fertility rate has received little attention, yet is similar or lower compared to women’s ( Schoumaker, 2017 ). Both similar and dissimilar factors affect the male fertility rate, including the higher male-to-female population, age when pregnancy occurs, registration rate of the father at birth, and biomedical factors ( Dudel and Klusener, 2019 ). Some evidence suggests that decreased male fertility is due to an annual decline of 1.4% in sperm concentration and 1.6% in total sperm count, although the impact on TRF is yet unknown ( Levine et al. , 2017 ; Jørgensen et al. , 2021 ; Levine et al. , 2023 ). Decreased male fertility has been associated with an increased disease burden including heart disease, cancer, and early death ( Kasman et al. , 2020 ). Moreover, both male and female reproductive health is deteriorating, especially in industrialized regions, suggesting important roles of environmental factors, such as endocrine-disrupting chemicals and pesticides, in causing the observed decline in fertility ( Le Moal et al., 2016 ; Skakkebæk et al. , 2022 ).

Fertility decline initially results in more working-age adults relative to children, potentially leading to accelerated economic growth and a temporary ‘demographic dividend’ ( Starrs et al. , 2018 ). However, in countries with fertility rates below the replacement level, a different population pyramid with more elderly people and fewer working adults will eventually occur. An increasing number of countries have implemented policies, including improved access to infertility treatments, aiming to increase their fertility rate, restore the demographic pyramid, and increase the working age group’s positive economic impact ( De Geyter et al. , 2020 ; Central Intelligence Agency, The World Factbook: Field Listing—Total Fertility Rate, 2022 ). Nevertheless, globally fertility care currently generates little impact on the fertility rate since most countries, especially LMICs irrespective of their TFR, do not have equitable and universal access to treatments—especially ART ( Inhorn and Patrizio, 2015 ; Chiware et al. , 2021 ; Duffy et al. , 2021 ; Brodeur et al. , 2022 ; Karaga et al. , 2023 ).

Another factor responsible for lowering TFR is that many women in both developed and LMICs are delaying first birth and having children at an older age when there is a natural decline in fecundity (defined as the capacity to have a live birth). Therefore, later marriage and older age when attempting pregnancy increase the risk of infertility. UN statistics demonstrate that the average age of women at first childbirth has increased by ∼1 year per decade since 1970 in developed countries (Organization for Economic Cooperation and Development, OECD Family Database SF2.3). Furthermore, there is immense variation in maternal age at first childbirth depending on the country and region. Nineteen countries, mainly in central and west Africa, still have a mean age of women at first childbirth of under 20 years, compared with only one country in the Americas and none in Asia and Europe. On the other hand, the mean age of mothers at first childbirth in 35 countries in Europe and Asia is ≥28 years ( Central Intelligence Agency, Field Listing—Mother’s Mean Age at First Birth, 2022 ).

The National Survey of Family Growth reported 1-year infertility rates increased from 6% for women younger than 24 years of age to over 30% at ages 35–44 years ( Abma et al. , 1997 ). Mean monthly probability of pregnancy leading to live birth remains optimal until age 31 years. Relative fertility is decreased by about half at age 40 years compared with women in their late 20s and early 30s, the time of peak fertility ( Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Reproductive Endocrinology and Infertility, 2022 ). The average age at last childbirth in the general population is 40–41 years ( ESHRE Capri Workshop Group, 2010 ). Postponing childbearing contributes to fertility decline, having fewer children than desired or no children at all, increased need for infertility treatment, and increased morbidity and costs for both mothers and children, delivery, and post-birth ( Luke and Brown, 2007 ).

Environmental and lifestyle factors, such as smoking, excessive alcohol intake, obesity, and poor nutrition, can negatively affect both male and female fertility. Exposure to environmental pollutants, such as endocrine-disrupting chemicals, and toxicants, such as pesticides, can be directly deleterious to gametes (oocytes and spermatozoa), resulting in decreased numbers and quality, and subsequent infertility ( Gore et al. , 2015 ; Segal and Giudice, 2019 ; World Health Organization, 2021 ; Skakkebæk et al. , 2022 ; Giudice et al. , 2023 ). In addition, infertility, especially secondary, is more prevalent in areas with a high incidence of sexually transmitted infection (STI). In 2016 chlamydia, gonorrhea, syphilis, and trichomoniasis accounted for an estimated 376 million new infections worldwide ( Rowley et al. , 2019 ). Left untreated, pelvic inflammatory disease will result in infertility in one-quarter of people ( World Health Organization, 2008 ). Especially in LMICs, tubal disease with ensuing infertility also arises from complications of unsafe abortion, postpartum sepsis, pelvic tuberculosis, bilharzial salpingitis, and iatrogenic tubal obstructions ( Serour et al. , 1988 ; Scholes et al. , 1996 ; Tsevat et al. , 2017 ).

Factors associated with decreased TFR in the male and female vary globally. Major factors are socioeconomic, cultural, religious, educational, gender equity, and environmental ( Nargund, 2009 ; Population Reference Bureau, 2021 ; Skakkebæk et al. , 2022 ; World Economic Forum, 2022 ). Other factors include infertility prevalence, insufficient fertility knowledge and awareness, and limited access to care (including heterosexual couples, same-sex couples, single women and men, and transgender individuals). The use of donor eggs, sperm, embryos, and surrogacy has made it possible for these persons/couples to access treatment, including ART. The demographic impact of these new family forms, along with fertility preservation to postpone childbearing, is yet unknown.

In the last two decades, there has been a moderate recovery of fertility rates in some developed countries in Europe: e.g. Sweden from 1.54 to 1.67. Trends in other countries can be observed in Table 1 ( UNFPA, 2022 ). This may be due to an increase in births in women who had postponed motherhood, policy measures supporting families and working women, increased access to ART services, and the higher fertility rate among immigrant women ( Organization for Economic Cooperation and Development (OECD), 2009 ; De Geyter et al. , 2020 ). Furthermore, data from 2017 show that medically assisted reproduction (MAR)—defined as ‘reproduction brought about through various interventions, procedures, surgeries, and technologies (including ART) to treat different forms of fertility impairment and infertility’—contributed from 3.2% to almost 10% of births in European countries compared with <1% in Latin America and 2% in the USA ( Wyns et al. , 2021 ; Zegers-Hochschild et al. , 2017 ). While it is difficult to isolate the overall effect of ART in raising fertility rates from other behavioral and policy drivers, the impact appears to be approximately a 0.05–0.10 increase in TFR where access to fertility treatment is widely available ( Grant et al. , 2007 ; Habbema et al. , 2009 ; Lazzari et al. , 2021 ).

Conclusion and recommendations

TFR is declining globally in women and men, for multiple reasons.

While it is difficult to measure the overall impact of ART in raising fertility rates, the potential benefits for the many individuals or couples who wish to have a child are profound.

The global trend of delaying parenthood negatively affects TFR.

There is an urgent need for more and better data on all aspects of global fertility and associated demographics.

Identified key knowledge gaps

Reliable data on fertility patterns, trends and causes of fertility or infertility are missing in developing countries, especially for male fertility.

The impact of infertility treatment, including ART, on fertility patterns is missing in most countries of the world.

It is imperative to identify measurable health indicators in order to quantify disease and measure progress resulting from interventions. Prevalence is the only reproductive health indicator for infertility formally adopted by the World Health Organization (WHO) ( World Health Organization, 2008 ). Infertility prevalence tells us how many lives are affected; both prevalence and measurement of the magnitude of infertility’s impact on people’s lives inform the burden of disease. The definition of infertility and its prevalence and burden of disease are controversial. Different categories of infertility definitions (clinical, epidemiological, demographic) in conjunction with variations in methodology and study populations give rise to wide-ranging estimates ( Gnoth et al. , 2005 ; Barratt et al. , 2017 ; Cox et al., 2022 ; World Health Organization, 2023 ). For primary 12-month infertility (never pregnant), the pooled lifetime and period prevalence reported by WHO in 2023 were 9.6% and 9.0%, respectively. For secondary 12-month infertility (prior pregnancy, regardless of outcome), pooled lifetime and period prevalence were 6.5% and 4.9%, respectively: less than primary infertility but still a very large number of people ( World Health Organization, 2023 ). Quantitative burden-of-disease studies lack measurement of the qualitative impact of infertility disease and do not consider how bringing forth new life affects the quality of existing lives. Primary infertility is known generally to have a high burden of disease. Secondary infertility may or may not carry a similar burden for any given person depending on their personal and societal circumstances, including that a child is from a previous relationship. Additionally, secondary infertility applies to many who have become pregnant and/or delivered but subsequently suffered pregnancy loss or death of a child. A rich qualitative narrative describes the often-profound consequences of infertility as a social reality as well as a medical disease ( Greil et al. , 2010 ; Inhorn and Patrizio, 2015 ).

There are two commonly applied clinical definitions of infertility. According to the WHO, infertility is a disease defined by the absence of pregnancy after 12 months of regular unprotected intercourse, which is in line with the definition of male and female infertility in the International Classification of Diseases (ICD-11) ( Zegers-Hochschild et al. , 2009 ). The International Glossary on Infertility and Fertility Care, which reflects high-level international consensus, incorporates the WHO definition while being more comprehensive and inclusive by adding, ‘or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner’ ( Zegers-Hochschild et al. , 2017 ). Moreover, by referring to infertility as a disability per se without specifying infertility as disability of the reproductive system, the International Glossary recognizes that fertility and parenthood transcend reproductive organs and affect the entire person, couple, and their social matrix.

Globally, infertility is one of the most frequent chronic diseases among reproductive-aged people. Until publication of the recent WHO document, the most comprehensive systematic review covering infertility studies from 1990 to 2021 gave pooled estimates for period and lifetime infertility prevalence of 12.6% (95% CI 10.7, 14.6) and 17.5% (95% CI 15.0, 20.3), respectively, when estimated among all study participants regardless of risk of pregnancy ( Cox et al. , 2022 ; World Health Organization, 2023 ). However, as most people are unaware of their fertility potential (fecundity) before trying to have children, it is also important to estimate infertility prevalence among those who are trying or have tried to have children. For this group, the range of the estimated point prevalence of infertility has been reported as 4–34% after 12 months of ‘trying’ and that of cumulative lifetime prevalence as 8–35% ( Schmidt and Münster, 1995 ; Chandra et al. , 2013 ; Zhou et al. , 2018 ; Cox et al. , 2022 ). This seeming paradox can be explained by pro-natal reproductive behaviors that are directly or indirectly associated with risk factors for infertility, including low uptake of contraceptive methods, early sexual debut, early age at first pregnancy, unsafe delivery practices, and high background rates of sexually transmitted diseases.

Causes and risk factors

Infertility can be caused by female and/or male factors or can be unexplained. Prominent female factors include advanced age and resultant diminished ovarian reserve associated with voluntary or involuntary delay of pregnancy, chronic anovulation, tubal factor infertility (especially secondary to STIs or pregnancy-related sepsis), other pelvic pathology (e.g. endometriosis, adenomyosis, uterine fibroids, adhesions, congenital anomalies), and exposure to environmental contaminants. The extent to which these factors contribute to female infertility varies from country to country. Male infertility—which accounts for or contributes to infertility in approximately one-half of couples—can result from impaired sperm production or sperm ejaculation due to a variety of underlying conditions including hormonal, infectious, and genetic and environmental etiologies ( World Health Organization, 2020 ). In addition, sexual and other factors may impact intercourse. Infertility may be caused by medical interventions, such as cancer therapy or complications of inappropriate care, as well as environmental factors and toxicant exposures during in utero development and/or in adulthood ( ASRM Practice Committee, 2019 ; Skakkebæk et al. , 2022 ; Giudice et al. , 2023 ). Many of these factors are aggravated by increasing age.

