Mastering the Art of Scoping
Reviews: A Comprehensive Guide for Public Health and Allied Health students
Russell
Kabir1, Ali Davod Parsa1, Haniya Zehra Syed1,
Ancy Chandrababu Mercy Bai1, Remsha
Hussain1, Muhammad Feroz Khan1, Sauda Parvin2,
Divya Vinnakota3, Brijesh Sathian4, Madhini
Sivasubramanian3, Indrajit Banerjee5, Mohammad Rocky Khan
Chowdhury6, Masoud Mohammadnezhad7, S. M. Yasir Arafat8,
Muhammad Aaqib9, Marthoenis Marthoenis10,
Syed Shajee Husain1, Richard Hayhoe1
1School of Allied Health, Anglia
Ruskin University, UK
2Barking, Havering and Redbridge
Hospitals, UK
3Department Nursing and Public
Health, University of Sunderland London, UK
4Geriatric Medicine Department,
Hamad Medical Cooperation, Qatar
5Department of Pharmacology, SSR
Medical College, Mauritius
6School of Public Health and
Preventive Medicine, Monash University, Australia
7Faculty of Health, Education and
Life Sciences, Birmingham City University, UK
8Department of Psychiatry,
Bangladesh Specialized Hospital Limited, Bangladesh
9Department of Pharmacology, All
India Institute of Medical Sciences, India
10Department of Psychiatry and Mental
Health Nursing, University of Syiah Kuala, Indonesia
*Corresponding author: Russell.kabir@aru.ac.uk
Submitted: 22.07.2024 Accepted: 31.07.2024 Published: 05.08.2024
Keywords: Scoping Review,
Steps, Guide, Public Health
Introduction
The
swift growth in evidence production across various fields, including public
health, has necessitated the organisation and synthesis of
this evidence by reviews
Scoping reviews (ScR) are defined as ‘a type of evidence synthesis that
aims to systematically identify and map the breadth of evidence available on a
particular topic, field, concept, or issue, often irrespective of source (ie, primary research, reviews, non-empirical evidence)
within or across contexts. Scoping reviews can clarify key concepts/definitions
in the literature and identify key characteristics or factors related to a
concept, including those related to methodological research’
A scoping review
may also be referred to as a scoping study, scoping project, scoping exercise,
scoping report, scoping method, scoping exercise method, as well as literature
mapping, mapping of research, evidence mapping, systematic mapping, literature review,
and rapid review
There are several
reasons for conducting ScR, which include to explore
the breadth and characteristics of existing literature, develop evidence maps
and summaries, guide future research and review and to identify gaps in
research
There are differences
between scoping and systematic review. Systematic reviews typically search,
identify, evaluate and synthesise original studies on
a particular topic in an unbiased manner to provide evidence for practice
Systematic reviews
are not advised to be included in a scoping review because they are usually
regarded as secondary studies. However, including the papers considered by an
earlier systematic review would be acceptable.
Steps
of conducting a scoping review:
As set out by
Figure 1. Steps of
a Scoping Review
1.
Formulating a straightforward research question or
objective
Scoping Reviews
are usually developed for 'preliminary exploration ' and to explain a subject
or issue's operational designations and theoretical limitations
The research
question (RQ) is the compass that guides and directs the development of
specific inclusion and exclusion criteria, giving control over the research
process (Tricco et al., 2016). The RQ will also
facilitate the effectiveness of the literature search
Research
objectives identify, explore, determine, and map the primary investigation
Example Review question and objective:
These questions of
different studies seek information and knowledge about the subjects' old and
new healthcare provision and research areas
There are many
formats for developing research questions and guiding information inclusion and
exclusion in review studies; however, only the PCC format is recommended for ScR
Once the review
question is determined, it is essential to identify the critical terms conveyed
in the question (Pollock et al., 2021). After that, the protocol, logic grid,
or concept map must be created. The Logic Grid represents the effectiveness of
the concept, and each column demonstrates the discrete concepts of
Participants, Concept, and Context (Fusar-Poli et
al., 2020). Table 1 demonstrates the Logic Grid of the study ‘Large-scale
healthcare facility redevelopment: A scoping review’ by Eljiz
et al. (2022). Another example of a scoping review is, 'Public Participation in
Health Care Priority Setting: A Scoping Review' by Mitton et al. (2009); the
analysis of the Research Question, Research Objective and PCC Format by the
Inclusion Criteria is presented in Table 1.
