688185
research-article2017
JHLXXX10.1177/0033354916688185Journal of Human LactationDodgson
Column
About Research: Literature Reviews
Joan E. Dodgson, PhD, MPH, RN, FAAN1
In our world of rapidly expanding knowledge
and exponential growth in published research,
synthesis of knowledge has become ever more
important. The most up-to-date method for doing
this in our field, as well as many others, is a schol-
arly analysis of published research studiesthe
literature review. Not so long ago, knowledge syn-
thesis was the main purpose of textbooks; how-
ever, by the time a textbook is published, the
content is already several years old. Clinicians,
program planners, and policy makers need more
updated information and often cannot spend the
time to obtain all the relevant literature on a topic.
Joan E. Dodgson.
Literature reviews fill this gap.
Recognizing the importance of this type of research, we
are publishing four literature reviews in this issue (two sys-
tematic reviews, a scoping review, and a critical review) that
illustrate the topics covered in this column. Different disci-
plines use different techniques for analyzing and presenting
knowledge synthesis (literature reviews). In this inaugural
About Research column, along with describing these differ-
ent approaches to conducting literature reviews, process stan-
dards and determining rigor in this type of research are
discussed. What all types of reviews have in common and
what makes them scholarly is the critical analysis that occurs
during the knowledge synthesis process. Synthesis without
critical analysis is just reporting, not research. Therefore, in
evaluating this type of research, one needs to examine how
the critical analysis was done, ensuring the rigor in the meth-
odology and the review process and checking for possible
bias (Whittemore, Chao, Jang, Minges, & Park, 2014). Bias
has a number of sources when synthesizing knowledge, stem-
ming from the researchers choices surrounding the develop-
ment of the research aim/question, the selection of articles to
review, and the transparency in their process or lack of it.
Establishing Rigor in Research Reviews
One component of assessing the methodological rigor used in
literature reviews is to determine how completely and transpar-
ently the authors have detailed their review process. Reporting
the basic components of methodological structure is essential.
These basic structural components guiding the research process
are (1) the design (e.g., which type of review methodology is
being used and why; when the review was conducted), (2) the
sample (e.g., the criteria for how studies were chosen and why;
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2017, Vol. 33(1) 115118
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sample size), (3) the way the data were collected
(e.g., the search strategy used, databases searched
and why), and (4) the way the data were analyzed
(e.g., what components were critically analyzed
and why). Although all of these basic components
are common to all types of research, authors of
literature reviews have not always reported them.
This has occurred for a variety of reasons related
to misconceptions about the nature of, and stan-
dards for, conducting literature reviews.
Standards developed by academic consor-
tiums exist for reporting systematic reviews
(Eden, Levit, Berg, & Morton, 2011; Moher
etal., 2015) and Cochrane Reviews (Higgins
& Green, 2008). For other types of reviews, discussed
below, guidelines have been written by a variety of sources,
but no definitive standards exist. Other types of standards
are those set by publishing consortiums and journal editors,
which provide direction for authors. JHL has established
specific author guidelines for reporting reviews, as well.
(The reviews published in this issue provide examples of
how this is done at JHL.)
As professionals, we are always evaluating what we read
for possible bias and errors in logical thinking. In applying
this notion to literature reviews, we must examine (1) the
research aim/question and (2) how the researchers obtained
their sample, meaning what databases and search terms were
used to conduct their search of the literature. The researchers
need to have clear research question(s) that identify their
focus area, population, and concepts/variables of interest.
For example, in JHL, this can easily be identified in the
abstract and then repeated just before the methods section.
The key question to ask concerning search terms is,
Were all the relevant terms used while running the search or
were key terms missed? This is a question best answered by
those clinicians and scholars working directly in the area of
interest. The more complete the search terms, the more
1
Patricia and James R. Hemak Endowed Professor of Maternal Child
Nursing Research at the School of Nursing, Saint Louis University, Saint
Louis MO USA
Corresponding Author:
Joan E. Dodgson, Patricia and James R. Hemak Endowed Professor of
Maternal Child Nursing Research at the School of Nursing, Saint Louis
University, Saint Louis MO USA.
Email: dodgsonje@slu.edu
116 Journal of Human Lactation 33(1)
comprehensive the search and the more likely that critically
important articles will not be missed. Limiting search strat-
egies to only those articles of which one can easily get a
full-text copy online may result in sample selection bias
that influences the findings of review. Although this
approach may be the only one that some researchers, par-
ticularly those in remote areas, can use, it does affect the
quality of the results. In all of the reviews published in this
issue, you will see a diagram called a PRISMA [Preferred
Reporting Items for Systematic Reviews and Meta-
Analyses] flow chart diagram, named for the organization
(Transparent Reporting of Systematic Reviews and Meta-
Analyses) that created it. This diagram details the research-
ers search of the literature and has become the standard
way to convey how the articles for review were selected.