Most causes of infertility are acquired, and many are amenable to prevention. Health behaviors, such as smoking, obesity, use of cannabis and anabolic steroids, are risk factors for both women and men ( Bala et al. , 2021 ; Carson and Kallen, 2021 ; Eisenberg et al. , 2023 ). Traditionally, prevention has focused on STI prevention, safe obstetric practices, lifestyle modifications, avoidance of age-related female infertility, and early identification and treatment of male cryptorchidism (one of the most common congenital conditions in male neonates). There is a need for increased education and research on intervention strategies for environmental impacts on male and female infertility ( Giudice et al. , 2023 ).

Ultimately, prevention and intervention strategies need to be informed by the social determinants of infertility: the causes of the causes. For example, advanced female age is linked to the social determinants of education and gender equality, since both may delay acting on fertility desires and opportunities for procreation ( Broekmans et al. , 2009 ; Fall et al. , 2015 ; Van Roode et al. , 2017 ; Cedars, 2022 ; Choi et al. , 2023 ). At the same time, lack of gender equality may influence women’s ability to negotiate safe sexual practices or contraception usage, compromise health literacy, and limit women’s ability to access appropriate reproductive health services.

Conclusions and recommendations

Infertility is one of the most common chronic diseases in individuals of reproductive age.

Infertility is also common in men, accounting for ∼50% of all couples’ infertility.

Pooled period prevalence of infertility is 12.6% with regional differences when estimated among women/couples regardless of whether they are ‘trying’ to have children or not.

Pooled lifetime prevalence of infertility is 17.5% with regional differences when estimated among women/couples regardless of whether they are ‘trying’ or tried to have children or not.

Infertility has many causes and risk factors, including genetic and medical disorders, health behavior, age, and exposure to environmental contaminants.

We recommend global, regional, and national monitoring of infertility in population-based studies among persons trying or having tried to have children.

Lack of conclusive data pertaining to infertility prevalence.

Lack of national and global monitoring of population-based infertility prevalence.

Infertility is a common chronic disease and a major life burden. But awareness about infertility, its risk factors, and possible treatments vary widely across the globe ( Bunting et al. , 2013 ). Personal consequences of infertility can include a profound sense of shame, loss, anxiety, depression, anger, and feelings of failure, both physically and in sexual roles and social responsibilities ( van Balen and Bos, 2009 ). These effects can lead to isolation, ostracism, and violence specifically against women, regardless of the etiology of their infertility. The reasons for these variable effects are complex and include cultural mores, the status of women in each society, the importance of childbearing to the marital relationship, gender power dynamics within the family, and religious, political, and economic factors ( van Balen and Bos, 2009 ; Inhorn and Patrizio, 2015 ; Stellar et al. , 2016 ; Bayoumi et al. , 2018 ). They may also feel stigma and embarrassment about help-seeking, leading to a reduced chance of pregnancy (International Federation of Gynecology and Obstetrics, https://fertilitytool.com/tools/basic-tool-1-why-care/ ). While recent years have shown an increase in interventions to reduce the stigma of infertility in low-, middle-, and high-income countries, generally poor knowledge about infertility means that most people cannot avoid risks or seek help in a timely fashion when having difficulty achieving pregnancy or fathering a child ( Pedro et al. , 2018 ; Gerrits et al. , 2023 ). Thus, awareness about infertility and its prevention and treatment are key to well-being and to global family-building and family-planning efforts. A summary of global strategies and challenges to increase fertility awareness and infertility prevention underscores unmet needs of education and research.

Fertility awareness has been defined as ‘the understanding of reproduction, fecundity, fecundability, and related individual risk factors (e.g. advanced age, sexual health factors, such as STIs, and lifestyle factors such as smoking and obesity) and non-individual risk factors (e.g. environmental and workplace factors)’ including the awareness of societal and cultural factors affecting options to meet reproductive family planning, as well as family-building needs ( Zegers-Hochschild et al. , 2017 ). There is a general lack of awareness regarding reproductive health in most societies. Lay populations, especially, have a limited and misconstrued understanding of both the relationship of age to infertility and the limitations of available reproductive technologies to overcome the effects of age ( Bunting et al. , 2013 ; Pedro et al. , 2018 ; Delbaere et al. , 2020 ; Choi et al. , 2023 ). Many women are aware that age impacts fertility, but they lack specific knowledge about when and to what extent fertility declines, making it difficult for them to act on their knowledge in a way that does not undermine parenthood goals (e.g. when to start trying to become pregnant, use of fertility preservation). Due to poor knowledge levels, fertility education initiatives have been suggested to guide people making decisions about fertility ( ASRM Practice Committee, 2019 ; Delbaere et al. , 2020 ).

Qualitative research shows that culturally tailored fertility awareness tools are feasible and acceptable ( Bayoumi et al. , 2021 ). This tailoring is needed because evidence is emerging that prevalence of risk factors for infertility varies according to country. Anthropologists have documented infertility campaigns in LMICs led by government, professional societies, patient groups, and activists ( Gerrits et al. , 2023 ). For example, in Iran reproductive health authorities have initiated educational campaigns to ‘create a culture’ of infertility awareness through films, books, and leaflets intended for popular audiences ( Tremayne, 2009 ). Most campaigns in LMICs have not been shown to have major impact because they have lacked visibility and formal evaluation ( Ombelet and Campo, 2007 ; Thevenon and Gauthier, 2011 ; Tan, 2020 ).

Prevention of infertility has targeted different societal levels and pathways. Figure 3 illustrates a conceptual model of infertility prevention based on theory and extant research ( Boivin and Inhorn, 2022 ). Four aspects of prevention should be considered in evaluating these efforts, namely the target of intervention (individual, couple, society), the proposed mechanism of action (behavior change, early detection), the intervention outcomes (e.g. prevalence of infertility), and any moderators that could impact the effectiveness of interventions (e.g. ethnicity). Figure 3 also makes clear that prevention efforts could be at primary, secondary, and tertiary care levels. Specifically, prevention efforts can be directed before the disease is present (i.e. primary prevention), for example, delivered opportunistically during contraceptive or smoking cessation programs ( Macaluso et al. , 2010 ; Delbaere et al. , 2020 ). Secondary prevention can occur when a health condition is present but not yet fertility limiting (e.g. early detection and treatment of endometriosis or fertility preservation for cancer patients). Tertiary prevention can apply to existing infertility, with prevention aiming to limit impacts of fertility care on health and quality of life (e.g. single embryo transfer to avoid multiple pregnancy).

Conceptual model of infertility prevention based on theory and existing infertility research. Modified and reprinted with permission from Boivin and Inhorn (2022).

Conceptual model of infertility prevention based on theory and existing infertility research. Modified and reprinted with permission from Boivin and Inhorn (2022) .

Research is needed to address the effect of prevention strategies on significant clinical outcomes, which could be behavior change targets (e.g. weight loss) and fertility outcomes (e.g. live births). Prevention research should also examine the moderators of the effects of prevention (e.g. gender, age, ethnicity, education). The effects of prevention at primary, secondary, and tertial levels on fertility have not been extensively evaluated. Effects of primary prevention strategies targeting behavior changes to eliminate or minimize risk associated with infertility are uncertain due to the paucity of high-quality evidence. One non-randomized trial in India suggested that men willing to stop smoking showed better quality sperm within 3 months of smoking cessation than men unwilling to stop smoking ( Kulaksiz et al. , 2022 ). One randomized controlled trial (RCT) showed that in Japan provision of fertility information accelerated the timing of births in partnered women, and that couples tried to achieve pregnancy 15 months earlier, important in Japan where people typically start family building in their mid to late 30s ( Maeda et al. , 2018 ). Qualitative research suggests gaps in primary awareness campaigns, for example, not being inclusive across cultures and not targeting men presenting specific risks for male infertility ( Berthelsen et al. , 2021 ).

Benefits of secondary and tertiary prevention strategies that target early treatment of STIs and pelvic inflammatory disease, or avoidance of pregnancy or abortion-related infections, are effective in eliminating infection, but subsequent effects on fertility are unknown because fertility outcomes are not being measured in research ( Savaris et al. , 2020 ). One public health RCT showed that provision of fertility information in undiagnosed men meeting the definition of infertility was associated with timely medical help-seeking compared to control groups ( Maeda et al. , 2018 ). Systematic reviews and prevention campaigns among the diagnosed infertile (e.g. pre-conception, lifestyle advice) are effective in reducing intermediate endpoints (weight loss, biomarkers) but not in markedly increasing fertility outcomes such as live births ( Boedt et al. , 2021 ). Often, conclusions are uncertain due to low-quality evidence.

Prevention at societal level exists but is incidental rather than targeted. About 60% of countries with below-replacement fertility levels have adopted fertility-friendly policies (e.g. reducing costs of childcare, healthcare, and MAR) or fertility risk-reducing policies (e.g. occupational safety and environmental health) ( Bergsvik et al. ,2020 ). However, systematic reviews demonstrate that infertility itself is not integrated into sexual and reproductive health policies or, if it is, prevention is not included ( Morshed-Behbahani e t al. , 2020 ; Ravindran and Govender, 2020 ). Major barriers to inclusion are limited political commitment and under-recognition of the burden of infertility, in addition to costs of MAR ( Afferri et al. , 2022 ). Other societal level interventions, such as regulation about exposure to occupational and environmental hazards, potentially reduce rates of infertility but are not specifically designed with fertility outcomes in mind despite compelling evidence supporting recent recommendations from ESHRE to collect more surveillance data and initiate public awareness campaigns ( Skakkebæk et al. , 2022 ; ESHRE Environment Seminar, 2023). Concern over the impact of endocrine disruptor exposure on reproductive health has led to calls for a multi-country monitoring system ( Le Moal et al. , 2016 ).

The significant gaps in knowledge about the efficacy of prevention efforts point to the need for policy and research to implement and evaluate prevention strategies on fertility outcomes and the moderators of these effects. Most prevention efforts continue to target women in high-income countries despite repeated calls for such efforts to also target people in LMICs.

The quality of research into effects of prevention campaigns needs to be more rigorous and include fertility outcomes.

Advocacy and additional educational efforts, which will require appropriate funding, are needed to increase awareness and acceptance of infertility as a disease with a high burden.

Prevention through (in)fertility awareness and access to care should be prioritized in national health and education agendas globally and at all levels (primary, secondary, tertiary).

Appropriate conceptual models of prevention of infertility that are culturally informed should be used to guide the design of education and prevention resources and in the selection of fertility indicators.

The creation of sustainable multidisciplinary and multi-stakeholder consortia to deliver prevention programs should be supported.

High-quality actionable evidence should be generated to direct policy about the value of prevention efforts.

Geographic regions with a high proportion of LMICs are poorly represented in research on prevention.

Men, single persons, LGBTQ+ individuals and couples, and people with disabilities or health conditions are largely omitted in research; this needs to change.

Attention is needed on causal impacts and assessment of relevant fertility outcomes.

Co-production of educational resources with multiple stakeholders (i.e. people with a current or future child wish, policymakers, researchers, healthcare professionals, community groups, schools) is needed, as in other areas of reproductive health.

Infertility treatment and fertility care are increasingly being recognized globally as effective therapies to achieve family-building goals, especially in most high-income countries (HICs). Data on access to non-ART fertility care are minimal globally, so only available data on access to ART can be used. Access to fertility care can only be realized when ART services are present, and the geographical location and activities are known ( Markets and Markets, 2021 ). However, large variations exist in the number of clinics per capita. Reducing these disparities will require the global effort of governments, industry, and non-governmental organizations to provide accessible infrastructure, training, and affordable models ( Ombelet, 2011 ; Chiware et al. , 2021 ).

