Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

Affiliation.

  • 1 Mathematica Policy Research, Washington, DC, USA, [email protected].
  • PMID: 26105671
  • PMCID: PMC4512966
  • DOI: 10.1007/s11606-015-3311-9

Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. For a variety of reasons, however, the practice of primary care has been in decline in the U.S. This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary care and the broader health care system, and offers research priorities to support future measurement, delivery and understanding of the role of primary care features on health care costs and quality.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Continuity of Patient Care
  • Delivery of Health Care / methods*
  • Primary Health Care / methods*
  • Quality of Health Care*
  • Treatment Outcome
  • USC Libraries
  • Research Guides

Organizing Your Social Sciences Research Paper

  • 5. The Literature Review
  • Purpose of Guide
  • Design Flaws to Avoid
  • Independent and Dependent Variables
  • Glossary of Research Terms
  • Reading Research Effectively
  • Narrowing a Topic Idea
  • Broadening a Topic Idea
  • Extending the Timeliness of a Topic Idea
  • Academic Writing Style
  • Applying Critical Thinking
  • Choosing a Title
  • Making an Outline
  • Paragraph Development
  • Research Process Video Series
  • Executive Summary
  • The C.A.R.S. Model
  • Background Information
  • The Research Problem/Question
  • Theoretical Framework
  • Citation Tracking
  • Content Alert Services
  • Evaluating Sources
  • Primary Sources
  • Secondary Sources
  • Tiertiary Sources
  • Scholarly vs. Popular Publications
  • Qualitative Methods
  • Quantitative Methods
  • Insiderness
  • Using Non-Textual Elements
  • Limitations of the Study
  • Common Grammar Mistakes
  • Writing Concisely
  • Avoiding Plagiarism
  • Footnotes or Endnotes?
  • Further Readings
  • Generative AI and Writing
  • USC Libraries Tutorials and Other Guides
  • Bibliography

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

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

  • << Previous: Theoretical Framework
  • Next: Citation Tracking >>
  • Last Updated: May 18, 2024 11:38 AM
  • URL: https://libguides.usc.edu/writingguide

Research Methods

  • Getting Started
  • Literature Review Research
  • Research Design
  • Research Design By Discipline
  • SAGE Research Methods
  • Teaching with SAGE Research Methods

Literature Review

  • What is a Literature Review?
  • What is NOT a Literature Review?
  • Purposes of a Literature Review
  • Types of Literature Reviews
  • Literature Reviews vs. Systematic Reviews
  • Systematic vs. Meta-Analysis

Literature Review  is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.

Also, we can define a literature review as the collected body of scholarly works related to a topic:

  • Summarizes and analyzes previous research relevant to a topic
  • Includes scholarly books and articles published in academic journals
  • Can be an specific scholarly paper or a section in a research paper

The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic

  • Help gather ideas or information
  • Keep up to date in current trends and findings
  • Help develop new questions

A literature review is important because it:

  • Explains the background of research on a topic.
  • Demonstrates why a topic is significant to a subject area.
  • Helps focus your own research questions or problems
  • Discovers relationships between research studies/ideas.
  • Suggests unexplored ideas or populations
  • Identifies major themes, concepts, and researchers on a topic.
  • Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
  • Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
  • Indicates potential directions for future research.

All content in this section is from Literature Review Research from Old Dominion University 

Keep in mind the following, a literature review is NOT:

Not an essay 

Not an annotated bibliography  in which you summarize each article that you have reviewed.  A literature review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.

Not a research paper   where you select resources to support one side of an issue versus another.  A lit review should explain and consider all sides of an argument in order to avoid bias, and areas of agreement and disagreement should be highlighted.

A literature review serves several purposes. For example, it

  • provides thorough knowledge of previous studies; introduces seminal works.
  • helps focus one’s own research topic.
  • identifies a conceptual framework for one’s own research questions or problems; indicates potential directions for future research.
  • suggests previously unused or underused methodologies, designs, quantitative and qualitative strategies.
  • identifies gaps in previous studies; identifies flawed methodologies and/or theoretical approaches; avoids replication of mistakes.
  • helps the researcher avoid repetition of earlier research.
  • suggests unexplored populations.
  • determines whether past studies agree or disagree; identifies controversy in the literature.
  • tests assumptions; may help counter preconceived ideas and remove unconscious bias.

As Kennedy (2007) notes*, it is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the original studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally that become part of the lore of field. In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews.

Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are several approaches to how they can be done, depending upon the type of analysis underpinning your study. Listed below are definitions of types of literature reviews:

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

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

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

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

Systematic Review      This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyse data from the studies that are included in the review. Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?"

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

* Kennedy, Mary M. "Defining a Literature."  Educational Researcher  36 (April 2007): 139-147.

All content in this section is from The Literature Review created by Dr. Robert Larabee USC

Robinson, P. and Lowe, J. (2015),  Literature reviews vs systematic reviews.  Australian and New Zealand Journal of Public Health, 39: 103-103. doi: 10.1111/1753-6405.12393

current literature data

What's in the name? The difference between a Systematic Review and a Literature Review, and why it matters . By Lynn Kysh from University of Southern California

current literature data

Systematic review or meta-analysis?

A  systematic review  answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.

A  meta-analysis  is the use of statistical methods to summarize the results of these studies.

Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:

  • clearly stated objectives with pre-defined eligibility criteria for studies
  • explicit, reproducible methodology
  • a systematic search that attempts to identify all studies
  • assessment of the validity of the findings of the included studies (e.g. risk of bias)
  • systematic presentation, and synthesis, of the characteristics and findings of the included studies

Not all systematic reviews contain meta-analysis. 

Meta-analysis is the use of statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review.  More information on meta-analyses can be found in  Cochrane Handbook, Chapter 9 .

A meta-analysis goes beyond critique and integration and conducts secondary statistical analysis on the outcomes of similar studies.  It is a systematic review that uses quantitative methods to synthesize and summarize the results.

An advantage of a meta-analysis is the ability to be completely objective in evaluating research findings.  Not all topics, however, have sufficient research evidence to allow a meta-analysis to be conducted.  In that case, an integrative review is an appropriate strategy. 

Some of the content in this section is from Systematic reviews and meta-analyses: step by step guide created by Kate McAllister.

