Overview

This chapter discusses the importance of the PICO framework when developing a literature search strategy.  Common databases for literature scoping are shown.  Strategies for critically appraising the literature are presented and examples of information management systems for effective literature reviews are included.  This chapter ends with some examples of information management systems that can be used or modified to facilitate a succinct and relevant literature review.

Introduction

Once Phase 1 of literature scoping has been completed and a topic has been identified, and a PICO/PIO question developed it is time to begin Phase 2 of literature scoping.  The second phase of a literature review is to help you delve deeper into what evidence is available on your topic or program of interest (Burke & Dempsey, 2022).  Although literature reviews can be time consuming it is an extremely important component of a capstone project.  Literature reviews are used to describe the population or community using supporting data.  Literature reviews also begin to introduce the population or community needs or problem to substantiate a program or intervention.  Literature reviews are also used with grant proposals and Institutional Review Board (IRB applications) as a means of supporting evidence-based practice.  Once you have selected a topic and created a PIO/PICO question, literature should be reviewed for similar programs.  Exploring other programs can help you understand challenges, successes, and potential funding streams associated with program development.  Furthermore, students should be knowledgeable about what similar programs exist so as not to reinvent the wheel (Doll, 2010).

The purpose of the literature search is to identify existing published research or information in a particular area of interest.  This will assist you in clarifying your guiding question(s), and to identify whether your guiding question has been answered.  A literature review must be strategic and systematic and informed by documented strategies.  Search strategies have two major considerations: search terms and databases (Considine et al., 2017).

Developing a Search Strategy

The PIO/PICO framework (Chapter 3) should be used to develop search terms that are informed by the PIO/PICO question, Medical Subject Headings (MeSH), and any other terms deemed relevant.  Alternative terms and spellings must also be considered (see Table 5.1:  Examples of Alternative Terms)

Table 5.1:  Examples of Alternative Terms

Performing the Literature Search (Literature Sourcing)

With a solid PICO/PIO question, selection of databases begins.  Conducting a literature search involves the use of web-based search engines along with electronic research databases.  Electronic bibliographic databases collect and index publications in a focus area.   To find the correct database(s), explore what material it covers and develop knowledge of the search features within the database.  This is also a great time for you to meet with their school’s librarian,  who can help you determine the most suitable databases available (Burke & Dempsey, 2022; DeIuliis, Bednarski, Bell, & DeAngelis,  2020).

To carry out a good literature review, you need to draw it from the latest research and information.  While some books are good for providing you with a helicopter view of a topic, before the average book is written and published at least a year has passed.  Consequently, books that have been published two or three years ago more than likely contain research that is over five years old (Burke & Dempsey, 2022).  Yet each year, there are at least one million new academic articles published in peer-reviewed journals.  For this reason, the most effective way of sourcing literature is by reading and reviewing peer-reviewed journal articles.  Many peer-reviewed journal articles are accessible via open access.  Literature sourcing can be done via Google Scholar, Touro Scholar, and other open access platforms; however, they are not exhaustive.  That’s why it is useful for you to draw from some of the databases available through the library of your educational institution  (Burke & Dempsey, 2022).  (Refer to Table 5.2:  Common Databases for Literature Scoping).

Table 5.2:  Common Databases for Literature Scoping

Source:  DeIuliis, E. D., Bednarski, J. A., Bell, A., & DeAngelis, T. (2020). 3. In The entry level Occupational Therapy Doctorate Capstone: A Framework for the experience and project (pp. 41–55). essay, SLACK Incorporated.

To find the right database(s), explore what material it covers, and become familiarized with the search features within the database.  It is best practice to search multiple databases that are relevant to your topic because different databases can yield different search results.  Furthermore, all databases will allow you to truncate terms to find different word endings and expand your results.  Note that the truncation symbol is usually the asterisk (*).  For example, nurs* will find nurses, nurse, and nursing.  The wildcard is usually a question mark symbol (?) that can be used to replace a single character in a word to find different spellings.  For example, wom?n will show results for both woman and women.  It is important to save your search strategy as this information is considered an important component of your capstone project (Considine et al., 2017).

The process that you use to search for and select literature should be organized and systematic, Although the majority of capstone projects will undergo the process of a rapid review of the literature, systematic reviews can also be completed. Rapid reviews have narrow search criteria to answer a policy or practice issue and systematic reviews have more expansive search criteria needed to answer a broader question (DeIuliis et al., 2020).

Getting and Reporting Your Search Results

Once search results are completed, the next step is for you to review all titles and abstracts and to remove duplicates.  The remaining titles and abstracts are critiqued against the PIO/PICO question and the articles can then be labeled as included, excluded, or possibility.  The full-text articles are then retrieved and read in detail for appraisal against the PIO/PICO question (Considine et al., 2017).  One system to consider using to guide the critical reading of results obtained from the literature search is the Preview, Question, Read, and Summarize (PQRS) Model (Refer to Table 5.3:  PQRS Model for Critical Reading).  At this point, additional literature scoping can be done by hand searching the reference lists of the full-text papers for secondary sources.  At the end of this process, it is imperative to have documented the literature search in a systematic fashion (Considine et al., 2017).  This will be covered in the Information Management section of this chapter.