Access to fertility care, as with healthcare in general, has multiple dimensions (availability, accessibility, acceptability, and quality) and does not comprise a single, measurable entity ( Dyer et al. , 2020 ). Access to healthcare is disease-specific and determined by the demand for health services (reflecting individual perceptions of illness, preferences, economic resources, sociocultural, and epidemiological factors), as well as supply (reflecting health system factors such as availability, cost, funding, affordability, regulations, and quality) ( Chambers et al. , 2009 ). Distinct disparities in infertility care exist, largely due to barriers to access aligned with race, class, socioeconomic status, gender, sexual orientation, and other forms of difference ( ASRM The Ethics Committee, 2021 ). Evaluation of access to fertility care is complex and includes variable metrics, populations, as well as the absence of data—especially in LMICs ( Zegers-Hochschild et al. , 2017 ; Canadian Assisted Reproductive Technologies Register Plus (CARTR Plus), 2018 ; Dyer et al. , 2019 ; Ishihara et al. , 2020 ; De Geyter et al. , 2020 ; Hu et al. , 2020 ; Lanes et al. , 2020 ; Wyns et al. , 2021 ; Australia and New Zealand Assisted Reproduction Database (ANZARD), 2022 ; Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/art/artdata/index.html ). ART utilization is considered to reflect ‘realized access’ and is a proxy for access. It is calculated based on annually collected global data. The estimated annual demand for ART in 2001 was treatment of 1500 couples (not 1500 cycles) per million population ( ESHRE Capri Workshop Group, 2001 ). Countries with high ART utilization generally have good access to non-ART fertility care, whereas poor access to ART is usually paralleled by poor access to non-ART fertility care ( Botha et al. , 2018 ).

Utilization of ART is multifactorial

Utilization rates require both a numerator and denominator. In ART, there are numerous possible denominators depending on which aspect of the continuum of treatment is being considered. Standardizing global results requires using commonly available metrics such as start of an ART cycle. Arguably, the best metric is the number of couples utilizing services, but such data are rarely available. It is essential to compare similar metrics when assessing utilization ( Adashi and Dean, 2016 ; Dyer et al. , 2020 ; Kawwass et al. , 2021 ; Beroukhim et al. , 2022 ).

The denominator of utilization rate usually reflects the entire population, millions of women, or females of reproductive age. Different countries have different age and gender distributions, and data are often not available and/or inconsistently defined. Population demographics are usually determined only once every 10 years or more from census counts and often overall age distribution is extrapolated from subgroups of ages. Finally, there are almost no data available regarding men’s access to fertility care ( Nachtigall, 2006 ; Tarsi and Tuff, 2012 ; Rogers, 2017 ; Dyer et al. , 2020 ).

ART availability, which affects utilization, is affected by the number of clinics and service locations, and geographic locations. Larger clinics are generally more available than smaller ones. High population density countries have more availability than low. Larger countries geographically and those with difficult topography tend to have lower availability. Other population variables include geographic and urban/rural distribution, as well as country development, which affects the ease of transportation ( Brodeur et al. , 2022 ).

Accessibility and utilization are affected by physical features of clinics (e.g. access for the disabled, male services available only in female clinics), limitation of reproductive health information, and a regulatory environment that might restrict services and/or discriminate, e.g. LGBTQ+ or single people ( ASRM The Ethics Committee, 2021 ; Oliveira et al. , 2021 ). The acceptability of care influences utilization. This includes the structure of the health system and its ability to provide respectful, culturally appropriate, gender, and life-cycle-sensitive care according to patient preferences ( Rich and Domar, 2016 ; Beroukhim et al. , 2022 ). Finally, the actual and perceived quality of treatment based on a scientific approach, its medically appropriate use, and quality of service impacts utilization ( Dyer et al. , 2020 ). Countries with different TFRs, immigration and social policies could perceive utilization rates differently. The variable effectiveness of ART treatments impacts the number of cycles performed, multiple pregnancy rates, and the number of babies born.

The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) collects global data annually from ∼80 countries reflecting over 90% of global ART activity ( Chambers et al. , 2021 ). China has just begun reporting utilization rates of 657 per million for 2017 ( Bai et al. , 2020 ). The global utilization rate is 535/million population with dramatic country differences ranging from 16 to 5203 ( Chambers et al. , 2021 ). Country-specific utilization rates have varied only slightly over time. Not all countries collect ART data, in many countries not all clinics report, and data quality and validation are variable ( De Geyter et al. , 2020 ; Chambers et al. , 2021 ). A minority of countries collect cycle-by-cycle data; most collect only aggregated clinic data. Very few countries report the number of women or men utilizing treatment as opposed to the number of ART cycles performed. Cross-border care is poorly reported. Few report non-ART treatments, and these are mostly IUI cycles. There are almost no registry data on ovulation induction, empirical ovarian stimulation, female surgical interventions, or other treatments, and essentially no registries or data for men.

Consensus is needed on the optimal way to measure access to care and success of treatment. The numerator and the denominator for calculation need standardization, and confounding variables quantified. The following should be documented: total oocyte aspirations, freeze-all cycles, preimplantation genetic testing, frozen embryo transfers, third-party cycles, and cross-border care; restrictions on access; number of clinic service locations, population, area, and urbanization index; live birth rate, multiple birth, and complication rates; women, men, and number of treatment cycles for each; number of singletons, twins, and triplets or higher babies; detailed demographic information on gender and age; proportion of the non-fecund population at age 50 years, including those choosing to remain child-free, IUI, non-traditional family-building services for LGBTQ+ and singles; number of children per couple/person; and age of childbearing.

In most countries ART is under-utilized. High costs related to ART and/or insufficient reimbursement making ART unaffordable to many or most people result in reduced access, whereas uncontrolled reimbursement or consumer behavior in a commercial environment may provoke over-utilization ( Bai et al. , 2020 ). More complete and robust data would help health authorities develop appropriate ART policies.

Understanding the status of access to fertility care is essential to ensure individual reproductive rights and promote societal population goals.

Current data have identified the need for significantly increased access to quality fertility care in almost all global jurisdictions.

Many complexities, deficiencies, and challenges remain to improve available data so that individual rights and societal reproductive goals can be optimized through public health policies.

Identified key knowledge gaps can only be rectified by significantly increased and more detailed surveillance.

Unrestricted access to fertility care may result in over utilization.

The underlying population need for ART remains largely unknown.

The association between ART utilization and access to non-ART fertility care is uncertain.

Almost no data exist on non-ART fertility treatments.

The major deficiency regarding access is its complexity and lack of a standardized quantifiable approach.

The major deficiency regarding measurement of utilization of infertility care is that data are limited or absent for all populations, especially LGBTQ+, singles, minorities, and males.

Policymakers have insufficient knowledge and lack awareness of the true demand for infertility treatment in high-, middle-, and low-income countries.

A human right

Article 16.1 of the UN Declaration of Human Rights states that ‘men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family’: United Nations Charter Article 16 (United Nations, https://www.ohchr.org/en/human-rights/universal-declaration/translations/english ). The human right of persons to access infertility treatment is consistent with the 1948 UN Declaration of Human Rights and the ICPD plan of action Cairo 1994 (United Nations, http://www.ohchr.org ; International Conference on Population and Development, https://partners-popdev.org/icpd/ICPD_POA_summary.pdf ). Therefore, addressing infertility is fundamental to realizing the right of individuals and couples to found a family ( Zegers‐Hochschild et al. , 2013 ; Mburu et al. , 2023 ). Infertility treatments must not be limited to the affluent. Although both male and female factors can be the cause of infertility, women bear the most severe consequences and burdens even if they are not the cause of infertility ( Starrs et al. , 2018 ; Vollset et al. , 2020 ).

Ways to improve access to care include reducing cost and other structural barriers to access, addressing diversity, equity, inclusion, and belonging, providing culturally appropriate care, increasing availability in low resource settings, and demonstrating the economic burden of infertility ( Ombelet, 2011 ; Chiware et al. , 2021 ; Afferri et al. , 2022 ; International Federation of Gynecology and Obstetrics, https://fertilitytool.com/tools/basic-tool-1-why-care/ ).

Affordability

Consumer affordability is clearly a strong driver of access ( Fig. 4 ) and is defined as the consumer out-of-pocket cost relative to average disposable income. Affordability can be increased by reducing the cost and complexity of infertility interventions, increasing reimbursement, and increasing individuals’ disposable income ( Chambers et al. , 2014 ). However, only treatment cost and reimbursement arrangements are amenable to policy interventions. Since ART is a widely practiced, mature technology, its cost should be decreasing. However, the primary focus on maximizing pregnancy rates per cycle—especially in HICs—has often created very complex and expensive ART. Often such efforts do not result in increased success rates proportionate to the cost, especially from a cumulative (multiple cycles) live birth rate perspective compared to non-ART treatments such as ovulation induction, ovarian stimulation with IUI or surgery in selected patients. Furthermore, ART is usually offered in a free-market economy where providers, and often commercial owners of clinics, are incentivized to make a profit.

Correlation between affordability (mean cost of a fresh IVF cycle as a percentage of average disposable income) and the utilization (number of fresh non-donor cycles per million women of reproductive age (15–49 years)). Correlation co-efficient = −0.35. Reprinted with permission from Chambers et al. (2014).

Correlation between affordability (mean cost of a fresh IVF cycle as a percentage of average disposable income) and the utilization (number of fresh non-donor cycles per million women of reproductive age (15–49 years)). Correlation co-efficient = −0.35. Reprinted with permission from Chambers et al. (2014) .

Reducing the societal cost of infertility treatment also includes reducing pregnancy, neonatal, and long-term costs associated with multiple pregnancies resulting from ART. By improving affordability, the incentive to transfer more than one embryo is minimized and promotes this goal ( Chambers et al. , 2014 ). The Belgian reimbursement policy in which reimbursement of ART-related laboratory activities is linked to a transfer policy aiming at substantial multiple pregnancy reduction, turned out to become a good example of cost-efficient health care through responsible, well considered clinical practice ( Ombelet et al. , 2005 ). The cost of multiple births that have been associated with fertility treatment is a legitimate concern of policymakers, providers, and patients. Fertility providers have responded by decreasing substantially the percentage of multiple pregnancies. In 2022, the percentage of twins globally is approaching 10% and in some countries is only slightly higher than naturally occurring twin rates. There are strong trends in technology advances and clinical practice that should ensure continued reduction in multiple births from fertility care. Due to high cost and/or unaffordability, ART remains out of reach for many, even in resource-rich countries ( Dyer et al. , 2020 ; ASRM The Ethics Committee, 2021 ; Njagi et al. , 2023 ). There is wide variation in regulatory and funding arrangements by governments and third parties. Less than half of reporting countries provide any financial support for ART, and only 20% offer full reimbursement ( International Federation of Fertility Societies’ Surveillance (IFFS), 2022 ).

Societal economic benefit

Fertility care is often not affordable for individuals who have to pay out of pocket for such treatments ( Dyer, 2002 ; Ombelet et al. , 2008 ; Chambers et al. , 2013 ; Bahamondes and Makuch, 2014 ; Koniares et al. , 2022 ). In contrast, fertility care is very affordable from a societal perspective ( Chambers et al. , 2009 ; Connolly et al. , 2010 ; Vélez et al., 2014 ). Indeed, fertility care is cost-effective and represents a positive return on public investment through the future economic value of babies resulting from fertility treatments ( ESHRE Capri Workshop Group, 2015 ). Identifying the optimal economic framework to assess the cost and benefits of fertility care remains challenging because infertility and its treatment are unique in the health care system because its goal is the creation of a new life ( Martins and Connolly, 2022 ). Compelling economic reasons to support increased access to fertility care in most countries include the relatively low societal cost to obtain a live birth, future economic productivity of the resulting individuals, and the high net present value of future tax payments from those individuals ( Connolly et al. , 2008 ; Martins and Connolly, 2022 ). For instance, lifetime revenue from tax-paying citizens, calculated in the UK, was eight times the return on investment from the total cost of fertility care ( Connolly et al. , 2009 ). Comparable benefits have been reported for other countries such as Canada, USA, Denmark, Sweden, and South Africa ( Connolly et al. , 2008 ; Svensson et al. , 2008 ). IVF and naturally conceived individuals in the Netherlands have negative yet similar discounted net tax revenue at the end of life in an analytic framework that undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits ( Moolenaar et al. , 2014 ). Another way to conceptualize the importance of fertility care is to assess the statistical value of a human life (estimated to be US$5.7 million), which far exceeds the cost of creating a life through fertility treatment ( Keller et al. , 2021 ). This median value ranged from $858 599 in developing countries to $8 342 027 in developed countries. Estimates of the statistical value of a human life were up to 4.66 times higher when parents were asked to value their children’s rather than their own lives ( Keller et al. , 2021 ). In addition to improving the quality of life of individuals and couples, by any measure, the net economic impact of fertility care is highly positive for all societies.