  • << Previous: Getting Started
  • Next: Research Design >>
  • Last Updated: Aug 21, 2023 4:07 PM
  • URL: https://guides.lib.udel.edu/researchmethods

Log in using your username and password

  • Search More Search for this keyword Advanced search
  • Latest content
  • Current issue
  • Write for Us
  • BMJ Journals More You are viewing from: Google Indexer

You are here

  • Volume 24, Issue 2
  • Five tips for developing useful literature summary tables for writing review articles
  • Article Text
  • Article info
  • Citation Tools
  • Rapid Responses
  • Article metrics

Download PDF

  • http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 1 , 2 ,
  • http://orcid.org/0000-0002-7839-8130 Parveen Ali 3 , 4
  • 1 Memorial University of Newfoundland , St John's , Newfoundland , Canada
  • 2 Swat College of Nursing , Pakistan
  • 3 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
  • 4 Sheffield University Interpersonal Violence Research Group , Sheffield University , Sheffield , UK
  • Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St John's, NL A1C 5C4, Canada; ay6133{at}mun.ca

https://doi.org/10.1136/ebnurs-2021-103417

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Introduction

Literature reviews offer a critical synthesis of empirical and theoretical literature to assess the strength of evidence, develop guidelines for practice and policymaking, and identify areas for future research. 1 It is often essential and usually the first task in any research endeavour, particularly in masters or doctoral level education. For effective data extraction and rigorous synthesis in reviews, the use of literature summary tables is of utmost importance. A literature summary table provides a synopsis of an included article. It succinctly presents its purpose, methods, findings and other relevant information pertinent to the review. The aim of developing these literature summary tables is to provide the reader with the information at one glance. Since there are multiple types of reviews (eg, systematic, integrative, scoping, critical and mixed methods) with distinct purposes and techniques, 2 there could be various approaches for developing literature summary tables making it a complex task specialty for the novice researchers or reviewers. Here, we offer five tips for authors of the review articles, relevant to all types of reviews, for creating useful and relevant literature summary tables. We also provide examples from our published reviews to illustrate how useful literature summary tables can be developed and what sort of information should be provided.

Tip 1: provide detailed information about frameworks and methods

  • Download figure
  • Open in new tab
  • Download powerpoint

Tabular literature summaries from a scoping review. Source: Rasheed et al . 3

The provision of information about conceptual and theoretical frameworks and methods is useful for several reasons. First, in quantitative (reviews synthesising the results of quantitative studies) and mixed reviews (reviews synthesising the results of both qualitative and quantitative studies to address a mixed review question), it allows the readers to assess the congruence of the core findings and methods with the adapted framework and tested assumptions. In qualitative reviews (reviews synthesising results of qualitative studies), this information is beneficial for readers to recognise the underlying philosophical and paradigmatic stance of the authors of the included articles. For example, imagine the authors of an article, included in a review, used phenomenological inquiry for their research. In that case, the review authors and the readers of the review need to know what kind of (transcendental or hermeneutic) philosophical stance guided the inquiry. Review authors should, therefore, include the philosophical stance in their literature summary for the particular article. Second, information about frameworks and methods enables review authors and readers to judge the quality of the research, which allows for discerning the strengths and limitations of the article. For example, if authors of an included article intended to develop a new scale and test its psychometric properties. To achieve this aim, they used a convenience sample of 150 participants and performed exploratory (EFA) and confirmatory factor analysis (CFA) on the same sample. Such an approach would indicate a flawed methodology because EFA and CFA should not be conducted on the same sample. The review authors must include this information in their summary table. Omitting this information from a summary could lead to the inclusion of a flawed article in the review, thereby jeopardising the review’s rigour.

Tip 2: include strengths and limitations for each article

Critical appraisal of individual articles included in a review is crucial for increasing the rigour of the review. Despite using various templates for critical appraisal, authors often do not provide detailed information about each reviewed article’s strengths and limitations. Merely noting the quality score based on standardised critical appraisal templates is not adequate because the readers should be able to identify the reasons for assigning a weak or moderate rating. Many recent critical appraisal checklists (eg, Mixed Methods Appraisal Tool) discourage review authors from assigning a quality score and recommend noting the main strengths and limitations of included studies. It is also vital that methodological and conceptual limitations and strengths of the articles included in the review are provided because not all review articles include empirical research papers. Rather some review synthesises the theoretical aspects of articles. Providing information about conceptual limitations is also important for readers to judge the quality of foundations of the research. For example, if you included a mixed-methods study in the review, reporting the methodological and conceptual limitations about ‘integration’ is critical for evaluating the study’s strength. Suppose the authors only collected qualitative and quantitative data and did not state the intent and timing of integration. In that case, the strength of the study is weak. Integration only occurred at the levels of data collection. However, integration may not have occurred at the analysis, interpretation and reporting levels.

Tip 3: write conceptual contribution of each reviewed article

While reading and evaluating review papers, we have observed that many review authors only provide core results of the article included in a review and do not explain the conceptual contribution offered by the included article. We refer to conceptual contribution as a description of how the article’s key results contribute towards the development of potential codes, themes or subthemes, or emerging patterns that are reported as the review findings. For example, the authors of a review article noted that one of the research articles included in their review demonstrated the usefulness of case studies and reflective logs as strategies for fostering compassion in nursing students. The conceptual contribution of this research article could be that experiential learning is one way to teach compassion to nursing students, as supported by case studies and reflective logs. This conceptual contribution of the article should be mentioned in the literature summary table. Delineating each reviewed article’s conceptual contribution is particularly beneficial in qualitative reviews, mixed-methods reviews, and critical reviews that often focus on developing models and describing or explaining various phenomena. Figure 2 offers an example of a literature summary table. 4

Tabular literature summaries from a critical review. Source: Younas and Maddigan. 4

Tip 4: compose potential themes from each article during summary writing

While developing literature summary tables, many authors use themes or subthemes reported in the given articles as the key results of their own review. Such an approach prevents the review authors from understanding the article’s conceptual contribution, developing rigorous synthesis and drawing reasonable interpretations of results from an individual article. Ultimately, it affects the generation of novel review findings. For example, one of the articles about women’s healthcare-seeking behaviours in developing countries reported a theme ‘social-cultural determinants of health as precursors of delays’. Instead of using this theme as one of the review findings, the reviewers should read and interpret beyond the given description in an article, compare and contrast themes, findings from one article with findings and themes from another article to find similarities and differences and to understand and explain bigger picture for their readers. Therefore, while developing literature summary tables, think twice before using the predeveloped themes. Including your themes in the summary tables (see figure 1 ) demonstrates to the readers that a robust method of data extraction and synthesis has been followed.

