a scoping review

• Open access
• Published: 08 October 2021

Scoping reviews: reinforcing and advancing the methodology and application

• Micah D. J. Peters 1 , 2 , 3 ,
• Casey Marnie 1 ,
• Heather Colquhoun 4 , 5 ,
• Chantelle M. Garritty 6 ,
• Susanne Hempel 7 ,
• Tanya Horsley 8 ,
• Etienne V. Langlois 9 ,
• Erin Lillie 10 ,
• Kelly K. O’Brien 5 , 11 , 12 ,
• Ӧzge Tunçalp 13 ,
• Michael G. Wilson 14 , 15 , 16 ,
• Wasifa Zarin 17 &
• Andrea C. Tricco   ORCID: orcid.org/0000-0002-4114-8971 17 , 18 , 19  

Systematic Reviews volume  10 , Article number:  263 ( 2021 ) Cite this article

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Scoping reviews are an increasingly common approach to evidence synthesis with a growing suite of methodological guidance and resources to assist review authors with their planning, conduct and reporting. The latest guidance for scoping reviews includes the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews. This paper provides readers with a brief update regarding ongoing work to enhance and improve the conduct and reporting of scoping reviews as well as information regarding the future steps in scoping review methods development. The purpose of this paper is to provide readers with a concise source of information regarding the difference between scoping reviews and other review types, the reasons for undertaking scoping reviews, and an update on methodological guidance for the conduct and reporting of scoping reviews.

Despite available guidance, some publications use the term ‘scoping review’ without clear consideration of available reporting and methodological tools. Selection of the most appropriate review type for the stated research objectives or questions, standardised use of methodological approaches and terminology in scoping reviews, clarity and consistency of reporting and ensuring that the reporting and presentation of the results clearly addresses the review’s objective(s) and question(s) are critical components for improving the rigour of scoping reviews.

Rigourous, high-quality scoping reviews should clearly follow up to date methodological guidance and reporting criteria. Stakeholder engagement is one area where further work could occur to enhance integration of consultation with the results of evidence syntheses and to support effective knowledge translation. Scoping review methodology is evolving as a policy and decision-making tool. Ensuring the integrity of scoping reviews by adherence to up-to-date reporting standards is integral to supporting well-informed decision-making.

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Introduction

Given the readily increasing access to evidence and data, methods of identifying, charting and reporting on information must be driven by new, user-friendly approaches. Since 2005, when the first framework for scoping reviews was published, several more detailed approaches (both methodological guidance and a reporting guideline) have been developed. Scoping reviews are an increasingly common approach to evidence synthesis which is very popular amongst end users [ 1 ]. Indeed, one scoping review of scoping reviews found that 53% (262/494) of scoping reviews had government authorities and policymakers as their target end-user audience [ 2 ]. Scoping reviews can provide end users with important insights into the characteristics of a body of evidence, the ways, concepts or terms have been used, and how a topic has been reported upon. Scoping reviews can provide overviews of either broad or specific research and policy fields, underpin research and policy agendas, highlight knowledge gaps and identify areas for subsequent evidence syntheses [ 3 ].

Despite or even potentially because of the range of different approaches to conducting and reporting scoping reviews that have emerged since Arksey and O’Malley’s first framework in 2005, it appears that lack of consistency in use of terminology, conduct and reporting persist [ 2 , 4 ]. There are many examples where manuscripts are titled ‘a scoping review’ without citing or appearing to follow any particular approach [ 5 , 6 , 7 , 8 , 9 ]. This is similar to how many reviews appear to misleadingly include ‘systematic’ in the title or purport to have adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement without doing so. Despite the publication of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and other recent guidance [ 4 , 10 , 11 , 12 , 13 , 14 ], many scoping reviews continue to be conducted and published without apparent (i.e. cited) consideration of these tools or only cursory reference to Arksey and O’Malley’s original framework. We can only speculate at this stage why many authors appear to be either unaware of or unwilling to adopt more recent methodological guidance and reporting items in their work. It could be that some authors are more familiar and comfortable with the older, less prescriptive framework and see no reason to change. It could be that more recent methodologies such as JBI’s guidance and the PRISMA-ScR appear more complicated and onerous to comply with and so may possibly be unfit for purpose from the perspective of some authors. In their 2005 publication, Arksey and O’Malley themselves called for scoping review (then scoping study) methodology to continue to be advanced and built upon by subsequent authors, so it is interesting to note a persistent resistance or lack of awareness from some authors. Whatever the reason or reasons, we contend that transparency and reproducibility are key markers of high-quality reporting of scoping reviews and that reporting a review’s conduct and results clearly and consistently in line with a recognised methodology or checklist is more likely than not to enhance rigour and utility. Scoping reviews should not be used as a synonym for an exploratory search or general review of the literature. Instead, it is critical that potential authors recognise the purpose and methodology of scoping reviews. In this editorial, we discuss the definition of scoping reviews, introduce contemporary methodological guidance and address the circumstances where scoping reviews may be conducted. Finally, we briefly consider where ongoing advances in the methodology are occurring.

What is a scoping review and how is it different from other evidence syntheses?

A scoping review is a type of evidence synthesis that has the objective of identifying and mapping relevant evidence that meets pre-determined inclusion criteria regarding the topic, field, context, concept or issue under review. The review question guiding a scoping review is typically broader than that of a traditional systematic review. Scoping reviews may include multiple types of evidence (i.e. different research methodologies, primary research, reviews, non-empirical evidence). Because scoping reviews seek to develop a comprehensive overview of the evidence rather than a quantitative or qualitative synthesis of data, it is not usually necessary to undertake methodological appraisal/risk of bias assessment of the sources included in a scoping review. Scoping reviews systematically identify and chart relevant literature that meet predetermined inclusion criteria available on a given topic to address specified objective(s) and review question(s) in relation to key concepts, theories, data and evidence gaps. Scoping reviews are unlike ‘evidence maps’ which can be defined as the figural or graphical presentation of the results of a broad and systematic search to identify gaps in knowledge and/or future research needs often using a searchable database [ 15 ]. Evidence maps can be underpinned by a scoping review or be used to present the results of a scoping review. Scoping reviews are similar to but distinct from other well-known forms of evidence synthesis of which there are many [ 16 ]. Whilst this paper’s purpose is not to go into depth regarding the similarities and differences between scoping reviews and the diverse range of other evidence synthesis approaches, Munn and colleagues recently discussed the key differences between scoping reviews and other common review types [ 3 ]. Like integrative reviews and narrative literature reviews, scoping reviews can include both research (i.e. empirical) and non-research evidence (grey literature) such as policy documents and online media [ 17 , 18 ]. Scoping reviews also address broader questions beyond the effectiveness of a given intervention typical of ‘traditional’ (i.e. Cochrane) systematic reviews or peoples’ experience of a particular phenomenon of interest (i.e. JBI systematic review of qualitative evidence). Scoping reviews typically identify, present and describe relevant characteristics of included sources of evidence rather than seeking to combine statistical or qualitative data from different sources to develop synthesised results.

Similar to systematic reviews, the conduct of scoping reviews should be based on well-defined methodological guidance and reporting standards that include an a priori protocol, eligibility criteria and comprehensive search strategy [ 11 , 12 ]. Unlike systematic reviews, however, scoping reviews may be iterative and flexible and whilst any deviations from the protocol should be transparently reported, adjustments to the questions, inclusion/exclusion criteria and search may be made during the conduct of the review [ 4 , 14 ]. Unlike systematic reviews where implications or recommendations for practice are a key feature, scoping reviews are not designed to underpin clinical practice decisions; hence, assessment of methodological quality or risk of bias of included studies (which is critical when reporting effect size estimates) is not a mandatory step and often does not occur [ 10 , 12 ]. Rapid reviews are another popular review type, but as yet have no consistent, best practice methodology [ 19 ]. Rapid reviews can be understood to be streamlined forms of other review types (i.e. systematic, integrative and scoping reviews) [ 20 ].

Guidance to improve the quality of reporting of scoping reviews

Since the first 2005 framework for scoping reviews (then termed ‘scoping studies’) [ 13 ], the popularity of this approach has grown, with numbers doubling between 2014 and 2017 [ 2 ]. The PRISMA-ScR is the most up-to-date and advanced approach for reporting scoping reviews which is largely based on the popular PRISMA statement and checklist, the JBI methodological guidance and other approaches for undertaking scoping reviews [ 11 ]. Experts in evidence synthesis including authors of earlier guidance for scoping reviews developed the PRISMA-ScR checklist and explanation using a robust and comprehensive approach. Enhancing transparency and uniformity of reporting scoping reviews using the PRISMA-ScR can help to improve the quality and value of a scoping review to readers and end users [ 21 ]. The PRISMA-ScR is not a methodological guideline for review conduct, but rather a complementary checklist to support comprehensive reporting of methods and findings that can be used alongside other methodological guidance [ 10 , 12 , 13 , 14 ]. For this reason, authors who are more familiar with or prefer Arksey and O’Malley’s framework; Levac, Colquhoun and O’Brien’s extension of that framework or JBI’s methodological guidance could each select their preferred methodological approach and report in accordance with the PRISMA-ScR checklist.

Reasons for conducting a scoping review

Whilst systematic reviews sit at the top of the evidence hierarchy, the types of research questions they address are not suitable for every application [ 3 ]. Many indications more appropriately require a scoping review. For example, to explore the extent and nature of a body of literature, the development of evidence maps and summaries; to inform future research and reviews and to identify evidence gaps [ 2 ]. Scoping reviews are particularly useful where evidence is extensive and widely dispersed (i.e. many different types of evidence), or emerging and not yet amenable to questions of effectiveness [ 22 ]. Because scoping reviews are agnostic in terms of the types of evidence they can draw upon, they can be used to bring together and report upon heterogeneous literature—including both empirical and non-empirical evidence—across disciplines within and beyond health [ 23 , 24 , 25 ].

When deciding between whether to conduct a systematic review or a scoping review, authors should have a strong understanding of their differences and be able to clearly identify their review’s precise research objective(s) and/or question(s). Munn and colleagues noted that a systematic review is likely the most suitable approach if reviewers intend to address questions regarding the feasibility, appropriateness, meaningfulness or effectiveness of a specified intervention [ 3 ]. There are also online resources for prospective authors [ 26 ]. A scoping review is probably best when research objectives or review questions involve exploring, identifying, mapping, reporting or discussing characteristics or concepts across a breadth of evidence sources.

Scoping reviews are increasingly used to respond to complex questions where comparing interventions may be neither relevant nor possible [ 27 ]. Often, cost, time, and resources are factors in decisions regarding review type. Whilst many scoping reviews can be quite large with numerous sources to screen and/or include, there is no expectation or possibility of statistical pooling, formal risk of bias rating, and quality of evidence assessment [ 28 , 29 ]. Topics where scoping reviews are necessary abound—for example, government organisations are often interested in the availability and applicability of tools to support health interventions, such as shared decision aids for pregnancy care [ 30 ]. Scoping reviews can also be applied to better understand complex issues related to the health workforce, such as how shift work impacts employee performance across diverse occupational sectors, which involves a diversity of evidence types as well as attention to knowledge gaps [ 31 ]. Another example is where more conceptual knowledge is required, for example, identifying and mapping existing tools [ 32 ]. Here, it is important to understand that scoping reviews are not the same as ‘realist reviews’ which can also be used to examine how interventions or programmes work. Realist reviews are typically designed to ellucide the theories that underpin a programme, examine evidence to reveal if and how those theories are relevant and explain how the given programme works (or not) [ 33 ].

Increased demand for scoping reviews to underpin high-quality knowledge translation across many disciplines within and beyond healthcare in turn fuels the need for consistency, clarity and rigour in reporting; hence, following recognised reporting guidelines is a streamlined and effective way of introducing these elements [ 34 ]. Standardisation and clarity of reporting (such as by using a published methodology and a reporting checklist—the PRISMA-ScR) can facilitate better understanding and uptake of the results of scoping reviews by end users who are able to more clearly understand the differences between systematic reviews, scoping reviews and literature reviews and how their findings can be applied to research, practice and policy.

Future directions in scoping reviews

The field of evidence synthesis is dynamic. Scoping review methodology continues to evolve to account for the changing needs and priorities of end users and the requirements of review authors for additional guidance regarding terminology, elements and steps of scoping reviews. Areas where ongoing research and development of scoping review guidance are occurring include inclusion of consultation with stakeholder groups such as end users and consumer representatives [ 35 ], clarity on when scoping reviews are the appropriate method over other synthesis approaches [ 3 ], approaches for mapping and presenting results in ways that clearly address the review’s research objective(s) and question(s) [ 29 ] and the assessment of the methodological quality of scoping reviews themselves [ 21 , 36 ]. The JBI Scoping Review Methodology group is currently working on this research agenda.

Consulting with end users, experts, or stakeholders has been a suggested but optional component of scoping reviews since 2005. Many of the subsequent approaches contained some reference to this useful activity. Stakeholder engagement is however often lost to the term ‘review’ in scoping reviews. Stakeholder engagement is important across all knowledge synthesis approaches to ensure relevance, contextualisation and uptake of research findings. In fact, it underlines the concept of integrated knowledge translation [ 37 , 38 ]. By including stakeholder consultation in the scoping review process, the utility and uptake of results may be enhanced making reviews more meaningful to end users. Stakeholder consultation can also support integrating knowledge translation efforts, facilitate identifying emerging priorities in the field not otherwise captured in the literature and may help build partnerships amongst stakeholder groups including consumers, researchers, funders and end users. Development in the field of evidence synthesis overall could be inspired by the incorporation of stakeholder consultation in scoping reviews and lead to better integration of consultation and engagement within projects utilising other synthesis methodologies. This highlights how further work could be conducted into establishing how and the extent to which scoping reviews have contributed to synthesising evidence and advancing scientific knowledge and understandings in a more general sense.

Currently, many methodological papers for scoping reviews are published in healthcare focussed journals and associated disciplines [ 6 , 39 , 40 , 41 , 42 , 43 ]. Another area where further work could also occur is to gain greater understanding on how scoping reviews and scoping review methodology is being used across disciplines beyond healthcare including how authors, reviewers and editors understand, recommend or utilise existing guidance for undertaking and reporting scoping reviews.

Whilst available guidance for the conduct and reporting of scoping review has evolved over recent years, opportunities remain to further enhance and progress the methodology, uptake and application. Despite existing guidance, some publications using the term ‘scoping review’ continue to be conducted without apparent consideration of available reporting and methodological tools. Because consistent and transparent reporting is widely recongised as important for supporting rigour, reproducibility and quality in research, we advocate for authors to use a stated scoping review methodology and to transparently report their conduct by using the PRISMA-ScR. Selection of the most appropriate review type for the stated research objectives or questions, standardising the use of methodological approaches and terminology in scoping reviews, clarity and consistency of reporting and ensuring that the reporting and presentation of the results clearly addresses the authors’ objective(s) and question(s) are also critical components for improving the rigour of scoping reviews. We contend that whilst the field of evidence synthesis and scoping reviews continues to evolve, use of the PRISMA-ScR is a valuable and practical tool for enhancing the quality of scoping reviews, particularly in combination with other methodological guidance [ 10 , 12 , 44 ]. Scoping review methodology is developing as a policy and decision-making tool, and so ensuring the integrity of these reviews by adhering to the most up-to-date reporting standards is integral to supporting well informed decision-making. As scoping review methodology continues to evolve alongside understandings regarding why authors do or do not use particular methodologies, we hope that future incarnations of scoping review methodology continues to provide useful, high-quality evidence to end users.

Availability of data and materials

All data and materials are available upon request.

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Acknowledgements

The authors would like to acknowledge the other members of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) working group as well as Shazia Siddiqui, a research assistant in the Knowledge Synthesis Team in the Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto.

The authors declare that no specific funding was received for this work. Author ACT declares that she is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. KKO is supported by a Canada Research Chair in Episodic Disability and Rehabilitation with the Canada Research Chairs Program.

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Micah D. J. Peters & Casey Marnie

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Micah D. J. Peters

The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, South Australia

Department of Occupational Science and Occupational Therapy, University of Toronto, Terrence Donnelly Health Sciences Complex, 3359 Mississauga Rd, Toronto, Ontario, L5L 1C6, Canada

Heather Colquhoun

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Kelly K. O’Brien

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Ӧzge Tunçalp

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MDJP, CM, HC, CMG, SH, TH, EVL, EL, KKO, OT, MGW, WZ and AT all made substantial contributions to the conception, design and drafting of the work. MDJP and CM prepared the final version of the manuscript. All authors reviewed and approved the final version of the manuscript.

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Peters, M.D.J., Marnie, C., Colquhoun, H. et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev 10 , 263 (2021). https://doi.org/10.1186/s13643-021-01821-3

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A scoping review of scoping reviews: advancing the approach and enhancing the consistency

a Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada

b Division of Public Health Risk Sciences, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario, N1G 5B2, Canada

Andrijana Rajić

c Food Safety and Quality Unit, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy

Judy D Greig

Jan m sargeant.

d Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada

Andrew Papadopoulos

Scott a mcewen, associated data.

The scoping review has become an increasingly popular approach for synthesizing research evidence. It is a relatively new approach for which a universal study definition or definitive procedure has not been established. The purpose of this scoping review was to provide an overview of scoping reviews in the literature.

A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in four bibliographic databases and the gray literature to identify scoping review studies. Review selection and characterization were performed by two independent reviewers using pretested forms.

The search identified 344 scoping reviews published from 1999 to October 2012. The reviews varied in terms of purpose, methodology, and detail of reporting. Nearly three-quarter of reviews (74.1%) addressed a health topic. Study completion times varied from 2 weeks to 20 months, and 51% utilized a published methodological framework. Quality assessment of included studies was infrequently performed (22.38%).

Conclusions

Scoping reviews are a relatively new but increasingly common approach for mapping broad topics. Because of variability in their conduct, there is a need for their methodological standardization to ensure the utility and strength of evidence. © 2014 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd.

1. Background

The scoping review has become an increasingly popular approach for synthesizing research evidence (Davis et al. , 2009 ; Levac et al. , 2010 ; Daudt et al. , 2013 ). It aims to map the existing literature in a field of interest in terms of the volume, nature, and characteristics of the primary research (Arksey and O'Malley, 2005 ). A scoping review of a body of literature can be of particular use when the topic has not yet been extensively reviewed or is of a complex or heterogeneous nature (Mays et al. , 2001 ). They are commonly undertaken to examine the extent, range, and nature of research activity in a topic area; determine the value and potential scope and cost of undertaking a full systematic review; summarize and disseminate research findings; and identify research gaps in the existing literature (Arksey and O'Malley, 2005 ; Levac et al. , 2010 ). As it provides a rigorous and transparent method for mapping areas of research, a scoping review can be used as a standalone project or as a preliminary step to a systematic review (Arksey and O'Malley, 2005 ).

Scoping reviews share a number of the same processes as systematic reviews as they both use rigorous and transparent methods to comprehensively identify and analyze all the relevant literature pertaining to a research question (DiCenso et al. , 2010 ). The key differences between the two review methods can be attributed to their differing purposes and aims. First, the purpose of a scoping review is to map the body of literature on a topic area (Arksey and O'Malley, 2005 ), whereas the purpose of a systematic review is to sum up the best available research on a specific question (Campbell Collaboration, 2013 ). Subsequently, a scoping review seeks to present an overview of a potentially large and diverse body of literature pertaining to a broad topic, whereas a systematic review attempts to collate empirical evidence from a relatively smaller number of studies pertaining to a focused research question (Arksey and O'Malley, 2005 ; Higgins and Green, 2011 ). Second, scoping reviews generally include a greater range of study designs and methodologies than systematic reviews addressing the effectiveness of interventions, which often focus on randomized controlled trials (Arksey and O'Malley, 2005 ). Third, scoping reviews aim to provide a descriptive overview of the reviewed material without critically appraising individual studies or synthesizing evidence from different studies (Arksey and O'Malley, 2005 ; Brien et al. , 2010 ). In contrast, systematic reviews aim to provide a synthesis of evidence from studies assessed for risk of bias (Higgins and Green, 2011 ).

Scoping reviews are a relatively new approach for which there is not yet a universal study definition or definitive procedure (Arksey and O'Malley, 2005 ; Anderson et al. , 2008 ; Davis et al. , 2009 ; Levac et al. , 2010 ; Daudt et al. , 2013 ). In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping reviews with the aims of clarifying when and how one might be undertaken. They proposed an iterative six-stage process: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarizing and reporting the results, and (6) an optional consultation exercise (Arksey and O'Malley, 2005 ). Arksey and O'Malley intended for their framework to stimulate discussion about the value of scoping reviews and provide a starting point toward a methodological framework. Since its publication, a few researchers have proposed enhancements to the Arksey and O'Malley framework based on their own experiences with it (Brien et al. , 2010 ; Levac et al. , 2010 ; Daudt et al. , 2013 ) or a review of a selection of scoping reviews (Anderson et al. , 2008 ; Davis et al. , 2009 ).

In recent years, scoping reviews have become an increasingly adopted approach and have been published across a broad range of disciplines and fields of study (Anderson et al. , 2008 ). To date, little has been published of the extent, nature, and use of completed scoping reviews. One study that explored the nature of scoping reviews within the nursing literature found that the included reviews ( N = 24) varied widely in terms of intent, procedure, and methodological rigor (Davis et al. , 2009 ). Another study that examined 24 scoping reviews commissioned by a health research program found that the nature and type of the reports were wide ranging and reported that the value of scoping reviews is ‘increasingly limited by a lack of definition and clarity of purpose’ (Anderson et al. , 2008 ). Given that these studies examined only a small number of scoping reviews from select fields, it is not known to what extent scoping reviews have been undertaken in other fields of research and whether these findings are representative of all scoping reviews as a whole. A review of scoping reviews across the literature can provide a better understanding of how the approach has been used and some of the limitations and challenges encountered by scoping review authors. This information would provide a basis for the development and adoption of a universal definition and methodological framework.