Socio-cultural factors

Religion and cultural beliefs about fertility reflect the level of acceptability of ART and thus influence access to fertility care. Indeed, the moral status of the embryo, use of frozen gametes, and third-party reproduction have been central to many religious debates, particularly in the Middle East, Latin America, parts of Europe (where there is reduced acceptability of ART), and the USA ( Serour and Serour, 2021 ). Although most world religions support the use of ART, fostering culturally appropriate care (e.g. accommodating language barriers, respecting gender, and privacy norms), and removing structural barriers would ameliorate many of the disparities in access to infertility care (International Federation of Gynecology and Obstetrics, https://fertilitytool.com ).

Gender equity

The increasing understanding of how gender norms and disparities affect pathways to health outcomes helps explain why there are such inequalities in access to fertility care. Countries with high ART utilization rates (a proxy for access) generally have high levels of gender equality, particularly reflected in education, labor force participation, empowerment, and reproductive rights ( Fig. 5 ) ( Chambers and Fauser, 2021 ). Infertility and its treatment are particularly sensitive to gender inequalities because it largely remains a gendered problem, with women carrying much of the stigma and burden ( Greil et al. , 2010 ). Emphasizing the importance of a life-course approach to the integration of fertility care in women’s social and physical health, both the WHO and the UN recently included fertility care under the definitions of sexual and reproductive health and rights ( United Nations, 2019 ).

Relation between ART utilization (cycles per million population) and the degree of gender equality in countries reporting to the United Nation’s Development Program Gender Inequality Index. Each black dot represents a country. Utilization from the ICMART 2012 World Registry. Reprinted with permission from Chambers and Fauser (2021).

Relation between ART utilization (cycles per million population) and the degree of gender equality in countries reporting to the United Nation’s Development Program Gender Inequality Index. Each black dot represents a country. Utilization from the ICMART 2012 World Registry. Reprinted with permission from Chambers and Fauser (2021) .

Diversity, equity, inclusion, and belonging

Infertility can negate the realization of the right of every person to found a family. Inequities in access to fertility care adversely affect all minorities, whether racial, religious, gender-based, or other. Such disparities in access often arise from restrictive legislation, government policies, and inappropriate care pathways ( Seifer et al. , 2022 ). Embracing the principles of diversity, equity, and inclusion while addressing infertility and fertility care improves emotional health and well-being, promotes gender equity, advances diversity, equity, inclusion, and belonging goals, and enhances social justice.

ART has predominantly been developed in HICs. Approximately three-quarters of all global ART cycles are performed in just 10 countries. Complex and expensive ART protocols are less applicable in low-resource settings because the context is significantly different ( Macklon and Fauser, 2020 ). Comparing ART from many parts of the world in a useful manner remains challenging because standardized outcome measures, involving success rates along with the burden of treatment, risks and cost, are not yet available ( Fauser 2019 ). Simplified, lower cost, high-quality ART procedures are urgently needed to establish affordable ART, especially in LMICs ( Ombelet 2011 ; Chiware et al. , 2021 ).

Cost, affordability, socio-cultural and diversity factors, and gender inequality represent the most important drivers in unequal access to fertility care.

Fertility care is not affordable for many people around the world, especially in low-resource settings.

The child who results from fertility care represents a strong economic benefit for society.

Policies and practices need to be developed to reduce disparities in fertility care based on class, gender, sexual orientation, and other differences.

Striving for gender equality and universal reproductive rights will foster more equitable, culturally appropriate access to fertility care.

There is an urgent need to develop simpler, less expensive ART.

Infrastructure and training support are needed to increase access to care, especially in low-resource countries.

The development and evaluation of simplified fertility treatments, especially ART.

Effective ways to reduce disparities in access to fertility care for single women and men, and LGBTQ+ people.

Quantification of economic benefits of infertility care in different settings.

Economic development, urbanization, improved education, secularization, gender equity, and family-planning policies have all contributed to slowing world population growth. Global TFR is decreasing, which will eventually result in a declining global population and radically changed demographics in most countries worldwide during this century. Although all declining, major regional differences in absolute TFR numbers remain. While a beneficial impact on the environment is anticipated, these drastic changes will have major societal and economic implications that will severely challenge nations and the global community. Policies will need to be developed to optimize the management of these changes. More focus on developing effective family-building policies should represent an important component of such strategies.

Globally, infertility is one of the most frequent chronic diseases among women and men of reproductive age, with several well-known risk factors and a high burden globally. Both success and safety of infertility treatments have improved significantly in recent decades. More recently, these technologies are also increasingly applied in other populations of individuals and the LGBTQ+ community in need of fertility care to form a family. Since the right to found a family is fundamental to every person, appropriate funding should be provided for fertility care, evaluation, and treatment. Because of a lack of awareness and appreciation of the prevalence and burden of infertility, however, only a few countries globally meet these needs. Fertility care, including infertility treatment, should be considered a principal component of family building and family planning.

Fertility care is now successful enough to justify its widespread global availability for those in need of reproductive assistance to realize their family goals and improve their personal well-being. Doing so will also help mitigate the declining TFR. This mitigation can be achieved in harmony with goals related to climate change, since it is human activity—linked to rising gross domestic product per capita and resultant consumption—rather than human numbers per se that does the greatest damage to the environment ( United Nations, 2021 ).

The economic benefits to society of providing fertility care clearly exceed the cost of treatment, and these benefits will only increase as populations become more aged. The medical profession, policymakers, other stakeholders, and the public can use the information provided to increase their understanding of fertility care. Such increased understanding will enable the development of integrative family-planning policies that meet the needs of those needing fertility care to establish their family, while also helping societies manage the decreasing TFR and resulting demographic and societal challenges.

Concerning awareness

Increase awareness that family building should become an integral part of global family-planning policies.

Increase awareness of stakeholders, policymakers, and the public regarding the distinct societal implications of decreasing TFR.

Focus more on family building and the prevention of infertility in educational programs for young adults.

Promote research that provides answers to critical gaps in the knowledge of family building.

Recognize the distinct global need for nations to develop and implement effective strategies to prevent infertility.

Educate stakeholders, policymakers, and the public regarding the ability of fertility care to help mitigate the consequences of a reducing TFR.

Promote research on the diagnosis and treatment of male infertility.

Concerning human rights

Recognize and promote the right of all individuals to have children if desired.

Concerning access to care

Recognize the global need to improve access to fertility care, especially in LMICs, by developing less complex and more affordable, high quality fertility care (both diagnosis and treatment).

Reduce complications of fertility care, especially multiple pregnancies, to diminish the societal cost of fertility care.

Realize more equitable access by increasing public and insurance funding of fertility care and expanding coverage to individuals and same-sex couples.

All data are incorporated into the article. The data underlying this article are available in the article and in the source references listed at the end of the article.

The authors acknowledge the work of Samantha Adams and Yannik Bramer for administrative support and Mimi Wainwright (Wainwright Medical Communications) for editorial support. The authors are grateful to the following members and contributors from the International Federation of Fertility Societies Demographics and Access to Care Review Board for their review and feedback of the manuscript drafts (listed alphabetically): Oladapo Ashiru, PhD; Simon Brown, MA; Karianne Bye, MA on behalf of Fertility Europe; Carlos Calhaz-Jorge, MD president of the European Society of Human Reproduction and Embryology (ESHRE); Barbara Collura, MA on behalf of RESOLVE, The National Infertility Association; Petra De Sutter, MD; Luca Gianaroli, MD; Linda Giudice, MD; Osamu Ishihara, MD; Edgar V. Mocanu, MD president of IFFS; Willem Ombelet, MD; Rishma Pai, MD, Chair of the IFFS Demographics and Access to Care Review Board; Guido Pennings, PhD; James Raymer, PhD; and Hugh Taylor, MD past president of the American Society for Reproductive Medicine (ASRM).

B.C.F. and G.D.A. contributed project conceptualization, data curation, analysis, investigation, methodology, project administration, supervision, validation, writing the original draft and review, and editing; B.C.F. also acquired funding. J.B. contributed to project conceptualization, data curation, analysis, investigation, methodology, validation, writing the original draft and review, and editing. G.C. provided data curation, analysis, investigation, methodology, validation, writing the original draft and review, and editing. C.d.G. contributed to data curation, analysis, validation, writing the original draft and review, and editing. S.D. contributed to project conceptualization, data curation, analysis, investigation, methodology, validation, writing the original draft and review, and editing. M.C.I. contributed to project conceptualization, analysis, validation, writing the original draft and review, and editing. L.S., G.S., B.T., and F.Z. contributed to project conceptualization, data curation, analysis, investigation, methodology, validation, writing the original draft and review, and editing.

This work was funded in part by an unrestricted educational grant from Ferring to the International Federation of Fertility Societies (IFFS) for administrative and editorial support.

B.C.F. reports grants from Dutch Medical Research Counsel (paid to University of Utrecht) and Nederlandse Hartstichting (paid to Erasmus University); he has received consulting fees from Ferring; honoraria from Ferring, Bain Capital, Celmatix, Pantharei Bioscience, Shieldler, UpToDate; Meeting and travel support from Ferring, ESHRE, IFFS; participation on an advisory board for Myovant; holds position of Director of Science for IFFS and co-chair of Controversies in Obstetrics & Gynecology. G.D.A. reports funding from IFFS (administrative and editorial support; authors’ meeting) for the subject manuscript; consulting fees to ARC Fertility from Labcorp and Cooper; and noncompensated leadership roles with ICMART (Chair) and WERF (President). J.B. reports study support to her institution from Merck Serono Ltd; consulting fees from Ferring BV and Ferring Pharmaceuticals A/S; speakers bureau honoraria from Organon JJC, Merck Group, and Ferring Arzneimittel GmbH; payment for expert testimony from the British Parliament; precongress meeting travel support from ESHRE; compensation as Director of Psych-Fertility Consulting Ltd. G.C. reports research and study grants from ICMART, Australian Medical Future Fund, and Australian National Health Medical Research Committee; non-compensated board member of ICMART. C.d.G. reports no conflict of interests. S.D. reports travel funding from IFFS, grant to institution; consulting fees from Science for Africa Foundation to Institution, honoraria paid to institution; travel support paid to institution from the Egyptian Foundation of Reproductive Medicine and Embryology; member of Science and Technology Advisory Group, HRP WHO (meeting travel expenses); Board member ICMART (non-compensated), Director ANARA (non-compensated), member of IFFS Education Committee (non-compensated); Observer, Board of the African Federation of Fertility Societies (non-compensated). M.C.I. reports no conflicts of interest. L.S. reports no conflicts of interest. G.S. reports no conflicts of interest. B.T. reports no conflicts of interest. F.Z.-H. reports honoraria from Ferring and Merck for two industry-funded conferences at regional symposia and also declares positions as Chair of the Latin American Registry of ART, Vice Chair International Committee for Monitoring ART (ICMART), Board member of Chilean Institute for Reproductive Medicine, Director of Ethics Committee of the Chilean Society of Obstetrics and Gynecology, and Board member of the Latin American Network of Assisted Reproduction (REDLARA).