Tip 5: create your personalised template for literature summaries

Often templates are available for data extraction and development of literature summary tables. The available templates may be in the form of a table, chart or a structured framework that extracts some essential information about every article. The commonly used information may include authors, purpose, methods, key results and quality scores. While extracting all relevant information is important, such templates should be tailored to meet the needs of the individuals’ review. For example, for a review about the effectiveness of healthcare interventions, a literature summary table must include information about the intervention, its type, content timing, duration, setting, effectiveness, negative consequences, and receivers and implementers’ experiences of its usage. Similarly, literature summary tables for articles included in a meta-synthesis must include information about the participants’ characteristics, research context and conceptual contribution of each reviewed article so as to help the reader make an informed decision about the usefulness or lack of usefulness of the individual article in the review and the whole review.

In conclusion, narrative or systematic reviews are almost always conducted as a part of any educational project (thesis or dissertation) or academic or clinical research. Literature reviews are the foundation of research on a given topic. Robust and high-quality reviews play an instrumental role in guiding research, practice and policymaking. However, the quality of reviews is also contingent on rigorous data extraction and synthesis, which require developing literature summaries. We have outlined five tips that could enhance the quality of the data extraction and synthesis process by developing useful literature summaries.

  • Aromataris E ,
  • Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

  • Open access
  • Published: 14 May 2024

Protocol for a scoping review study on learning plan use in undergraduate medical education

  • Anna Romanova   ORCID: orcid.org/0000-0003-1118-1604 1 ,
  • Claire Touchie 1 ,
  • Sydney Ruller 2 ,
  • Victoria Cole 3 &
  • Susan Humphrey-Murto 4  

Systematic Reviews volume  13 , Article number:  131 ( 2024 ) Cite this article

Metrics details

The current paradigm of competency-based medical education and learner-centredness requires learners to take an active role in their training. However, deliberate and planned continual assessment and performance improvement is hindered by the fragmented nature of many medical training programs. Attempts to bridge this continuity gap between supervision and feedback through learner handover have been controversial. Learning plans are an alternate educational tool that helps trainees identify their learning needs and facilitate longitudinal assessment by providing supervisors with a roadmap of their goals. Informed by self-regulated learning theory, learning plans may be the answer to track trainees’ progress along their learning trajectory. The purpose of this study is to summarise the literature regarding learning plan use specifically in undergraduate medical education and explore the student’s role in all stages of learning plan development and implementation.

Following Arksey and O’Malley’s framework, a scoping review will be conducted to explore the use of learning plans in undergraduate medical education. Literature searches will be conducted using multiple databases by a librarian with expertise in scoping reviews. Through an iterative process, inclusion and exclusion criteria will be developed and a data extraction form refined. Data will be analysed using quantitative and qualitative content analyses.

By summarising the literature on learning plan use in undergraduate medical education, this study aims to better understand how to support self-regulated learning in undergraduate medical education. The results from this project will inform future scholarly work in competency-based medical education at the undergraduate level and have implications for improving feedback and supporting learners at all levels of competence.

Scoping review registration:

Open Science Framework osf.io/wvzbx.

Peer Review reports

Competency-based medical education (CBME) has transformed the approach to medical education to focus on demonstration of acquired competencies rather than time-based completion of rotations [ 1 ]. As a result, undergraduate and graduate medical training programs worldwide have adopted outcomes-based assessments in the form of entrustable professional activities (EPAs) comprised of competencies to be met [ 2 ]. These assessments are completed longitudinally by multiple different evaluators to generate an overall impression of a learner’s competency.

In CBME, trainees will progress along their learning trajectory at individual speeds and some may excel while others struggle to achieve the required knowledge, skills or attitudes. Therefore, deliberate and planned continual assessment and performance improvement is required. However, due to the fragmented nature of many medical training programs where learners rotate through different rotations and work with many supervisors, longitudinal observation is similarly fragmented. This makes it difficult to determine where trainees are on their learning trajectories and can affect the quality of feedback provided to them, which is a known major influencer of academic achievement [ 3 ]. As a result, struggling learners may not be identified until late in their training and the growth of high-performing learners may be stifled [ 4 , 5 , 6 ].

Bridging this continuity gap between supervision and feedback through some form of learner handover or forward feeding has been debated since the 1970s and continues to this day [ 5 , 7 , 8 , 9 , 10 , 11 ]. The goal of learner handover is to improve trainee assessment and feedback by sharing their performance and learning needs between supervisors or across rotations. However, several concerns have been raised about this approach including that it could inappropriately bias subsequent assessments of the learner’s abilities [ 9 , 11 , 12 ]. A different approach to keeping track of trainees’ learning goals and progress along their learning trajectories is required. Learning plans (LPs) informed by self-regulated learning (SRL) theory may be the answer.

SRL has been defined as a cyclical process where learners actively control their thoughts, actions and motivation to achieve their goals [ 13 ]. Several models of SRL exist but all entail that the trainee is responsible for setting, planning, executing, monitoring and reflecting on their learning goals [ 13 ]. According to Zimmerman’s SRL model, this process occurs in three stages: forethought phase before an activity, performance phase during an activity and self-reflection phase after an activity [ 13 ]. Since each trainee leads their own learning process and has an individual trajectory towards competence, this theory relates well to the CBME paradigm which is grounded in learner-centredness [ 1 ]. However, we know that medical students and residents have difficulty identifying their own learning goals and therefore need guidance to effectively partake in SRL [ 14 , 15 , 16 , 17 ]. Motivation has also emerged as a key component of SRL, and numerous studies have explored factors that influence student engagement in learning [ 18 , 19 ]. In addition to meeting their basic psychological needs of autonomy, relatedness and competence, perceived learning relevance through meaningful learning activities has been shown to increase trainee engagement in their learning [ 19 ].

LPs are a well-known tool across many educational fields including CBME that can provide trainees with meaningful learning activities since they help them direct their own learning goals in a guided fashion [ 20 ]. Also known as personal learning plans, learning contracts, personal action plans, personal development plans, and learning goals, LPs are documents that outline the learner’s roadmap to achieve their learning goals. They require the learner to self-identify what they need to learn and why, how they are going to do it, how they will know when they are finished, define the timeframe for goal achievement and assess the impact of their learning [ 20 ]. In so doing, LPs give more autonomy to the learner and facilitate objective and targeted feedback from supervisors. This approach has been described as “most congruent with the assumptions we make about adults as learners” [ 21 ].