The Research
Objective: Much literature articulates the need for Public Engagement
(PE) in healthcare decision-making; however, there needs to be more evidence
and consent on when and how PE should be used. Therefore, the objective of ScR was to determine when and how PE is used in priority
setting and to determine the actual uses of PE during decision-making and
resource allocation.
Table 1. Example
of Relation between review objectives and questions and a logic Grid for the
PCC framework based on the study by Elliz et al.
(2022)
People: Formal public
participation in Healthcare Priority Setting (HPS) and resource allocation
activity seems constrained. Public input in HPS is scarce, and more attention
needs to be given to the precision of the methods.
Concept: Public Engagement
(PE) during healthcare policymaking, managerial, or administrative procedures
needs to be deeper and easier to infer due to the lack of literature and
resources. The healthcare industry faces many challenges during decision-making
due to a lack of public engagement and poorly designed guidance, resources, and
evidence. PE guidance in HPS also results in clarity, cost, and adequate
settlement among the stakeholders.
Context: The lack of
constructive PE in HPS has resulted in a rare systematic source for comparison.
There is hardly any apparent consensus in the literature demonstrating the
serviceability of public engagement or how to incorporate public assignation by
decision-makers into priority setting and resource allocation processes.
Table 2. Represents
the Logic Grid of the ScR by Mitton et al. (2009)
|
Research question |
Participants |
Concept |
Context |
|
What public engagement
practices are used in the priority setting and resource allocation? |
General people, Patients,
Consumers, Stakeholders |
Public Engagement (PE)
during healthcare policymaking, managerial or administrative procedures. |
2. Setting inclusion
and exclusion criteria
As with systematic
reviews (SR), inclusion criteria provide a guide to understanding the
reviewers' proposals and, more importantly, a guide for the reviewers to decide
on the sources to be included in the SR (Skinner, no date) (Peters et al.,
2015). However, the inclusion criteria for ScR are
broader than those for SR, as one has to search for
what has already been done, how many studies are available, and what kind of
study designs are available
Developing Eligibility Criteria
Papers included in
the review undergo a process called Eligibility criteria (EC). EC must be
balanced (Peters et al., 2020). The volume of the included paper will become
too heavy if the EC is too broad; contrarily, if the EC is too narrow, many
valuable papers can be left out, which might have been vital for the review
(Levac et al., 2010). EC is directly linked with RO and RQ (Munn et al., 2018).
The inclusion and exclusion criteria are determined by the PCC framework, which
is initially used to dictate the RO and RQ
Participants: Public participation and public engagement processes in
health care priority setting.
Concept: Public Engagement (PE) during healthcare policymaking,
managerial or administrative procedures. The healthcare industry faces
challenges during decision-making due to a lack of public engagement and poorly
designed guidance, resources, and evidence. The lack of PE guidance in HPS also
results in confusion, cost, and inadequate settlement among the stakeholders.
Context: Healthcare priority settings.
3.
Identifying relevant search term
Identifying
relevant search terms is a crucial step in conducting a scoping review, as it
directly influences the comprehensiveness and relevance of the collected data.