The purpose of this paper is to provide an overview of existing scoping reviews in the literature. The four specific objectives of this scoping review were to (1) conduct a systematic search of the published and gray literature for scoping review papers, (2) map out the characteristics and range of methodologies used in the identified scoping reviews, (3) examine reported challenges and limitations of the scoping review approach, and (4) propose recommendations for advancing the approach and enhancing the consistency with which they are undertaken and reported.

This scoping review began with the establishment of a research team consisting of individuals with expertise in epidemiology and research synthesis (Levac et al. , 2010 ). The team advised on the broad research question to be addressed and the overall study protocol, including identification of search terms and selection of databases to search.

The methodology for this scoping review was based on the framework outlined by Arksey and O'Malley ( 2005 ) and ensuing recommendations made by Levac et al . ( 2010 ). The review included the following five key phases: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting the results. The optional ‘consultation exercise’ of the framework was not conducted. A detailed review protocol can be obtained from the primary author upon request.

2.1. Research question

This review was guided by the question, ‘What are the characteristics and range of methodologies used in scoping reviews in the literature?’ For the purposes of this study, a scoping review is defined as a type of research synthesis that aims to ‘map the literature on a particular topic or research area and provide an opportunity to identify key concepts; gaps in the research; and types and sources of evidence to inform practice, policymaking, and research’ (Daudt et al. , 2013 ).

2.2. Data sources and search strategy

The initial search was implemented on June 17, 2011, in four electronic databases: MEDLINE/PubMed (biomedical sciences, 1946–present), SciVerse Scopus (multidisciplinary; 1823–present), CINAHL/EBSCO (nursing and allied health; 1981–present) and Current Contents Connect/ISI Web of Knowledge (multidisciplinary current awareness; 1998–present). The databases were selected to be comprehensive and to cover a broad range of disciplines. No limits on date, language, subject or type were placed on the database search. The search query consisted of terms considered by the authors to describe the scoping review and its methodology: scoping review, scoping study, scoping project, literature mapping, scoping exercise, scoping report, evidence mapping, systematic mapping, and rapid review. The search query was tailored to the specific requirements of each database (see Additional file 1).

Applying the same search string that was used for the search in SciVerse Scopus (Elsevier), a web search was conducted in SciVerse Hub (Elsevier) to identify gray literature. The a priori decision was made to screen only the first 100 hits (as sorted by relevance by Scopus Hub) after considering the time required to screen each hit and because it was believed that further screening was unlikely to yield many more relevant articles (Stevinson and Lawlor, 2004 ). The following websites were also searched manually: the Health Services Delivery Research Programme of the National Institute for Health Research ( http://www.netscc.ac.uk/hsdr/ ), the National Co-ordinating Centre for NHS Service Delivery and Organisation ( http://php.york.ac.uk/inst/spru/pubs/main.php ), NHS Evidence by the National Institute for Health and Clinical Excellence ( http://evidence.nhs.uk/ ), the University of York Social Policy Research Unit ( http://php.york.ac.uk/inst/spru/pubs/main.php ), the United Kingdom's Department of Health ( http://www.dh.gov.uk/en/index.htm ), and Google ( http://www.google.com ).

The reference lists of 10 randomly selected relevant articles (Hazel, 2005 ; Vissandjee et al. , 2007 ; Gagliardi et al. , 2009 ; Meredith et al. , 2009 ; Bassi et al. , 2010 ; Ravenek et al. , 2010 ; Sawka et al. , 2010 ; Churchill et al. , 2011 ; Kushki et al. , 2011 ; Spilsbury et al. , 2011 ) and eight review articles on scoping reviews (Arksey and O'Malley, 2005 ; Anderson et al. , 2008 ; Davis et al. , 2009 ; Grant and Booth, 2009 ; Hetrick et al. , 2010 ; Levac et al. , 2010 ; Rumrill et al. , 2010 ; Armstrong et al. , 2011 ) were manually searched to identify any further scoping reviews not yet captured. A ‘snowball’ technique was also adopted in which citations within articles were searched if they appeared relevant to the review (Hepplestone et al. , 2011 ; Jaskiewicz and Tulenko, 2012 ).

A follow-up search of the four bibliographic databases and gray literature sources was conducted on October 1, 2012 to identify any additional scoping reviews published after the initial search [see Additional file 1]. A search of Google with no date restrictions was also conducted at this time; only the first 100 hits (as sorted by relevance by Google) were screened.

2.3. Citation management

All citations were imported into the web-based bibliographic manager RefWorks 2.0 (RefWorks-COS, Bethesda, MD), and duplicate citations were removed manually with further duplicates removed when found later in the process. Citations were then imported into the web-based systematic review software DistillerSR (Evidence Partners Incorporated, Ottawa, ON) for subsequent title and abstract relevance screening and data characterization of full articles.

2.4. Eligibility criteria

A two-stage screening process was used to assess the relevance of studies identified in the search. Studies were eligible for inclusion if they broadly described the use of a scoping review methodology to identify and characterize the existing literature or evidence base on a broad topic. Because of limited resources for translation, articles published in languages other than English, French, or Spanish were excluded. Papers that described the scoping review process without conducting one and reviews of scoping reviews were excluded from the analysis, but their reference list was reviewed to identify additional scoping reviews. When the same data were reported in more than one publication (e.g., in a journal article and electronic report), only the article reporting the most complete data set was used.

2.5. Title and abstract relevance screening

For the first level of screening, only the title and abstract of citations were reviewed to preclude waste of resources in procuring articles that did not meet the minimum inclusion criteria. A title and abstract relevance screening form was developed by the authors and reviewed by the research team (see Additional file 2). The form was pretested by three reviewers (M. P., J. G., I. Y.) using 20 citations to evaluate reviewer agreement. The overall kappa of the pretest was 0.948, where a kappa of greater than 0.8 is considered to represent a high level of agreement (Dohoo et al. , 2012 ). As there were no significant disagreements among reviewers and the reviewers had no revisions to recommend, no changes were made to the form. The title and abstract of each citation were independently screened by two reviewers. Reviewers were not masked to author or journal name. Titles for which an abstract was not available were included for subsequent review of the full article in the data characterization phase. Reviewers met throughout the screening process to resolve conflicts and discuss any uncertainties related to study selection (Levac et al. , 2010 ). The overall kappa was 0.90.

2.6. Data characterization

All citations deemed relevant after title and abstract screening were procured for subsequent review of the full-text article. For articles that could not be obtained through institutional holdings available to the authors, attempts were made to contact the source author or journal for assistance in procuring the article. A form was developed by the authors to confirm relevance and to extract study characteristics such as publication year, publication type, study sector, terminology, use of a published framework, quality assessment of individual studies, types of data sources included, number of reviewers, and reported challenges and limitations (see Additional file 3). This form was reviewed by the research team and pretested by all reviewers (M. P., A. R., J. G., I. Y., K. G.) before implementation, resulting in minor modifications to the form. The characteristics of each full-text article were extracted by two independent reviewers (M. P. and J. G./K. G.). Studies excluded at this phase if they were found to not meet the eligibility criteria. Upon independently reviewing a batch of 20 to 30 articles, the reviewers met to resolve any conflicts and to help ensure consistency between reviewers and with the research question and purpose (Levac et al. , 2010 ).

2.7. Data summary and synthesis

The data were compiled in a single spreadsheet and imported into Microsoft Excel 2010 (Microsoft Corporation, Redmond, WA) for validation and coding. Fields allowing string values were examined for implausible values. The data were then exported into STATA version 12 (StataCorp, College Station, TX) for analyses. Descriptive statistics were calculated to summarize the data. Frequencies and percentages were utilized to describe nominal data.

3.1. Search and selection of scoping reviews

The original search conducted in June 2011 yielded 2528 potentially relevant citations. After deduplication and relevance screening, 238 citations met the eligibility criteria based on title and abstract and the corresponding full-text articles were procured for review. Four articles could not be procured and were thus not included in the review (Levy and Sanghvi, 1986 ; Bhavaraju, 1987 ; Centre for Reviews and Dissemination, 2004 ; Connell et al. , 2006 ). After data characterization of the full-text articles, 182 scoping reviews remained and were included in the analysis. The updated search in October 2012 produced 758 potentially relevant citations and resulted in another 162 scoping reviews being included. In total, 344 scoping reviews were included in the study. The flow of articles through identification to final inclusion is represented in Figure ​ Figure1 1 .

PRISMA flowchart of study selection process.

Many citations were excluded upon screening at the title and abstract level as several terms used in the search algorithm also corresponded to other study designs. For example, the term ‘scoping study’ was also used to describe studies that assessed the chemical composition of samples (e.g., Behrens et al. , 1998 ; Banks and Banks, 2001 ; Forrest et al. , 2011 ) and preliminary mining studies (Butcher, 2002 ; Bhargava et al. , 2008 ). ‘Scoping exercise’ also described studies that scoped an issue using questionnaires, focus groups, and/or interviews (e.g., Malloch and Burgess, 2007 ; Willis et al. , 2011 ; Norwood and Skinner, 2012 ). ‘Rapid review’ was also used to describe the partial rescreening of negative cervical smears as a method of internal quality assurance (e.g., Faraker and Boxer, 1996 ; Frist, 1997 ; Shield and Cox, 1998 ). ‘Systematic mapping’ was also used in studies pertaining to topographic mapping (e.g., Noda and Fujikado, 1987 ; Gunnell, 1997 ; Liu et al. , 2011 ) and mapping of biomolecular structures (e.g., Camargo et al. , 1976 ; Descarries et al. , 1982 ; Betz et al. , 2006 ).

3.2. General characteristics of included scoping reviews

The general characteristics of scoping reviews included in this study are reported in Table ​ Table1. 1 . All included reviews were published between 1999 and October 2012, with 68.9% (237/344) published after 2009. Most reviews did not report the length of time taken to conduct the review; for the 12.8% (44/344) that did, the mean length was approximately 5.2 months with a range of 2 weeks to 20 months. Journal articles (64.8%; 223/344) and government or research station reports (27.6%; 95/344) comprised the majority of documents included in the review. The number of journal articles was slightly underrepresented as 10 were excluded as duplicates because the same scoping review was also reported in greater detail in a report. The included reports ranged greatly in length, from four pages (Healthcare Improvement Scotland, 2012 ) to over 300 pages (Wallace et al. , 2006 ).

General characteristics of included scoping reviews ( n = 344)

The included scoping reviews varied widely in terms of the terminology used to describe the methodology. ‘Scoping review’ was the term most often used, reported in 61.6% (212/344) of included studies. An explicit definition or description of what study authors meant by ‘scoping review’ was reported in 63.1% (217/344) of articles. Most definitions centered around scoping reviews as a type of literature that identifies and characterizes, or maps, the available research on a broad topic. However, there was some divergence in how study authors characterized the rigor of the scoping review methodology. The terms ‘systematic’, ‘rigorous’, ‘replicable’, and ‘transparent’ were frequently used to describe the methodology, and several authors described scoping reviews to be comparable in rigor to systematic reviews (Gagliardi et al. , 2009 ; Liu et al. , 2010 ; Ravenek et al. , 2010 ; Feehan et al. , 2011 ; Heller et al. , 2011 ). In contrast, some studies described the methodology as less rigorous or systematic than a systematic review (Cameron et al. , 2008 ; Levac et al. , 2009 ; Campbell et al. , 2011 ). Brien et al. ( 2010 ) commented that scoping reviews were ‘often misinterpreted to be a less rigorous systematic review, when in actual fact they are a different entity’.

Some reviews were conducted as stand-alone projects while others were undertaken as parts of larger research projects. Study authors reported that a main purpose or objective for the majority of articles (97.4%; 335/344) was to identify, characterize, and summarize research evidence on a topic, including identification of research gaps. Only 6.4% (22/344) of included articles conducted the scoping review methodology to identify questions for a systematic review. As response options were not mutually exclusive, some reviews reported multiple purposes and/or objectives. A commissioning source was reported in 31.4% (108/344) of reviews; some reported that they were specifically commissioned to advise a funding body as to what further research should be undertaken in an area (e.g., Arksey et al. , 2002 ; Carr-Hill et al. , 2003 ; Fotaki et al. , 2005 ; Baxter et al. , 2008 ; Williams et al. , 2008 ; Trivedi et al. , 2009 ; Crilly et al. , 2010 ; Brearley et al. , 2011 ).

The majority of the included scoping reviews addressed a health topic, making up 74.1% (255/344) of reviews. The use of scoping reviews in software engineering—or ‘systematic mapping’ as termed in the sector—has increased in recent years with 92.7% (38/41) published after 2010. The topics examined in the included scoping reviews ranged greatly, spanning from data on multiplayer online role-playing games (Meredith et al. , 2009 ), to factors that influence antibiotic prophylaxis administration (Gagliardi et al. , 2009 ). The topics investigated were generally broad in nature, such as ‘what is known about the diagnosis, treatment and management of obesity in older adults’ (Decaria et al. , 2012 ). Some reviews that were conducted under short time frames (e.g., 1 month) addressed more specific questions such as ‘what is the published evidence of an association between hospital volume and operative mortality for surgical repair (open and endovascular) of unruptured and ruptured abdominal aortic aneurysms?’ (Healthcare Improvement Scotland, 2011 ).

3.3. Methodological characteristics of included scoping reviews

The methodological characteristics of included scoping reviews are reported in Table ​ Table2. 2 . Approximately half of the reviews (50.6%; 174/344) reported using one or more methodological frameworks for carrying out the scoping review. Framework use varied greatly between reviews from different sectors, such as in 85.4% (35/41) of reviews from the software engineering sector and in 44.0% (89/202) of health sector reviews. Overall, the Arksey and O'Malley ( 2005 ) framework was the most frequently used, reported in 62.6% (109/174) of studies that reported using a framework. Among reviews from the software engineering sector that reported using a framework, frameworks by Kitchenham and Charters ( 2007 ) (40.0%; 14/35) and Petersen et al . ( 2008 ) (51.4%; 18/35) were most commonly employed. The use of a framework increased over time, from 31.6% (6/19) of reviews published from 2000 to 2004, to 42.5% (37/87) of reviews from 2005 to 2009, and to 55.3% (131/237) of reviews published from 2010 onward.

Methodological characteristics of included reviews ( n = 344)

Following the search, 79.7% (174/344) of reviews used defined inclusion and exclusion criteria to screen out studies that were not relevant to the review question(s). Among these, only six reviews explicitly reported that criteria were redefined or amended on a post hoc basis during the review process (While et al. , 2005 ; Marsella, 2009 ; Crooks et al. , 2010 ; Johnston et al. , 2010 ; Snyder et al. , 2011 ; Victoor et al. , 2012 ). The selection criteria in a few reviews were unclear due to ambiguous wording such as ‘real paper’ (Saraiva et al. , 2012 ), ‘scientific papers’ (Victoor et al. , 2012 ), and ‘culling low-interest articles’ (Catts et al. , 2010 ). Compared with the study selection process, fewer details were generally reported about the data characterization (or charting) of individual studies. Nearly a quarter of reviews (23.8%; 82/344) did not report any detail as to how the included studies were characterized, and it was unclear in 33.4% (115/344) as to how many reviewers were involved.

The majority of included reviews (77.7%, 267/344) did not assess the methodological quality of individual studies. A number of these studies reported that quality assessment was not conducted as it is not a priority in scoping reviews or part of the scoping review methodology. Two studies reported the use of publication in a peer-reviewed publication as a proxy for good quality (Baxter et al. , 2008 ; Pita et al. , 2011 ) and another reported using studies included in existing reviews or meta-analyses to ‘overcome’ the lack of quality assessment (MacDougall, 2011 ). Of the 22.4% (77/344) of articles that reported a critical appraisal step, the rigor with which it was conducted ranged from the reviewer's subjective assessment using a scale of high, medium, or low (Roland et al. , 2006 ), to the use of published tools such as the Jadad scale (Jadad et al. , 1996 ) for randomized control trials (Deshpande et al. , 2009 ; Borkhoff et al. , 2011 ).

The level of detail reported about the search strategy varied considerably across the reviews. Table ​ Table3 3 displays information about the search strategy reported in the included reviews by time. Overall, the detail of reporting for the search increased numerically over time. For example, 78.06% of reviews published after 2009 reported complete strings or a complete list of search terms, compared with 57.89% of reviews published between 2000 and 2004 and 67.82% of reviews published between 2005 and 2009.

Search strategy details reported in included reviews, by year

Table ​ Table4 4 summarizes how some of the results of the included reviews were reported and ‘charted’. A flow diagram was used to display the flow of articles from the initial search to final selection in 35.8% of reviews (123/344). Characteristics of included studies were often displayed in tables (82.9%; 285/344), ranging from basic tables that described the key characteristics of each included study, to cross-tabulation heat maps that used color-coding to highlight cell values. Study characteristics were also mapped graphically in 28.8% (99/344) of reviews, often in the form of histograms, scatterplots, or pie charts. Reviews from the software engineering sector frequently used bubble charts to map the data (Figure ​ (Figure2 2 is an example of a bubble chart). In summarizing the reviewed literature, 77.6% (267/344) of reviews noted gaps where little or no research had been conducted, and 77.9% (268/344) recommended topics or questions for future research.

Reporting of results the included scoping reviews

Bubble plot of scoping reviews published by year and sector. The size of a bubble is proportional to the number of scoping reviews published in the year and sector corresponding to the bubble coordinates.

Stakeholder consultation is an optional sixth-step in the Arksey and O'Malley ( 2005 ) framework and was reported in 39.8% (137/344) of reviews. This optional step was reported in 34.9% (38/109) of reviews that used the Arksey and O'Malley framework, compared with 42.13% (99/235) of reviews that did not. Stakeholders were most often consulted at the search phase to assist with keyword selection for the search strategy or help identify potential studies to include in the review (74.5%; 102/137). Stakeholders were less frequently involved in the interpretation of research findings (30.7%; 42/137) and in the provision of comments at the report writing stage (24.1%; 33/137). Ongoing interaction with stakeholders throughout the review process was reported in 25.9% (89/344) of all reviews. Comparing between sectors, the proportion of reviews that reported consulting with stakeholders was highest in the social sciences sector (71.4%; 10/14) and lowest in the software engineering sector (2.4%; 1/41).

3.4. Reported challenges and limitations

Limitations in the study approach were reported in 71.2% (245/344) of reviews. The most frequent limitation reported in the reviews was the possibility that the review may have missed some relevant studies (32.0%; 110/344). This limitation was frequently attributed to database selection (i.e., searching other databases may have identified additional relevant studies), exclusion of the gray literature from the search, time constraints, or the exclusion of studies published in a language other than English. In comparison with systematic reviews, one review noted that it was ‘unrealistic to retrieve and screen all the relevant literature’ in a scoping review due to its broader focus (Gentles et al. , 2010 ), and a few noted that all relevant studies may not have been identified as scoping reviews are not intended to be as exhaustive or comprehensive (Cameron et al. , 2008 ; Levac et al. , 2009 ; Boydell et al. , 2012 ).

The balance between breadth and depth of analysis was a challenge reported in some reviews. Brien et al. ( 2010 ) and Cronin de Chavez et al . ( 2005 ) reported that it was not feasible to conduct a comprehensive synthesis of the literature given the large volume of articles identified in their reviews. Depth of analysis was also reported to be limited by the time available to conduct the review (Freeman et al. , 2000 ; Gulliford et al. , 2001 ; Templeton et al. , 2006 ; Cahill et al. , 2008 ; Bostock et al. , 2009 ; Brodie et al. , 2009 ).

The lack of critical appraisal of included studies was reported as a study limitation in 16.0% (55/344) of reviews. One review commented that this was the primary limitation of scoping reviews (Feehan et al. , 2011 ), and others noted that without this step, scoping reviews cannot identify gaps in the literature related to low quality of research (Hand and Letts, 2009 ; Brien et al. , 2010 ). Additionally, two reviews reported that their results could not be used to make recommendations for policy or practice because they did not assess the quality of included studies (Bostrom et al. , 2011 ; Churchill et al. , 2011 ). Conversely, Njelesani et al . ( 2011 ) noted that ‘by not addressing the issues of quality appraisal, this study dealt with a greater range of study designs and methodologies than would have been included in a systematic review’, and McColl et al. ( 2009 ) commented that ‘the emphasis of a scoping study is on comprehensive coverage, rather than on a particular standard of evidence’.

4. Discussion

In this paper, we provided an overview of scoping reviews identified in the gray and published literature. Our search for scoping reviews in the published and gray literature aimed to be comprehensive while also balancing practicality and available resources. It was not within the remit of this scoping review to assess the methodological quality of individual scoping reviews included in the analysis. Based on the characteristics, range of methodologies and reported challenges in the included scoping reviews, we have proposed some recommendations for advancing the scoping review approach and enhancing the consistency with which they are undertaken and reported.

4.1. Overview of included scoping reviews

Our results corroborate that scoping reviews are a relatively new approach that has gained momentum as a distinct research activity in recent years. The identified reviews varied in terms of terminology, purpose, methodological rigor, and level of detail of reporting; therefore, there appears to be a lack of clarity or agreement around the appropriate methodology for scoping reviews. In a scoping review that reviewed 24 scoping reviews from the nursing literature, Davis et al. ( 2009 ) also reported that the included scoping reviews varied widely in terms of intent, procedural, and methodological rigor. Given that scoping reviews are a relatively new methodology for which there is not yet a universal study definition, definitive procedure or reporting guidelines, the variability with which scoping reviews have been conducted and reported to date is not surprising. However, efforts have been made by scoping review authors such as Arksey and O'Malley ( 2005 ); Anderson et al. ( 2008 ); Davis et al. ( 2009 ); Brien et al. ( 2010 ); Levac et al. ( 2010 ) and Daudt et al. ( 2013 ) to guide other researchers in undertaking and reporting scoping reviews, as well as clarifying, enhancing, and standardizing the methodology. Their efforts seem to be having some impact given the increase in the number of scoping reviews disseminated in the published and gray literature, the growth in the use of a methodological framework, and the greater amount of detail and consistency with which scoping review processes have been reported.