LP use has been explored across various clinical settings and at all levels of medical education; however, most of the experience lies in postgraduate medical education [ 22 ]. Medical students are a unique learner population with learning needs that appear to be very well suited for using LPs for two main reasons. First, their education is often divided between classroom and clinical settings. During clinical training, students need to be more independent in setting learning goals to meet desired competencies as their education is no longer outlined for them in a detailed fashion by the medical school curriculum [ 23 ]. SRL in the workplace is also different than in the classroom due to additional complexities of clinical care that can impact students’ ability to self-regulate their learning [ 24 ]. Second, although most medical trainees have difficulty with goal setting, medical students in particular need more guidance compared to residents due to their relative lack of experience upon which they can build within the SRL framework [ 25 ]. LPs can therefore provide much-needed structure to their learning but should be guided by an experienced tutor to be effective [ 15 , 24 ].

LPs fit well within the learner-centred educational framework of CBME by helping trainees identify their learning needs and facilitating longitudinal assessment by providing supervisors with a roadmap of their goals. In so doing, they can address current issues with learner handover and identification as well as remediation of struggling learners. Moreover, they have the potential to help trainees develop lifelong skills with respect to continuing professional development after graduation which is required by many medical licensing bodies.

An initial search of the JBI Database, Cochrane Database, MEDLINE (PubMed) and Google Scholar conducted in July–August 2022 revealed a paucity of research on LP use in undergraduate medical education (UGME). A related systematic review by van Houten–Schat et al. [ 24 ] on SRL in the clinical setting identified three interventions used by medical students and residents in SRL—coaching, LPs and supportive tools. However, only a couple of the included studies looked specifically at medical students’ use of LPs, so this remains an area in need of more exploration. A scoping review would provide an excellent starting point to map the body of literature on this topic.

The objective of this scoping review will therefore be to explore LP use in UGME. In doing so, it will address a gap in knowledge and help determine additional areas for research.

This study will follow Arksey and O’Malley’s [ 26 ] five-step framework for scoping review methodology. It will not include the optional sixth step which entails stakeholder consultation as relevant stakeholders will be intentionally included in the research team (a member of UGME leadership, a medical student and a first-year resident).

Step 1—Identifying the research question

The overarching purpose of this study is to “explore the use of LPs in UGME”. More specifically we seek to achieve the following:

Summarise the literature regarding the use of LPs in UGME (including context, students targeted, frameworks used)

Explore the role of the student in all stages of the LP development and implementation

Determine existing research gaps

Step 2—Identifying relevant studies

An experienced health sciences librarian (VC) will conduct all searches and develop the initial search strategy. The preliminary search strategy is shown in Appendix A (see Additional file 2). Articles will be included if they meet the following criteria [ 27 ]:

Participants

Medical students enrolled at a medical school at the undergraduate level.

Any use of LPs by medical students. LPs are defined as a document, usually presented in a table format, that outlines the learner’s roadmap to achieve their learning goals [ 20 ].

Any stage of UGME in any geographic setting.

Types of evidence sources

We will search existing published and unpublished (grey) literature. This may include research studies, reviews, or expert opinion pieces.

Search strategy

With the assistance of an experienced librarian (VC), a pilot search will be conducted to inform the final search strategy. A search will be conducted in the following electronic databases: MEDLINE, Embase, Education Source, APA PsycInfo and Web of Science. The search terms will be developed in consultation with the research team and librarian. The search strategy will proceed according to the JBI Manual for Evidence Synthesis three-step search strategy for reviews [ 27 ]. First, we will conduct a limited search in two appropriate online databases and analyse text words from the title, abstracts and index terms of relevant papers. Next, we will conduct a second search using all identified key words in all databases. Third, we will review reference lists of all included studies to identify further relevant studies to include in the review. We will also contact the authors of relevant papers for further information if required. This will be an iterative process as the research team becomes more familiar with the literature and will be guided by the librarian. Any modifications to the search strategy as it evolves will be described in the scoping review report. As a measure of rigour, the search strategy will be peer-reviewed by another librarian using the PRESS checklist [ 28 ]. No language or date limits will be applied.

Step 3—Study selection

The screening process will consist of a two-step approach: screening titles/abstracts and, if they meet inclusion criteria, this will be followed by a full-text review. All screening will be done by two members of the research team and any disagreements will be resolved by an independent third member of the team. Based on preliminary inclusion criteria, the whole research team will first pilot the screening process by reviewing a random sample of 25 titles/abstracts. The search strategy, eligibility criteria and study objectives will be refined in an iterative process. We anticipate several meetings as the topic is not well described in the literature. A flowchart of the review process will be generated. Any modifications to the study selection process will be described in the scoping review report. The papers will be excluded if a full text is not available. The search results will be managed using Covidence software.

Step 4—Charting the data

A preliminary data extraction tool is shown in Appendix B (see Additional file 3 ). Data will be extracted into Excel and will include demographic information and specific details about the population, concept, context, study methods and outcomes as they relate to the scoping review objectives. The whole research team will pilot the data extraction tool on ten articles selected for full-text review. Through an iterative process, the final data extraction form will be refined. Subsequently, two members of the team will independently extract data from all articles included for full-text review using this tool. Charting disagreements will be resolved by the principal and senior investigators. Google Translate will be used for any included articles that are not in the English language.

Step 5—Collating, summarising and reporting the results

Quantitative and qualitative analyses will be used to summarise the results. Quantitative analysis will capture descriptive statistics with details about the population, concept, context, study methods and outcomes being examined in this scoping review. Qualitative content analysis will enable interpretation of text data through the systematic classification process of coding and identifying themes and patterns [ 29 ]. Several team meetings will be held to review potential themes to ensure an accurate representation of the data. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) will be used to guide the reporting of review findings [ 30 ]. Data will be presented in tables and/or diagrams as applicable. A descriptive summary will explain the presented results and how they relate to the scoping review objectives.

By summarising the literature on LP use in UGME, this study will contribute to a better understanding of how to support SRL amongst medical students. The results from this project will also inform future scholarly work in CBME at the undergraduate level and have implications for improving feedback as well as supporting learners at all levels of competence. In doing so, this study may have practical applications by informing learning plan incorporation into CBME-based curricula.

We do not anticipate any practical or operational issues at this time. We assembled a team with the necessary expertise and tools to complete this project.