In the field of public health, this process begins with a clear understanding
of the research question and objectives, which help define the scope and
boundaries of the review. For instance, if the review aims to explore the
impact of social determinants on mental health outcomes, researchers should
start by identifying key concepts like "social determinants,"
"mental health," "socioeconomic status," and "health
disparities." It is also important to consider synonyms and related terms
such as "psychological well-being," "income inequality,"
and "access to healthcare." Utilizing Boolean operators (AND, OR,
NOT), truncation, and wildcards can further refine the search strategy,
allowing for the inclusion of various forms and combinations of keywords. A
well-structured search strategy ensures that the review captures a wide range
of relevant studies, preventing the omission of crucial information due to
overly narrow search terms.
Moreover, it is
essential to iterate and refine the search terms throughout the review process.
This iterative process involves testing the initial set of terms in selected
public health databases, reviewing the results for relevance, and adjusting the
terms accordingly. For example, if an initial search using "mental
health" and "socioeconomic status" yields limited results,
expanding the search to include terms like "psychosocial factors" or
"social class" might capture additional relevant studies. Researchers
should be flexible and willing to adapt their search terms as they encounter
new concepts and keywords during the initial phases of the search.
Additionally, documenting the search strategy, including the rationale behind
chosen terms and modifications, is vital for transparency and reproducibility.
Using established guidelines and frameworks, such as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses Extension for Scoping Reviews), can help ensure a systematic
approach. Ultimately, the careful identification and selection of relevant
search terms enhance the quality and validity of the scoping review, providing
a solid foundation for mapping the existing literature and identifying gaps for
future research in public health.
4.
Conducting the Literature Search
The first step of
conducting a literature review is identifying relevant databases and sources. Academic
Databases contain the primary research on the relevant subjects and are easy to
access
Evidence search
should be in a broad range of related databases. These may include Medline,
CINAHL, OVID Emcare, Cochrane, Joanna Briggs
Institute EBP, and Nursing and Allied Health databases for nursing and
midwifery. Electronic searches can be conducted from different Databases such
as Pubmed, Pubmed Central,
CINAHL Plus, Cochrane Library, Embase, Web of Science, Science Direct,
Directive of Open Access Journal (DOAJ), Trip Database, Web of Science, Scopus,
Eric, Hinari, Psych Info, JBI, Cochrane Library,
Prospero, Google Scholar for the articles. The search can be conducted for the
last five years. Australian and New Zealand Clinical Trial Registry (ANZCTR) is
suitable for clinical trial studies. ProQuest Dissertations and Theses
databases are good sources for Theses Studies.
A significant
advantage of ScR is that a variety of literature can
be added, including Grey literature such as conference abstracts, theses,
government reports, patents, and clinical practice guidelines (Aromataris & Riitano, 2014). This is
predominantly advantageous in emerging matters where peer-reviewed articles are
scarce (Aromataris & Riitano, 2014). Grey literature
also enables the identification of available resources for consumers, patients,
or relatives (Pollock et al., 2021). Grey literature is readily available
through search engines such as Google, Bing, Yahoo, and Public Health sites.
Including grey literature in a scoping review can be beneficial for various
reasons. For example,
There is a
detailed outline of how to search grey literature through OpenGrey.eu,
Greylit.org or Grey Matters by Aromataris and Riitano (2014). Grey literature
can also be retrieved from the CADTH, showing how to retrieve information in a
most comprehensive and documented approach. Grey literature searching can be
challenging because it is not necessarily structured or indexed like peer-reviewed
articles in academic databases (Pollock et al., 2021). Balancing the
sensitivity and specificity of the search with resource limitations,
particularly time restrictions, is challenging. It is compulsory to establish
and validate a grey literature search if it is conducted
Developing and
implementing a search strategy occurs in the following stages, and cooperation
with a research librarian is essential. These stages include:
1.
Initial
search: Article Search for the review topic in relevant databases and
identify words and phrases found in the title, abstract and index of papers
most likely to be included in the final search strategy.
2.
Further
search: The initial search's identified words, phrases and terms can then be
used to guide different databases and grey literature sites. Documentation is
necessary for these searches for inclusion in the final PRISMA flow chart
3.