Table 5.3:  PQRS Model for Critical Reading

Source:  DeIuliis, E. D., Bednarski, J. A., Bell, A., & DeAngelis, T. (2020). 3. In The entry level Occupational Therapy Doctorate Capstone: A Framework for the experience and project (pp. 41–55). essay, SLACK Incorporated.

Evaluating the Literature

Once the inclusion/exclusion process of the literature is complete, the resultant articles are re-reviewed and the level, quality, relevance and strength of the evidence is critically appraised (Refer to Table 5.4:  Level, Quality, Relevance, and Strength of Evidence Checklist)

Table 5.4:  Level, Quality, Relevance, and Strength of Evidence Checklist

Source:  Considine, J., Shaban, R. Z., Fry, M., & Curtis, K. (2017). Evidence based emergency nursing: designing a research question and searching the literature. International emergency nursing, 32, 78-82.

Levels of Evidence:  Quantitative Studies

Levels of evidence are based on the principle that certain study types have more rigor and these higher quality study designs provide more confidence to associated clinical decision-making (Tomlin & Borgetto, 2011).  It is important to note that in many areas of health, it is difficult to attain high-level evidence.  Consequently, the focus should be on determining the highest available level of evidence (Refer to Table 5.5:  Levels of Evidence)

Table 5.5:  Levels of Evidence

Source:  DeIuliis, E. D., Bednarski, J. A., Bell, A., & DeAngelis, T. (2020). 3. In The entry level Occupational Therapy Doctorate Capstone: A Framework for the experience and project (pp. 41–55). essay, SLACK Incorporated.

The levels of evidence are an important component of evidence-based practice (EBP) .  Understanding the levels and why they are assigned to publications can help you prioritize information.  With that being said, not all Level IV or V evidence should be ignored nor all Level I be accepted as fact.  The levels of evidence table within this chapter (Table 5.5) can be used as a guide; however, you will still need to be cautious when interpreting results (Burns, Rohrich, & Chung, 2011).

Information Management (CAPs Matrix, COREQ)

Developing an effective strategy for managing information before you begin to engage with the literature is vital.  Using reference manager software or developing an information management system will help to enable efficient saving and sorting of references.  There are several techniques that can be used for information management that we will review; however, it is important to discuss information management with your capstone course instructors and mentors to ensure you are meeting specific course and program requirements.  It should also be noted that any information management system used can be modified to meet your and/or individual program needs and requirements.

Microsoft Excel Note-Taking Spreadsheet

A simple technique for managing information is to create a Microsoft Excel spreadsheet comprised of information you require for your literature review (Refer to Table 5.6:  Example of Note-Taking Spreadsheet for Literature Review).

Table 5.6:  Example of Note-Taking Spreadsheet for Literature Review

Critically Appraised Paper (CAP)

A CAP is an at-a-glance summary of the method, findings, study limitations, and clinical implications of a selective quantitative or qualitative-based article. Critically Appraised Papers are used to provide a detailed appraisal of an individual study to determine its value and relevance to a capstone project.   Each article would have its own CAP and each CAP would be numbered (Refer to Appendix 5.A:  Sample Critically Appraised Paper (CAP).

Matrix Tables

Using a review matrix enables you to quickly compare and contrast articles in order to determine the scope of research across time. A review matrix can be used for quantitative or qualitative studies and can help you easily spot differences and similarities between journal articles about a given research topic. Review matrixes are especially helpful for health sciences literature reviews covering the complete scope of a research topic over time. Matrix tables expand both horizontally and vertically, with the number of rows and columns being determined by the number of unique values in the specific fields (Refer to Appendix 5.B:  Sample Matrix Table).

Consolidated Criteria for Reporting Qualitative Studies (COREQ) Checklist

For qualitative research, you can also use the Consolidated Criteria for Reporting Qualitative Studies Checklist (COREQ) for reporting purposes.  The COREQ is a 32-item checklist developed to promote explicit and comprehensive reporting of interviews and focus groups   It is important that you include sufficient detail on the methods of data analysis and the relationship between the analysis and their findings in this research report so reviewers can assess the rigor of the research analysis and the credibility of research findings (Booth, Hannes, Harden, Noyes, Harris & Tong, 2014).  (Refer to Appendix 5.C:  Sample COREQ (Consolidated Criteria for Reporting Qualitative Research Checklist).

Citing Sources

Once you have consulted the literature and are ready to synthesize your information, be sure to adequately give credit to original authors by citing appropriately.  You must cite the source every time you incorporate research, words, ideas, data, or information that is not your own.  Typically, citations consist of standard elements and contain the information necessary to identify and track down publications.  Citations may look different, depending on what is being cited and which style is used to create them.  Plagiarism occurs when you borrow another’s words or ideas and do not acknowledge that you have done so.  The best way to avoid plagiarism is to cite your sources, both within the body of your paper and also within the bibliography of sources, or reference page.  It is important for you to discuss citation style and requirements with your program and capstone instructors to ensure you are citing your sources according to program and course policies (Boston University School of Public Health, 2021).  It should also be noted that there are a number of citation management tools that can help you organize your references such as RefWorks and Zotero.  Your educational institution’s library can provide you with more guidance with citation management tools available to students.

Conclusion

To understand the importance and relevance of available literature, you must locate, identify, and analyze available literature that supports your topic.  Using a systematic process for literature scoping and information management is essential to the literature review process.  Level of evidence interpretation can also help you effectively critically appraise the evidence and report on your findings.