Availability of data and materials

All data generated or analysed during this study will be included in the published scoping review article.

Abbreviations

  • Competency-based medical education

Entrustable professional activity

  • Learning plan
  • Self-regulated learning
  • Undergraduate medical education

Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638–45.

Article   PubMed   Google Scholar  

Shorey S, Lau TC, Lau ST, Ang E. Entrustable professional activities in health care education: a scoping review. Med Educ. 2019;53(8):766–77.

Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81–112.

Article   Google Scholar  

Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad Med. 2005;80(10 Suppl):S84–7.

Warm EJ, Englander R, Pereira A, Barach P. Improving learner handovers in medical education. Acad Med. 2017;92(7):927–31.

Spooner M, Duane C, Uygur J, et al. Self-regulatory learning theory as a lens on how undergraduate and postgraduate learners respond to feedback: a BEME scoping review : BEME Guide No. 66. Med Teach. 2022;44(1):3–18.

Frellsen SL, Baker EA, Papp KK, Durning SJ. Medical school policies regarding struggling medical students during the internal medicine clerkships: results of a National Survey. Acad Med. 2008;83(9):876–81.

Humphrey-Murto S, LeBlanc A, Touchie C, et al. The influence of prior performance information on ratings of current performance and implications for learner handover: a scoping review. Acad Med. 2019;94(7):1050–7.

Morgan HK, Mejicano GC, Skochelak S, et al. A responsible educational handover: improving communication to improve learning. Acad Med. 2020;95(2):194–9.

Dory V, Danoff D, Plotnick LH, et al. Does educational handover influence subsequent assessment? Acad Med. 2021;96(1):118–25.

Humphrey-Murto S, Lingard L, Varpio L, et al. Learner handover: who is it really for? Acad Med. 2021;96(4):592–8.

Shaw T, Wood TJ, Touchie T, Pugh D, Humphrey-Murto S. How biased are you? The effect of prior performance information on attending physician ratings and implications for learner handover. Adv Health Sci Educ Theory Pract. 2021;26(1):199–214.

Artino AR, Brydges R, Gruppen LD. Chapter 14: Self-regulated learning in health professional education: theoretical perspectives and research methods. In: Cleland J, Duning SJ, editors. Researching Medical Education. 1st ed. John Wiley & Sons; 2015. p. 155–66.

Chapter   Google Scholar  

Cleland J, Arnold R, Chesser A. Failing finals is often a surprise for the student but not the teacher: identifying difficulties and supporting students with academic difficulties. Med Teach. 2005;27(6):504–8.

Reed S, Lockspeiser TM, Burke A, et al. Practical suggestions for the creation and use of meaningful learning goals in graduate medical education. Acad Pediatr. 2016;16(1):20–4.

Wolff M, Stojan J, Cranford J, et al. The impact of informed self-assessment on the development of medical students’ learning goals. Med Teach. 2018;40(3):296–301.

Sawatsky AP, Halvorsen AJ, Daniels PR, et al. Characteristics and quality of rotation-specific resident learning goals: a prospective study. Med Educ Online. 2020;25(1):1714198.

Article   PubMed   PubMed Central   Google Scholar  

Pintrich PR. Chapter 14: The role of goal orientation in self-regulated learning. In: Boekaerts M, Pintrich PR, Zeidner M, editors. Handbook of self-regulation. 1st ed. Academic Press; 2000. p. 451–502.

Kassab SE, El-Sayed W, Hamdy H. Student engagement in undergraduate medical education: a scoping review. Med Educ. 2022;56(7):703–15.

Challis M. AMEE medical education guide No. 19: Personal learning plans. Med Teach. 2000;22(3):225–36.

Knowles MS. Using learning contracts. 1 st ed. San Francisco: Jossey Bass; 1986.

Parsell G, Bligh J. Contract learning, clinical learning and clinicians. Postgrad Med J. 1996;72(847):284–9.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Teunissen PW, Scheele F, Scherpbier AJJA, et al. How residents learn: qualitative evidence for the pivotal role of clinical activities. Med Educ. 2007;41(8):763–70.

Article   CAS   PubMed   Google Scholar  

van Houten-Schat MA, Berkhout JJ, van Dijk N, Endedijk MD, Jaarsma ADC, Diemers AD. Self-regulated learning in the clinical context: a systematic review. Med Educ. 2018;52(10):1008–15.

Taylor DCM, Hamdy H. Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach. 2013;35(11):e1561–72.

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

Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalol H. Chapter 11: Scoping reviews. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. JBI; 2020. https://synthesismanual.jbi.global. . Accessed 30 Aug 2022.

McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol. 2016;75:40–6.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.

Venables M, Larocque A, Sikora L, Archibald D, Grudniewicz A. Understanding indigenous health education and exploring indigenous anti-racism approaches in undergraduate medical education: a scoping review protocol. OSF; 2022. https://osf.io/umwgr/ . Accessed 26 Oct 2022.

Download references

Acknowledgements

Not applicable.

This study will be supported through grants from the Department of Medicine at the Ottawa Hospital and the University of Ottawa. The funding bodies had no role in the study design and will not have any role in the collection, analysis and interpretation of data or writing of the manuscript.

Author information

Authors and affiliations.

The Ottawa Hospital – General Campus, 501 Smyth Rd, PO Box 209, Ottawa, ON, K1H 8L6, Canada

Anna Romanova & Claire Touchie

The Ottawa Hospital Research Institute, Ottawa, Canada

Sydney Ruller

The University of Ottawa, Ottawa, Canada

Victoria Cole

The Ottawa Hospital – Riverside Campus, Ottawa, Canada

Susan Humphrey-Murto

You can also search for this author in PubMed   Google Scholar

Contributions

AR designed and drafted the protocol. CT and SH contributed to the refinement of the research question, study methods and editing of the manuscript. VC designed the initial search strategy. All authors reviewed the manuscript for final approval. The review guarantors are CT and SH. The corresponding author is AR.

Authors’ information

AR is a clinician teacher and Assistant Professor with the Division of General Internal Medicine at the University of Ottawa. She is also the Associate Director for the internal medicine clerkship rotation at the General campus of the Ottawa Hospital.

CT is a Professor of Medicine with the Divisions of General Internal Medicine and Infectious Diseases at the University of Ottawa. She is also a member of the UGME Competence Committee at the University of Ottawa and an advisor for the development of a new school of medicine at Toronto Metropolitan University.