4.2. Recommendations

Levac et al. ( 2010 ) remarked that discrepancies in nomenclature between ‘scoping reviews’, ‘scoping studies’, ‘scoping literature reviews’, ‘scoping exercises’, and so on lead to confusion, and consequently used the term ‘scoping study’ for consistency with the Arksey and O'Malley framework. We agree that there is a need for consistency in terminology; however, we argue that the term ‘scoping review’ should be adopted in favor of ‘scoping study’ or the other terms that have been used to describe the method. Our review has found that ‘scoping review’ is the most commonly used term in the literature to denote the methodology and that a number of the other terms (i.e., scoping study, scoping exercise, and systematic mapping) have been used to describe a variety of primary research study designs. Furthermore, we find that the word ‘review’ more explicitly indicates that the term is referring to a type of literature review, compared with ‘study’ or ‘exercise’.

As scoping reviews share many of the same processes with the more commonly known systematic review, many of the included reviews compared and contrasted the two methods. We concur with Brien et al. ( 2010 ) that scoping reviews are often misinterpreted as a less rigorous version of a systematic review, when in fact they are a ‘different entity’ with a different set of purposes and objectives. We contend that researchers adopting a systematic review approach but with concessions in rigor to shorten the timescale, refer to the process as a ‘rapid review’. Scoping reviews are one method among many available to reviewing the literature (Arksey and O'Malley, 2005 ), and researchers need to consider their research question or study purpose when deciding which review approach is most appropriate. Additionally, given that some of the included reviews took over 1 year to complete, we agree that it would be wrong to necessarily assume that scoping reviews represent a quick alternative to a systematic review (Arksey and O'Malley, 2005 ).

There is an ongoing deliberation in the literature regarding the need for quality assessment of included studies in the scoping review process. While Arksey and O'Malley stated that ‘quality assessment does not form part of the scoping (review) remit’, they also acknowledged this to be a limitation of the method. This may explain why quality assessment was infrequently performed in the included reviews and why it was reported as a study limitation among a number of these reviews. In their follow-up recommendations to the Arksey and O'Malley framework, Levac et al. ( 2010 ) did not take a position on the matter but recommended that the debate on the need for quality assessment continue. However, a recent paper by Daudt et al. ( 2013 ) asserts that it is a necessary component of scoping reviews and should be performed using validated tools. We argue that scoping reviews should include all relevant literature regardless of methodological quality, given that their intent is to present an overview of the existing literature in a field of interest without synthesizing evidence from different studies (Arksey and O'Malley, 2005 ). In doing so, scoping reviews can provide a more complete overview of all the research activity related to a topic. However, we also recognize that some form of quality assessment of all included studies would enable the identification of gaps in the evidence base—and not just where research is lacking—and a better determination of the feasibility of a systematic review. The debate on the need for quality assessment should consider the challenges in assessing quality among the wide range of study designs and large volume of literature that can be included in scoping reviews (Levac et al. , 2010 ).

The lack of consistency among the included reviews was not surprising given the lack of a universal definition or purpose for scoping reviews (Anderson et al. , 2008 ; Davis et al. , 2009 ; Levac et al. , 2010 ; Daudt et al. , 2013 ). The most commonly cited definition scoping reviews may be the one set forth by Mays et al . ( 2001 ) and used by Arksey and O'Malley: ‘scoping studies aim to map rapidly the key concepts underpinning a research area and the main sources and types of evidence available and can be undertaken as standalone projects in their own right, especially where an area is complex or has not been reviewed extensively before’. However, we believe that a recently proposed definition by Daudt et al . ( 2013 ) is more straightforward and fitting of the method: ‘scoping studies aim to map the literature on a particular topic or research area and provide an opportunity to identify key concepts; gaps in the research; and types and sources of evidence to inform practice, policymaking, and research’. While we would replace the term ‘scoping studies’ with ‘scoping reviews’, we endorse the Daudt et al . definition because it clearly articulates that scoping reviews are a type of literature review and removes the emphasis away from being ‘rapid’ process.

It has been suggested that the optimal scoping review is ‘one that demonstrates procedural and methodological rigor in its application’ (Davis et al. , 2009 ). We found that some scoping reviews were not reported in sufficient detail to be able to demonstrate ‘rigor in its application’. When there is a lack of clarity or transparency relating to methodology, it is difficult to distinguish poor reporting from poor design. We agree that it is crucial for scoping review authors to clearly report the processes and procedures undertaken—as well as any limitations of the approach—to ensure that readers have sufficient information to determine the value of findings and recommendations (Arksey and O'Malley, 2005 ; Davis et al. , 2009 ). The development of reporting guidelines for scoping reviews would help to ensure the quality and transparency of those undertaken in the future (Brien et al. , 2010 ). Given that reporting guidelines do not currently exist for scoping reviews (Brien et al. , 2010 ), researchers conducting scoping reviews may want to consider using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( http://prisma-statement.org/ ) as a guide, where applicable.

4.3. Strengths and limitations of this scoping review

This scoping review used rigorous and transparent methods throughout the entire process. It was guided by a protocol reviewed by a research team with expertise in knowledge synthesis and scoping reviews. To ensure a broad search of the literature, the search strategy included four electronic bibliographic databases, the reference list of eighteen different articles, two internet search engines, the websites of relevant organizations, and the snowball technique. The relevance screening and data characterization forms were pretested by all reviewers and revised as needed prior to implementation. Each citation and article was reviewed by two independent reviewers who met in regular intervals to resolve conflicts. Our use of a bibliographic manager (RefWorks) in combination with systematic review software (DistillerSR) ensured that all citations and articles were properly accounted for during the process. Furthermore, an updated search was performed in October 2012 to enhance the timeliness of this review.

This review may not have identified all scoping reviews in the published and gray literature despite attempts to be as comprehensive as possible. Our search algorithm included nine different terms previously used to describe the scoping process; however, other terms may also exist. Although our search included two multidisciplinary databases (i.e., Scopus, Current Contents) and Google, the overall search strategy may have been biased toward health and sciences. Searching other bibliographic databases may have yielded additional published scoping reviews. While our review included any article published in English, French or Spanish, our search was conducted using only English terms. We may have missed some scoping reviews in the gray literature as only the first 100 hits from each Web search were screened for inclusion. Furthermore, we did not contact any researchers or experts for additional scoping reviews we may have missed.

Other reviewers may have included a slightly different set of reviews than those included in this present review. We adopted Arksey and O'Malley's definition for scoping reviews at the outset of the study and found that their simple definition was generally useful in guiding study selection. However, we encountered some challenges during study selection with reviews that also reported processes or definitions more typically associated with narrative, rapid or systematic reviews. We found that some reviews blurred the line between narrative and scoping reviews, between scoping and rapid reviews, and between scoping and systematic reviews. Our challenges echoed the questions: ‘where does one end and the other start?’ (Arksey and O'Malley, 2005 ) and ‘who decides whether a particular piece of work is a scoping (review) or not?’ (Anderson et al. , 2008 ). For this review, the pair of reviewers used their judgment to determine whether each review as a whole sufficiently met our study definition of a scoping review. On another note, characterization and interpretation of the included reviews were also subject to reviewer bias.

5. Conclusions

This scoping review of scoping reviews characterized and described the nature of scoping reviews in the published and gray literature. Scoping reviews are a relatively new approach to reviewing the literature, which has increased in popularity in recent years. As the purpose, methodological process, terminology, and reporting of scoping reviews have been highly variable, there is a need for their methodological standardization to maximize the utility and relevance of their findings. We agree that the establishment of a common definition and purpose for scoping reviews is an important step toward enhancing the consistency with which they are conducted (Levac et al. , 2010 ); this would provide a common platform from which debates regarding the methodology can ensue, and the basis for future methodological frameworks and reporting guidelines. We hope that the results of our study can contribute to the ongoing collective work of a number of researchers to further clarifying and enhancing the scoping review methodology.

Acknowledgments

Funding for this project was provided by the OMAFRA-University of Guelph Knowledge Translation and Transfer Program (#299514).

We would like to thank our project collaborators Lisa Waddell, Dr. Barbara Wilhelm, and Dr. Ian Young for their expertise and guidance throughout the project. We would also like to acknowledge Dr. Ian Young and Kathleen Gropp for their assistance in screening articles for the review.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

A. R. and S. M. conceived of the study. M. P., A. R., and S. M. participated in the design of the study. M. P., J. G., and A. R. undertook the literature review process. All authors drafted the manuscript. All authors read and approved the final manuscript.

Supporting Information

Additional supporting information may be found in the online version of this article at the publisher's web site.

Supporting info item

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• Stevinson C, Lawlor DA. Searching multiple databases for systematic reviews: added value or diminishing returns? Complementary Therapies in Medicine. 2004; 12 (4):228–232. DOI: 10.1016/j.ctim.2004.09.003 . [ PubMed ] [ Google Scholar ]
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• Victoor A, Delnoij DM, Friele RD, Rademakers JJ. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Services Research. 2012; 12 (1):272. DOI: 10.1186/1472-6963-12-272 . [ PMC free article ] [ PubMed ] [ Google Scholar ]
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• Scoping Review

What is a Scoping Review?

A scoping review is a type of knowledge synthesis which follows a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps  (Tricco, et. al, 2019). Scoping reviews serve to synthesize evidence and assess the scope of literature on a topic. Among other objectives, scoping reviews help determine whether a systematic review of the literature is warranted. Scoping reviews can be a precursor to a systematic review and may take longer than a systematic review to complete. Use a scoping review to identify key concepts in the field, gaps in the research, and types and sources of evidence to inform practice, policymaking, and research (Daudt, 2013).

Per Coloquhoun et al. (2014) "A scoping review or scoping study is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge"

Note: Scoping reviews don't typically include a risk of bias assessment or critical appraisal of studies.

“A key difference between scoping reviews and systematic reviews is that the former are generally conducted to provide an overview of the existing evidence regardless of methodological quality or risk of bias (4, 5). Therefore, the included sources of evidence are typically not critically appraised for scoping reviews” (Tricco et al., 2018).

Per Peters et al. (2020) indications for a scoping review are:

• as a precursor to a systematic review;
• to identify the types of evidence available in a given field;
• to identify and analyze knowledge gaps;
• to clarify key concepts and definitions in the literature;
• to examine how research is conducted on a certain topic or field;
• to identify key characteristics or factors related to a concept.

Per Arskey & O'Malley (2005)   scoping reviews use rigorous methods to describe the literature in a field, including the amount and characteristics of the literature, to determine gaps in the literature. They do not usually appraise the literature or provide a synthesis (Foster & Jewell, 2022).

The stages of a scoping review are:

• Stage 1: identifying the research question
• Stage 2: identifying relevant studies
• Stage 3: study selection
• Stage 4: charting the data
• Stage 5: collating, summarizing and reporting the results
• Optional 'consultation exercise' to inform and validate findings from the main scoping review.

(Arskey & O'Malley, 2005).

Resources for Scoping Reviews

• JBI Manual for Evidence Synthesis - Chapter 11: Scoping Reviews.
• JBI Sumari Protocol Template for Scoping Reviews  Download a template from JBI Evidence Synthesis .
• PRISMA -ScR: Reporting Guidelines for Scoping Reviews  PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. The checklist contains 20 essential reporting items and 2 optional items to include when completing a scoping review. Statement / Explanatory paper (Tricco et al., 2018).
• Scoping Reviews: What They Are and How You Can Do Them  A series of videos from a  Cochrane Learning Live  webinar delivered in partnership with GESI: the Global Evidence Synthesis Initiative, August, 2017.
• What is a scoping review?  Information and resources from Stephanie Roth, MLIS, former Medical Library Association Systematic Review Caucus chair.

In the video below, Associate Professor Zachary Munn (Director of the Evidence-based Healthcare Research Division of JBI) provides an introduction to scoping reviews, including an overview of the JBI methods for conducting scoping reviews. 

Andrea Tricco of the  JBI  Scoping Review Methodology Group explains below how to conduct and report your scoping review using the latest guidance.

The video below by Carrie Price provides an overview of the differences between a systematic review and a scoping review. 

"Systematic vs Scoping Review: What's the Difference" by Carrie Price, MLS, Albert S. Cook Library, Towson University is licensed under CC BY-NC 4.0.

In the video below, Associate Professor Zachary Munn and Dr Danielle Pollock discuss the definition for scoping reviews formalized by the JBI Scoping Reviews Methodology Group (2022):

Arksey, & O’Malley, L. (2005). Scoping studies: towards a methodological framework.  International Journal of Social Research Methodology ,  8 (1), 19–32. https://doi.org/10.1080/1364557032000119616

Colquhoun, H. L., Levac, D., O'Brien, K.,K., Straus, S., Tricco, A. C., Perrier, L., . . . Moher, D. (2014). Scoping reviews: Time for clarity in definition, methods, and reporting.  Journal of Clinical Epidemiology,  67 (12), 1291-4. doi:https://doi.org/10.1016/j.jclinepi.2014.03.013

Daudt, H. M., van Mossel, C., & Scott, S. J. (2013).Enhancing the scoping study methodology: A large, inter-professional team's experience with Arksey and O'Malley's framework.  BMC Medical Research Methodology, 13 :48. https://doi.org/10.1186/1471-2288-13-48

Foster, M. J., & Jewell, S. T. (Eds.). (2022).  Piecing together systematic reviews and other evidence syntheses . Rowman & Littlefield.

Martin, G. P., Jenkins, D. A., Bull, L., Sisk, R., Lin, L., Hulme, W., Wilson, A., Wang, W., Barrowman, M., Sammut-Powell, C., Pate, A., Sperrin, M., & Peek, N. (2020). Toward a framework for the design, implementation, and reporting of methodology scoping reviews.  Journal of Clinical Epidemiology, 127,  191–197. https://doi.org/10.1016/j.jclinepi.2020.07.0144

Munn, Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach.  BMC Medical Research Methodology,18 (1), 143–143. https://doi.org/10.1186/s12874-018-0611-x

Munn, Z., Pollock, D., Khalil, H., Alexander, L., Mclnerney, P., Godfrey, C. M., Peters, M., & Tricco, A. C. (2022). What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis.  JBI Evidence Synthesis, 20 (4), 950.   https://doi.org/10.11124/JBIES-21-00483

Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews.  JBI evidence synthesis ,  18 (10), 2119–2126. https://doi.org/10.11124/JBIES-20-00167

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., Lewin, S., … Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation.  Annals of Internal Medicine, 169 (7)10.7326/M18-0850

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• Published: 19 November 2018

Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach

• Zachary Munn   ORCID: orcid.org/0000-0002-7091-5842 1 ,
• Micah D. J. Peters 1 ,
• Cindy Stern 1 ,
• Catalin Tufanaru 1 ,
• Alexa McArthur 1 &
• Edoardo Aromataris 1  

BMC Medical Research Methodology volume  18 , Article number:  143 ( 2018 ) Cite this article

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Scoping reviews are a relatively new approach to evidence synthesis and currently there exists little guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising evidence. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate.

Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.

Conclusions

Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

Peer Review reports

Systematic reviews in healthcare began to appear in publication in the 1970s and 1980s [ 1 , 2 ]. With the emergence of groups such as Cochrane and the Joanna Briggs Institute (JBI) in the 1990s [ 3 ], reviews have exploded in popularity both in terms of the number conducted [ 1 ], and their uptake to inform policy and practice. Today, systematic reviews are conducted for a wide range of purposes across diverse fields of inquiry, different evidence types and for different questions [ 4 ]. More recently, the field of evidence synthesis has seen the emergence of scoping reviews, which are similar to systematic reviews in that they follow a structured process, however they are performed for different reasons and have some key methodological differences [ 5 , 6 , 7 , 8 ]. Scoping reviews are now seen as a valid approach in those circumstances where systematic reviews are unable to meet the necessary objectives or requirements of knowledge users. There now exists clear guidance regarding the definition of scoping reviews, how to conduct scoping reviews and the steps involved in the scoping review process [ 6 , 8 ]. However, the guidance regarding the key indications or reasons why reviewers may choose to follow a scoping review approach is not as straightforward, with scoping reviews often conducted for purposes that do not align with the original indications as proposed by Arksey and O’Malley [ 5 , 6 , 7 , 8 , 9 , 10 ]. As editors and peer reviewers for various journals we have noticed that there is inconsistency and confusion regarding the indications for scoping reviews and a lack of clarity for authors regarding when a scoping review should be performed as opposed to a systematic review. The purpose of this article is to provide practical guidance for reviewers on when to perform a systematic review or a scoping review, supported with some key examples.

Indications for systematic reviews

Systematic reviews can be broadly defined as a type of research synthesis that are conducted by review groups with specialized skills, who set out to identify and retrieve international evidence that is relevant to a particular question or questions and to appraise and synthesize the results of this search to inform practice, policy and in some cases, further research [ 11 , 12 , 13 ]. According to the Cochrane handbook, a systematic review ‘uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.’ [ 14 ] Systematic reviews follow a structured and pre-defined process that requires rigorous methods to ensure that the results are both reliable and meaningful to end users. These reviews may be considered the pillar of evidence-based healthcare [ 15 ] and are widely used to inform the development of trustworthy clinical guidelines [ 11 , 16 , 17 ].

A systematic review may be undertaken to confirm or refute whether or not current practice is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. Such variations in practice may be due to conflicting evidence and undertaking a systematic review should (hopefully) resolve such conflicts. Conducting a systematic review may also identify gaps, deficiencies, and trends in the current evidence and can help underpin and inform future research in the area. Systematic reviews can be used to produce statements to guide clinical decision-making, the delivery of care, as well as policy development [ 12 ]. Broadly, indications for systematic reviews are as follows [ 4 ]:

Uncover the international evidence

Confirm current practice/ address any variation/ identify new practices

Identify and inform areas for future research

Identify and investigate conflicting results

Produce statements to guide decision-making

Despite the utility of systematic reviews to address the above indications, there are cases where systematic reviews are unable to meet the necessary objectives or requirements of knowledge users or where a methodologically robust and structured preliminary searching and scoping activity may be useful to inform the conduct of the systematic reviews. As such, scoping reviews (which are also sometimes called scoping exercises/scoping studies) [ 8 ] have emerged as a valid approach with rather different indications to those for systematic reviews. It is important to note here that other approaches to evidence synthesis have also emerged, including realist reviews, mixed methods reviews, concept analyses and others [ 4 , 18 , 19 , 20 ]. This article focuses specifically on the choice between a systematic review or scoping review approach.

Indications for scoping reviews

True to their name, scoping reviews are an ideal tool to determine the scope or coverage of a body of literature on a given topic and give clear indication of the volume of literature and studies available as well as an overview (broad or detailed) of its focus. Scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review [ 21 ]. They can report on the types of evidence that address and inform practice in the field and the way the research has been conducted.

The general purpose for conducting scoping reviews is to identify and map the available evidence [ 5 , 22 ]. Arskey and O’Malley, authors of the seminal paper describing a framework for scoping reviews, provided four specific reasons why a scoping review may be conducted [ 5 , 6 , 7 , 22 ]. Soon after, Levac, Colquhoun and O’Brien further clarified and extended this original framework [ 7 ]. These authors acknowledged that at the time, there was no universally recognized definition of scoping reviews nor a commonly acknowledged purpose or indication for conducting them. In 2015, a methodological working group of the JBI produced formal guidance for conducting scoping reviews [ 6 ]. However, we have not previously addressed and expanded upon the indications for scoping reviews. Below, we build upon previously described indications and suggest the following purposes for conducting a scoping review:

To identify the types of available evidence in a given field

To clarify key concepts/ definitions in the literature

To examine how research is conducted on a certain topic or field

To identify key characteristics or factors related to a concept

As a precursor to a systematic review.

To identify and analyse knowledge gaps

Deciding between a systematic review and a scoping review approach

Authors deciding between the systematic review or scoping review approach should carefully consider the indications discussed above for each synthesis type and determine exactly what question they are asking and what purpose they are trying to achieve with their review. We propose that the most important consideration is whether or not the authors wish to use the results of their review to answer a clinically meaningful question or provide evidence to inform practice. If the authors have a question addressing the feasibility, appropriateness, meaningfulness or effectiveness of a certain treatment or practice, then a systematic review is likely the most valid approach [ 11 , 23 ]. However, authors do not always wish to ask such single or precise questions, and may be more interested in the identification of certain characteristics/concepts in papers or studies, and in the mapping, reporting or discussion of these characteristics/concepts. In these cases, a scoping review is the better choice.

As scoping reviews do not aim to produce a critically appraised and synthesised result/answer to a particular question, and rather aim to provide an overview or map of the evidence. Due to this, an assessment of methodological limitations or risk of bias of the evidence included within a scoping review is generally not performed (unless there is a specific requirement due to the nature of the scoping review aim) [ 6 ]. Given this assessment of bias is not conducted, the implications for practice (from a clinical or policy making point of view) that arise from a scoping review are quite different compared to those of a systematic review. In some cases, there may be no need or impetus to make implications for practice and if there is a need to do so, these implications may be significantly limited in terms of providing concrete guidance from a clinical or policy making point of view. Conversely, when we compare this to systematic reviews, the provision of implications for practice is a key feature of systematic reviews and is recommended in reporting guidelines for systematic reviews [ 13 ].

Exemplars for different scoping review indications

In the following section, we elaborate on each of the indications listed for scoping reviews and provide a number of examples for authors considering a scoping review approach.

Scoping reviews that seek to identify the types of evidence in a given field share similarities with evidence mapping activities as explained by Bragge and colleagues in a paper on conducting scoping research in broad topic areas [ 24 ]. Chambers and colleagues [ 25 ] conducted a scoping review in order to identify current knowledge translation resources (and any evaluations of them) that use, adapt and present findings from systematic reviews to suit the needs of policy makers. Following a comprehensive search across a range of databases, organizational websites and conference abstract repositories based upon predetermined inclusion criteria, the authors identified 20 knowledge translation resources which they classified into three different types (overviews, summaries and policy briefs) as well as seven published and unpublished evaluations. The authors concluded that evidence synthesists produce a range of resources to assist policy makers to transfer and utilize the findings of systematic reviews and that focussed summaries are the most common. Similarly, a scoping review was conducted by Challen and colleagues [ 26 ] in order to determine the types of available evidence identifying the source and quality of publications and grey literature for emergency planning. A comprehensive set of databases and websites were investigated and 1603 relevant sources of evidence were identified mainly addressing emergency planning and response with fewer sources concerned with hazard analysis, mitigation and capability assessment. Based on the results of the review, the authors concluded that while there is a large body of evidence in the field, issues with its generalizability and validity are as yet largely unknown and that the exact type and form of evidence that would be valuable to knowledge users in the field is not yet understood.