Appendix: Contributors (listed alphabetically)

Contributors and members of the IFFS Demographics and Access to Care Review Board:

Oladapo Ashiru, PhD

Simon Brown, MA

Karianne Bye, MA on behalf of Fertility Europe

Carlos Calhaz-Jorge, MD, past president of the European Society of Human Reproduction and Embryology (ESHRE)

Barbara Collura, MA on behalf of RESOLVE, The National Infertility Association

Petra De Sutter, MD

Luca Gianaroli, MD

Linda Giudice, MD, past president IFFS

Osamu Ishihara, MD

Edgar V. Mocanu, MD, president of IFFS

Willem Ombelet, MD

Rishma Pai, MD, Chair of the review board

Guido Pennings, PhD

James Raymer, PhD

Hugh Taylor, MD, past president of the American Society for Reproductive Medicine (ASRM)

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Zegers-Hochschild F , Crosby JA , Musri C , Maria do Carmo Borges de Souza M , Gustavo Martinez A , Amaral Silva A , Mojarra M , Masoli J , Posada D ; the Latin American Network of Assisted Reproduction . Assisted reproductive technology in Latin America: the Latin American Registry, 2017 . Reprod Biomed Online 2020 ; 41 : 44 – 54 .

Zegers‐Hochschild F , Dickens BM , Dughman‐Manzur S. Human rights to in vitro fertilization . Int J Gynaecol Obstet 2013 ; 123 : 86 – 89 .

Zhou Z , Zheng D , Wu H , Li R , Xu S , Kang Y , Cao Y , Chen X , Zhu Y , Xu S et al.  Epidemiology of infertility in China: a population-based study . BJOG 2018 ; 125 : 432 – 441 .

Ziebe S , Devroey P ; State of ART 2007 Workshop Group . Assisted reproductive technologies are an integrated part of national strategies addressing demographic and reproductive challenges . Hum Reprod Update 2008 ; 14 : 583 – 592 .

Key terminology used in current document

(No consensus concerning definitions exists in this complex field, and alternative explanations (clinical, epidemiological, or demographic) may exist.)

Author notes

  • family planning
  • health services accessibility
  • infertility
  • population growth
  • reproductive physiological process
  • fertility rate
  • infertility therapy
  • narrative review
  • fertility care

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Ai-assisted literature reviews.

Three Iowa student sitting at a table in a study space.

ChatGPT has a reputation for generating hallucinations, or false information. Can an Artificial Intelligence (AI) platform be trusted to assist in a literature review? Yes, if the tool you're using is the right one for the job. ChatGPT and Copilot are not designed to provide accurate citations. Instead, use them to brainstorm research questions. Keep alert for misinformation, hallucinations, and bias that could be part of the generative AI’s responses. Be aware of historical biases in the literature, which can also influence the output you encounter. 

Be sure to keep track of what tools you use, your purpose for using them, and the output from your interactions. Be prepared to disclose the AI tools, databases, and criteria used to select and analyze sources. Remember you are the one ultimately responsible for anything you create, generative AI is only your assistant.  

Try these five AI platforms to assist you in your literature reviews and academic research: 

  • Copilot . Many people are exploring the ways that AI can be used to improve research. Even with a general generative AI platform like Copilot, you can use AI to help you brainstorm or discover new perspectives on research topics. An example prompt for this purpose can be found in David Maslach's article, " Generative AI Can Supercharge Your Academic Research ": “I am thinking about [insert topic], but this is not a very novel idea. Can you help me find innovative papers and research from the last 10 years that has discussed [insert topic]?”  
  • Elicit . This AI research assistant helps in evidence synthesis and text extraction. You can enter a research question, and the AI identifies top papers in the field, even without perfect keyword matching. Elicit only includes academic papers, since Elicit is designed around finding and analyzing academic papers specifically. Elicit pulls from over 126 million papers through Semantic Scholar. Elicit organizes papers into an easy-to-use table and provides features for brainstorming research questions. 
  • Consensus . This is an AI-powered search engine that pulls answers from research papers. Consensus is  not meant to be used to ask questions about basic facts such as, “How many people live in Europe?” or “When is the next leap year?” as there would likely not be research dedicated to investigating these subjects. Consensus is more effective with research questions on topics that have likely been studied by researchers. Yes/no questions will generate a “Consensus” from papers on the topic. Papers in Consensus also are from Semantic Scholar. Results in a Consensus search can be filtered by sample size of the study, population studied, study types, and more. This makes Consensus an interesting tool for finding related literature on your search topic. 
  • Research Rabbit . An AI research assistant designed to assist you in literature research, discovering and organizing academic papers efficiently. It offers features such as interactive visualizations, collaborative exploration, and personalized recommendations. You can create collections of papers, visualize networks of papers and co-authorships, and explore research questions. Unlike the previous two platforms listed, Research Rabbit doesn’t start with a question, but a paper that already is known. You need to have a starting article to go down a “rabbit hole” to see connections between papers. 
  • Litmaps . A similar tool to Research Rabbit, a Litmap shows the relationships between the articles in your collection in the form of connecting lines, which trace the citations for you. It allows a user to start with a citation, or a seed, and then through a simple interface, investigate connections between papers. 

For further reading, see " How to Write AI-Powered Literature Reviews: Balancing Speed, Depth, and Breadth in Academic Research ," which includes a helpful table comparing the different tools that specialize in literature searching. And check out the February 2024 webinar, " Unlock the Power of AI for Academic Research ," hosted by Tracy Mendolia-Moore and Brett Christie for more information on this topic. 

College & Research Libraries ( C&RL ) is the official, bi-monthly, online-only scholarly research journal of the Association of College & Research Libraries, a division of the American Library Association.

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Yan Quan Liu is Professor of Library and Information Science at Southern Connecticut State University, email: [email protected] .

Arlene Bielefield is Associate Professor of Library and Information Science at Southern Connecticut State University, email: [email protected] .

Jennifer Beckwith is an MLIS Graduate of Southern Connecticut State University and a Children’s Librarian at Guilford Free Library, email: [email protected] .

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ADA Digital Accessibility on Academic Library Websites

Yan Quan Liu, Arlene Bielefield, and Jennifer Beckwith *

Studying ADA accessibility at library websites of top universities selected from the U.S. News and World Report , the authors used WAVE and AChecker to assess data in compliance with WCAG 2.0 standards. Almost 8 out of 10 public university academic libraries reported accessibility errors as one of the major findings. Low color contrast was becoming a more commonly occurring accessibility issue, making it difficult for people with vision impairments to perceive the color of the image. The outcomes of the study suggest that academic libraries around the world should continue improving their website accessibility.

Introduction

We are embarking upon the 2020s with assistive and accessible websites continuing to elude many public academic library websites. This became more evident when we faced a global pandemic beginning in 2020. It included a lockdown that shut down schools, universities, and many public libraries, forcing students of all ages and abilities to learn from home via the internet. Digital accessibility (or the lack thereof) became more evident during this time since the most adversely affected students were those with disabilities. Inaccessibility and incompatibility in educational software, hardware, and websites became increasingly apparent when the students had to use varied devices and internet services to learn.

Under Title II of the Americans with Disabilities Act (ADA), public universities must provide equal access to services and programs including activities and architectural changes to physical facilities, 1 yet digital accommodations and access still face legal scrutiny. Common inaccessibility errors and noncompliance issues include but are not limited to improper text size, missing alt text in images, missing labels for input text types, anchor links with no text, incorrect H1 or header tag placement, and images with low-contrast text. 2

In determining the level of accessibility for individuals with disabilities accessing academic library websites at public universities, this study collected data starting in 2019 and continued through the global pandemic in 2020 and 2021. The intent is to demonstrate the importance of digitally accessible library websites for students and others with disabilities.

Literature Review

Research on the accessibility of websites can be found everywhere in the world. Website inaccessibility errors significantly affect users with disabilities. In their 2018 study, Acosta-Vargas, Acosta, and Lujan-Mora 3 used the Web Accessibility Evaluation Tool, WAVE 4 to study Latin American University websites and found that many of them lack accessibility in one key area—alternative image text.

In a 2019 qualitative study conducted by Mulliken, 5 eighteen blind library users tested an academic website using screen readers, a common assistive technology. 6 One of the results from the study demonstrated that screen readers significantly increase the amount of time needed for disabled students to access information. A task that would take a few minutes for the nondisabled person to complete took upwards of 20 to 30 minutes 7 for an individual with disabilities to complete. Even with a screen reader, a student with a degree of low vision would need much more time to complete something as simple as an essay question and could quickly fall behind.

Cassner, Maxey-Harris, and Anaya 8 reviewed public academic library websites for usability with people with disabilities as the end users. Focusing specifically on the topic of accessibility, the topics they explored were the library services offered or which should be offered for easily locatable services or items from library websites. Their recommended general guidelines of accessibility were: ease of website navigation, a friendly welcoming website, and a site that is designed with accessibility for end users versus staff. 9

Liu, Bielefield, and McKay in their 2018 study examined 122 library homepages of Urban Library Council [ULC] members and found that only 7 homepages presented as error free when tested for compliance with the Section 508 standards. 10 Following this examination, Liu led another team probing private colleges in 2020. 11 This evaluation indicated that although errors described as missing form label still occur on these websites, other known accessibility errors and issues have been significantly improved compared to the results found five years earlier.

Susan B. Asselin stressed the importance of knowledge in the area of learning/assistive technologies for the success of students with disabilities. 12 She believes that the accessibility of these technologies gives the student necessary flexibility and addresses their unique needs to successfully learn in the ever-growing digital academic environment. 13

Relevant studies and articles indicate recommendations for improving digital accessibility through training and updated information. Library staff members must be better informed through training sessions to understand the updates of ADA law and assistive technology advancements. For web designers, ADA accessibility should be included in the development of websites. Accessibility, usability, and inclusion must be considered with the current and well-established guidelines such as WCAG. Deque University 14 offers accessibility training and certification on their website, www.dequeuniversity.com . Professional organizations such as International Association of Accessibility Professionals (IAAP) are also leading the way for certifications including resources, membership, and international chapters. 15

The related literature shows accessibility is never over and done with; it is a constantly evolving responsibility. In light of the global pandemic, critical work, along with continued improvements in technology and employee training, should provide greater digital accessibility for all.

Legal Implications

Disabilities are not just physical but can also be mental. An individual with a disability can be defined as a person who has a physical or mental impairment that substantially limits one or more major life activities; has a record of such impairment; and/or is regarded as having such impairment. Being disabled, one can acquire employable skills and tools, but without accessible places of employment, it can be a struggle to support oneself and gain personal independence. The inception of the ADA made way for individuals with disabilities to lead independent lives that would not segregate them from working, living, and accessing the physical world along with their nondisabled peers. 16

Until recently, many plaintiffs with disabilities had a difficult time gaining access to most websites. 17 Even now, despite the uptick of litigation and the requests for clarification, there is no clear legal resolution to the issue of cyberspace being a public place of accommodation. 18 Websites and online communications based on the fundamentals of availability ought to appear accessible to all. 19 In 2019 there was some movement in the legal discussion of digital space as a public arena of accommodation. At that time, however, the U.S. Supreme Court declined to hear an appeal from Domino’s Pizza Inc. [ Domino’s Pizza v. Robles ] over its website and mobile app and whether they were required to comply with federal disability law. 20 In short, it was deemed that all websites with physical public locations must be accessible to disabled citizens.

During the inception of the ADA in 1990, Section 508 was written without digital accessibility in mind. Given the current digital world, an update was needed. The “Refresh of 2018” began in January 2017 when revisions and court interpretations gave way to updated requirements for information and technology to Section 508. 21 The Refresh became effective on January 18, 2018. 22 The major requirements included in the Refresh were: the functionality of the web page, accessibility for individuals with disabilities, and keeping pace with advances in technology. 23 The Refresh also included how software, operating systems, and the equipment interact with assistive technologies. 24

The Internet does not have geographic borders and can be accessed globally. With global accessibility in mind, the Refresh of 2018 incorporated the global standards from the Web Content Accessibility Guideline s under the federal guidelines. These global standards are more commonly known as WCAG 2.0 under the W3C. Section 508 was now using recognized and accepted global standards of practice for accessibility, including giving clarity on the use of assistive technologies, and creating and displaying accessible content on the web. 25

Research Design and Methodologies

As a continuing effort from earlier studies of the ADA and digital accessibility on ivy league library websites 26 and urban public libraries websites, 27 this study combined quantitative and qualitative content analysis to examine the library websites of 100 Top Ranked U.S. Public Universities and Colleges from U.S. News and World Reports. 28

A population sample this size would allow for the review of a broad range of colleges and universities with various student body sizes from across the United States, plus be large enough to examine trends and patterns within the results. In this way, the results of the study would impact a larger number of students.