Additional
Reference list search or snowballing: Further studies can be derived from the
reference list of initial and further search research papers, from full-text
articles and the related review articles. Although this process is quite
time-consuming, many helpful articles and papers can be derived from this
method. Scanning the article's reference list is beneficial and more
manageable. Scanning the reference list identified in the search can also be
helpful. The librarians are practical at this stage as they have the 'Peer
Review of Electronic Search Strategies (PRESS) checklist to evaluate the search
strategy. The Peer Review of Electronic Search Strategies (PRESS) is a
checklist developed by librarians and a helpful tool
Table 3: Examples
of using MeSH terms
|
("Diabetes Mellitus,
Type 2"[MeSH] OR "Type 2 Diabetes")
AND ("Disease Management"[MeSH] OR
"Management" OR "Treatment") |
|
("Breast
Neoplasms"[MeSH] OR "Breast Cancer")
AND ("Mammography"[MeSH] OR
"Mammogram") AND ("Early Detection of Cancer"[MeSH] OR "Early Detection") |
|
("Hypertension"[MeSH] OR "High Blood Pressure") AND ("Lifestyle"[MeSH] OR "Lifestyle Changes" OR
"Diet" OR "Exercise") |
The second step of conducting a literature review is creating
a Database Search Plan. A precise and targeted research question is essential
for your search. Connect the terms in your review question. Using Medical
Subject Headings (MeSH), enumerate all pertinent keywords and subject headings.
Using both subject headers and keyword searches is recommended practice for
searching. one database at a time (start with Medline and work your way up to
Ovid/CINAHL/PUBMED), also investigate a single idea at a time
PRISMA:
PRISMA flow
diagram visually illustrates the diverse stages of the systematic review. It
draws out the number of studies identified, included and excluded and the
causes for eliminations
Facilitating, complete and thorough reporting is essential to
improving ScR's methodological quality and
transparency
There is a fundamental difference in objectives and
methodological approach between SR and ScR.
Subsequently, some PRISMA items in SR may not be appropriate for ScR, while other vital factors may be missing
Figure 2. PRISMA
for scoping review process
5.
Data Extraction and Charting
Charting the
outcomes is the term used to describe the data extraction procedure in scoping
reviews. This procedure gives the reader a clear and concise synopsis of the
findings that is in line with the scoping review's goal and/or question(s).
To document the
essential details of the source, including the author, reference, and any
conclusions or findings pertinent to the review question or questions, a draft
charting table or form should be created at the protocol stage. At the review
stage, this might be further improved, and the charting table updated
accordingly. The following are some essential details that reviewers may decide
to chart:
a)
Author(s)
b)
Year
of publication
c)
Origin/country
of origin (where the study was published or conducted)
d)
Aims/purpose
e)
Study
population and sample size (if applicable)
f)
Methodology/methods
g)
Intervention
type, comparator and details of these (e.g. duration of the intervention) (if
applicable)
h)
Duration
of the intervention (if applicable)
i)
Outcomes and details of these (e.g. how
measures) (if applicable)
j)
Key
findings that relate to the scoping review question/s
Table 4. Example
of Charting the Results
|
Author(s) |
Year |
Design |
Population |
Intervention/
Exposure |
Outcomes |
Key Findings |
|
Arafat
et al |
2016 |
RCT |
200
patients |
Drug A
vs. Placebo |
BP
reduction |
Drug A
significantly reduced BP compared to placebo. |
|
Kar and
Syed |
2021 |
Cohort |
600
patients |
Lifestyle
intervention |
Weight
loss |
Significant
weight loss observed |
|
Parsa
and Kabir |
2022 |
Cross-sectional |
280
adults |
Dietary
choices |
Nutrient
intake |
Dietary
habits were positively |
|
Haniya
and Divya |
2017 |
Case
control |
100
patients vs. 100controls |
Physical
activity |
Cardiovascular
health |
Higher
physical activity levels associated with better cardiovascular health. |
6.