To clarify key concepts/definitions in the literature

Scoping reviews are often performed to examine and clarify definitions that are used in the literature. A scoping review by Schaink and colleagues 27 was performed to investigate how the notion of “patient complexity” had been defined, classified, and understood in the existing literature. A systematic search of healthcare databases was conducted. Articles were assessed to determine whether they met the inclusion criteria and the findings of included articles were grouped into five health dimensions. An overview of how complexity has been described was presented, including the varying definitions and interpretations of the term. The results of the scoping review enabled the authors to then develop a complexity framework or model to assist in defining and understanding patient complexity [ 27 ].

Hines et al. [ 28 ] provide a further example where a scoping review has been conducted to define a concept, in this case the condition bronchopulmonary dysplasia. The authors revealed significant variation in how the condition was defined across the literature, prompting the authors to call for a ‘comprehensive and evidence-based definition’. [ 28 ]

To examine how research is conducted on a certain topic

Scoping reviews can be useful tools to investigate the design and conduct of research on a particular topic. A scoping review by Callary and colleagues 29 investigated the methodological design of studies assessing wear of a certain type of hip replacement (highly crosslinked polyethylene acetabular components) [ 29 ]. The aim of the scoping review was to survey the literature to determine how data pertinent to the measurement of hip replacement wear had been reported in primary studies and whether the methods were similar enough to allow for comparison across studies. The scoping review revealed that the methods to assess wear (radiostereometric analysis) varied significantly with many different approaches being employed amongst the investigators. The results of the scoping review led to the authors recommending enhanced standardization in measurements and methods for future research in this field [ 29 ].

There are other examples of scoping reviews investigating research methodology, with perhaps the most pertinent examples being two recent scoping reviews of scoping review methods [ 9 , 10 ]. Both of these scoping reviews investigated how scoping reviews had been reported and conducted, with both advocating for a need for clear guidance to improve standardization of methods [ 9 , 10 ]. Similarly, a scoping review investigating methodology was conducted by Tricco and colleagues 30 on rapid review methods that have been evaluated, compared, used or described in the literature. A variety of rapid review approaches were identified with many instances of poor reporting identified. The authors called for prospective studies to compare results presented by rapid reviews versus systematic reviews.

Scoping reviews can be conducted to identify and examine characteristics or factors related to a particular concept. Harfield and colleagues (2015) conducted a scoping review to identify the characteristics of indigenous primary healthcare service delivery models [ 30 , 31 , 32 ]. A systematic search was conducted, followed by screening and study selection. Once relevant studies had been identified, a process of data extraction commenced to extract characteristics referred to in the included papers. Over 1000 findings were eventually grouped into eight key factors (accessible health services, community participation, culturally appropriate and skilled workforce, culture, continuous quality improvement, flexible approaches to care, holistic health care, self-determination and empowerment). The results of this scoping review have been able to inform a best practice model for indigenous primary healthcare services.

Scoping reviews conducted as precursors to systematic reviews may enable authors to identify the nature of a broad field of evidence so that ensuing reviews can be assured of locating adequate numbers of relevant studies for inclusion. They also enable the relevant outcomes and target group or population for example for a particular intervention to be identified. This can have particular practical benefits for review teams undertaking reviews on less familiar topics and can assist the team to avoid undertaking an “empty” review [ 33 ]. Scoping reviews of this kind may help reviewers to develop and confirm their a priori inclusion criteria and ensure that the questions to be posed by their subsequent systematic review are able to be answered by available, relevant evidence. In this way, systematic reviews are able to be underpinned by a preliminary and evidence-based scoping stage.

A scoping review commissioned by the United Kingdom Department for International Development was undertaken to determine the scope and nature of literature on people’s experiences of microfinance. The results of this scoping review were used to inform the development of targeted systematic review questions that focussed upon areas of particular interest [ 34 ].

In their recent scoping review on the conduct and reporting of scoping reviews, Tricco and colleagues 10 reveal only 12% of scoping reviews contained recommendations for the development of ensuing systematic reviews, suggesting that the majority of scoping review authors do not conduct scoping reviews as a precursor to future systematic reviews.

To identify and analyze gaps in the knowledge base

Scoping reviews are rarely solely conducted to simply identify and analyze gaps present in a given knowledge base, as examination and presentation of what hasn’t been investigated or reported generally requires exhaustive examination of all of what is available. In any case, because scoping reviews tend to be a useful approach for reviewing evidence rapidly in emerging fields or topics, identification and analysis of knowledge gaps is a common and valuable indication for conducting a scoping review. A scoping review was recently conducted to review current research and identify knowledge gaps on the topic of “occupational balance”, or the balance of work, rest, sleep, and play [ 35 ]. Following a systematic search across a range of relevant databases, included studies were selected and in line with predetermined inclusion criteria, were described and mapped to provide both an overall picture of the current state of the evidence in the field and to identify and highlight knowledge gaps in the area. The results of the scoping review allowed the authors to illustrate several research ‘gaps’, including the absence of studies conducted outside of western societies, the lack of knowledge around peoples’ levels of occupational balance, as well as a dearth of evidence regarding how occupational balance may be enhanced. As with other scoping reviews focussed upon identifying and analyzing knowledge gaps, results such as these allow for the identification of future research initiatives.

Scoping reviews are now seen as a valid review approach for certain indications. A key difference between scoping reviews and systematic reviews is that in terms of a review question, a scoping review will have a broader “scope” than traditional systematic reviews with correspondingly more expansive inclusion criteria. In addition, scoping reviews differ from systematic reviews in their overriding purpose. We have previously recommended the use of the PCC mnemonic (Population, Concept and Context) to guide question development [ 36 ]. The importance of clearly defining the key questions and objectives of a scoping review has been discussed previously by one of the authors, as a lack of clarity can result in difficulties encountered later on in the review process [ 36 ].

Considering their differences from systematic reviews, scoping reviews should still not be confused with traditional literature reviews. Traditional literature reviews have been used as a means to summarise various publications or research on a particular topic for many years. In these traditional reviews, authors examine research reports in addition to conceptual or theoretical literature that focuses on the history, importance, and collective thinking around a topic, issue or concept. These types of reviews can be considered subjective, due to their substantial reliance on the author’s pre-exiting knowledge and experience and as they do not normally present an unbiased, exhaustive and systematic summary of a topic [ 12 ]. Regardless of some of these limitations, traditional literature reviews may still have some use in terms of providing an overview of a topic or issue. Scoping reviews provide a useful alternative to literature reviews when clarification around a concept or theory is required. If traditional literature reviews are contrasted with scoping reviews, the latter [ 6 ]:

Are informed by an a priori protocol

Are systematic and often include exhaustive searching for information

Aim to be transparent and reproducible

Include steps to reduce error and increase reliability (such as the inclusion of multiple reviewers)

Ensure data is extracted and presented in a structured way

Another approach to evidence synthesis that has emerged recently is the production of evidence maps [ 37 ]. The purpose of these evidence maps is similar to scoping reviews to identify and analyse gaps in the knowledge base [ 37 , 38 ]. In fact, most evidence mapping articles cite seminal scoping review guidance for their methods [ 38 ]. The two approaches therefore have many similarities, with perhaps the most prominent difference being the production of a visual database or schematic (i.e. map) which assists the user in interpreting where evidence exists and where there are gaps [ 38 ]. As Miake-Lye states, at this stage ‘it is difficult to determine where one method ends and the other begins.’ [ 38 ] Both approaches may be valid when the indication is for determining the extent of evidence on a particular topic, particularly when highlighting gaps in the research.

A further popular method to define and scope concepts, particularly in nursing, is through the conduct of a concept analysis [ 39 , 40 , 41 , 42 ]. Formal concept analysis is ‘a process whereby concepts are logically and systematically investigated to form clear and rigorously constructed conceptual definitions,’ [ 42 ] which is similar to scoping reviews where the indication is to clarify concepts in the literature. There is limited methodological guidance on how to conduct a concept analysis and recently they have been critiqued for having no impact on practice [ 39 ]. In our opinion, scoping reviews (where the purpose is to systematically investigate a concept in the literature) offer a methodologically rigorous alternative to concept analysis with their results perhaps being more useful to inform practice.

Comparing and contrasting the characteristics of traditional literature reviews, scoping reviews and systematic reviews may help clarify the true essence of these different types of reviews (see Table 1 ).

Rapid reviews are another emerging type of evidence synthesis and a substantial amount of literature have addressed these types of reviews [ 43 , 44 , 45 , 46 , 47 ]. There are various definitions for rapid reviews, and for simplification purposes, we define these review types as ‘systematic reviews with shortcuts.’ In this paper, we have not discussed the choice between a rapid or systematic review approach as we are of the opinion that perhaps the major consideration for conducting a rapid review (as compared to a systematic or scoping review) is not the purpose/question itself, but the feasibility of conducting a full review given financial/resource limitations and time pressures. As such, a rapid review could potentially be conducted for any of the indications listed above for the scoping or systematic review, whilst shortening or skipping entirely some steps in the standard systematic or scoping review process.

There is some overlap across the six listed purposes for conducting a scoping review described in this paper. For example, it is logical to presume that if a review group were aiming to identify the types of available evidence in a field they would also be interested in identifying and analysing gaps in the knowledge base. Other combinations of purposes for scoping reviews would also make sense for certain questions/aims. However, we have chosen to list them as discrete reasons in this paper in an effort to provide some much needed clarity on the appropriate purposes for conducting scoping reviews. As such, scoping review authors should not interpret our list of indications as a discrete list where only one purpose can be identified.

It is important to mention some potential abuses of scoping reviews. Reviewers may conduct a scoping review as an alternative to a systematic review in order to avoid the critical appraisal stage of the review and expedite the process, thinking that a scoping review may be easier than a systematic review to conduct. Other reviewers may conduct a scoping review in order to ‘map’ the literature when there is no obvious need for ‘mapping’ in this particular subject area. Others may conduct a scoping review with very broad questions as an alternative to investing the time and effort required to craft the necessary specific questions required for undertaking a systematic review. In these cases, scoping reviews are not appropriate and authors should refer to our guidance regarding whether they should be conducting a systematic review instead.

This article provides some clarification on when to conduct a scoping review as compared to a systematic review and clear guidance on the purposes for conducting a scoping review. We hope that this paper will provide a useful addition to this evolving methodology and encourage others to review, modify and build upon these indications as the approach matures. Further work in scoping review methods is required, with perhaps the most important advancement being the recent development of an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for scoping reviews [ 48 ] and the development of software and training programs to support these reviews [ 49 , 50 ]. As the methodology advances, guidance for scoping reviews (such as that included in the Joanna Briggs Institute Reviewer’s Manual) will require revision, refining and updating.

Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Researchers may preference the conduct of a scoping review over a systematic review where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts, investigate research conduct, or to inform a systematic review. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

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ZM: Led the development of this paper and conceptualised the idea for a paper on indications for scoping reviews. Provided final approval for submission. MP: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CS: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. CT: Contributed conceptually to the paper and wrote sections of the paper. Provided final approval for submission. AM: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided final approval for submission. EA: Contributed conceptually to the paper and reviewed and provided feedback on all drafts. Provided approval and encouragement for the work to proceed. Provided final approval for submission.

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Munn, Z., Peters, M.D.J., Stern, C. et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 18 , 143 (2018). https://doi.org/10.1186/s12874-018-0611-x

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What is a Scoping Review?

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Updated on August 24, 2022

Scoping reviews are similar to systematic reviews but are conducted for different reasons. Scoping reviews tend to focus on the nature, volume, or characteristics of studies rather than on the synthesis of published data.

Scoping reviews were developed in the early 2000s. Researchers saw the need for a review type that could be published that was less detailed than a systematic review but more detailed than a narrative (summary) review. These can be more speculative: Scoping a research area in order to highlight possible new research directions. These can also position researchers as potential "thought leaders" within areas and so are popular article types to write as they can garner high citation rates.

According to a research article on scoping reviews, "Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct." (Munn, et al. 2018) .

To date, no set methods for scoping reviews have been established. General guidelines have been published and are detailed below. Despite the lack of rules, scoping reviews must contain valid, transparent research methods. As with all research studies, the methods above all must be reproducible by other authors.

A scoping review is a relatively new research methodology. However, when performed correctly, it can contribute greatly to a research field.

What is a scoping review?

Scoping reviews are similar to systematic reviews, but they tend to focus on the nature, volume, or characteristics of studies or gaps in knowledge. In contrast, systematic reviews evaluate and synthesize data on a particular subject or question.

Scoping reviews are performed to "scope" a broad topic in a research field.

Daudt et al. (2013) suggested the following definition of scoping studies: "Scoping studies aim to map the literature on a particular topic or research area and provide an opportunity to identify key concepts; gaps in the research; and types and sources of evidence to inform practice, policymaking, and research."

The purpose of a scoping review

According to Munn et al., 2018, "Scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review. They can report on the types of evidence that address and inform practice in the field and the way the research has been conducted."

You may perform a scoping review when there is little data on a topic or when data are heterogeneous. This may be when evidence is still emerging or unclear. Thus, scoping reviews can be performed prior to a detailed systematic review on a topic.

For example, many scoping reviews have been conducted on COVID-19. This is because COVID-19 is a relatively new disease and data are still being collected.

What level of evidence is a scoping review?

Systematic reviews have the highest level of evidence of all research types.

Scoping reviews do not contain the level of detail of systematic reviews. They may have a higher risk of bias due to higher heterogeneity. Thus, their level of evidence is considered only moderate.

The benefit of scoping reviews is that they help map the literature on a specific topic. Additionally, they can inform future research and systematic reviews on that topic.

How to conduct a scoping review

In 2005, Arksey and O'Malley published a scoping review framework. Their framework has been modified over the years, but the concepts remain the same.

They proposed an iterative six-stage process:

(1) identify the research question

(2) identify relevant studies

(3) select studies

(4) chart the data

(5) collect, summarize and report the results

(6 - optional) perform a consultation exercise

Over the years, this framework has been enhanced by researchers such as Daudt et al. (2013).

There is no consensus on the length of a scoping review. Reviews should be long enough to clearly present the results but should not contain irrelevant information.

Scoping review protocols

Several websites outlining the gold-standard reporting guidelines for scoping reviews exist. Additionally, a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist specifically for scoping reviews has been published. Click here to review the PRISMA checklist .

The general protocol for a scoping review is as follows:

• Introduction
• Definitions
• Review objective(s)
• Preliminary search details, if performed
• Explanation of the need for this review
• Eligibility criteria
• Sample search strategy
• Explanation of the search approach
• Black and gray literature that was searched
• Reasons for including the literature
• Study selection process,
• Include an explanation of how disagreements between reviewers will be resolved
• The table/form used for data extraction and an explanation of the form
• Presentation of results and data
• This may include text, tables, charts, figures, etc.

For additional information, Click here to see the Joanna Briggs Institute's website on scoping reviews .

Click here for an example of a published scoping review protocol .

Click here to review multiple scoping review preprints .

Scoping reviews versus other types of reviews

Many types of reviews exist. The most common are systematic reviews, scoping reviews, and narrative reviews. Narrative reviews are also called summary reviews. It can be hard to know which type of review to choose.

Systematic reviews

Systematic reviews are often accompanied by meta-analyses. The goal of a systematic review is to summarize existing data on a specific research question. For example, does nutritional status in infancy affect obesity risk in early childhood? Another way to think about this is researching research! Research studies included in a systematic review must meet specific criteria regarding methods, outcomes, sampling, etc.

Munn et al. (2018) notes that "According to the Cochrane handbook, a systematic review ‘uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.'"

Additionally, systematic reviews mostly focus on specific study types; for example, case-cohort studies, prospective studies, etc. Scoping reviews can summarize data from many different study types (Arksey and O'Malley, 2005).

Scoping reviews

Scoping reviews also aim to answer a research question. However, the question can be a bit more broad, and the inclusion criteria not as strict. For example, you can include multiple study types in a scoping review, while study types in systematic reviews are generally restricted. Scoping reviews still must use reproducible research methods, but the methodology is not as strict.

As noted in Munn et al. (2018), "Scoping reviews are similar to systematic reviews in that they follow a structured process, however they are performed for different reasons and have some key methodological differences."

Narrative reviews (summary reviews)

Narrative reviews do not aim to answer a research question. Rather, they aim to summarize the available data on a topic in a descriptive format. Narrative reviews are more similar to literature reviews or book chapters than research papers. Generally, no methods need to be followed because you are "telling the story" of a particular topic.

See below for a quick summary of the components of all three review types:

Final thoughts

While scoping reviews may not be as detailed as systematic reviews, they play a beneficial role in the research landscape. Scoping reviews can help summarize known and yet unknown data on a specific topic. This is especially true for new research topics, such as new diseases or technologies.

If your research interests involve new frontiers, consider publishing a scoping review.

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Scoping reviews: what they are and how you can do them.

In these videos from a  Cochrane Learning Live  webinar delivered in partnership with  GESI: the Global Evidence Synthesis Initiative , Dr Andrea C. Tricco presents the definition of a scoping review, examples of scoping reviews, steps of the scoping review process, and methods used in 494 scoping reviews from the literature. In the second video, Kafayat Oboirien presents her experiences of conducting a scoping review on strengthening clinical governance in low and middle income countries.

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Dr. Andrea C. Tricco (PhD, MSc) holds a Tier 2 Canada Research Chair in Knowledge Synthesis. Her research interests are related to responding to knowledge users (including patients, healthcare providers, and policy-makers) through knowledge synthesis. Her research also focuses on advancing the science of knowledge synthesis and she is leading research projects related to rapid reviews, network meta-analysis, and scoping reviews.

Kafayat Oboirien has a MPH in Health Economics. She has been involved in the analysis of utilisation in South Africa and a cross-country project evaluating reforms towards universal health coverage. Her present research interest lies in knowledge synthesis, specifically in mapping and documenting health systems’ work practices in LMICs.

Part 1: Scoping reviews: an overview with examples

Part 2: Example: Strengthening clinical governance in low- and middle-income countries

Part 3: Examples of non-health related scoping reviews

Part 4: Doing scoping reviews

Part 5: Polling questions and Q&A session

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A scoping review is a literature review which maps the extent, range, or nature of research on a topic or question. It uses explicit, reproducible methods to identify all studies meeting pre-specified eligibility criteria to determine whether a systematic review is necessary, summarize available evidence, identify gaps in research, and plan for future research. ¹   ²

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There are many types of literature reviews.

Before beginning a scoping review, consider whether it is the best type of review for your question, goals, and resources. The table below compares a few different types of reviews to help you decide which is best for you. 

The following article provides information for authors about choosing between a systematic and scoping review: 

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology , 18 (1), 143. https://doi.org/10.1186/s12874-018-0611-x 

• Systematic Review Guide For more information about systematic reviews, refer to the UNC HSL Systematic Review Guide.

• UNC HSL's Scoping Review Process Map A PDF file of the HSL's Scoping Review Process Map.
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The average systematic review takes 1,168 hours to complete. ¹   A librarian can help you speed up the process.

The methodology for scoping reviews is similar to systematic reviews. While there are some differences, they still require significant time and resources to complete. Scoping reviews follow established guidelines and best practices to produce high-quality research. Librarian involvement in scoping reviews is based on two levels. In Tier 1, the librarian will collaborate with researchers in a consultative manner. In Tier 2, the librarian will be an active member of your research team and co-author on your review. Roles and expectations of librarians vary based on the level of involvement desired. Examples of these differences are outlined in the table below.

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The following are systematic and scoping reviews co-authored by HSL librarians.

Only the most recent 15 results are listed. Click the website link at the bottom of the list to see all reviews co-authored by HSL librarians in PubMed

• Scoping studies: Towards a methodological framework Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
• PRISMA Scoping Review Guidelines The PRISMA extension for scoping reviews was published in 2018. The checklist contains 20 essential reporting items and 2 optional items to include when completing a scoping review. Scoping reviews serve to synthesize evidence and assess the scope of literature on a topic. Among other objectives, scoping reviews help determine whether a systematic review of the literature is warranted.
• Joanna Briggs Institute Reviewer's Manual, Chapter 11: Scoping Reviews Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-12
• Understanding scoping reviews: Definition, purpose, and process Peterson, F., Pearce, A., Ferguson, A., & Langford, A. (2017). Understanding scoping reviews: Definition, purpose, and process. Journal of the American Association of Nurse Practitioners, 29(1), 12–16. https://doi.org/10.1002/2327-6924.12380
• A scoping review on the conduct and reporting of scoping reviews Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K., Colquhoun, H., Kastner, M., Levac, D., Ng, C., Sharpe, J. P., Wilson, K., Kenny, M., Warren, R., Wilson, C., Stelfox, H. T., & Straus, S. E. (2016). A scoping review on the conduct and reporting of scoping reviews. BMC Medical Research Methodology, 16, 15. https://doi.org/10.1186/s12874-016-0116-4
• Guidance for conducting systematic scoping reviews Peters, M. D. , Godfrey, C. M. , Khalil, H. , McInerney, P. , Parker, D. & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare, 13 (3), 141-146. doi: 10.1097/XEB.0000000000000050.

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A scoping review is a broad overview of a general topic that maps a large and diverse body of literature to provide forms of evidence. 

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• To clarify key concepts/ definitions in the literature
• To examine how research is conducted on a certain topic or field
• To identify key characteristics or factors related to a concept
• As a precursor to a systematic review
• To identify and analyze knowledge gaps

Note: The full scoping review methodology is outside the scope of almost all class assignments or dissertation/thesis. If you are considering assigning one, please meet with a librarian about a modified version that will fit your course's needs and limits. .

The following are the steps for the scoping review process:

• Determine subject for review and develop some general questions
• Highly recommended to develop a protocol after the first step!
• Use the PCC framework
• Conduct systematic searches
• Determine eligibility of papers from results with a screening process
• Data extraction of relevant information
• Document the evidence
• See also: the JBI scoping review YouTube playlist

Scoping reviews share a lot of the same methodology as systematic reviews, but there are some differences.