Globally recognized website evaluators, WAVE & AChecker, evaluate a website’s accessibility by checking its HTML and XML codes. Both WAVE and AChecker aim to check websites against Section 508 standards and WCAG 2.0 guidelines. Studies that successfully identify website accessibility issues using WAVE can be seen in Challenges to Assess Accessibility in Higher Education Websites: A Comparative Study of Latin American Universities 29 and Evidence of Our Values: Disability Inclusion on Library Instruction Websites in 2018. 30 A recent study using AChecker to evaluate website accessibility can be found in Journal of King Saud University—Computer and Information Sciences titled Accessibility of Indian Universities’ Homepages: An Exploratory Study written by Ismail and Kuppusamy. 31 Data collection occurred over an extended period from 2000 to 2015 in a review of digital accessibility at universities in India. 32

In this study, each library’s home webpage was put into the WAVE and AChecker tools and outcomes for the number of total accessibility errors were recorded. After the data was collected, Excel spreadsheets were used to record precise data in a custom-designed codebook. Each of these randomly selected errors was recorded, calculated, and reviewed, with recommended options to fix them. The objectives were to identify errors using Web Content Accessibility Guidelines along with human evaluation and observation of web content, and then pinpoint them into these categories: reported errors, contrast errors, alerts, features, and structural elements.

WAVE and AChecker found errors that were labeled differently; in WAVE as reported errors and in AChecker as known problems . For the simplicity of this research study and limitation of time, data from the tabs reported errors and known problems were compiled and the specific errors: missing form label and low contrast under WAVE and img element missing alt attribute and id attribute were not unique under AChecker were randomly selected and quantified.

Research Findings

Samples of accessibility errors were reviewed, tabulated, and analyzed in this study indicating there are continued obstacles to accessibility despite the Refresh of 2018. Accessibility errors continue to be a major issue on most university library websites. While WAVE and AChecker report issues differently, the online tools give out a similar percentage of the overall error-free count. Both evaluators employ the global WCAG standards to run their error reports with independent algorithms and programming parameters, but both reach similar conclusions.

Overall error reporting results from WAVE and AChecker indicated that 80 percent and 81 percent of public university academic libraries had accessibility errors under WCAG 2.0 (Level A) guidelines [See Figure 1] and conversely 20 percent and 19 percent respectively were error-free. Software overlap in error-free data was found in two universities: Montclair State University and University of Wyoming.

Top Major Error

In WAVE, the missing form label error means “a form control does not have a corresponding label.” 33 In Section 508, missing form label is defined as a text label for a form control is missing or hidden. 34 Form labels provide important descriptions for screen readers and help disabled users navigate around a page and perform simple tasks like searches and data input. If there is no associated text label, screen readers will not read what is on the screen and disabled users will be unable to input information. The missing form label error represents a failure of basic website accessibility and creates a deterrent to academic success and independent learning for individuals with disabilities.

Statistics from the data set analyzed by WAVE indicated that 38 percent of schools had the missing form label error and 62 percent did not. Figure 2 displays the percentage of the webpages with errors in ascending order. The reported errors ranged from less than 1 percent to 10.71 percent as the highest.

In terms of the mean, it was 1.12 of missing form labels per school; in terms of numbers, the lowest count was 1 and the highest individual count at 12 was the University of Pittsburgh.

WAVE’s recommendation to correct or avoid the missing form label error is: “If a text label for a form control is visible, use the <label> element to associate it with its respective form control. If there is no visible label, either provide an associated label, add a descriptive title attribute to the form control, or reference the label(s) using aria-labelled (sic) by. Labels are not required for image, submit, reset, button, or hidden form controls.” 35 This study recommends that when labels are hidden (implicit) visually, then the website developers need to provide code that is supported by assistive technology.

Additional Errors

Low Contrast

The low contrast error per WAVE occurs when there is little color difference or contrast between foreground and background colors. 36 This error can affect (but is not limited to) color blind and low vision individuals. Many individuals with colorblindness have specific shades or color frequencies that are difficult to distinguish in both digital and non-digital environments. One example of a low contrast error would be a white font on a yellow background.

Of the 100 academic library websites reviewed with WAVE, 94 percent reported low contrast errors. Purdue University-West Lafayette had the largest sum of reported errors per school, with 111 low contrast errors. Only 6 percent of universities had error-free presentations: Arizona State University-Tempe, Temple University, University of Connecticut-Storrs, University of Maryland-College Park, University of Virginia, and the University of Wisconsin-Madison. The mean was 4.01 errors; the adjusted mean removing the skew of 111 contrast problems from Purdue University, went down to 2.90 errors.

When text and images of texts are utilized, contrast ratios must be 4.5:1 according to WCAG 2.0 (Level AA) Distinguishable rule 1.4.3. 37 When utilizing larger text, a minimum of 18 point should be used. 39 The minimum font size for smaller content is 14 points, with a bold font size of 14. A contrast ratio of at least 3:135 is required for both text sizes. 40

A screen view sample of the low contrast error from the University of Pittsburgh ( www.library.pitt.edu/ ) is shown in Figure 3. The lighter lettering appears to be difficult to read on the white background. The recommended fix would be to use a larger, black font. This would correspond with the WAVE guideline for enhanced contrast.

Id Attribute is Not Unique

The id attribute is not unique error resulted in a roughly 50/50 split between schools with and without the error. Forty-four percent of the 100 data points had an id attribute that is not unique error, while 56 percent did not. With assistive technology at the heart of ADA accessibility, this finding is highly disheartening since the need for unique identifiers while using assistive technologies is essential for disabled users.

This data shows that over half of the public universities studied do not acknowledge or accommodate assistive devices. A student with a disability attending a state institution may have a tough time navigating their college library website with this kind of oversight. Failure to accommodate disabled users significantly limits college options for students with disabilities who may already face financial challenges, whether they choose to live away from home or stay close to home. Because not all universities provide the same programs or the same level of accessibility with those programs, disabled students end up limiting their career or life aspirations.

The University of California System provides a good example of assistive technology incompatibility. Because several schools appeared on the sample set, they were regarded as a good sample within the data set demonstrating this error. The error computations were a statistical inverse of the overall data set, which was an intriguing side note. Nonetheless, they revealed how many universities within a single state were adversely affected. More than half of California public colleges’ academic libraries lacked software or hardware that made websites accessible to people with disabilities. In comparison to the entire data, the compatibility vs incompatibility of assistive technology accessibility is almost 50/50. When looking for schools in California, students with disabilities may find it difficult to believe that less than half of the California university library websites recognize their assistive technology. Table 1 shows compatibility and incompatibility among the California Public Universities.

Img Element Missing Alt Attribute

The img element missing alt attribute is an ongoing source of frustration for people with disabilities. Missing image alternative text and attributes, or the img element missing alt attribute , was found in 19 percent of the surveyed institutions, with the total error count of 382 and a mean of 3.82. Skewed data occurred from two universities with very high counts of this error: University of Maryland-Baltimore County (135) and Temple University (144). When removed from the mean for skewness; the adjusted mean went down to 1.05 errors per university. The data indicated that there is often only one error per full webpage, which is somewhat encouraging, but means there is still work to do. Figure 4 illustrates 19 schools with the percentage img element missing alt attribute error per academic library website; the remaining 81 schools had a zero count. The percentages ranged from 0.26 percent to 37.70 percent.

Individuals with auditory and visual disabilities are most affected by the img element missing alt attribute , which as stated in the WCAG 2.0 (Level A) guideline 1.1 requires that organizations provide a text equivalent for every non-text element on a webpage. In the same way that the missing form label hampered academic achievement, the img element missing alt attribute hampered digital access, academic performance, and autonomous learning at the post-secondary level. According to the reasoning of this study, individuals with visual disabilities can use alternate text to substitute for the image they can’t see, while those with auditory disabilities can read.

For any image or video on a page, there needs to be alternate text and/or closed captioning (CC). When using CC, it is important to review and edit it, as errors in automatic transcription from audio software may occur. When observed on the University of Pittsburgh’s website ( www.library.pitt.edu ), the label “GIVE NOW” had no explanation, audio, or alternate text of its purpose. When using assistive technology, the user would hover over the box with their assistive technology, with no alternate attribute of the image to what is the box’s function. A study recommendation: place a tag next to the “GIVE NOW” with a simple explanation and label for those using screen readers or similar tools.

Conclusion and Future Study Perspectives

According to “WCAG Guideline 1.3. Adaptable,” to be adaptable for individuals with disabilities, content should be presented in accessible layouts that don’t lose the content or structure of the webpage and make it easier for disabled users to operate and navigate content. At the very least, website designers should supply alt text for images so there are detailed descriptions of what an image is. A bigger fix would be to run their pages through WAVE or AChecker and correct all the errors they can.

Section 508 was updated in 2018 with technological and legal improvements, including the adoption of WCAG standards that are universally acknowledged. Many parents, educators, and researchers were reminded by the ongoing epidemic that a lack of academic accessibility for people with disabilities was becoming more obvious than ever. According to the findings of this and other studies, there is a dearth of substantial support for digital accessibility in the United States, especially assistive technology detection. When students are looking for post-secondary institutions, a lack of accessibility may obstruct or interfere with their college choices, academic achievement, as well as life goals such as independent living and future earning potential.

Additional longitudinal studies revisiting the same data set in the future would be valuable and advantageous by comparing data from the studies in a quantitative way over time. The argument for using the same data set is that collecting error data and using the same error samples would disclose a lot of important information for suggestions on how to improve accessibility and/or make modifications, as well as how to design more error-free websites. This study’s findings confirm and reinforce the necessity of digital accessibility in today’s ever-changing digital ecosystem, where it is required, achievable, and possible.

Acknowledgments

The research study covered in this article was funded by a Faculty Research Grant from the American Association of University Professors (CSU-AAUP) for the 2019–2020 academic year. The survey was conducted and the report was written by Jennifer Beckwith in accordance with Dr. Yan Quan Liu’s directions. The study topic was proposed by Dr. Arlene C. Bielefield, who also edited the manuscript. The research was overseen by Dr. Yan Quan Liu, who finalized the draft of the paper for publication.

Appendix A. Table of Relevant Studies

Alphabetical by author.

Appendix B. Data Set

Appendix c. overall error counts for wave.

Totals in descending order

Appendix D. Total Known Errors with AChecker

This table is in descending order.

1. ADA Network, “What Are the Public or Private College-University’s Responsibilities to Students with Disabilities?” https://adata.org/faq/what-are-public-or-private-college-universitys-responsibilities-students-disabilities .

2. Mike Cristancho, “How to Make Your Site ADA Compliant,” Medium, August 18, 2017, https://medium.com/gauge-interactive/how-to-make-your-site-ada-compliant-74eb2a92ff3f .  

3. Patricia Acosta-Vargas, Tania Acosta, Sergio Lujan-Mora, “Challenges to Assess Accessibility in Higher Education Websites: A Comparative Study of Latin American Universities,” IEEE Access, vol. 6 (2018), https://ieeexplore.ieee.org/document/8388714 .

4. WAVE, Web Accessibility Evaluation Tool, “Site-Wide WAVE Tools,”  http://wave.webaim.org/sitewide .

5. Adina Mulliken, “Eighteen Blind Library Users’ Experiences with Library Websites and Search Tools in U.S. Academic Libraries: A Qualitative Study,”  College and Research Libraries, vol 80, no. 2 (2019), https://crl.acrl.org/index.php/crl/article/view/16947/19428 .