SH is an Associate Professor with the Department of Medicine at the University of Ottawa and holds a Tier 2 Research Chair in Medical Education. She is also the Interim Director for the Research Support Unit within the Department of Innovation in Medical Education at the University of Ottawa.

CT and SH have extensive experience with medical education research and have numerous publications in this field.

SR is a Research Assistant with the Division of General Internal Medicine at the Ottawa Hospital Research Institute.

VC is a Health Sciences Research Librarian at the University of Ottawa.

SR and VC have extensive experience in systematic and scoping reviews.

Corresponding author

Correspondence to Anna Romanova .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1. prisma-p 2015 checklist., 13643_2024_2553_moesm2_esm.docx.

Additional file 2: Appendix A. Preliminary search strategy [ 31 ].

Additional file 3: Appendix B. Preliminary data extraction tool.

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Romanova, A., Touchie, C., Ruller, S. et al. Protocol for a scoping review study on learning plan use in undergraduate medical education. Syst Rev 13 , 131 (2024). https://doi.org/10.1186/s13643-024-02553-w

Download citation

Received : 29 November 2022

Accepted : 03 May 2024

Published : 14 May 2024

DOI : https://doi.org/10.1186/s13643-024-02553-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Systematic Reviews

ISSN: 2046-4053

  • Submission enquiries: Access here and click Contact Us
  • General enquiries: [email protected]

current literature data

U.S. flag

An official website of the United States government

Here's how you know

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Keeping Current with the Literature

One of the biggest challenges is keeping up with all the literature. This guide will provide instructions to creating alerts for many of the top services, and also some of the other tools to keep current with emerging research. There are several types of alerts which can be created to keep up to date on various advances;

  • Open access
  • Published: 15 May 2024

Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke

  • Helena Teede 1 , 2   na1 ,
  • Dominique A. Cadilhac 3 , 4   na1 ,
  • Tara Purvis 3 ,
  • Monique F. Kilkenny 3 , 4 ,
  • Bruce C.V. Campbell 4 , 5 , 6 ,
  • Coralie English 7 ,
  • Alison Johnson 2 ,
  • Emily Callander 1 ,
  • Rohan S. Grimley 8 , 9 ,
  • Christopher Levi 10 ,
  • Sandy Middleton 11 , 12 ,
  • Kelvin Hill 13 &
  • Joanne Enticott   ORCID: orcid.org/0000-0002-4480-5690 1  

BMC Medicine volume  22 , Article number:  198 ( 2024 ) Cite this article

2 Altmetric

Metrics details

In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit.

Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement.

Conclusions

The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.

Peer Review reports

Internationally, health systems are facing a crisis, driven by an ageing population, increasing complexity, multi-morbidity, rapidly advancing health technology and rising costs that threaten sustainability and mandate transformation and improvement [ 1 , 2 ]. Although research has generated solutions to healthcare challenges, and the advent of big data and digital health holds great promise, entrenched siloes and poor integration of knowledge generation, knowledge implementation and healthcare delivery between stakeholders, curtails momentum towards, and consistent attainment of, evidence-and value-based care [ 3 ]. This is compounded by the short supply of research and innovation leadership within the healthcare sector, and poorly integrated and often inaccessible health data systems, which have crippled the potential to deliver on digital-driven innovation [ 4 ]. Current approaches to healthcare improvement are also often isolated with limited sustainability, scale-up and impact [ 5 ].

Evidence suggests that integration and partnership across academic and healthcare delivery stakeholders are key to progress, including those with lived experience and their families (referred to here as consumers and community), diverse disciplines (both research and clinical), policy makers and funders. Utilization of evidence from research and evidence from practice including data from routine care, supported by implementation research, are key to sustainably embedding improvement and optimising health care and outcomes. A strategy to achieve this integration is through the Learning Health System (LHS) (Fig.  1 ) [ 2 , 6 , 7 , 8 ]. Although there are numerous publications on LHS approaches [ 9 , 10 , 11 , 12 ], many focus on research perspectives and data, most do not demonstrate tangible healthcare improvement or better health outcomes. [ 6 ]

figure 1

Monash Learning Health System: The Learn Together for Better Health Framework developed by Monash Partners and Monash University (from Enticott et al. 2021 [ 7 ]). Four evidence quadrants: Q1 (orange) is evidence from stakeholders; Q2 (green) is evidence from research; Q3 (light blue) is evidence from data; and, Q4 (dark blue) is evidence from implementation and healthcare improvement

In developed nations, it has been estimated that 60% of care provided aligns with the evidence base, 30% is low value and 10% is potentially harmful [ 13 ]. In some areas, clinical advances have been rapid and research and evidence have paved the way for dramatic improvement in outcomes, mandating rapid implementation of evidence into healthcare (e.g. polio and COVID-19 vaccines). However, healthcare improvement is challenging and slow [ 5 ]. Health systems are highly complex in their design, networks and interacting components, and change is difficult to enact, sustain and scale up. [ 3 ] New effective strategies are needed to meet community needs and deliver evidence-based and value-based care, which reorients care from serving the provider, services and system, towards serving community needs, based on evidence and quality. It goes beyond cost to encompass patient and provider experience, quality care and outcomes, efficiency and sustainability [ 2 , 6 ].

The costs of stroke care are expected to rise rapidly in the next decades, unless improvements in stroke care to reduce the disabling effects of strokes can be successfully developed and implemented [ 14 ]. Here, we briefly describe the Monash LHS framework (Fig.  1 ) [ 2 , 6 , 7 ] and outline an exemplar case in order to demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare. The Australian LHS exemplar in stroke care has driven nationwide improvement in stroke care since 2007.

An evidence-based Learning Health System framework

In Australia, members of this author group (HT, AJ, JE) have rigorously co-developed an evidence-based LHS framework, known simply as the Monash LHS [ 7 ]. The Monash LHS was designed to support sustainable, iterative and continuous robust benefit of improved clinical outcomes. It was created with national engagement in order to be applicable to Australian settings. Through this rigorous approach, core LHS principles and components have been established (Fig.  1 ). Evidence shows that people/workforce, culture, standards, governance and resources were all key to an effective LHS [ 2 , 6 ]. Culture is vital including trust, transparency, partnership and co-design. Key processes include legally compliant data sharing, linkage and governance, resources, and infrastructure [ 4 ]. The Monash LHS integrates disparate and often siloed stakeholders, infrastructure and expertise to ‘Learn Together for Better Health’ [ 7 ] (Fig.  1 ). This integrates (i) evidence from community and stakeholders including priority areas and outcomes; (ii) evidence from research and guidelines; (iii) evidence from practice (from data) with advanced analytics and benchmarking; and (iv) evidence from implementation science and health economics. Importantly, it starts with the problem and priorities of key stakeholders including the community, health professionals and services and creates an iterative learning system to address these. The following case study was chosen as it is an exemplar of how a Monash LHS-aligned national stroke program has delivered clinical benefit.