Scoping reviews answer different types of questions than systematic reviews. Arksey and O'Malley identified 4 reasons to conduct a scoping review:

• To examine the extent, range and nature of research activity
• To determine the value of undertaking a full systematic review
• To summarize and disseminate research findings
• To identify research gaps in the existing literature

Writing your protocol

The JBI Scoping Review chapter has guidance on writing your protocol. Also, the National Institutes of Health (NIH) Library has developed a Scoping Review Protocol Guidance template and informational document containing goals and requirements for the protocol plus helpful tips and examples.

Registering your protocol

There is not as centralized a location for registering scoping review protocols as there is for systematic reviews, but there are a few ways to do it. You can put it into an open science repository such as:

These have the added features of being a place where you can make any supplemental materials available, such as the full text of your searches, and the advantage of being fast since they don’t require the approval process of the journals below. They have the disadvantage of the protocol only being findable by people searching that repository.

There are also several journals that publish protocols:

• BMC Systematic Reviews  
• JMIR Research Protocols
• JBI Evidence Synthesis

These have the advantage of being included in several databases, but the disadvantage of having to go through the submission and approval process.

The PCC framework stand for the following and include these elements:

This framework can be used for mixed methods of qualitative and quantitative research.

By using this framework, it is also important to surface the varying including and excluding criteria to explicitly guide the scope of what is being investigated. This is helpful to document in your protocol to provide clarity about what information needs to be looked for in supporting your research question. 

• Systematic vs Scoping Review: What's the Difference? A short video from Carrie Price.
• Should I undertake a scoping review or a systematic review? A video from JBI.
• Scoping reviews: What they are and how you can do them on YouTube  or on Cochrane's website   Cochrane video training series.
• Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014 Dec;5(4):371-85. doi: 10.1002/jrsm.1123. Epub 2014 Jul 24. PMID: 26052958; PMCID: PMC4491356.
• Levac, Danielle, Heather Colquhoun, and Kelly K. O'Brien. "Scoping studies: advancing the methodology." Implementation Science 5.1 (2010): 1-9. https://doi.org/10.1186/1748-5908-5-69
• Scoping reviews: reinforcing and advancing the methodology and application . Micah D. J. Peters, Casey Marnie, Heather Colquhoun, Chantelle M. Garritty, Susanne Hempel, Tanya Horsley, Etienne V. Langlois, Erin Lillie, Kelly K. O’Brien, Ӧzge Tunçalp, Michael G. Wilson, Wasifa Zarin & Andrea C. Tricco. Systematic Reviews volume 10, Article number: 263 (2021)
• Khalil H, Peters M, Godfrey CM, McInerney P, Soares CB, Parker D. An Evidence-Based Approach to Scoping Reviews. Worldviews Evid Based Nurs. 2016 Apr;13(2):118-23. doi: 10.1111/wvn.12144 . Epub 2016 Jan 28. PMID: 26821833 .
• Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach ; by Zachary Munn, Micah D. J. Peters, Cindy Stern, Catalin Tufanaru, Alexa McArthur & Edoardo Aromataris. BMC Med Res Methodol 18, 143 (2018). https://doi.org/10.1186/s12874-018-0611-x
• Evidence maps - often based on a ScR: Miake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products . Syst Rev. 2016;5(1):28.

Reporting Guidelines

• PRISMA Extension for Scoping Reviews The PRISMA extension for scoping reviews, or PRISMA-ScR for short, contains 20 essential reporting items and 2 optional items to include when completing a scoping review.

Dev Wilder UW MLIS Candidate 2023

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Systematic Reviews: Scoping Reviews

• Systematic Review Defined
• Guides, Standards and Resources
• Data Extraction
• Risk of Bias
• WCM's Data Retention Policy & Systematic Reviews
• Scoping Reviews
• Narrative Reviews
• Covidence This link opens in a new window
• Collaborations 2022-present
• Collaborations 2012-2021

What is a Scoping Review?

Our Systematic Review Service can also assist you and your team with Scoping Reviews. 

A scoping review is a relatively new approach to evidence synthesis and differs from systematic reviews in its purpose and aims. The purpose of a scoping review is to provide an overview of the available research evidence without producing a summary answer to a guide clinical decision-making.

Scoping reviews are a form of knowledge synthesis, which incorporate a range of study designs to comprehensively summarize and synthesize evidence with the aim of informing practice, programs, and policy and providing direction to future research priorities.

The general purpose for conducting scoping reviews is to identify and map the available evidence.

Adapted from: Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005 Feb;8(1):19–32.

Sucharew H, Macaluso, M. Methods for Research Evidence Synthesis: The Scoping Review Approach. J. Hosp. Med 2019;7;416-418.

How is this different from a Systematic Review?

• Scoping reviews share a number of the same processes as systematic reviews, as they both use rigorous and transparent methods to comprehensively identify and analyze all the relevant literature pertaining to a research question.
• The key differences between the two review methods can be attributed to their differing purposes and aims. The purpose of a scoping review is to map the body of literature on a topic area . The purpose of a systematic review is to synthesize the best available research on a specific intervention . 
• Scoping reviews identify key characteristics or factors related to a concept. They do not produce statements to guide decision-making. 
• A scoping review seeks to present an overview of a potentially large and diverse body of literature pertaining to a broad topic . A systematic review attempts to collate empirical evidence from a relatively smaller number of studies pertaining to a focused research question. 
• Scoping reviews aim to provide a descriptive overview of the reviewed material without critically appraising individual studies or synthesizing evidence from different studies (no risk of bias or meta-analysis/statistical pooling is performed). In contrast, systematic reviews aim to provide a synthesis of evidence from studies assessed for risk of bias .

Adapted from: Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014 Dec;5(4):371–85.  

The PCC Question Development Framework

Because the aim of a scoping review differs from that of a systematic review, question development may not fit into the PICO (Patient/Intervention/Comparison/Outcome) framework . Therefore, PCC (Population/Concept/Context) may be a more useful framework.

Per JBI's Scoping Review Manual : "The 'PCC' mnemonic is recommended as a guide to construct a clear and meaningful title for a scoping review. The PCC mnemonic stands for the Population, Concept, and Context. There is no need for explicit outcomes, interventions or phenomena of interest to be stated for a scoping review; however elements of each of these may be implicit in the concept under examination."

When do I perform a Systematic Review? When do I perform a Scoping Review?

• When you have a specific clinical question that fits into the PICO framework or a hypothesis you are looking to test, you'll want to perform a systematic review. 
• If you are looking for a broad overview on a topic, with no hypothesis or specific clinical question, you'll want to perform a scoping review.  

Adapted from: Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018 Nov 19;18(1):143.

How are both Systematic and Scoping Reviews different from Traditional Literature Reviews?

Systematic and scoping reviews aim to be comprehensive, transparent, reproducible, and unbiased – this is not typically the case with a traditional literature review. With clear and explicit methodology, the reader knows exactly how the authors of a study came to their conclusions, rather than relying on expert opinion or subjective selection that is usually found in a literature review. 

Additional Resources

• Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation . Ann Intern Med. 2018 Oct 2;169(7):467–73.
• Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version) . In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020.
• Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach . BMC Med Res Methodol. 2018 Nov 19;18(1):143.
• Arksey H, O’Malley L. Scoping studies: towards a methodological framework . Int J Soc Res Methodol. 2005 Feb;8(1):19–32.
• Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency . Res Synth Methods. 2014 Dec;5(4):371–85.
• Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting . J Clin Epidemiol. 2014 Dec;67(12):1291–4.
• Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews . Int J Evid Based Healthc. 2015 Sep;13(3):141–6.
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• Next: Narrative Reviews >>
• Last Updated: Mar 28, 2024 5:23 PM
• URL: https://med.cornell.libguides.com/systematicreviews

Systematic Reviews & Other Review Types

• What is a Systematic Review?

What is a Scoping Review?

• What is a literature review?
• What is a Rapid Review?
• What is a Mixed Methods Review?
• What is a Network Meta-Analysis?
• What is an Overview of Reviews?
• What is a Meta-Syntheses?
• What is an Integrative Review?
• What is a Diagnostic Test Accuracy Review?
• What is a Living Systematic Review?

Scoping reviews are a "preliminary assessment of potential size and scope of available research literature.  Aims to identify nature and extent of research evidence (usually including ongoing research)."   Grant and Booth (2009).

Requires fewer data sources and doesn't require assessing individual studies for risk of bias. 

Often a scoping review is confused with a mapping review.  They are  not systematic reviews , but the methodology is closely related. 

Scoping Reviews are best:

"When a body of literature has not yet been comprehensively reviewed, or exhibits a large, complex, or heterogeneous nature not amenable to a more precise systematic review."

To map existing literature in terms of nature, features, volume

To clarify working definitions and conceptual boundaries of a topic or field

To identify gaps in existing literature/research

(Pete rs M, Godfrey C,  Khalil  H, et al)

How a Scoping Review Differs from a Systematic Review

Timeframe:  12+ months, (same amount of time as a systematic review or longer).

Question:  Answers broader questions beyond those related to the effectiveness of treatments or interventions.  A priori review protocol is recommended.

Sources and searches: Is still as comprehensive as a systematic review but much broader.  May involve multiple structured searches rather than a single structured search.  This will produce more results than a systematic review.  Must include a modified PRISMA flow diagram.

Selection:  Based on inclusion/exclusion criteria, due to the iterative nature of a scoping review some changes may be necessary.  May require more time spent screening articles due to the larger volume of results from broader questions.

Appraisal:  Not applicable for scoping reviews. 

Synthesis: The extraction of data for a scoping review may include a charting table or form.  Results may include a logical diagram or table or any descriptive form that aligns with the scope and objectives of the review.  May incorporate a numerical summary and qualitative thematic analysis.

Source: MDJ Peters et al. (2015), Levac et al. (2010)

Scoping Review Resources

• PRISMA SCR-Scoping Reviews Statement and Checklist
• Scoping studies: advancing the methodology
• Scoping Studies: Towards a Methodological Framework
• A scoping review of scoping reviews: advancing the approach and enhancing the consistency
• An Evidence-Based Approach to Scoping Reviews
• Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach
• CURRENT BEST PRACTICES FOR THE CONDUCT OF SCOPING REVIEWS
• Scoping reviews: establishing the role of the librarian
• Methodology for JBI Scoping Reviews

Limitations of a Scoping Review

• Is not easier than a systematic review.
• Is not faster than a systematic review, may take longer.
• More citations to screen
• Different screening criteria/process than a systematic review
• Often leads to a broader, less defined search.
• Requires multiple structured searches instead of one.
• Increased emphasis for hand searching the literature.
• May require larger teams because of larger volume of literature.
• Inconsistency in the conduct of scoping reviews.

Other names for a Scoping Review

Scoping Study, Systematic Scoping Review, Scoping Report, Scope of the Evidence, Rapid Scoping Review, Structured Literature Review, Scoping Project, Scoping Meta Review

Temple Attribution

Adapted with permission from Temple University Libraries. https://guides.temple.edu/systematicreviews

• Last Updated: Mar 13, 2024 4:27 PM
• URL: https://touromed.libguides.com/review_types

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Open Access

Peer-reviewed

Research Article

Typhoid intestinal perforation in Francophone Africa, a scoping review

Roles Investigation, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America

Roles Investigation, Writing – review & editing

Affiliation Département de Chirurgie, Hôpital de la SIM, Galmi, Niger

Roles Conceptualization, Investigation, Writing – review & editing

Affiliation Département de Chirurgie et Spécialités Chirurgicales, Hôpital National de Niamey, Niamey, Niger

• Leah Sukri, 
• Audry Banza, 
• Katherine Shafer, 
• Yakoubou Sanoussi, 
• Kathleen M. Neuzil, 
• Rachid Sani

• Published: March 29, 2024
• https://doi.org/10.1371/journal.pgph.0003056
• Peer Review
• Reader Comments

Typhoid intestinal perforation (TIP) is a leading cause of peritonitis and indication for emergency surgery in Africa, with reported mortality rates up to 30% in pediatric patients. Currently, data on TIP in Western databases are primarily from countries that speak English, likely due to non-English publication and citation biases. Despite the high burden of infectious diseases in Francophone Africa, data from these countries regarding TIP remain limited. This study aims to highlight the incidence and morbidity of TIP in Francophone African countries using an extended search algorithm. We conducted a scoping review using the PubMed, EMBASE, and SCOPUS databases with the keywords “peritonitis”, “non-traumatic ileal perforation”, and “typhoid” in Francophone African countries. Additionally, we contacted surgeons in Africa and concurrently used citation chasing to obtain data not found in western databases. In total, 32 studies from 12 countries were identified and included in this review. A total of 22 publications were in French. Patient median age was 20 years and TIP caused a median of 35% of acute peritonitis cases. Mortality rates ranged from 6–37% (median: 16%). Rate of complications ranged from 15–92% (median: 46%). Ileostomy creation as a treatment for TIP varied between hospitals (0–79%), with the highest rates reported in Niger. In Francophone Africa, TIP is associated with high morbidity and mortality, most commonly in children and young adults. Interventions, including improved sanitation and the introduction of typhoid conjugate vaccines into routine vaccination programs, have the potential to significantly decrease typhoid fever and its complications.

Citation: Sukri L, Banza A, Shafer K, Sanoussi Y, Neuzil KM, Sani R (2024) Typhoid intestinal perforation in Francophone Africa, a scoping review. PLOS Glob Public Health 4(3): e0003056. https://doi.org/10.1371/journal.pgph.0003056

Editor: Rashi Jhunjhunwala, Beth Israel Deaconess Medical Center, UNITED STATES

Received: September 20, 2023; Accepted: March 4, 2024; Published: March 29, 2024

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

Data Availability: All data used for this study is included as supporting information file labeled " S1 Table ".

Funding: This publication is based on research funded in part by the Bill & Melinda Gates Foundation (Investment ID INV-030857 to KMN). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

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

Introduction

Typhoid fever is caused by Salmonella enterica serovar Typhi ( S . Typhi), a gram-negative bacterium primarily transmitted through the consumption of contaminated water or food [ 1 ]. In 2019, there were more than 9 million cases of typhoid fever and approximately 110,000 deaths worldwide [ 2 ]. Children are disproportionately impacted, with 53.6% of all typhoid deaths occurring in patients under 15 years old [ 3 ]. Furthermore, the prevalence of typhoid fever is highest in low-and-middle-income countries that lack safe water, sanitation, and hygiene (WASH) infrastructure [ 3 ].

Typhoid intestinal perforation (TIP) is a late complication of typhoid fever that generally occurs approximately two weeks after initial symptoms [ 1 ]. Patients present with fever and non-specific symptoms, such as abdominal pain, rebound tenderness, and vomiting [ 4 , 5 ]. One or more oval anti-mesenteric perforations in the distal ileum, as described in operative reports, is considered pathognomonic for TIP [ 6 , 7 ]. While rare in developed countries, TIP remains a common surgical condition in typhoid-endemic settings, particularly amongst children [ 7 – 9 ].

Prior to 2018, uptake of typhoid vaccines was low and typically limited to travelers and outbreak control. This changed in 2018, when a single dose of typhoid conjugate vaccine (TCV) was recommended by the World Health Organization (WHO) for routine use in children 6 months of age and older in endemic countries [ 1 ]. Three large clinical trials of TCV were conducted amongst children aged 9 months through 12–15 years in Bangladesh [ 10 ], Malawi [ 11 ], and Nepal [ 12 ]. A single dose of TCV was demonstrated to be safe with an efficacy rate of 79–85% across the studies. Additionally, TCV remains efficacious over four years [ 13 ]. TCV can be safely co-administered with routine childhood immunizations to include measles-rubella, polio, meningococcal capsular group A conjugate, yellow fever, and human papillomavirus vaccines [ 14 ]. Yet, limited data on country-specific typhoid burden and its complications remains a major barrier to vaccine introduction in many regions.

There are 21 Francophone African countries, representing 25% of the total population in Africa [ 15 ]. Socioeconomic, infrastructure, and language barriers present additional challenges to most of these countries. Insufficient WASH infrastructure and taxed health systems lead to a higher burden of infectious diseases in these countries, compared to non-Francophone countries [ 16 ]. Definitive data on disease burden in many Francophone countries is lacking, due in part to limited funding for healthcare resources and to the availability of information in French [ 17 ].

Understanding the relationship between typhoid fever and TIP has immediate implications for decision-making and public health policy regarding TCV introduction. In recent reviews on TIP in Africa, Francophone countries were underrepresented [ 7 , 18 ]. To address this knowledge gap, we conducted a scoping review on the incidence of TIP in Francophone Africa and examined the rate of TIP in the pediatric population given the WHO recommendations for use of TCV in children and its potential to reduce the incidence of this life-threatening surgical disease.

Materials and methods

This scoping review followed the Arksey and O’Malley framework for scoping studies [ 19 ]. A search strategy was developed in consultation with surgeons from Francophone African countries, experts in typhoid fever, and University of Maryland, Baltimore librarians. We searched EMBASE, PubMed, and SCOPUS databases using keywords such as “peritonitis”, “non-traumatic ileal perforation”, and “typhoid” along with individual Francophone country names that included Benin, Burkina Faso, Burundi, Cameroon, the Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, the Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Gabon, Guinea, Madagascar, Mali, Niger, Rwanda, Senegal, the Seychelles, and Togo.

We concurrently contacted African surgeons and other local health leaders and conducted citation chasing. We included all full text studies in Francophone Africa, with a reported rate of TIP, published from 1 January 2000 through 12 January 2023. Studies were excluded if data sets were duplicates or the age range of participants was not reported. French language articles were translated into English before data extraction.

Data, including author names, date of publication, study location, study period, number of patients, age range, mortality rate, morbidity rate, and ileostomy creation rate, were extracted and entered into a Microsoft Excel sheet. If specific data were not reported in the study, the variable was left blank. We summarized findings using Microsoft Excel.

A total of 6052 articles were identified with 4736 titles and abstracts screened after the removal of duplicates ( Fig 1 ). After screening, 215 manuscripts were assessed for eligibility with 39 articles that met the inclusion criteria; 7 were subsequently excluded, as 4 did not report participant age and 3 were sub-studies already included in the review. In total, 32 manuscripts were included: 10 in English, 22 in French ( S1 Table ). Nineteen manuscripts were identified through the database searches and 13 through citation chasing and local outreach.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pgph.0003056.g001

Twelve countries are represented in this review with studies conducted in 28 hospitals. Benin, Burkina Faso, and Niger were the most represented countries with 5, 5, and 6 studies, respectively. The rest of the countries had three or fewer studies. Study years ranged from 1990–2019, with 79% of studies conducted after 2000.

Table 1 summarizes the number of patients, age, incidence, and complication rate of TIP per country for all age groups. Data from individual studies can be found in S1 Table . The median age was 20 years. The number of TIP patients ranged from 7–2931 per study and TIP accounted for a median of 35% of acute peritonitis (range 15–92%). The median mortality rate was 16% (range 6–37%) while median morbidity rates was 46% (range 15–92%). Ileostomy as a treatment for TIP ranged from 0–79%. There were no trends based on study year.

https://doi.org/10.1371/journal.pgph.0003056.t001

A total of 15 articles from 10 countries reported on pediatric and young adult populations ranging from 0 to 20 years ( Table 2 ). Among this population, TIP accounted for a median of 56% of acute peritonitis with post-operative mortality rates of 4–33% and morbidity rates of 16–91%. Only six studies reported ileostomy rates in this population, which ranged from 0–63%.

https://doi.org/10.1371/journal.pgph.0003056.t002

This scoping review describes the prevalence of TIP in Francophone Africa. Although the number of TIP cases varied across countries, typhoid accounted for a large proportion of acute peritonitis in this region and was a major cause of emergency abdominal surgery. Consistent with prior studies, TIP remains a disease of the pediatric and young adult populations [ 7 , 18 ]. In 75% of the included articles, the average age amongst TIP patients was under 25 years. The median case fatality rate (CFR) amongst Francophone countries is 16%, which is comparable to a historical CFR of 20% for TIP cases in Africa [ 7 ]. In pediatric patients, the TIP CFR in Francophone Africa was 4–33%, which remains consistent with the previously reported CFR of 11–30% amongst children in Sub-Saharan Africa [ 18 ].

Morbidity of TIP cases was extremely high, likely due to resource limitations in Francophone African countries where access to appropriate and timely healthcare is often difficult. As a result, patients present with severe disease, which is associated with an increased number of post-operative complications. The most common complications reported in prior studies include surgical site infection, wound dehiscence, and enterocutaneous fistula, all of which increase length of hospital stay and place a significant burden on families [ 7 , 52 ]. Furthermore, increased disease severity is associated with higher degrees of peritoneal contamination. In severe cases, surgeons often perform damage control surgery, requiring patients to return to the operating room several times during their hospital stay. Additionally, simple suture repair or bowel resection is oftentimes not appropriate in these severe cases due to high risk of further infection, necessitating the creation of ileostomies [ 53 ]. Although inconsistently reported in previous studies, our review found that ileostomies were frequently used to treat TIP cases, with ileostomy creation rates up to 79% in one study. Ileostomies are difficult to manage and in low-resource settings, complications–such as skin irritation, malnutrition, prolapse, and hernia–are common [ 53 ].

Typhoid fever has significant health implications and a high economic burden on patients and their families. In Malawi, the mean cost of inpatient healthcare for typhoid fever was approximately $296 USD where the mean monthly household income is $23.71 USD per person [ 52 ]. Costs for TIP patients are much higher and vary widely depending on surgical needs. Ileostomy creation remains the most expensive procedure, with an average cost of $519 USD in one Nigerien hospital, approximately 30% more than comparable TIP surgeries without ileostomies [ 44 ]. Ileostomies lead to significant social strain on patients as well. Due to social stigma, women with ileostomies are at a risk of being abandoned by their husbands, leaving them and their children without a source of income. Children with ileostomies often miss more than 1 year of school after their surgery and are at a higher risk of leaving the school system earlier compared to their peers [ 54 ]. In resource-limited settings, the introduction of TCV is highly cost-effective [ 55 ]. Fortunately, Gavi, the Vaccine Alliance, an international organization that supports equitable and sustainable use of vaccines in the poorest of countries, has included TCV in their portfolio beginning in 2018. Gavi will fully finance the operational and vaccine costs of a one-time TCV catch-up campaign in children up to 15 years of age in low resource countries, and provide co-financing support including vaccine, vaccination supplies, and operational costs for nationwide introduction into routine immunization programs [ 56 ].