The purpose is to increase transparency in the reviewers
process by standardizing reporting. JHL adheres to
PRISMA guidelines.
Today, numerous electronic databases exist that contain
relevant research on any one particular topic. It is unfortu-
nate that most of these databases can be accessed only
through subscriptions; however, most universities do have a
wide variety of electronic databases. Searching only one
database is no longer sufficient to obtain a valid picture of
the published literature on any given topic. Indeed, searching
even two or three databases may not be adequate. Two data-
bases often overlooked by health care professionals in our
field are JSTOR (humanities and social science literature)
and PsycINFO (psychology and other social sciences). When
I am doing literature searches on breastfeeding topics, I often
find several key articles on these sites that are not in any
other database. Bias in selection of databases or search terms
leads to a biased literature review, having limited usefulness
and perhaps creating misperceptions among readers.
Bias also may be introduced into a literature review
through the researcher selectively reporting outcomes from
the reviewed studies, which is harder for the reader to iden-
tify. This is one of the many reasons we have a peer review
process for all submitted manuscripts. Peer reviewers are
selected because of their expertise in the field and would
identify this type of bias. Although it is the responsibility of
editors and peer reviewers to identify and avoid publishing
biased reviews, readers also have a responsibility to critically
evaluate what is published. It is unfortunate that not all pro-
fessional journals have the same quality standards; it is left to
the consumer to have a basic understanding of how to deter-
mine quality work when reading a literature review.
Another issue concerning the quality of a literature review
is the publication date. How old is too old? This really
depends on how the information in the review will be used.
If it is being used to guide practice or develop policy or pro-
tocols, given the lag time in publishing for most journals,
even 2 years may be too old. Many journals publish the date
that each article was accepted for publication, so you can see
this lag time. If the review is being used to establish general
background information on a topic, a more extended time-
frame may be adequate. In other words, the usefulness of
literature reviews has a shelf life.
Specific Types of Literature Reviews
The variety of types of literature reviews stems from the
approaches that different health professions have taken
toward developing knowledge. For example, systematic
reviews, more commonly conducted by medicine, have been
in use longer and have more developed objective criteria with
strict established protocols (Moher etal., 2015). Integrative
reviews are more commonly conducted in nursing; although
having established guidelines, this method has a broader
approach that includes both qualitative and quantitative arti-
cles (Whittemore etal., 2014). The approach that is widely
viewed as the gold standard for literature reviews that inform
clinical practice is the Cochrane Review. This methodology
targets a very narrow research question and takes a deep dive
into the quality of the methodology. The most common types
of literature reviews are discussed in more detail below.
Although the descriptions below are not an exhaustive list of
all types of literature reviews, they are the most relevant to the
field of lactation.
Systematic Review
Systematic reviews are the most common published type of
knowledge synthesis, which includes Cochrane Reviews,
discussed separately in the following section. Systematic
reviews are more often used to evaluate intervention
research and evaluate outcomes. Both of the systematic
reviews published in this issue have evaluated breastfeed-
ing-specific outcomes. The standards for conducting and
reporting systematic reviews have long been established by
the PRISMA organization (Liberati etal., 2009; Moher,
Liberati, Tetzlaff, Altman, & PRISMA Group, 2009) and
more recently by the U.S. Institute of Medicine (Eden etal.,
2011). Many journals adhere to these standards, including
JHL. Both organizations have checklists of the components
necessary to include when conducting systematic reviews to
guide researchers and serve a standard for editors and read-
ers to evaluate the quality of a review. One notable emphasis
within these standards is an emphasis on reducing the risk of
bias when selecting articles to review and on reducing bias
in selectively reporting outcomes of reviewed studies.
Ensuring transparency and a nonbiased research process is
enhanced greatly by this standardized methodology, creat-
ing more reliable results that can be used to inform health
care practice and policy. These methodological procedures
are not built into all types of literature reviews; the nature
and/or purpose of other types of literature reviews may
make having standardized protocols inappropriate.