Analysing and synthesising the data
Generally, the
data analysis performed in scoping reviews is much simpler than that usually
carried out in systematic reviews. Since the main goals of scoping reviews do
not include either synthesis of results or outcomes of included sources, in
most cases, a basic descriptive analysis is sufficient to achieve satisfactory
results (Pollock et al., 2023). The common frequencies typically include the
distribution of various study designs and the contexts in which the evidence
was generated. This might encompass the number of evidence syntheses,
randomized controlled trials (RCTs), and surveys conducted. Additionally,
scoping reviews often categorize the geographical locations or specific
contexts where the studies were carried out, such as healthcare settings,
educational institutions, or community environments. Understanding these
frequencies helps to identify research patterns and gaps, providing a
comprehensive overview of the existing evidence base (Pollock et al., 2023).
Multiple software
programs can be utilized during the data extraction, analysis, and presentation
phases of a scoping review. These include (but are not limited to) google
sheets, Microsoft Excel (Redmond, Washington, USA) and NVivo (QSR
International, United Kingdom). Furthermore, data visualization programs such
as Microsoft Power BI (Salesforce, California, USA), EPPI-Mapper (Digital
Solution Foundry and EPPI-Centre, London, UK), and EndNote (Clarivate
Analytics, PA, USA) may be used. It is generally recommended that authors use
software which they are familiar with as this helps facilitate data extraction,
analysis, as well as presentation of results (Pollock et al., 2023).
If a scoping
review is looking at characteristics, concepts, barriers, or facilitators, then
a basic qualitative content analysis may be required. Descriptive quality
techniques, such as the basic coding of data to categories, may be a useful
approach in some scoping reviews, particularly when the purpose is to identify
or clarify concepts or definitions within a field or to identify key
characteristics related to a concept (Pollock et al., 2023). If a basic
qualitative content analysis is required, then the guidelines laid down by JBI
(Peters et al., 2020), can be followed. This type of analysis is a descriptive
approach and simply involves a process of open coding to categorize concepts or
characteristics. Additionally, this approach can be followed for any evidence
source or study design and is not limited to primary qualitative studies. This
process of conducting analysis of qualitative data has been described in a
comprehensive table by the JBI (Pollock et al., 2023).
For primary
qualitative content analysis, three steps are described (Elo and Kyngäs., 2008): (1) Preparation, (2) Organizing (3)
Reporting. For the preparation step, the scoping review authors will determine
if there is a need for a basic qualitative analysis; if the aim of a review is
to describe or explore the influences or effects of a specific issue, then a
systematic review (qualitative) may be more appropriate (Munn et al., 2018). Following that, it should be determined
whether an inductive or deductive approach is needed for the scoping review
during the protocol stage. An inductive approach is typically used when there
is a lack of sufficient evidence on a topic, or if the goal is to develop a
conceptual framework (Elo & Kyngäs, 2008). In
contrast, the deductive approach is appropriate when the authors need to map
the data to an already formed framework or theory within literature.
Occasionally, such as if no suitable theory or framework is found, a deductive
approach may be used (Pollock et al., 2023). In such cases, the review team
should select a suitable framework during the protocol stage after consulting.
The second stage
(organizing) is dependent on the chosen approach of the scoping review authors.
In any case, the first step is to thoroughly go through the data including
reading and understanding all including evidence sources and how the data is
relevant to the research question(s) laid out initially (Elo and Kyngäs., 2008). Lastly the reporting step includes various
activities, including presentation of the finding in a sophisticated way that
the reader could grasp the finding of the report. Data presentation should,
like data extraction and analysis, be pre-specified when creating the protocol,
and again, it can be refined upon review of the contents of the available
included evidence. The researchers should consider the best approach to stating
the outcome or product of the study and how the scoping study findings will be
articulated to the readers (e.g. through themes, a framework, or a table of
strengths and gaps in the evidence). This product should be tied to the purpose
of the scoping review (Peters et al., 2020).