To date, six countries worldwide, including three in Africa–Liberia, Malawi, and Zimbabwe–have introduced TCV into their national routine immunization programs [ 56 ]. Despite demonstrated safety and efficacy of TCV, the decision to introduce a new vaccine on a national scale is a complicated process. Liberia was the first African country to introduce TCV in April 2021 based on high modeled estimates of typhoid burden [ 56 ]. In May 2021, Zimbabwe introduced TCV in response to multiple large typhoid outbreaks and the presence of drug-resistant strains [ 56 ]. Malawi’s decision to introduce TCV in 2023 was based on a high burden of disease, increasing drug resistance, and known vaccine efficacy [ 11 , 13 , 57 ]. To date, no Francophone African countries have introduced TCV, largely due to competing health priorities and a lack of sufficient country-specific data on the burden of typhoid and its complications, and a lack of knowledge of antimicrobial resistance patterns.

Due to the lack of blood culture availability in many endemic countries, cases of typhoid fever often go undetected, leading to underreported case numbers. As a result, alternative measures for typhoid disease burden are imperative, with TIP and non-traumatic intestinal perforations serving as indicators of disease. In Malawi, the seasonality of intestinal perforations mirrored the seasonality of blood culture-confirmed typhoid [ 9 , 58 ]. Similarly, monthly intestinal perforations were significantly correlated with monthly positive S . typhi cultures in a large typhoid surveillance study in six African countries [ 5 ]. In the DRC, surgeons also reported an increase in peritonitis cases during a severe outbreak of typhoid fever, putting additional strain on an already overburdened health care system [ 59 ], which could be mitigated with TCV introduction.

Data from Francophone African countries are limited and can be difficult to find due to language biases. Writing for English medical journals may be difficult for many non-English speaking authors. As a result, many will choose to publish manuscripts in their native language [ 60 ]. Unfortunately, there is consistent evidence that systematic reviews often exclude non-English manuscripts or fail to identify these papers in the searching and screening phases, neglecting potentially large amounts of viable data and information [ 17 ]. Similarly, non-English papers are cited at much lower rates than their English counterparts [ 60 ]. This review attempts to address these gaps in information at a country level.

This review has notable limitations. Due to a lack of readily available diagnostics for typhoid fever, there is an inconsistent definition of TIP amongst studies. Only 3 studies diagnosed patients with blood culture confirmation, and most studies used clinical and operative findings to diagnose TIP. As a result, there is variability in study populations. Another limitation is the mix of adult and pediatric populations included in the studies. Previous literature suggests there may be differences in TIP prevalence and progression between children and adults [ 7 , 18 ]. Finally, this review relied on citation chasing and networking with local surgeons in Francophone African countries to identify TIP manuscripts not available in traditional databases. Thus, despite our broad approach to identifying manuscripts, we likely missed relevant articles in lesser accessed journals. In the future, identifying TIP experts in each country may ensure that each country is appropriately represented. Another possible progression of this study is the creation of a centralized African typhoid database with standardized diagnostic criterion of TIP. This would facilitate further collaboration between Francophone and non-Francophone countries and could also be used to identify or predict areas of typhoid outbreaks and drug resistance throughout the continent.

In this review, we found a high burden of TIP in Francophone Africa. TIP remains a surgical emergency with high morbidity and mortality, resulting in an immense strain on the fragile health care system in these countries. The presence of TIP in a region should serve to catalyze efforts to prevent and treat typhoid fever. While WASH improvements are necessary, these are often difficult and costly to implement and maintain, especially in resource-limited countries. TCVs are proven effective and safe, and vaccination campaigns and routine immunizations remain an advantageous tool, to reach all children, even those in rural and remote areas. TIP may provide the key to bringing TCVs to the most underserved and vulnerable regions, to significantly decrease this preventable disease in children across all of Africa.

Supporting information

S1 checklist. prisma checklist..

https://doi.org/10.1371/journal.pgph.0003056.s001

S1 Table. Data from all included studies included in the review.

https://doi.org/10.1371/journal.pgph.0003056.s002

Acknowledgments

We would like to acknowledge the University of Maryland Health Sciences and Human Services Library staff for their assistance with development of our search strategy.

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SYSTEMATIC REVIEW article

Interventions addressing the impostor phenomenon: a scoping review.

• 1 Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
• 2 Department of Human Resources Management, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
• 3 Vulnérabilité, Capabilité et Rétablissement (VCR), Ecole de Psychologues Praticiens of Catholic University of Paris, Paris, France
• 4 INSERM INSPIIRE UMR 1319, Lorraine University, Nancy, France

Introduction: The Impostor Phenomenon (IP) refers to a psychological experience characterized by unjustified feelings of intellectual and professional fraud, accompanied by the fear of not maintaining performance and of being exposed. IP is receiving increasing attention in the fields of psychological health at work and occupational psychology as well as among the general public, since it affects the functioning of both individuals and organizations. The aim of this scoping review is to map the range of interventions that have been conducted to address IP among individuals experiencing it in a professional context.

Methods: The search and selection process to identify relevant reports was conducted using the PRISMA-ScR methodology and JBI recommendations and resulted in the selection of 31 studies.

Results: The results reported concerning the characteristics of the studies, the interventions described, and the effects identified are heterogeneous. More than half of the studies used research designs (experimental, pre-experimental, exploratory, etc.). Two major types of intervention emerge: training and counseling. The effectiveness of the interventions varies according to the evaluation methodology that was used, although most authors conclude that the proposed intervention is relevant.

Discussion: In light of these results, recognizing and educating individuals regarding the various manifestations of IP, as well as offering support in a group context, appear to be primary intervention levers. Future intervention proposals should explore psychosocial and educational influences as well as the impact of the immediate environment on IP-related beliefs.

Introduction

Since its emergence in the late 1970s ( Clance and Imes, 1978 ), the concept of impostor phenomenon (IP) is drawing increasing scientific interest and gaining popularity among the general public. It is characterized by an intense and secret psychological experience of intellectual and professional fraud (e.g., Clance and Imes, 1978 ; Harvey and Katz, 1985 ). These unjustified feelings of phoniness in the face of success, known as impostor feelings , are accompanied by the fear of not being able to reproduce one’s performance and the fear of being discovered ( Clance and Imes, 1978 ; Clance, 1985 ). IP seems to be a common experience, as Tewfik (2022) pointed out, “ may unwittingly come from common work experiences such as a promotion in which one is suddenly expected to successfully execute unfamiliar responsibilities ” (p. 992). Moreover, going through a major life transition or acquiring a new role, in a professional or a private context, can put individuals at risk of developing IP ( Harvey, 1981 ; Fujie, 2010 ). IP can also be considered a vicious circle, where each repetition reinforces the dysfunctional beliefs and associated negative feelings (e.g., Clance and Imes, 1978 ; Clance, 1985 ; Chrisman et al., 1995 ). With the exception of rare positive accounts ( Fruhan, 2002 ; McElwee and Yurak, 2010 ; Tewfik, 2022 ), the expression of the IP is considered to be very detrimental to health and wellbeing at work (e.g., Vergauwe et al., 2015 ) and, consequently, to the proper functioning of organizations (e.g., Kets de Vries, 2005 ). Addressing IP seems to be a significant lever of action for organizations wishing to promote good health at work, and employee fulfillment and performance. Yet, as revealed by the systematic review by Bravata et al. (2020) , treatments for IP have been little studied to date. To fill this gap, this review examines interventions to address IP and proposes a benchmark for future contributions to this field of research.

To better understand its objectives, it is worth mentioning the broader context of current knowledge about IP. First of all, data on the prevalence of IP within the population vary widely, from 9% to 82%, depending on the psychometric instrument and cut-off score ( Bravata et al., 2020 ). It is generally associated with a decrease in wellbeing and life satisfaction ( Clance and O’Toole, 1987 ; September et al., 2001 ). Furthermore, IP can affect individuals’ psychological health in various ways (e.g., Bernard et al., 2002 ; Brauer and Wolf, 2016 ). Indeed, it predicts up to 15% of self-reported psychological distress ( Oriel et al., 2004 ). The most frequently associated comorbidities are depression (e.g., Oriel et al., 2004 ; Leonhardt et al., 2017 ), anxiety (e.g., Bernard et al., 2002 ; Kananifar et al., 2015 ) low self-esteem ( Neureiter and Traut-Mattausch, 2016 ), and somatic symptoms and social dysfunction ( Kananifar et al., 2015 ). Moreover, IP is now considered by many experts to be a psychopathological reality (e.g., Chassangre, 2016 ) and some researchers have suggested that it should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) ( Bravata et al., 2020 ).

Observational studies of IP in a work context have been carried out in various fields, such as academia (e.g., Clance and Imes, 1978 ; Byrnes and Lester, 1995 ), healthcare (e.g., Ares, 2018 ; LaDonna et al., 2018 ), marketing (e.g., Fried-Buchalter, 1997 ), and management ( Rohrmann et al., 2016 ). In professional context, IP is generally associated with reduced job satisfaction ( Vergauwe et al., 2015 ). Studies have demonstrated its link with stress (e.g., Rohrmann et al., 2016 ; Alrayyes et al., 2020 ), burn-out (e.g., Legassie et al., 2008 ; Vergauwe et al., 2015 ), and emotional exhaustion ( Leach et al., 2019 ). Furthermore, IP is known to negatively affect work-life balance ( Crawford et al., 2016 ) and it is positively related to workaholism ( Mir and Kamal, 2018 ), suggesting that persons who experience IP are more likely to work harder and longer, in order to avoid their fear of failure. In addition, it can often become an obstacle to career progression and the motivation to take on a leadership role ( Neureiter and Traut-Mattausch, 2016 , 2017 ). It can also influence decisions about whether to continue in an educational program or a career (e.g., Clance and O’Toole, 1987 ; Blondeau and Awad, 2018 ). Moreover, IP is usually known to lead to maladaptive organizational behaviors (e.g., Bechtoldt, 2015 ; Neureiter and Traut-Mattausch, 2016 ). More recently, Tewfik (2022) has nuanced this observation by demonstrating that those who experience IP were evaluated as more interpersonally effective. What is more, this relational efficiency does not come at the expense of competence-related outcomes. IP is also known as a factor influencing absenteeism and turnover in companies ( Kets de Vries, 2005 ). However, organizational functioning and managerial attitudes can mitigate the deleterious effects of IP (e.g., Bechtoldt, 2015 ; Crawford et al., 2016 ).

That being said, an important aspect of the theoretical background is the lack of conceptual clarity regarding IP and the persistent discussion over the nature of the construct. Beyond the lack of uniformity in the terms used to designate it (sometimes a phenomenon, a syndrome, impostorism , an experience, a feeling, thoughts, etc.), a lack of consensus remains on its consideration as a trait or a state ( Gullifor et al., 2023 ) or on the dimensionality of the phenomenon ( Mak et al., 2019 ). Indeed, IP was described by early authors as a cognitive, behavioral, and emotional dynamic ( Clance, 1985 ), corresponding to a list of intrapersonal criteria ( Clance, 1985 ; Harvey and Katz, 1985 ). If, for many years, it was perceived as a stable personality trait (e.g., Topping, 1983 ; Sonnak and Towell, 2001 ), it was later seen as an affective state that could manifest itself in certain situations (e.g., Leary et al., 2000 ; McElwee and Yurak, 2007 ); a psychological experience according to McElwee and Yurak (2010) . Since then, this aspect of the discussion has not really been elucidated, as Gullifor et al. (2023) pointed out. In response to this issue, these authors proposed a trait–state conceptualization of IP. On the other hand, Mak et al. (2019) , in a systematic review of IP measurement scales, identify that the lack of conceptual clarity around the dimensionality of the IP has limited the establishment of a gold standard measure.

Despite these critical gaps in the scientific literature, which are legitimately deplored by the authors of systematic reviews on the subject ( Mak et al., 2019 ; Bravata et al., 2020 ; Gullifor et al., 2023 ), the field of research of the interventions addressing IP is, quite recently, expanding. According to recent perspectives (e.g., Kark et al., 2022 ), IP presents as a psycho-social issue that affects the psychological health, wellbeing, and careers of individuals. These findings justify a scoping review, to support both current intervention approaches and the development of future research in this field. A scoping review is particularly relevant to the topic of interventions addressing IP given that the subject is emergent and has not been extensively reviewed. Like systematic reviews, scoping reviews follow a rigorous, systematic literature search and identification process; however, they are more exploratory in nature ( Colquhoun et al., 2014 ; Lockwood and Tricco, 2020 ).

Therefore, the aim of this scoping review is to provide a more comprehensive overview of the research landscape, map the range of interventions that have been conducted to address IP among individuals experiencing it in a professional context, which is currently unavailable in the literature. In line with this objective, it addresses the following questions: (1) What types of studies and methodologies have been undertaken to explore interventions addressing IP expressed in occupational contexts? (2) What are the modalities and characteristics of these interventions? and (3) What are the effects of these interventions?

This scoping review uses a systematic approach to analyze and aggregate scientific data on a given topic to identify concepts, theories, sources, and gaps associated with current knowledge (e.g., Munn et al., 2018 ; Tricco et al., 2018 , 2022 ). However, unlike a systematic review, a scoping review must examine all relevant literature, regardless of the study design. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews (PRISMA-ScR) (2018) guidelines and the recommendations of the Joanna Briggs Institute (JBI) (2020). PRISMA-ScR Check List is presented as Supplementary Table 2 .

Framing elements were defined to guide the identification and selection of references. These elements concern: (1) the target population of adults in a professional context (such as employees, managers, self-employed workers, but also student trainees and interns), (2) the concept of interventions to address IP, and (3) the organizational, training or private context of these interventions.

Search and selection process of references

Search terms and sources.

Relevant references were identified using an iterative process, initiated in November 2022, supported by a librarian specialized in database selection, keyword identification, equation development and search strategy. This approach was then refined in light of the initial results.

Six databases covering psychological, medical, and business literature were selected: APA PsycArticles, APA PsycINFO (EBSCO), Business Source Complete (EBSCO), PubPsych, Scopus, and MEDLINE. The search equation was developed by combining impostor phenomenon (IP) keywords and treatment terms. In the literature, the terms Impostor Syndrome (IS) and Impostor Phenomenon (IP) are synonymous. Other less common terms, such as Impostor Experience, Fraud Syndrome , and Impostorism , were also included. These terms were associated with the keywords Treatment, Intervention, Therapy, Counseling, Rehabilitation , and Management .

The database search identified a total of 394 references. It was subsequently completed by a manual search and consultation of the reference lists, which identified a further 14 references. As an example, the search strategy for APA PsycInfo is presented in Supplementary Table 1 .

Selection of references

The selection of references was based on predetermined eligibility criteria ( Table 1 ).

Table 1. Eligibility criteria for reference selection.

According to the JBI, the broad scope of scoping reviews allows for “ less restrictive inclusion criteria ” ( Peters et al., 2015 , p. 7) and may draw upon data from any type of evidence and research methodology ( Peters et al., 2020 ). Furthermore, based on the defined objectives and framing elements, the definition of inclusion criteria (in terms of dates, diversity of sources and types of methodology) ensured broad coverage of all the literature relevant to this scoping review; including exploratory, prescriptive, and non-experimental scientific literature. In addition, although this research falls within the field of organizational psychology, it was decided to include studies involving students; as long as they are in internship situations, which utilize their skills as future professionals rather than strictly academic competencies. Exclusion criteria were defined to eliminate references that would not have pertinently addressed the questions raised by this scoping review (e.g., excluding studies focusing on children, references without any interventions, etc.).

After deleting duplicates, the titles and abstracts of all references were examined for relevance. Those that clearly did not meet the criteria were eliminated. Two reviewers then applied these criteria to all the abstracts retained after the first selection ( n = 124), and then to the full texts ( n = 48) to determine their eligibility. In the end, 31 publications were retained. Figure 1 presents the PRISMA flow diagram.

Figure 1. Flow diagram of the selection process of references according to PRISMA-ScR guidelines.

Data extraction

The information and characteristics of the selected references were extracted using a coding grid. They included title, authors, geographical origin, year and type of publication, study objectives, study population and sample size (if applicable), participant characteristics, methodology, measures used, type of intervention, results of analyses, and finally, limitations and main conclusions.

General overview

Of the 31 references on IP interventions selected, 26 are scientific articles from peer-reviewed journals, with a wide range of contents and formats; 4 are chapters in scientific or professional books and 1 is a doctoral thesis.

The interventions presented in these documents vary depending on the context of the studies. First, most interventions were conducted in Europe or the United States (over 80%). Second, the majority of the interventions were deployed in the healthcare and higher education (university) sectors, among participants reporting IP in relation to their professional activities.

Regarding the characteristics of the participants, most of the interventions were carried out with a sample of participants composed primarily of women. Some even specifically targeted professional women (e.g., Mann et al., 2023 ). Moreover, in half the studies, the average age of participants was under 40 years. In addition, the fact that the participants were young professionals was sometimes reported as an important aspect (e.g., Harte and McGlade, 2018 ; Danhauer et al., 2019 ; Baumann et al., 2020 ). However, not all authors reported the age of participants (e.g., Deshmukh et al., 2022 ).

In terms of temporal landmarks, it is very interesting to observe that the field of research on interventions addressing IP is recently in full expansion. This is even more true when considering only studies based on a research design (all post-2018). Figure 2 presents the number of publications related to IP interventions over the years. This observation constitutes an additional argument in favor of proposing a synthesis of existing data and gaps in the current literature.

Figure 2. Number of publications related to interventions addressing IP between 1978 and 2023 (October).

Considering the great heterogeneity of the selected references and to clearly report the results, as well as to be able to make consistent comparisons between types of intervention, the decision was made to split the references into two categories. The objective of splitting the references into two categories is to facilitate the distinction between both and to help the readers further discern the conclusions drawn from these two types of literature. The results from these two types of literature are thus presented separately below.

Studies carried out using a research design

Table 2 presents references describing an intervention tested using a scientific research design.

Table 2. References testing an intervention in a scientific study design.

Study characteristics

Different research designs were used to guide each study. The main characteristics of the studies are reported in Table 3 .

Table 3. Main study characteristics.

The robustness of the study design varied widely from one study to another. Only a few studies involved a randomized controlled trial comparing the effects of their interventions with a control group (i.e., no intervention or a waiting list) ( Zanchetta et al., 2020 ; Fainstad et al., 2022 ; Liu et al., 2023 ; Mann et al., 2023 ). Most other studies measured the variables before and after the intervention. Three studies used a cross-sectional design ( Haney et al., 2018 ; Baumann et al., 2020 ; Deshmukh et al., 2022 ) and also collected qualitative data on the interventions (e.g., feedback). Finally, two studies used a descriptive ( Magro, 2022 ) or interpretative ( Popovic, 2020 ) phenomenological approach. Regarding sample size, there is considerable variability. For example, the study by Mann et al. (2023) includes more than a thousand participants while DeCandia Vitoria (2021) study presents a case study.

The research objectives formulated in each study also contributed to the heterogeneity between them. While several specifically addressed IP and evaluated the effects of the proposed intervention (e.g., Zanchetta et al., 2020 ), others situated their objectives within a broader framework (e.g., Fainstad et al., 2022 ; Mann et al., 2023 ). It should be noted that very few studies examined the IP issue in isolation: most evaluated several variables simultaneously.

Intervention characteristics

Although intervention models varied from one study to another, common characteristics make it possible to identify trends ( Table 4 ).

Table 4. Main intervention characteristics.

First, two major types of approaches emerge among these models. More specifically, half the interventions were based on practices carried out in the context of counseling. These included coaching interventions, clinical supervision, and support groups. Additionally, almost all the other interventions adopted a professional training approach. Only one study ( Zanchetta et al., 2020 ) compared two types of intervention (individual coaching and group training).

Several interventions based on principles of counseling aimed to foster openness and sharing of experiences among peers, in order to break the sense of isolation that characterizes IP. This is particularly true of the reflection and support groups studied by Gold et al. (2019) and the small group discussion sessions offered by Baumann et al. (2020) . In the field of supervision, DeCandia Vitoria (2021) adopted an approach defined by simultaneous use of narrative therapy and interpersonal neurobiology. In her study, Popovic (2020) combined psychoeducation with group supervision and individual exercises. Finally, coaching interventions most often addressed the behavioral, cognitive, and emotional aspects of IP. These interventions are based on the coaching alliance, especially in the case of an individual approach ( Zanchetta et al., 2020 ; Magro, 2022 ).

Training courses are essentially aimed at enhancing knowledge, interpersonal skills or know-how. Some of the selected studies involved purely technical skills related to the activity (e.g., medical improvisational techniques , Deshmukh et al., 2022 ), others more cross-disciplinary or relational skills (e.g., adapting communication style, managing conflicts , etc., Danhauer et al., 2019 ). The intervention proposed by Metz et al. (2020) consisted of an online training module on IP presenting more appropriate coping mechanisms. Some training sessions took the form of participative and reflective pedagogical workshops (e.g., Haney et al., 2018 ; Ogunyemi et al., 2022 ), with the goal of promoting feelings of liberation and empowerment.

Interventions can also be distinguished based on whether they involve group or individual modalities. While most of the selected studies trended toward group interventions, some were individual. Duration of the interventions, which was highly variable, is another characteristic differentiating the studies. Duration ranged from a single 1-h session (e.g., Deshmukh et al., 2022 ) to several months (e.g., Mann et al., 2023 ). Nevertheless, most interventions involved multiple sessions. Finally, some interventions were also part of a broader program, while others focused specifically on the IP.

Characteristics of identified effects

Although most studies concluded that the proposed intervention was effective in treating IP, these conclusions were based on evidence that varied from study to study. Indeed, the type of design and the nature of the data collected undeniably influenced the effects identified and conclusions. A distinction can be drawn between the main effects reported by studies that collected quantitative data, using an experimental or pre-experimental design (pre-intervention and post-intervention measures), and the effects identified by studies that reported qualitative data.