About Research 117
Cochrane Review
Cochrane is named in honor of Archie Cochrane, a British
medical researcher and epidemiologist who was interested in
determining and using only the best possible evidence for
decision making in health care. It is an international network
of researchers, grouped by their areas of expertise, that exam-
ines the existing quantitative research using strict criteria for
determining the quality of these studies. Researchers rank the
evidence according to established standards with meta-analy-
ses and randomized controlled trials creating the best evi-
dence. Their goal is to provide high-quality information on
their chosen topics for clinicians and policy makers world-
wide. The Cochrane Library publishes these reviews, which
are open access after 1 year but can be accessed immediately
through subscribing libraries and other institutions at any time.
Their methodology is the gold standard for systematic reviews;
however, the research aims are very narrow and population
specific. They do publish a few reviews on breastfeeding top-
ics. Recent breastfeeding reviews are Antenatal Breast-
feeding Education for Increasing Breastfeeding Duration
(Lumbiganon etal., 2016) and Interventions for Encouraging
Women to Start Breastfeeding (Balogun etal., 2016).
Integrative Review
An integrative review summarizes past empirical or theoreti-
cal quantitative and qualitative literature using narrative
analysis methods to provide a more comprehensive under-
standing of a particular phenomenon or health care problem
(Whittemore & Knafl, 2005). The varied sampling frame of
integrative reviews in conjunction with the multiplicity of
purposes has the potential to result in a comprehensive por-
trayal of complex concepts, theories, or health care problems
of importance to nursing (p. 547). Although Whittemore
and Knafl have proposed methodological guidelines, no
well-established criteria have been established (Whittemore
etal., 2014). You will find that these reviews are conducted
using a broad array of approaches. Some authors focus on a
deep analysis of the state of the science on a particular topic
(Manant & Dodgson, 2011), whereas others may focus on a
particular methodology (Anthony & Jack, 2009) or the
effects of a specific type of care management (Stamp,
Machado, & Allen, 2014). This is a versatile methodology;
however, determining the rigor of specific reviews often
requires doctoral-level knowledge.
Scoping Review
Scoping reviews are becoming more popular and are used
by a broad range of developing and well-developed disci-
plines (Colquhoun etal., 2014). Scoping reviews tend to
focus on the breadth of coverage of the literature rather than
the depth of coverage (Par, Trudel, Jaana, & Kitsiou,
2015, p. 186). Indeed, no generally accepted definition for a
scoping review currently exists. Colquhoun etal. have sug-
gested the following definition: a form of knowledge syn-
thesis that addresses an exploratory research question aimed
at mapping key concepts, types of evidence and gaps in the
research related to a defined area (pp. 12931294). The
scoping review by Spiesser-Robelet, Brunie, de Andrade,
and Gagnayre (2017) published in this issue of JHL is con-
gruent with this definition. Tricco and colleagues (2016)
conducted an extensive scoping review on all published
scoping reviews. They identified the lack of consistency in
the methodology used and reporting format and suggested
that establishing criteria for conducting and evaluating the
quality of scoping reviews is necessary.
Critical Review
A critical review has a defined research question that is broad
with a search strategy that is targeted. The purpose is to iden-
tify areas of weakness, contradiction, and inconsistencies in
reviewed articles using established criteria. The critical
review by Casal, Lei, Young, and Tuthill (2017) in this issue
analyzes the existing instruments used to measure several
key concepts in breastfeeding studies using established crite-
ria for validity. Unlike a review that seeks to integrate exist-
ing work, a review that involves a critical assessment does
not necessarily compare the covered works to one another
(Par etal., 2015, p. 189). Researchers from many different
disciplines conduct critical reviews; therefore, a variety of
theoretical and operational approaches is taken. There are no
established standards for this type of review.
Conclusion
An overview of the complexity inherent in conducting and
evaluating research that synthesizes knowledge has been
presented. There is much more that could be said and that has
been written concerning all aspects of this type of research.
One frequently identified methodological issue has been the
lack of clear standards and guidelines for most types of
reviews. Conversely, few resources exist to guide research-
ers about which review method is most appropriate for a par-
ticular topic (Perrier, Lightfoot, Kealey, Straus, & Tricco,
2016). It is clear that there is work to be done.
The overarching purpose of all literature reviews is to
inform practice and policy about what is known, how well
established the evidence is on a topic, and which questions
go unanswered that need to be answered. To effectively
accomplish this purpose, knowledge synthesis research
needs to be held to the highest possible standard. It matters;
it has the potential to change health care practice and affect
many individuals. It is the responsibility of all who are
involved in the process of creating, publishing, and reading
these reviews to vigilantly maintain these high standards.
118 Journal of Human Lactation 33(1)
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