Australian Stroke Learning Health System

Internationally, the application of LHS approaches in stroke has resulted in improved stroke care and outcomes [ 12 ]. For example, in Canada a sustained decrease in 30-day in-hospital mortality has been found commensurate with an increase in resources to establish the multifactorial stroke system intervention for stroke treatment and prevention [ 15 ]. Arguably, with rapid advances in evidence and in the context of an ageing population with high cost and care burden and substantive impacts on quality of life, stroke is an area with a need for rapid research translation into evidence-based and value-based healthcare improvement. However, a recent systematic review found that the existing literature had few comprehensive examples of LHS adoption [ 12 ]. Although healthcare improvement systems and approaches were described, less is known about patient-clinician and stakeholder engagement, governance and culture, or embedding of data informatics into everyday practice to inform and drive improvement [ 12 ]. For example, in a recent review of quality improvement collaborations, it was found that although clinical processes in stroke care are improved, their short-term nature means there is uncertainty about sustainability and impacts on patient outcomes [ 16 ]. Table  1 provides the main features of the Australian Stroke LHS based on the four core domains and eight elements of the Learning Together for Better Health Framework described in Fig.  1 . The features are further expanded on in the following sections.

Evidence from stakeholders (LHS quadrant 1, Fig.  1 )

Engagement, partners and priorities.

Within the stroke field, there have been various support mechanisms to facilitate an LHS approach including partnership and broad stakeholder engagement that includes clinical networks and policy makers from different jurisdictions. Since 2008, the Australian Stroke Coalition has been co-led by the Stroke Foundation, a charitable consumer advocacy organisation, and Stroke Society of Australasia a professional society with membership covering academics and multidisciplinary clinician networks, that are collectively working to improve stroke care ( https://australianstrokecoalition.org.au/ ). Surveys, focus groups and workshops have been used for identifying priorities from stakeholders. Recent agreed priorities have been to improve stroke care and strengthen the voice for stroke care at a national ( https://strokefoundation.org.au/ ) and international level ( https://www.world-stroke.org/news-and-blog/news/world-stroke-organization-tackle-gaps-in-access-to-quality-stroke-care ), as well as reduce duplication amongst stakeholders. This activity is built on a foundation and culture of research and innovation embedded within the stroke ‘community of practice’. Consumers, as people with lived experience of stroke are important members of the Australian Stroke Coalition, as well as representatives from different clinical colleges. Consumers also provide critical input to a range of LHS activities via the Stroke Foundation Consumer Council, Stroke Living Guidelines committees, and the Australian Stroke Clinical Registry (AuSCR) Steering Committee (described below).

Evidence from research (LHS quadrant 2, Fig.  1 )

Advancement of the evidence for stroke interventions and synthesis into clinical guidelines.

To implement best practice, it is crucial to distil the large volume of scientific and trial literature into actionable recommendations for clinicians to use in practice [ 24 ]. The first Australian clinical guidelines for acute stroke were produced in 2003 following the increasing evidence emerging for prevention interventions (e.g. carotid endarterectomy, blood pressure lowering), acute medical treatments (intravenous thrombolysis, aspirin within 48 h of ischemic stroke), and optimised hospital management (care in dedicated stroke units by a specialised and coordinated multidisciplinary team) [ 25 ]. Importantly, a number of the innovations were developed, researched and proven effective by key opinion leaders embedded in the Australian stroke care community. In 2005, the clinical guidelines for Stroke Rehabilitation and Recovery [ 26 ] were produced, with subsequent merged guidelines periodically updated. However, the traditional process of periodic guideline updates is challenging for end users when new research can render recommendations redundant and this lack of currency erodes stakeholder trust [ 27 ]. In response to this challenge the Stroke Foundation and Cochrane Australia entered a pioneering project to produce the first electronic ‘living’ guidelines globally [ 20 ]. Major shifts in the evidence for reperfusion therapies (e.g. extended time-window intravenous thrombolysis and endovascular clot retrieval), among other advances, were able to be converted into new recommendations, approved by the Australian National Health and Medical Research Council within a few months of publication. Feedback on this process confirmed the increased use and trust in the guidelines by clinicians. The process informed other living guidelines programs, including the successful COVID-19 clinical guidelines [ 28 ].

However, best practice clinical guideline recommendations are necessary but insufficient for healthcare improvement and nesting these within an LHS with stakeholder partnership, enables implementation via a range of proven methods, including audit and feedback strategies [ 29 ].

Evidence from data and practice (LHS quadrant 3, Fig.  1 )

Data systems and benchmarking : revealing the disparities in care between health services. A national system for standardized stroke data collection was established as the National Stroke Audit program in 2007 by the Stroke Foundation [ 30 ] following various state-level programs (e.g. New South Wales Audit) [ 31 ] to identify evidence-practice gaps and prioritise improvement efforts to increase access to stroke units and other acute treatments [ 32 ]. The Audit program alternates each year between acute (commencing in 2007) and rehabilitation in-patient services (commencing in 2008). The Audit program provides a ‘deep dive’ on the majority of recommendations in the clinical guidelines whereby participating hospitals provide audits of up to 40 consecutive patient medical records and respond to a survey about organizational resources to manage stroke. In 2009, the AuSCR was established to provide information on patients managed in acute hospitals based on a small subset of quality processes of care linked to benchmarked reports of performance (Fig.  2 ) [ 33 ]. In this way, the continuous collection of high-priority processes of stroke care could be regularly collected and reviewed to guide improvement to care [ 34 ]. Plus clinical quality registry programs within Australia have shown a meaningful return on investment attributed to enhanced survival, improvements in quality of life and avoided costs of treatment or hospital stay [ 35 ].

figure 2

Example performance report from the Australian Stroke Clinical Registry: average door-to-needle time in providing intravenous thrombolysis by different hospitals in 2021 [ 36 ]. Each bar in the figure represents a single hospital