Among the studies that based their conclusions on quantitative data, some compared an experimental condition with a control condition. In a randomized controlled trial, they demonstrated the effectiveness of the proposed intervention compared to the absence of intervention. For example, after 6 months of professional coaching intervention, Fainstad et al. (2022) found a significant reduction in IP in female participants compared to those in the control group. The study by Zanchetta et al. (2020) compared two experimental conditions (training and coaching) and a control condition. It highlighted the lasting effectiveness of a coaching intervention in reducing IP issues. These authors concluded that training was less effective than coaching in reducing IP issues but was superior for acquiring associated knowledge. Other studies analyzed the variations in scores obtained by participants before and after the intervention, without comparison with a control group. For example, Metz et al. (2020) reported the beneficial effects of their online training module, as evidenced by a significant decrease in scores on the Clance Impostor Phenomenon Scale (CIPS) at the end of the semester, 4 months after their intervention.

Studies that reported qualitative data on the effects of interventions revealed complementary information. Some presented evaluations related to the satisfaction or experience of the participants, which were usually favorable or very favorable (e.g., Danhauer et al., 2019 , Baumann et al., 2020 ; Deshmukh et al., 2022 ). This positive outcome led the authors to conclude that their intervention adequately addressed the issues. For example, participants in the intervention conducted and evaluated by Gold et al. (2019) reported that it contributed to improving their wellbeing, self-awareness, and empathy skills. Similarly, according to Haney et al. (2018) , their training achieved its objectives, as the participants expressed feelings of liberation and empowerment after the workshop.

Finally, exploratory studies, whether descriptive phenomenology or case studies, clearly illustrate the mechanisms on which interventions rely to promote the reduction of IP, which they do not otherwise measure. Thus, Harte and McGlade (2018) concluded that coaching helped give direction and meaning to individual experience, which in turn helped counteract feelings of imposture. Magro (2022) , pointed to the counseling and the tools and techniques learned, which enabled clients to improve their awareness and manage their feelings of imposture. Similarly, the clinical supervision proposed by DeCandia Vitoria (2021) to a therapist seemed to enable her to regain confidence, reduce her feelings of shame and fear, and strengthen her self-empathy.

Studies carried out without a research design

Table 5 includes references presenting interventions carried out without a research design.

Table 5. References with no study design or that did not test an intervention.

Most of the references classified in this section are articles published in peer-reviewed journals and describe various intervention models carried out in diverse contexts ( Clance and Imes, 1978 ; Matthews and Clance, 1985 ; Steinberg, 1987 ; Clance et al., 1995 ; Parkman and Beard, 2008 ; Ramsey and Spencer, 2019 ). These articles present a description of the IP, the intervention carried out and its repercussions, as well as recommendations for practitioners wishing to develop a similar approach. However, the interventions described were neither carried out nor evaluated using a research design. Most often, neither the IP nor other variables were measured. These articles therefore present a professional view of IP interventions, outside the field of empirically based interventions. Therefore, the results reported cannot be compared to those obtained by the studies reported in the previous section. However, it is important to present them in order to better understand the current state of knowledge regarding IP interventions.

Among the selected references, one literature review ( Chassangre and Callahan, 2017 ) and one commentary ( Armstrong and Shulman, 2019 ) address general aspects and list guidelines as well as recommendations for interventions addressing IP. Three others provide scientifically supported recommendations, but their implementation is not described ( Dowd and Davidhizar, 1997 ; Arleo et al., 2021 ; Jaqua et al., 2021 ). In addition, this section includes a chapter from Clance (1985) and one from Harvey and Katz (1985) , pioneering authors on the subject of IP. These authors present interventions and recommendations based on their clinical experience. Similarly, the two chapters from the work of Chassangre and Callahan (2015a , b ) synthesize the contributions of the previous authors and integrate them into their proposed intervention on IP, within the psychotherapeutic framework.

In the references identified, two main types of interventions can be distinguished, those focusing on psychotherapy and those making recommendations for personal strategies.

Most of the interventions described fall within the field of psychotherapy and include both group therapy ( Clance and Imes, 1978 ; Matthews and Clance, 1985 ; Steinberg, 1987 ; Clance et al., 1995 ) and individual interventions ( Harvey and Katz, 1985 ; Dowd and Davidhizar, 1997 ; Chassangre and Callahan, 2015a , b ). Some authors also make recommendations for both modes of intervention ( Clance, 1985 ; Chassangre and Callahan, 2017 ). In terms of theoretical framework, several references adopt an approach derived from cognitive behavioral therapy (CBT) ( Clance, 1985 ; Harvey and Katz, 1985 ; Matthews and Clance, 1985 ; Chassangre and Callahan, 2015a , b , 2017 ). For example, Clance and Imes (1978) proposed an intervention integrating the contributions of CBT and Gestalt therapy. A few years later, Clance et al. (1995) suggested a feminist-oriented therapeutic group. An intervention put forward by Ramsey and Spencer (2019) resembles training, but also integrates some aspects of counseling, combining a psychoeducational component focusing on IP with small-group discussions and role-playing exercises.

Articles recommending interventions based on personal strategies to reduce IP also address the cognitive, emotional and behavioral components of the phenomenon (e.g., Chassangre and Callahan, 2015a ; Arleo et al., 2021 ; Jaqua et al., 2021 ). Among these recommendations, it is interesting to note that the approaches described have much in common with each other, but also with coaching (e.g., Zanchetta et al., 2020 ). For example, Jaqua et al. (2021) describe a seven-step counseling approach that involves acknowledging one’s own feelings and practicing self-compassion, yet also recommend finding a mentor in order to be able to rely on external resources. Overall, these interventions are more briefly described than those based on psychotherapy.

Most studies conducted without a research design offer a relatively brief description of the impact of interventions on participants. The effects described are exclusively qualitative in nature, or are estimates of expected effects, according to the clinical or professional experience of the authors. Nevertheless, the information is sufficiently complete to enable several observations.

Firstly, authors who have opted for a group intervention approach argue that it can help break the feeling of isolation often experienced with IP (e.g., Matthews and Clance, 1985 ). In this regard, Clance et al. (1995) suggest that their feminist-oriented therapeutic intervention makes it possible to counteract and substitute the familial and social influences initially received. Steinberg (1987) describes a peer discussion group ( The Impostor Group ) and identifies the sharing of knowledge and experiences as one of the main strengths of the intervention. However, individual support may also be indicated in certain cases, as described by Matthews and Clance (1985) , offering an opportunity to personalize the treatment of IP. Finally, some researchers suggest that training-based interventions enable the transmission of IP-related knowledge and its subsequent reevaluation on a personal level. For example, Ramsey and Spencer (2019) emphasize that their intervention enables participants to recognize their knowledge gaps more serenely and to seek help without concealing their feelings of imposture.

The aim of this scoping review, which situates the contribution of 31 references, is to address three main questions arising from the literature on interventions for IP. The first concerns the types of studies and methodologies that currently exist regarding such interventions. The second focuses on the modalities and characteristics of these interventions, and the third concerns their effects. These three questions are discussed below, followed by the limitations of this review and future perspectives for this field of research.

Type of studies and methodologies

Most of the references included in this scoping review are articles in peer-reviewed journals. However, not all present a scientific investigative approach. Those supported by a scientific research design are from after 2018, and used various methodologies. A majority proposed a quantitative design (e.g., Danhauer et al., 2019 ), while others relied on mixed or purely qualitative data (e.g., Haney et al., 2018 ). Research design robustness varied across studies: some presented randomized controlled trials (e.g., Fainstad et al., 2022 ) while others adopted exploratory approaches (e.g., Magro, 2022 ). Sample sizes also varied, ranging from individual case (e.g., DeCandia Vitoria, 2021 ) to studies including over a thousand participants (e.g., Mann et al., 2023 ).

That said, many of the interventions cited were conducted without the aid of a scientific research design. For example, some articles described professional experiments (e.g., Clance and Imes, 1978 ). Such interventions cannot be considered as evidence-based practices and are more exploratory in nature. However, the methodological recommendations for scoping reviews, unlike systematic reviews, make it possible to include these publications. In addition to the recent developments identified in this scoping review, this may also explain some of the differences found with the most recent published systematic reviews on IP ( Bravata et al., 2020 ; Gullifor et al., 2023 ). Thus, it is appropriate to be cautious when extracting the best practices from this literature to guide the development of future interventions.

Modalities and characteristics of interventions

Before discussing the intervention characteristics, it is important to note that most authors agreed on a common definition of IP, one that is consistent with its original conceptualization (e.g., Clance and Imes, 1978 ; Clance, 1985 ). Indeed, the definition of IP is not discussed in most of the studies selected, despite the persistent lack of conceptual clarity relating to IP. This observation echoes that of Gullifor et al. (2023) when challenging “ the implicit assumption that the conceptualization of IP is thoroughly and soundly developed ” (p. 2).

In fact, according to the authors, IP manifests on several levels: cognitive, emotional, and behavioral. Many interventions, whether psychotherapeutic or non-psychotherapeutic, take a CBT-inspired approach to address IP (e.g., Clance, 1985 ; Chassangre and Callahan, 2017 ; Gold et al., 2019 ). In particular, Chassangre and Callahan’s (2015a) interventions draw on intervention techniques described by Clance (1985) (e.g., Attribution Diary, Downward Arrow Technique , etc.), to influence the dynamics of the impostor cycle . Baumann et al. (2020) also point to the influence of CBT in their approach to IP discussion groups. However, interventions based on other conceptual frameworks, such as positive psychology ( Fainstad et al., 2022 ; Mann et al., 2023 ), narrative therapy and interpersonal biology ( DeCandia Vitoria, 2021 ) or Gestalt ( Clance and Imes, 1978 ), offer another perspective on the beliefs underlying IP (e.g., representations of success, professional skills, beliefs about one’s own abilities, etc.). They also suggest behavioral coping strategies, such as techniques to prevent procrastination (e.g., Metz et al., 2020 ).

Furthermore, pioneering authors ( Clance and Imes, 1978 ; Clance, 1985 ; Clance et al., 1995 ) considered IP to be a psycho-social and interpersonal problem. They emphasized the influence of social norms and stereotypes on the emergence of feelings of imposture, particularly among women. For this reason, Clance et al. (1995) proposed a group therapy approach aimed at overcoming the intrapsychic and sociocultural determinants that can lead to the development and maintenance of impostor feelings. IP continues to be viewed as partly a social and collective phenomenon rather than a strictly individual issue in some recent research (e.g., Haney et al., 2018 ; Baumann et al., 2020 ; Popovic, 2020 ; Arleo et al., 2021 ). Many interventions thus account for the role played by the social dimension of the work environment (e.g., Danhauer et al., 2019 ; Gold et al., 2019 ; Deshmukh et al., 2022 ) and aim to break the sense of isolation associated with IP. Although some authors opt for an individual approach (e.g., Harte and McGlade, 2018 ; Metz et al., 2020 ; DeCandia Vitoria, 2021 ); according to Steinberg (1987) , Parkman and Beard (2008) , and Armstrong and Shulman (2019) , IP is systemic in nature and therefore needs to be addressed at the organizational or social level. It may therefore be relevant to address it within educational programs, integration strategies, and human resource management policies. This is consistent with recent theoretical developments on IP at work, which suggests that it may emerge from the social context (e.g., Kark et al., 2022 ).

Finally, it should be noted that two main intervention modalities appear: those based on discussion and counseling, and those focused on training. Most approaches incorporate a psycho-educational component, either provided by the facilitator (e.g., Haney et al., 2018 ; Ogunyemi et al., 2022 ), or through suggested readings ( Matthews and Clance, 1985 ; Steinberg, 1987 ). Role-playing is a technique frequently mentioned in this context and can encourage the expression of feelings as well as regulation of IP manifestations (e.g., Ramsey and Spencer, 2019 ; Deshmukh et al., 2022 ).

Following these observations, intervention methods such as training or counseling seem to be the most popular, as are group-based interventions. The transmission of IP-related knowledge emerges as a trend to be retained as a good practice for interventions. Futures research should also clarify the conceptualization they adopt regarding IP.

Effects of interventions

As mentioned above, the impact of the interventions described differs according to the type of intervention and design used. In this section, the effects reported by interventions based on counseling and training, as well as the effects of more specific intervention modalities (e.g., role-playing), are discussed separately.

Among interventions based on counseling, coaching is repeatedly presented as being effective, as are peer exchange and support groups (e.g., Harte and McGlade, 2018 ; Baumann et al., 2020 ; Mann et al., 2023 ). These interventions seem to promote openness and awareness. They also encourage effort at the level of mentalization, as much as the concrete implementation of coping strategies (e.g., Harte and McGlade, 2018 ; Magro, 2022 ). Furthermore, in a group context, the impact of the facilitator’s counseling with participants seems to be amplified by the relationships among the participants themselves (e.g., Steinberg, 1987 ; Baumann et al., 2020 ; Fainstad et al., 2022 ). More specifically, this type of intervention can foster connection and a sense of social belonging ( Gold et al., 2019 ).

Training-based interventions are relevant for knowledge transmission. Several studies have shown a post-intervention increase in IP-related knowledge (e.g., Deshmukh et al., 2022 ; Ogunyemi et al., 2022 ). In addition, training can promote a decrease in IP (e.g., Metz et al., 2020 ), as well as positive feelings of liberation, empowerment, and connection with the peer group (e.g., Haney et al., 2018 ; Gold et al., 2019 ).

That said, when comparing coaching and training, the study by Zanchetta et al. (2020) is particularly interesting. According to these authors, coaching operates on multiple levels and produces a significant and lasting reduction in IP issues. However, training remains a more favorable approach for acquiring knowledge associated with IP. In the absence of studies comparing the different approaches, it is difficult to definitively establish the superiority of individual coaching over other modalities of intervention (i.e., training, support groups, etc.).

Future research could build on the promising approaches that counseling interventions seem to offer, by incorporating a psychoeducational component. Additionally, it appears that the group intervention modality seems appropriate for breaking the isolation related to IP. Although the current state of the literature provides interesting insights into the effectiveness of interventions, but it still needs to be enriched. It appears that mixed-method study designs, incorporating both quantitative measures and the analysis of qualitative data, would allow for an understanding of both if and how the interventions are useful and effective.

Limitations and futures research directions

This study has certain limitations that should be mentioned. A first limitation stems from the nature of the references included. Indeed, almost half do not present any research design. Consequently, the generalizability of their findings is extremely limited. Moreover, many studies that use a research design are exploratory and very few adopt a true experimental design. Most often, approaches to assessing the effects of intervention on IP are insufficiently robust. For example, some studies do not measure IP directly (e.g., Danhauer et al., 2019 ), others have no post-intervention measurement (e.g., Deshmukh et al., 2022 ), or assess intervention quality exclusively via self-reported satisfaction (e.g., Baumann et al., 2020 ). It is therefore difficult to generalize findings about the effects of these interventions on IP.

A second limitation arises from incomplete information regarding the characteristics and modalities of the interventions. Indeed, several studies offer a limited description of the design and implementation of the intervention for the IP. Aspects such as an overview of intervention content, duration, context, intervention mode and nature of interactions are not systematically reported by the authors (e.g., Clance and Imes, 1978 ; Baumann et al., 2020 ; DeCandia Vitoria, 2021 ). Details about the characteristics of these interventions are often lacking, even when they are essential.

A third limitation concerns the heterogeneity of the references collected and the interventions described, which constitutes an obstacle to comparing these interventions. For example, it would be inappropriate to compare the findings of an exploratory study ( Harte and McGlade, 2018 ) with those of a randomized controlled trial ( Mann et al., 2023 ). Similarly, it would not be reasonable to compare an intervention carried out over a period of 1 h ( Deshmukh et al., 2022 ) with one carried out over a period of 1 day ( Haney et al., 2018 ) or several months ( Zanchetta et al., 2020 ). Thus, while most interventions on IP have recognizable positive effects, it remains difficult to establish precise criteria when it comes to evaluating the effectiveness of interventions on IP.

A fourth limitation regards the student population samples used in many studies included in this scoping review. Although we have restricted the eligible population to students in internship situations or already working in a professional environment, it is legitimate to wonder whether this “in-between” situation raises the same issues as those encountered in a strictly professional environment. In order to truly understand and address the organizational issues associated with IP, it would be important for future research to investigate a professional audience, at the very heart of the activity.

While this scoping review cannot pinpoint the ideal intervention for all the reasons mentioned above, it nonetheless identifies certain favorable trends for effectively intervening on IP. For example, bidirectional approaches, which promote exchange and openness, have particularly favorable impact on IP. Moreover, it is essential to consider different modes of IP expression and psychoeducation when developing an intervention. That said, it would also be relevant to promote reflective work on the causes of IP (psycho-social, educational, systemic origins, etc.), as well as the role of the social environment in reinforcing the beliefs and patterns associated with it. Finally, this scoping review highlights the fact that group support (as opposed to individual intervention) appears advantageous. However, customizing the intervention should be considered, to allow participants to develop a better sense of self. Developing individuals’ psychological resources by promoting self-knowledge also seems a particularly relevant research focus. According to Gullifor et al. (2023) , the impostor phenomenon may emerge from an incongruence between one’s own self-concept and other self-concept. Therefore, any research perspective aimed at developing a more accurate vision of oneself is interesting. These avenues could be explored not only in future research, but also by those working with people reporting IP in an organizational context.

In summary, future research should respond to a dual contextual challenge: a gap to be bridged between the small number of scientific studies and the abundant lay literature on IP; and a lack of conceptual clarity regarding IP. From this perspective, future research should use more rigorous methodology in terms of variable measurement (e.g., systematic pre- and post-intervention measurements of the variables studied) and ensure that robust research designs are used (e.g., experimental or quasi-experimental designs). It may also be relevant to investigate the psychological processes involved in the development of IP in order to intervene on them. Regarding the framework and design of interventions, future studies could integrate a psychosocial understanding of the phenomenon into the aspects described above. This would distinguish them from the lay literature, build on advice and recommendations associated with purely individual strategies.

This scoping review is aimed at researchers and professionals interested in interventions for IP and presents the current state of knowledge in this regard. It discusses the different types of studies and methodologies emerging from this field of research, the modalities and characteristics of interventions, and their effects. It also provides insight into gaps and perspectives for future practices and research.

In conclusion, the study of interventions addressing IP is an emerging field of research that is recently experiencing considerable progress and still requires further exploration. Indeed, while the imposter syndrome is a topic that seems to have gained in popularity and is a common experience, there could be a risk involved in trivializing it. It represents a psychological health issue at work, ultimately affecting the proper functioning of organizations.

Although conceptual issues remain to be resolved to better understand IP, it is just as urgent to develop interventions aimed at reducing it, in view of its implications for people’s health and its negative consequences in the workplace. In light of the results reported in this scoping review, recognizing and educating individuals experiencing IP about its various manifestations, as well as offering support in a group context, appear to be important intervention strategies. Future interventions should aim to explore the psycho-social and educational influences, as well as the impact of the work environment on beliefs related to IP.

Data availability statement

The original contributions presented in this study are included in this article/ Supplementary material , further inquiries can be directed to the corresponding author.

Author contributions

EP: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Writing – original draft, Writing – review & editing. PD: Methodology, Project administration, Resources, Supervision, Validation, Visualization, Funding acquisition, Writing – original draft, Writing – review & editing. PM: Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. CM-K: Methodology, Project administration, Resources, Supervision, Validation, Visualization, Funding acquisition, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

We would like to thank Marjorie Bilodeau from Université du Québec à Trois-Rivières (Quebec, Canada), for her advice and assistance with the systematic search.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2024.1360540/full#supplementary-material

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Keywords : scoping review, impostor phenomenon, interventions, workplace, adults

Citation: Para E, Dubreuil P, Miquelon P and Martin-Krumm C (2024) Interventions addressing the impostor phenomenon: a scoping review. Front. Psychol. 15:1360540. doi: 10.3389/fpsyg.2024.1360540

Received: 23 December 2023; Accepted: 05 March 2024; Published: 28 March 2024.

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Copyright © 2024 Para, Dubreuil, Miquelon and Martin-Krumm. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Emma Para, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

• Open access
• Published: 22 March 2024

Mapping student engagement in health professions education policy and decision-making: a scoping review

• Hanieh Neshastesaz Kashi 1 ,
• Salime Goharinezhad 2 ,
• Samira Soleimanpour 3 &
• Ali Haji Mohammadi 1  

BMC Medical Education volume  24 , Article number:  325 ( 2024 ) Cite this article

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“Student engagement” (SE) is gaining momentum as an approach to improve the performance of health professions education (HPE). Nevertheless, despite the broad studies about the role of students in various areas, little is known about the role of SE in policy and decision-making activities. This study aimed to map SE in policy and decision-making regarding terms and definitions, engagement models, influencing factors, outcomes and achievements, and the interconnection between the influencing factors.

Five databases (PubMed, Scopus, ProQuest, Web of Science, and ERIC) were systematically searched from Jan 1, 1990, to Nov 12, 2022. The review was followed according to the Arksey and O’Malley framework for scoping reviews and reported according to the PRISMA-ScR guidelines. We included articles published in English focusing on HPE policy and decision-making. The authors summarized and synthesized the findings into themes, subthemes, tables, and models.

Of the 22 articles included in the full-text review, terms and definitions were tabled, and three themes were extracted: 1. models of SE, in which 10 studies (45.5%) presented the highly structured formal models as Organizations, 5 studies (22.7%) reported less-structured community and group as Programs, and 7 studies (31.8%) engaged students only in surveys or interviews as Perspective; 2. Factors influencing SE, that were categorized into 7 subthemes: structural, environmental, and motivational factors, member characteristics, training and mentoring, member relationships, valuing and recognizing. 3. Outcomes and achievements of SE related to systems and members. The interconnection between influencing factors is also demonstrated as a conceptual model.

There are various SE models in HPE policy and decision-making, which are mapped and categorized depending on the degree of formality, structuredness, and level of engagement. In our study, three more common SE models in HPE policy and decision-making were investigated. Additionally, these collaborative methods emphasized curriculum development and quality assurance and employed students in these activities. It is worth mentioning that to make SE models more efficient and sustainable, several influencing factors and their interconnections should be considered.