6. Ibid.

7. Ibid.

8. Mary Cassner, Charlene Maxey-Harris, Toni Anaya, “Differently Able: A Review of Academic Library Websites for People with Disabilities” Behavioral & Social Sciences Librarian , vol. 30, no. 1, (March 2011): 33–51, https://tandfonline.com/doi/abs/10.1080/01639269.2011.548722 .

9. Ibid.

10. Wenfang Yang, Bin Zhao, Yan Quan Liu, and Arlene Bielefield “Are Ivy League Libraries’ Websites ADA Compliant?” Information Technology and Libraries , vol. 39, no. 2 (2020); https://doi.org/10.6017/ital.v39i2.11577 .

11. Yan Quan Liu, Arlene Bielefield, and Peter McKay, “Are Urban Public Libraries’ Websites Accessible to Americans with Disabilities?” Universal Access in the Information Society 18 (2019): 191–206. https://doi.org/10.1007/s10209-017-0571-7 .

12. Susan B. Asselin, “Learning and Assistive Technologies for College Transition,” Journal of Vocational Rehabilitation , vol. 40, no. 3 (January 2014): 223–230, https://content.iospress.com/articles/journal-of-vocational-rehabilitation/jvr687 .

13. Ibid.

14. Deque University, “Become an Accessibility Expert” (May 25, 2021), www.dequeuniversity.com .

15. International Association of Accessibility Professionals (IAAP), “About IAAP,” https://www.accessibilityassociation.org/s/about .

16. Arlene Mayerson, “The History of the Americans with Disabilities Act, A Movement Perspective,”  Disability Rights Education and Defense Fund  [DREDF] (١٩٩٢) https://dredf.org/about-us/publications/the-history-of-the-ada/ .

17. Trevor Crowley, “Wheelchair Ramps in Cyberspace: Bringing the Americans with Disabilities Act into the 21st Century”  Brigham Young University Law Review , vol. 2013 issue 3, no. 11, (2013): 651–690, https://digitalcommons.law.byu.edu/lawreview/vol2013/iss3/11/ .

18. Kimberlieanne Podlas, “Website Accessibility and the Americans with Disabilities Act” Journal of Internet Law , vol 19 no. 5 (2015): 3–16.

19. Ibid.

20. Amanda Robert, “Disability Law, SCOTUS Rejects Pizza Delivery Company’s Appeal Over Web and Mobile App Accessibility,” ABA Journal. American Bar Association (October 7, 2019), http://www.abajournal.com/news/article/supreme-court-rejects-dominos-appeal-over-web-and-app-accessibility .

21. Martin LaGrow, “The Section 508 Refresh and What It Means for Higher Education” Educause Review (December 4, 2017), https://er.educause.edu/articles/2017/12/the-section-508-refresh-and-what-it-means-for-higher-education .

22. Ibid.

23. U.S. General Services Administration [USGSA], “2017 Accessibility Refresh Fact Sheet,” https://assets.section508.gov/files/2017_508-Refresh-Fact-sheet-updated.pdf

24. Ibid.

25. Ibid.

26. Yang, Zhao, and Liu, “Are Ivy League Libraries’ Websites ADA Compliant?”

27. Liu, Bielefield & McKay, “Are Urban Public Libraries’ Websites Accessible to Americans with Disabilities?”

28. U.S. News & World Report. Top Public Schools, National Universities [2019] , Data released and published Fall 2018.

29. Acosta-Vargas, Acosta, and Lujan-Mora, “Challenges to Assess Accessibility in Higher Education Websites: A Comparative Study of Latin American Universities.”

30. Stephanie J. Graves and Elizabeth German, “Evidence of Our Values: Disability Inclusion on Library Instruction Websites,” portal: Libraries and the Academy 18 no. 3 (July 2018): 559–574 https://doi.org/10.1353/pla.2018.0033 .

31. Abid Ismail, K.S. Kuppusamy, “Accessibility of Indian Universities’ Homepages: An Exploratory Study, ” Journal of King Saud University—Computer and Information Sciences, (April 2018): 268–278, .

32. Ibid.

33. WAVE, “Site-Wide WAVE Tools.”

34. Ibid.

35. Ibid.

36. Ibid.

37. W3C, “Web Standards,” https://www.w3.org/standards/ .

38. Screen view taken from University of Pittsburgh, www.library.pitt.edu retrieved in September 2022.

39. W3C, “Web Standards,” https://www.w3.org/standards/ .

40. Ibid.

* Yan Quan Liu is Professor of Library and Information Science at Southern Connecticut State University, email: [email protected] ; Arlene Bielefield is Associate Professor of Library and Information Science at Southern Connecticut State University, email: [email protected] ; Jennifer Beckwith is an MLIS Graduate of Southern Connecticut State University and a Children’s Librarian at Guilford Free Library, email: [email protected] . ©2024 Yan Quan Liu, Arlene Bielefield, and Jennifer Beckwith, Attribution-NonCommercial ( https://creativecommons.org/licenses/by-nc/4.0/ ) CC BY-NC.

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  • v.12(3); 2021 Jun

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Writing, reading, and critiquing reviews

Écrire, lire et revue critique, douglas archibald.

1 University of Ottawa, Ontario, Canada;

Maria Athina Martimianakis

2 University of Toronto, Ontario, Canada

Why reviews matter

What do all authors of the CMEJ have in common? For that matter what do all health professions education scholars have in common? We all engage with literature. When you have an idea or question the first thing you do is find out what has been published on the topic of interest. Literature reviews are foundational to any study. They describe what is known about given topic and lead us to identify a knowledge gap to study. All reviews require authors to be able accurately summarize, synthesize, interpret and even critique the research literature. 1 , 2 In fact, for this editorial we have had to review the literature on reviews . Knowledge and evidence are expanding in our field of health professions education at an ever increasing rate and so to help keep pace, well written reviews are essential. Though reviews may be difficult to write, they will always be read. In this editorial we survey the various forms review articles can take. As well we want to provide authors and reviewers at CMEJ with some guidance and resources to be able write and/or review a review article.

What are the types of reviews conducted in Health Professions Education?

Health professions education attracts scholars from across disciplines and professions. For this reason, there are numerous ways to conduct reviews and it is important to familiarize oneself with these different forms to be able to effectively situate your work and write a compelling rationale for choosing your review methodology. 1 , 2 To do this, authors must contend with an ever-increasing lexicon of review type articles. In 2009 Grant and colleagues conducted a typology of reviews to aid readers makes sense of the different review types, listing fourteen different ways of conducting reviews, not all of which are mutually exclusive. 3 Interestingly, in their typology they did not include narrative reviews which are often used by authors in health professions education. In Table 1 , we offer a short description of three common types of review articles submitted to CMEJ.

Three common types of review articles submitted to CMEJ

More recently, authors such as Greenhalgh 4 have drawn attention to the perceived hierarchy of systematic reviews over scoping and narrative reviews. Like Greenhalgh, 4 we argue that systematic reviews are not to be seen as the gold standard of all reviews. Instead, it is important to align the method of review to what the authors hope to achieve, and pursue the review rigorously, according to the tenets of the chosen review type. Sometimes it is helpful to read part of the literature on your topic before deciding on a methodology for organizing and assessing its usefulness. Importantly, whether you are conducting a review or reading reviews, appreciating the differences between different types of reviews can also help you weigh the author’s interpretation of their findings.

In the next section we summarize some general tips for conducting successful reviews.

How to write and review a review article

In 2016 David Cook wrote an editorial for Medical Education on tips for a great review article. 13 These tips are excellent suggestions for all types of articles you are considering to submit to the CMEJ. First, start with a clear question: focused or more general depending on the type of review you are conducting. Systematic reviews tend to address very focused questions often summarizing the evidence of your topic. Other types of reviews tend to have broader questions and are more exploratory in nature.

Following your question, choose an approach and plan your methods to match your question…just like you would for a research study. Fortunately, there are guidelines for many types of reviews. As Cook points out the most important consideration is to be sure that the methods you follow lead to a defensible answer to your review question. To help you prepare for a defensible answer there are many guides available. For systematic reviews consult PRISMA guidelines ; 13 for scoping reviews PRISMA-ScR ; 14 and SANRA 15 for narrative reviews. It is also important to explain to readers why you have chosen to conduct a review. You may be introducing a new way for addressing an old problem, drawing links across literatures, filling in gaps in our knowledge about a phenomenon or educational practice. Cook refers to this as setting the stage. Linking back to the literature is important. In systematic reviews for example, you must be clear in explaining how your review builds on existing literature and previous reviews. This is your opportunity to be critical. What are the gaps and limitations of previous reviews? So, how will your systematic review resolve the shortcomings of previous work? In other types of reviews, such as narrative reviews, its less about filling a specific knowledge gap, and more about generating new research topic areas, exposing blind spots in our thinking, or making creative new links across issues. Whatever, type of review paper you are working on, the next steps are ones that can be applied to any scholarly writing. Be clear and offer insight. What is your main message? A review is more than just listing studies or referencing literature on your topic. Lead your readers to a convincing message. Provide commentary and interpretation for the studies in your review that will help you to inform your conclusions. For systematic reviews, Cook’s final tip is most likely the most important– report completely. You need to explain all your methods and report enough detail that readers can verify the main findings of each study you review. The most common reasons CMEJ reviewers recommend to decline a review article is because authors do not follow these last tips. In these instances authors do not provide the readers with enough detail to substantiate their interpretations or the message is not clear. Our recommendation for writing a great review is to ensure you have followed the previous tips and to have colleagues read over your paper to ensure you have provided a clear, detailed description and interpretation.

Finally, we leave you with some resources to guide your review writing. 3 , 7 , 8 , 10 , 11 , 16 , 17 We look forward to seeing your future work. One thing is certain, a better appreciation of what different reviews provide to the field will contribute to more purposeful exploration of the literature and better manuscript writing in general.

In this issue we present many interesting and worthwhile papers, two of which are, in fact, reviews.

Major Contributions

A chance for reform: the environmental impact of travel for general surgery residency interviews by Fung et al. 18 estimated the CO 2 emissions associated with traveling for residency position interviews. Due to the high emissions levels (mean 1.82 tonnes per applicant), they called for the consideration of alternative options such as videoconference interviews.

Understanding community family medicine preceptors’ involvement in educational scholarship: perceptions, influencing factors and promising areas for action by Ward and team 19 identified barriers, enablers, and opportunities to grow educational scholarship at community-based teaching sites. They discovered a growing interest in educational scholarship among community-based family medicine preceptors and hope the identification of successful processes will be beneficial for other community-based Family Medicine preceptors.

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners by Allison Brown and team 20 studied the impact of COVID-19 on medical learners around the world. There were different concerns depending on the levels of training, such as residents’ concerns with career timeline compared to trainees’ concerns with the quality of learning. Overall, the learners negatively perceived the disruption at all levels and geographic regions.

The impact of local health professions education grants: is it worth the investment? by Susan Humphrey-Murto and co-authors 21 considered factors that lead to the publication of studies supported by local medical education grants. They identified several factors associated with publication success, including previous oral or poster presentations. They hope their results will be valuable for Canadian centres with local grant programs.

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions by Stephana Cherak and team 22 studied learner-wellness in various training environments disrupted by the pandemic. They reported a negative impact on learner wellness at all stages of training. Their results can benefit the development of future wellness interventions.

Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework by Dore, Bogie, et al. 23 invited program directors to reflect on the introduction of the CanMEDS framework into Canadian postgraduate medical education programs. Their survey revealed that while program directors (PDs) recognized the necessity of the accreditation process, they did not feel they had a voice when the change occurred. The authors concluded that collaborations with PDs would lead to more successful outcomes.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development by Laura Farrell and team 24 stressed several elements for effective longitudinal faculty development (LFD) initiatives. They found that participants benefited from a supportive and collaborative environment while trying to learn a new skill or concept.