The results
section should contain two distinct sections. The first one will describe the
results of the search and selection process, and a PRISMA flow diagram should
be included. The other essential part is a section which provides the key
information or results relevant to the objectives or questions for the scoping
review (Peters et al., 2020). In this section, authors can present the findings
in several different ways. Using detailed, comprehensive tables may be a good
approach in many cases since they can summarize a large amount of data whilst
explaining the process of extraction, the communication of results to a wider
community should be considered. Furthermore, large scoping reviews with many
evidence sources may result in tables that are too large to easily present in
the standard fashion. The researchers should consider the best approach to
stating the outcome of the study and how the scoping study findings will be
articulated to the readers (e.g. through themes, a framework, or a table of strengths
and gaps in the evidence). This product should be tied to the purpose of the
scoping review. Many creative approaches may be followed such as word
clouds, honeycombs to visualize outcomes of included evidence sources. A world
heat map may be created indicating how many evidence sources were conducted in
a specific country, a tree graph showing the categories, waffle charts, and
iconography can also be utilized. In addition, a supporting narrative must be
included that describes the results.
The PRISMA-ScR checklist for reporting scoping reviews can be used,
which provides guidelines to report extraction/data charting, analysis, as well
as presentation of data. A completed PRISMA-ScR
checklist which documents page numbers addressing these actions should be
included as a supplementary file.
Discussion
and Implications
The discussion
section, as is the case with systematic reviews, should include a thorough
explanation of the scoping review’s results and any limitations of the sources
used should be included in this section. The results of the charting stage
within the framework of existing research, practice and policy should be
clearly explained and elaborated on (Peters et al., 2015). While interpreting
the findings, it is essential to remember that any conclusions drawn should
match the review objective/question. The significant themes which have emerged
from the synthesized literature should be stated and explained. Comments can be
made about the future conduct of potentially beneficial systematic reviews, or
primary research that should be conducted in an area of interest (Peters et
al., 2015). It is essential to not just simply repeat the results section, but
to expand upon it and comprehensively discuss what the data means. Results can
be discussed in the context of current literature and gaps in literature. Since
a scoping review usually does not include critical appraisal, quality of the
research conducted should not be commented upon.
For instance,
(Archer et al., 2011) scoping review on Personal Health Records describes its
objective as follows: ‘to review the literature on PHRs, and to describe the
design, functionality, implementations, applications, outcomes and perceived
and real benefits of PHRs, with an emphasis on experience in the USA and
Canada.’ The discussion starts with comments on the amount of the research
being conducted, and it is stated that while there is some evidence for the
inclusion of certain functionalities in PHR systems, clinical effectiveness and
cost effectiveness of PHR interventions have not been adequately synthesized.
Another useful
example for reviewers is (Henni et al., 2023) study on oral health and oral
health-related quality of life among older adults receiving home health care
services (HHCS). The discussion section discusses the data gathered in detail
and mentions that there is a dearth of knowledge regarding this demographic,
and further research needs to be conducted on how oral health affects the
quality of life of these older adults. Furthermore, most of the studies
selected were conducted in high-income, well-developed countries such as
Netherlands, USA and Sweden, which indicates that more research needs to be
conducted in lesser developed countries.
Conclusion:
The scoping review
is an important option available to researchers and students wishing to conduct
a review. This type of review is especially valuable when the topic of review
has been under-explored previously or has a degree of complexity which would make
other methods such as systematic review particularly labor intensive and time
consuming and thus potentially unfeasible with finite resources and research
capacity. Scoping reviews, while following a methodical approach to reduce bias
in much the same way as systematic reviews, are primarily focused on
identifying and mapping evidence on a topic for subsequent researchers to
investigate further. This paper has detailed the processes involved in
conducting and writing up scoping reviews and provides structured guidelines
for researchers and students to follow to ensure preparation of good quality
manuscripts ready for publication.
Conflict of
Interest: None. Sources of Funding: None
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