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Introduction

Recent research indicates that health profession education (HPE) needs to undergo significant changes in engaging students [ 1 , 2 , 3 ]. This sense of change is affected by new trends such as progression in educational theories and student-centred approaches [ 4 ]. To achieve this, health sciences universities must adopt a ‘student as partner’ model instead of treating students as passive consumers. This requires a cultural shift and changes in systems and processes [ 3 , 5 , 6 ]. Students should be recognized as key stakeholders in the design and implementation of educational programs, and their perspectives and ideas should be actively solicited [ 7 , 8 ]. Educational institutions that give precedence to continuous improvement have prioritized “Student Engagement” (SE) as an essential element of their organizational strategies [ 9 , 10 ]. Thus, universities should develop new traditions that provide opportunities for SE to improve their institutional effectiveness [ 3 ].

As Peters [ 11 ] and Trowler [ 12 ] discuss, “Student Engagement encompasses a wide range of collaborative activities with staff in universities, which enhance student learning and development and contribute to improving the quality of academic environment and culture in the institutes.” In a more consolidated way, different stages of SE are distinguished as a continuum with consultation being the least engaged and involvement , participation , and student-staff partnership becoming progressively more engaged [ 13 , 14 ]. Consultation entails simply sharing opinions, while involvement allows for a more active role. Participation is a more formal and structured collaboration with staff, and student-staff partnership involves shared ownership in decision-making for both processes and outcomes [ 3 , 14 ].

Considering the broad concept and various dimensions of SE and its impact on creating novel educational changes, the key point for constructing a more efficient educational system is to use students’ power for political decision-making [ 15 ]. Additionally, students’ participation in university governance can facilitate a productive relationship between students, faculty, and administrators, and by working together, institutions can remain aware of how students view their function. Furthermore, program directors, coordinators, and students achieve a greater awareness that promotes student-staff collaboration and may benefit both the education program and the stakeholders [ 3 ]. In fact, university officials should delegate their power to students to control their education and development, making them feel valued [ 3 , 16 ]. Based on the literature, administrative committees with student members are more concerned with students’ issues. Moreover, involvement with organizations can enhance students’ viewpoint toward the workplace and their future careers [ 15 ]. During these engagements, students develop practical competencies that would be beneficial for their profession, such as strategic thinking, debating, networking, efficient communication, and organizing [ 3 , 17 ].

According to these findings, we decided to investigate the categories of SE among health sciences universities in all types of policy and decision-making activities inspired by the ASPIRE Student Engagement Criteria [ 18 ] Footnote 1 . The classification applied in this guideline allows us to better understand the areas of SE, especially the critical role of health profession students in university governance and policy-making bodies [ 19 ]. The ASPIRE initiative has been accepted by scholars and the academic community since 2012, and it has encouraged health sciences universities to plan for achieving excellence in SE as a portion of their mission [ 20 ].

However, we investigated research and found papers that discussed the theoretical perspectives and frameworks of SE. Also, many studies have examined the role of SE in teaching, learning or evaluations and have mostly studied medical students. There is a lack of research studying the students as partners and presenting the practical approaches to engaging students, especially in HPE policy and decision-making. Thus, we decided to capture all health professions students in our study and explore the published studies on SE in HPE policy and decision-making among health sciences universities. In doing so, we used the ASPIRE criteria to identify various types of operational models for involving students in governance and policy-making.

The primary aim of this study is to comprehensively investigate the various models/frameworks of SE in HPE policy and decision-making within universities. Additionally, the study seeks to explore the outcomes and achievements resulting from the implementation of SE in HPE policy and decision-making. Furthermore, the study aims to identify and analyze the factors that influence SE in HPE policy and decision-making, and to examine the interconnections among these influencing factors. By delving into these aspects, the study aims to provide a comprehensive understanding of SE in HPE and provide insights that can inform effective policy-making and decision-making processes in universities [ 3 , 21 , 22 ].

The review was followed according to the Arksey and O’Malley [ 23 ] framework in the form of a 5-step methodology as well as Joanna Briggs Institute (JBI) methodology [ 24 ]. In addition, we utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a guide for reporting our findings.

Identification of the research question

This review is guided by the following research questions:

What are terms used in the literature referring to SE in HPE policy and decision-making and their definitions?

What are the models of SE in HPE policy and decision-making in universities?

What factors influence SE in HPE policy and decision-making in universities?

What are the outcomes and achievements of the SE in HPE policy and decision-making in universities?

How influencing factors of SE in HPE policy and decision-making in universities are interconnected?

Identifying relevant studies and search strategy

An electronic search was launched through the following databases for literature published in PubMed, Scopus, ProQuest, Web of Science, and Education Resources Information Centre (ERIC). The search strategies for all of these databases were shaped with the help of an academic librarian (the fourth author S. S.) using keywords extracted from the study questions and aims. Some of the terms used for searching are provided: (“student engagement” OR “student partnership” OR “learner engagement” OR “student involvement” OR “student participation” OR “student contribution” AND (govern* OR “policy making” OR “decision making” OR “management”). Appendix S 1 provides a detailed search strategy. Following the databases, we identified additional articles by searching the references list in key peer-reviewed articles related to the subject of SE. Moreover, we included several published articles by hand-searching in key medical education journals (see Appendix S 2 ).

Eligibility criteria for inclusion of publication

According to our inclusion criteria, we selected papers with the following characteristics: 1. peer-reviewed articles published or on-press in English; 2. being part of the undergraduate HPE disciplines (medicine, pharmacy, dentistry, veterinary, nursing, and public health disciplines); 3. the focus of research is on SE in HPE policy and decision-making activities in universities, such as SE models, their outcomes, and influencing factors; and 4. The study is done in health sciences faculties. The following studies were excluded: 1. non-English papers, 2. articles with no existing full texts, 3. studies involving students merely in clinical decision-making, teaching and learning policies and just in curriculum evaluation, and 4. conference abstracts, letters and editorials. Detailed inclusion and exclusion criteria are presented in Appendix S 3 .

We restricted the search to studies published from Jan 1, 1990, to Nov 12, 2022, whether published or on-press, without performing a quality assessment. The results were extracted by our fourth author (S.S.) based on the search strategy and then exported to EndNote 20.4.1 (Clarivate, U.S.A.). Two reviewers (H. N. and A. H.) independently screened the titles, abstracts and full papers at each level according to the inclusion and exclusion criteria, accompanied by consultations with the third reviewer (S. G.) in cases of non-agreement.

Charting the data

Charting the data implemented via Google Sheets and the headings created based on JBI guideline [ 24 ] and through consensus of authors and were: title, first author, publication year, journal, study location, study design, aim of study, participants, study population size, data collection methods, main findings of study, term and definition related to SE, categories of SE, models of SE, influencing factors and prerequisites.

The study developed two categories of data charting in direct response to the research questions. The first category consists of models, frameworks, bodies, and forms of SE, while the second category includes influencing factors and prerequisites. To understand the outcomes and achievements of SE models, a separate category was not determined. Instead, titles such as “main findings of the study” and “aim of the study” were used. During the full-text review, we realized the great variety in how studies described the engagement of students. As a result, a separate column was created to extract different definitions of the terms related to SE.

To achieve a robust data extraction approach, the authors discussed and agreed on the mentioned key study characteristics that aligned with the research questions. As a pilot test, the authors independently extracted the data from the 10 random articles in Google Sheets to evaluate the efficiency and consistency of the sheet categories. After a meeting of discussion, the authors agreed on the refined format of the data extraction sheet. The remaining articles were allocated among the authors for data extraction based on the agreed sheet and key study characteristics.

Collating, summarizing and reporting results

We started with deductive coding to identify main themes using the research questions and initial literature review, followed inductively through included studies to proceed with thematic analysis [ 25 ]. Firstly, the authors (H.N. and A.H.) collected a summary of each study regarding the above extraction criteria. Then, key findings of the summaries were detected and highlighted. In the next step, two authors sorted and categorized the key findings and ended up in sub-themes. One author (H.N.) synthesized the findings of the SE models and their outcomes and achievements, and the other author (A.H.) synthesized the influencing factors. Lastly, a relational content analysis approach (cognitive mapping) [ 26 , 27 ] was also utilized by A.H. to demonstrate how influencing factors in SE are interconnected. The research team achieved consensus on a common set of themes as well as the conceptual model of influencing factors through iterative discussion. During the full-text review stage, we observed significant differences in how SE was defined or described across articles. As a result, we extracted the SE terms and definitions and compiled a table for comparison purposes.

Study selection process

Information about the different stages of the study selection process is illustrated in a PRISMA-ScR flowchart in Fig. 1 . After the removal of 3069 duplicated articles, the title and abstract screening process included 128 articles according to our selection criteria. Eighty articles met the full-text eligibility criteria, and 48 were excluded because they did not have any accessible English full-text version or consider any models, programs, or frameworks related to SE in HPE policy and decision-making. Finally, 22 articles were included in this scoping review.

Flowchart indicating the study selection process, which is constructed in line with the PRISMA extension for scoping reviews guidelines [ 23 ]

Study characteristics

As shown in Table 1 , studies from the USA were dominant (40.9%), with 59% of papers published in the last 6 years. Overall, the qualitative study design was the most common method (86.4%). However, the number of students involved in the studies was variable, and medical students had the predominant population size (68.2%) among the SE models. Moreover, 91% of papers targeted “curriculum development” or “quality assurance” as their categories utilizing student participation.

Terms and definitions of student engagement in health professions education policy and decision-making

Toward a deeper understanding of the SE concept, we have depicted the extended spectrum of the SE definitions used in various studies in Table 2 . However, various terms have been used instead of “engagement” in studies, which are as follows: a) involvement, b) participation, c) cooperation, d) contribution, e) consultation f) coproduction, and g) partnership.

Regarding the research questions, we thematically analyzed the included studies. Accordingly, the findings are charted in Table 3 in which the main themes are 1) the models, 2) influencing factors, 3) and outcomes and achievements of SE in HPE policy and decision-making in universities. Each subtheme contains the recognized activities and/or the definition of that subtheme. At last, a conceptual model is also presenting how influencing factors interact.

Models of SE in HPE policy and decision-making

To understand how the models of SE in decision-making bodies are designed and what frameworks assign student representation in HPE governance, we categorized various models based on several identified indicators [ 9 , 30 ]. In this way, we aim to illustrate how these student-led models cooperate with governance and policy-making bodies [ 31 , 32 ]. As described in Table 3 , we categorized these models into three subthemes: 1. Organization (45.5%), which includes formal and well-structured models established for long-term and sustainable SE; 2. Programs (22.7%), that are informal or less-structured models for usually short-term SE, and 3. Perspective (31.8%), that SE occurs through surveys and interviews.

Influencing factors of SE in HPE policy and decision-making

Concerning SE in HPE policy and decision-making, several factors play key roles in the establishment, maintenance and fruitfulness of collaborative activities. However, all the factors, including facilitators, challenges, barriers, and suggestions, are categorized into seven subthemes: 1. Structural factors; 2. Environmental factors and institutional culture; 3. Motivational Factors; 4. Members characteristics; 5. Training and mentoring; 6. Members relationship; 7. Valuing and recognizing SE. Details and elements of the subthemes are listed in Table 3 .

Outcomes and achievements of SE in HPE policy and decision-making

The outcomes of engaging students in HPE policy and decision-making activities are related to: 1. Systems: The whole university and school can benefit from SE, e.g., troubleshooting, promoting rules and policies, developing curriculum and promoting staff/faculty; 2. Members: individuals directly involved in SE models and processes attain a systematic and leadership perspective, empower their soft skills, develop valuable networks, and are more aware of making conscious decisions for their future careers (Table 3 ). Meanwhile, the most prominent achievements of different SE models are incorporating student leaders in educational decision-making to a) better identify system issues and b) improve curriculum development [ 1 , 4 , 8 , 9 , 29 , 30 , 32 , 33 , 35 , 39 , 40 , 41 ].

The interconnection of influencing factors in SE in HPE policy and decision-making

By the relational content analysis of the influencing factors in SE in HPE policy and decision-making, we investigated similarities among studies that describe how the dynamic of these factors acts in the real world. Consequently, the authors developed a conceptual model (Fig. 2 ) presenting 8 steps through which universities can create an efficient and sustainable SE model. This is a practical and integrated presentation of influencing factors listed in Table 3 .

In this picture, it is briefly shown that in order to create an efficient SE model, what steps should be taken and what factors influence it: Step 1,2. According to environmental factors and institutional culture, a well-defined structure is designed. Step 3. Based on motivational factors, an incentive system is created inside the structure. Step 4. Members are selected from student body and faculty/staff body, regarding to three questions Who should involve? How is the process of selection? When the structure call for membership? Step 5. Selected members enter training and mentoring plans. Step 6. The members establish, maintain and improve a high-quality relationship to collaborate on policy and decision-making activities. Step 7. The outcomes and achievements of this collaboration then recognized and valued throughout the institution; as a result, the environment and its culture gradually shift to support the SE. Step 8. Dynamically, the whole process undergoes regular evaluation and correction

According to the literature review, we identified that engaging students in HPE policy and decision-making can have a significant impact on the development of both universities and students. Such collaboration is often implemented through specific SE models, which are influenced by a variety of factors that interact with each other to create these models.

Our research shows that most (81.8%) models of SE have focused on curriculum development . This represents the educational universities’ need for student participation to revise, evaluate and improve the curriculum. On the other hand, there have not been enough studies or significant participation in other areas, i.e., planning for the educational program, quality assurance, and faculty/staff development. Thus, future research is needed to investigate the role and impact of SE in the mentioned areas.

Terms and definitions of SE in HPE policy and decision-making

Based on our research questions, we found several terms and their various definitions in the literature pertaining to SE in policy and decision-making, shown in Table 2 . We encountered an overlapping set of vocabularies pointing to student engagement. While these terms could be defined and interpreted differently (e.g., as a spectrum for the level of engagement), the most frequent and exhaustive term is still “Student engagement” [ 3 , 5 , 10 , 19 , 28 , 29 , 30 ].

Through the data analysis, we found SE models in HPE policy and decision-making and classified them into three categories based on their formality, structuredness, and level of student involvement: organizations , programs , and perspectives . In addition, we elicited seven factors that need to be considered throughout the SE process, especially in a highly structured model. We also determined the outcomes and achievements of SE, which could impact both members and systems . Besides, we discovered how influencing factors are interconnected to create an effective SE model.

Regarding our findings, SE models place students at the highest level of engagement, and students have a more objective impact on processes and decisions. Our findings reveal that engaging students in HPE policy and decision-making needs to establish formal or informal structures (Organizations and programs) or use the objective tools (perspective) that align with our second research question. If SE models are applied correctly and practically, they will lead to better identification of the educational system issues and the development of the health professions educational curriculum.

Additionally, some articles have recommended changes to the management framework to shift universities towards systematic engagement of student leaders, rather than just defining SE models [ 5 ]. In response to our third research question, we identified several common driving factors related to SE models, which were also found in our findings. These factors include peer mentoring, establishing supportive structures and culture, and optimizing feedback and communication [ 5 , 11 , 26 ].

According to our findings, a handful of studies made payments to support students financially to appreciate the collaborative activities of the students. It is worth mentioning that the students did not consider these receipts as their most important motivation for student participation, and they aimed to promote and improve the educational situation [ 3 , 30 ]. Based on our review, most of the SE models represented in studies did not prioritize the compensation of student activities with financial rewards in their partnership structure, and the effectiveness of financial motivation requires more study [ 3 , 4 , 30 ].

Our research aimed to explore the characteristics, functions, and structures of SE models that can lead to a positive outcome from SE. Studies have shown SE in policy and decision-making has potential benefits affecting both the whole university as a system and students as members [ 1 , 4 , 8 , 29 , 30 , 33 , 35 , 39 , 40 , 41 ]. While other studies have investigated methods for measuring SE and its outcomes, we suggest that future researchers focus on analyzing the outcomes of SE models using these measurement methods [ 26 ].

Through relational content analysis of influencing factors, we realized that constructing practical SE models requires a series of steps. Our conceptual model (Fig. 2 ) suggests that at the beginning of creating SE models, health sciences universities should determine their educational gaps and identify their institutional culture; So that the tasks and roles of students should be well-defined and concordant with these gaps and their environmental features. However, universities should identify their potential and adopt a conciliatory attitude to establish a strong cohesion between SE models and the academic system and create an atmosphere of accepting students’ feedback (Steps 1 and 2) [ 1 , 10 , 28 , 37 ]. Next, our research shows that students’ motivations and personality traits, such as leadership, critical thinking, etc. should be assessed before entering into SE models, to arrange the students with their roles properly (Step 3) [ 3 , 10 , 28 , 30 ]. Literature indicates that a transparent and disciplined member selection (students and faculty/staff) is a remarked characteristic of SE models (Step 4) [ 3 , 10 , 28 , 37 ]. Furthermore, the mentorship and coaching programs before the encounter with the real responsibilities can provide sufficient orientation for the junior members (Step 5) [ 3 , 8 , 10 , 28 , 31 , 36 , 39 ]. Finally, creating a safe environment where open dialogues and reciprocal communications flow among the members and students’ views are considered valuable and taken into consideration, makes the SE models more sustainable and efficient (Steps 6 and 7) [ 3 , 10 , 28 , 30 , 31 , 37 , 39 ]. Regularly, members’ performance and the SE processes should be evaluated and monitored, to clarify the outcomes of these models (Step 8) [ 3 , 8 ].

Limitations and further studies

Our study captures that most of the research papers in this field have been published on SE activities in the Western world; therefore, the extracted themes are based on these studies. Further studies are needed for these cases in other regions of the world, and they may differ to some extent. Considering the themes extracted from the surveys and interviews with relevant people and that most of the studies were qualitative, each strategy needs to be studied in-depth in terms of operational details and effectiveness. The current study has merely included undergraduate medicine, pharmacy, veterinary, and nursing disciplines. Thus, further investigation of other healthcare professions is recommended to derive SE models, outcomes and influencing factors in policy and decision-making activities more comprehensively. This review excluded heterogeneous publications such as perspective articles, opinion pieces and innovations. Hence, we have not considered some studies that could be important for understanding an emerging research space. Moreover, our data collection goes back to November 2022. Thus, some relevant studies might have been published after this date, and we have not included these probable new articles.

To conclude, the implementation of SE in policy and decision-making is crucial for the advancement of HPE. The models of SE primarily involve organization, programs, and perspective, with universities mainly utilizing SE for curriculum development and quality assurance. Developing SE models not only helps identify issues and generate solutions but also enhances faculty/staff development, leadership roles, and student networking. We categorized the influencing factors of SE in HPE policy and decision-making into seven subthemes: 1. Structural factors; 2. Environmental factors and institutional culture; 3. Motivational Factors; 4. Members characteristics; 5. Training and mentoring; 6. Members relationship; 7. Valuing and recognizing SE. Based on the data analysis of these factors, we proposed a conceptual model that helps HPE universities in practice to develop robust SE models. However, to effectively engage students, universities should adopt SE models that align with their goals and organizational capabilities. We suggest further studies to investigate the impact of SE in policy and decision-making in depth and more objectively.

Availability of data and materials

The content of the thematic analysis of qualitative data in this study is available from the corresponding author upon reasonable request.

ASPIRE Student Engagement: Criteria and Guidelines for Submitters 2023

Abbreviations

• Student engagement
• Health professions education

Systematic Reviews and Meta-Analyses extension for Scoping Reviews

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Acknowledgements

We are deeply grateful to all of this scoping review authors.

The authors state that no financial assistance was received for the design and preparation of this manuscript.

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Centre for Educational Research in Medical Sciences (CERMS), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

Hanieh Neshastesaz Kashi & Ali Haji Mohammadi

School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, UK, England

Salime Goharinezhad

Education Development Center (EDC), Iran University of Medical Sciences, Tehran, Iran

Samira Soleimanpour

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Conception and design of the study (HN, AH and SG), searching the electronic database (SS), data collection and analysis (HN and AH), initial drafting of the manuscript (HN, AH and SG), critical review of the manuscript (HN, AH, SG and SS) and all authors provided final approval of the submitted manuscript.

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Correspondence to Ali Haji Mohammadi .

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Neshastesaz Kashi, H., Goharinezhad, S., Soleimanpour, S. et al. Mapping student engagement in health professions education policy and decision-making: a scoping review. BMC Med Educ 24 , 325 (2024). https://doi.org/10.1186/s12909-024-05283-8

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Received : 02 October 2023

Accepted : 11 March 2024

Published : 22 March 2024

DOI : https://doi.org/10.1186/s12909-024-05283-8

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• Medical education
• Policy-making
• Decision-making
• Scoping review

BMC Medical Education

ISSN: 1472-6920

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Understanding scoping reviews: Definition, purpose, and process

Affiliation.

• 1 School of Nursing, Loyola University New Orleans, New Orleans, Louisiana.
• PMID: 27245885
• DOI: 10.1002/2327-6924.12380

Background/purpose: Scoping review design represents a methodology that allows assessment of emerging evidence, as well as a first step in research development. Despite its increasing use, to date no article reflecting use of scoping review methodology has been submitted for review at JAANP. The purpose of this article is to provide detailed information on scoping reviews, including definition, related processes, and uses, and discuss the relationship to nurse practitioner (NP) practice, policy, education, and research. The longer-term goal is that NPs will understand the related techniques, consider the methodology as a viable one for NP scholarship, and bring related reports to the forefront of NP publications.

Methods: This manuscript represents a brief report. Processes to develop the brief include detailed search and review of scoping review literature in CINAHL and PubMed. Both methodologic reports and reviews were included. Definitions and uses of scoping reviews were reviewed.

Conclusion: The definition and process of scoping review are evolving. Although there is controversy regarding the methodology, there is increasing visibility of scoping review methodology in the published literature since the year 2000, with over 500 published reviews currently available.

Implications for practice: A well-executed scoping review has potential to inform NP practice, policy, education, and research.

Keywords: Scoping review; concept mapping; evidence base; research methods; review.

©2016 American Association of Nurse Practitioners.

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• Research Design*
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