Brief Reports

The effect of COVID-19 on medical students’ education and wellbeing: a cross-sectional survey by Stephanie Thibaudeau and team 25 assessed the impact of COVID-19 on medical students. They reported an overall perceived negative impact, including increased depressive symptoms, increased anxiety, and reduced quality of education.

In Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum? Meshkat and co-authors 26 recorded the number of adult medical resuscitations and clinical procedures completed by PGY1 Fellow of the Royal College of Physicians in Emergency Medicine residents to compare them to the Competence by Design requirements. Their study underscored the importance of monitoring collection against pre-set targets. They concluded that residency program curricula should be regularly reviewed to allow for adequate clinical experiences.

Rehearsal simulation for antenatal consults by Anita Cheng and team 27 studied whether rehearsal simulation for antenatal consults helped residents prepare for difficult conversations with parents expecting complications with their baby before birth. They found that while rehearsal simulation improved residents’ confidence and communication techniques, it did not prepare them for unexpected parent responses.

Review Papers and Meta-Analyses

Peer support programs in the fields of medicine and nursing: a systematic search and narrative review by Haykal and co-authors 28 described and evaluated peer support programs in the medical field published in the literature. They found numerous diverse programs and concluded that including a variety of delivery methods to meet the needs of all participants is a key aspect for future peer-support initiatives.

Towards competency-based medical education in addictions psychiatry: a systematic review by Bahji et al. 6 identified addiction interventions to build competency for psychiatry residents and fellows. They found that current psychiatry entrustable professional activities need to be better identified and evaluated to ensure sustained competence in addictions.

Six ways to get a grip on leveraging the expertise of Instructional Design and Technology professionals by Chen and Kleinheksel 29 provided ways to improve technology implementation by clarifying the role that Instructional Design and Technology professionals can play in technology initiatives and technology-enhanced learning. They concluded that a strong collaboration is to the benefit of both the learners and their future patients.

In his article, Seven ways to get a grip on running a successful promotions process, 30 Simon Field provided guidelines for maximizing opportunities for successful promotion experiences. His seven tips included creating a rubric for both self-assessment of likeliness of success and adjudication by the committee.

Six ways to get a grip on your first health education leadership role by Stasiuk and Scott 31 provided tips for considering a health education leadership position. They advised readers to be intentional and methodical in accepting or rejecting positions.

Re-examining the value proposition for Competency-Based Medical Education by Dagnone and team 32 described the excitement and controversy surrounding the implementation of competency-based medical education (CBME) by Canadian postgraduate training programs. They proposed observing which elements of CBME had a positive impact on various outcomes.

You Should Try This

In their work, Interprofessional culinary education workshops at the University of Saskatchewan, Lieffers et al. 33 described the implementation of interprofessional culinary education workshops that were designed to provide health professions students with an experiential and cooperative learning experience while learning about important topics in nutrition. They reported an enthusiastic response and cooperation among students from different health professional programs.

In their article, Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques, Boulila and team 34 described the implementation of physiotherapist-led workshops, whether the workshops increased medical students’ musculoskeletal knowledge, and if they increased confidence in assessment techniques.

Instagram as a virtual art display for medical students by Karly Pippitt and team 35 used social media as a platform for showcasing artwork done by first-year medical students. They described this shift to online learning due to COVID-19. Using Instagram was cost-saving and widely accessible. They intend to continue with both online and in-person displays in the future.

Adapting clinical skills volunteer patient recruitment and retention during COVID-19 by Nazerali-Maitland et al. 36 proposed a SLIM-COVID framework as a solution to the problem of dwindling volunteer patients due to COVID-19. Their framework is intended to provide actionable solutions to recruit and engage volunteers in a challenging environment.

In Quick Response codes for virtual learner evaluation of teaching and attendance monitoring, Roxana Mo and co-authors 37 used Quick Response (QR) codes to monitor attendance and obtain evaluations for virtual teaching sessions. They found QR codes valuable for quick and simple feedback that could be used for many educational applications.

In Creation and implementation of the Ottawa Handbook of Emergency Medicine Kaitlin Endres and team 38 described the creation of a handbook they made as an academic resource for medical students as they shift to clerkship. It includes relevant content encountered in Emergency Medicine. While they intended it for medical students, they also see its value for nurses, paramedics, and other medical professionals.

Commentary and Opinions

The alarming situation of medical student mental health by D’Eon and team 39 appealed to medical education leaders to respond to the high numbers of mental health concerns among medical students. They urged leaders to address the underlying problems, such as the excessive demands of the curriculum.

In the shadows: medical student clinical observerships and career exploration in the face of COVID-19 by Law and co-authors 40 offered potential solutions to replace in-person shadowing that has been disrupted due to the COVID-19 pandemic. They hope the alternatives such as virtual shadowing will close the gap in learning caused by the pandemic.

Letters to the Editor

Canadian Federation of Medical Students' response to “ The alarming situation of medical student mental health” King et al. 41 on behalf of the Canadian Federation of Medical Students (CFMS) responded to the commentary by D’Eon and team 39 on medical students' mental health. King called upon the medical education community to join the CFMS in its commitment to improving medical student wellbeing.

Re: “Development of a medical education podcast in obstetrics and gynecology” 42 was written by Kirubarajan in response to the article by Development of a medical education podcast in obstetrics and gynecology by Black and team. 43 Kirubarajan applauded the development of the podcast to meet a need in medical education, and suggested potential future topics such as interventions to prevent learner burnout.

Response to “First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity” by Kumar and Hassan 44 acknowledged the previously published article by Biro et al. 45 that explored limitations in medical training for the LGBTQ2S community. However, Kumar and Hassen advocated for further progress and reform for medical training to address the health requirements for sexual and gender minorities.

In her letter, Journey to the unknown: road closed!, 46 Rosemary Pawliuk responded to the article, Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic, by Gutman et al. 47 Pawliuk agreed that international medical students (IMGs) do not have adequate formal representation when it comes to residency training decisions. Therefore, Pawliuk challenged health organizations to make changes to give a voice in decision-making to the organizations representing IMGs.

In Connections, 48 Sara Guzman created a digital painting to portray her approach to learning. Her image of a hand touching a neuron showed her desire to physically see and touch an active neuron in order to further understand the brain and its connections.

IMAGES

  1. 50 Smart Literature Review Templates (APA) ᐅ TemplateLab

    review of scholarly literature

  2. (PDF) A Guide to Writing the Dissertation Literature Review

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  3. (PDF) A Review of Literature on Medical Students and Scholarly Research

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  4. 39 Best Literature Review Examples (Guide & Samples)

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VIDEO

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  5. Effective Review of Literature

  6. Background, Literature Review, and Theoretical Framework -- Sarah Lynne Bowman

COMMENTS

  1. Writing a Literature Review

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  2. How to Write 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.

  3. Steps in Conducting a Literature Review

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

  4. What is a Literature Review?

    A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it ...

  5. Writing a literature review

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  6. Approaching literature review for academic purposes: The Literature

    A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field.

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  8. 5. The Literature Review

    A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated.

  9. Writing a Literature Review

    A literature review is a survey of scholarly sources that provides an overview of a particular topic. Literature reviews are a collection of the most relevant and significant publications regarding that topic in order to provide a comprehensive look at what has been said on the topic and by whom. The basic components of a literature review include:

  10. The Literature Review: A Foundation for High-Quality Medical Education

    The literature review is a crucial step for conducting high-quality research, but it can be challenging and time-consuming. This article provides a comprehensive guide for conducting a literature review, covering the types, purposes, methods, and quality assessment of literature reviews. It also offers practical tips and examples for researchers and students who want to improve their ...

  11. 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 ...

  12. How to write a superb literature review

    Attribute. Manubot. Overleaf. Google Docs. Cost. Free, open source. $15-30 per month, comes with academic discounts. Free, comes with a Google account. Writing language

  13. Writing a literature review

    Writing a literature review requires a range of skills to gather, sort, evaluate and summarise peer-reviewed published data into a relevant and informative unbiased narrative. Digital access to research papers, academic texts, review articles, reference databases and public data sets are all sources of information that are available to enrich ...

  14. Literature Review: Conducting & Writing

    Steps for Conducting a Lit Review; Finding "The Literature" Organizing/Writing; APA Style This link opens in a new window; Chicago: Notes Bibliography This link opens in a new window; MLA Style This link opens in a new window; Sample Literature Reviews. Sample Lit Reviews from Communication Arts; Have an exemplary literature review? Get Help!

  15. Literature Reviews, Theoretical Frameworks, and Conceptual Frameworks

    This section addresses such questions broadly while providing general guidance for writing a narrative literature review that evaluates the most pertinent studies. The literature review process should begin before the research is conducted. As Boote and Beile (2005, p. 3) suggested, researchers should be "scholars before researchers."

  16. Guidance on Conducting a Systematic Literature Review

    Literature review is an essential feature of academic research. Fundamentally, knowledge advancement must be built on prior existing work. To push the knowledge frontier, we must know where the frontier is. By reviewing relevant literature, we understand the breadth and depth of the existing body of work and identify gaps to explore.

  17. Literature review as a research methodology: An ...

    As mentioned previously, there are a number of existing guidelines for literature reviews. Depending on the methodology needed to achieve the purpose of the review, all types can be helpful and appropriate to reach a specific goal (for examples, please see Table 1).These approaches can be qualitative, quantitative, or have a mixed design depending on the phase of the review.

  18. Research, Writing and Publishing: Review Scholarly Literature

    Covidence is a systematic review management tool, but it can be used for any type of literature review. Covidence users can collect references from multiple databases and invite team members to screen titles, abstracts, and full text articles for a literature review.

  19. Q. What is a scholarly literature review? How can I find one?

    The purpose of a literature review is to provide an overview of the current knowledge on a topic, and/or to provide a context for new research. Click here to see a table that lists the various kinds of literature reviews that you may encounter in your research. (From Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 ...

  20. Research Guides: Literature Reviews: Literature Review Table

    Developing a Literature Review. Steps to Success: The Literature Review Process ; Literature Reviews Webinar Recording ; Literature Review Table ; Writing Like an Academic; Publishing in Academic Journals; Managing Citations This link opens in a new window

  21. Google Scholar

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  22. Reviewing literature for research: Doing it the right way

    Literature search. Fink has defined research literature review as a "systematic, explicit and reproducible method for identifying, evaluating, and synthesizing the existing body of completed and recorded work produced by researchers, scholars and practitioners."[]Review of research literature can be summarized into a seven step process: (i) Selecting research questions/purpose of the ...

  23. What is Scholarly Literature?

    Features of Scholarly Literature. Written by scholars and subject experts; Written for other scholars, professionals. and policy makers. Also read by student researchers ... In academic publishing, the goal of peer review is to assess the quality of articles submitted for publication in a scholarly journal. Before an article is deemed ...

  24. Literature Reviews

    Literature: a collection of materials on your topic.(does not mean "literature" in the sense of "language and literature" (To Kill a Mockingbird, Jane Eyre, etc.) —means understanding the difference between primary, secondary and tertiary literature Primary—peer reviewed, scholarly, original, review articles—secondary Review: to look again at what has been written.

  25. Declining global fertility rates and the implications ...

    A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews.

  26. AI-Assisted Literature Reviews

    This AI research assistant helps in evidence synthesis and text extraction. Users can enter a research question, and the AI identifies top papers in the field, even without perfect keyword matching. Elicit only includes academic papers, since Elicit is designed around finding and analyzing academic papers specifically.

  27. ADA Digital Accessibility on Academic Library Websites

    The related literature shows accessibility is never over and done with; it is a constantly evolving responsibility. In light of the global pandemic, critical work, along with continued improvements in technology and employee training, should provide greater digital accessibility for all. ... "Differently Able: A Review of Academic Library ...

  28. Writing, reading, and critiquing reviews

    Literature reviews are foundational to any study. They describe what is known about given topic and lead us to identify a knowledge gap to study. All reviews require authors to be able accurately summarize, synthesize, interpret and even critique the research literature. 1, 2 In fact, for this editorial we have had to review the literature on ...