The Australian Stroke Coalition endorsed the creation of an integrated technological solution for collecting data through a single portal for multiple programs in 2013. In 2015, the Stroke Foundation, AuSCR consortium, and other relevant groups cooperated to design an integrated data management platform (the Australian Stroke Data Tool) to reduce duplication of effort for hospital staff in the collection of overlapping variables in the same patients [ 19 ]. Importantly, a national data dictionary then provided the common data definitions to facilitate standardized data capture. Another important feature of AuSCR is the collection of patient-reported outcome surveys between 90 and 180 days after stroke, and annual linkage with national death records to ascertain survival status [ 33 ]. To support a LHS approach, hospitals that participate in AuSCR have access to a range of real-time performance reports. In efforts to minimize the burden of data collection in the AuSCR, interoperability approaches to import data directly from hospital or state-level managed stroke databases have been established (Fig.  3 ); however, the application has been variable and 41% of hospitals still manually enter all their data.

figure 3

Current status of automated data importing solutions in the Australian Stroke Clinical Registry, 2022, with ‘ n ’ representing the number of hospitals. AuSCR, Australian Stroke Clinical Registry; AuSDaT, Australian Stroke Data Tool; API, Application Programming Interface; ICD, International Classification of Diseases; RedCAP, Research Electronic Data Capture; eMR, electronic medical records

For acute stroke care, the Australian Commission on Quality and Safety in Health Care facilitated the co-design (clinicians, academics, consumers) and publication of the national Acute Stroke Clinical Care Standard in 2015 [ 17 ], and subsequent review [ 18 ]. The indicator set for the Acute Stroke Standard then informed the expansion of the minimum dataset for AuSCR so that hospitals could routinely track their performance. The national Audit program enabled hospitals not involved in the AuSCR to assess their performance every two years against the Acute Stroke Standard. Complementing these efforts, the Stroke Foundation, working with the sector, developed the Acute and Rehabilitation Stroke Services Frameworks to outline the principles, essential elements, models of care and staffing recommendations for stroke services ( https://informme.org.au/guidelines/national-stroke-services-frameworks ). The Frameworks are intended to guide where stroke services should be developed, and monitor their uptake with the organizational survey component of the Audit program.

Evidence from implementation and healthcare improvement (LHS quadrant 4, Fig.  1 )

Research to better utilize and augment data from registries through linkage [ 37 , 38 , 39 , 40 ] and to ensure presentation of hospital or service level data are understood by clinicians has ensured advancement in the field for the Australian Stroke LHS [ 41 ]. Importantly, greater insights into whole patient journeys, before and after a stroke, can now enable exploration of value-based care. The LHS and stroke data platform have enabled focused and time-limited projects to create a better understanding of the quality of care in acute or rehabilitation settings [ 22 , 42 , 43 ]. Within stroke, all the elements of an LHS culminate into the ready availability of benchmarked performance data and support for implementation of strategies to address gaps in care.

Implementation research to grow the evidence base for effective improvement interventions has also been a key pillar in the Australian context. These include multi-component implementation interventions to achieve behaviour change for particular aspects of stroke care, [ 22 , 23 , 44 , 45 ] and real-world approaches to augmenting access to hyperacute interventions in stroke through the use of technology and telehealth [ 46 , 47 , 48 , 49 ]. The evidence from these studies feeds into the living guidelines program and the data collection systems, such as the Audit program or AuSCR, which are then amended to ensure data aligns to recommended care. For example, the use of ‘hyperacute aspirin within the first 48 h of ischemic stroke’ was modified to be ‘hyperacute antiplatelet…’ to incorporate new evidence that other medications or combinations are appropriate to use. Additionally, new datasets have been developed to align with evidence such as the Fever, Sugar, and Swallow variables [ 42 ]. Evidence on improvements in access to best practice care from the acute Audit program [ 50 ] and AuSCR is emerging [ 36 ]. For example, between 2007 and 2017, the odds of receiving intravenous thrombolysis after ischemic stroke increased by 16% 9OR 1.06 95% CI 1.13–1.18) and being managed in a stroke unit by 18% (OR 1.18 95% CI 1.17–1.20). Over this period, the median length of hospital stay for all patients decreased from 6.3 days in 2007 to 5.0 days in 2017 [ 51 ]. When considering the number of additional patients who would receive treatment in 2017 in comparison to 2007 it was estimated that without this additional treatment, over 17,000 healthy years of life would be lost in 2017 (17,786 disability-adjusted life years) [ 51 ]. There is evidence on the cost-effectiveness of different system-focussed strategies to augment treatment access for acute ischemic stroke (e.g. Victorian Stroke Telemedicine program [ 52 ] and Melbourne Mobile Stroke Unit ambulance [ 53 ]). Reciprocally, evidence from the national Rehabilitation Audit, where the LHS approach has been less complete or embedded, has shown fewer areas of healthcare improvement over time [ 51 , 54 ].

Within the field of stroke in Australia, there is indirect evidence that the collective efforts that align to establishing the components of a LHS have had an impact. Overall, the age-standardised rate of stroke events has reduced by 27% between 2001 and 2020, from 169 to 124 events per 100,000 population. Substantial declines in mortality rates have been reported since 1980. Commensurate with national clinical guidelines being updated in 2007 and the first National Stroke Audit being undertaken in 2007, the mortality rates for men (37.4 deaths per 100,000) and women (36.1 deaths per 100,0000 has declined to 23.8 and 23.9 per 100,000, respectively in 2021 [ 55 ].

Underpinning the LHS with the integration of the four quadrants of evidence from stakeholders, research and guidelines, practice and implementation, and core LHS principles have been addressed. Leadership and governance have been important, and programs have been established to augment workforce training and capacity building in best practice professional development. Medical practitioners are able to undertake courses and mentoring through the Australasian Stroke Academy ( http://www.strokeacademy.com.au/ ) while nurses (and other health professionals) can access teaching modules in stroke care from the Acute Stroke Nurses Education Network ( https://asnen.org/ ). The Association of Neurovascular Clinicians offers distance-accessible education and certification to develop stroke expertise for interdisciplinary professionals, including advanced stroke co-ordinator certification ( www.anvc.org ). Consumer initiative interventions are also used in the design of the AuSCR Public Summary Annual reports (available at https://auscr.com.au/about/annual-reports/ ) and consumer-related resources related to the Living Guidelines ( https://enableme.org.au/resources ).

The important success factors and lessons from stroke as a national exemplar LHS in Australia include leadership, culture, workforce and resources integrated with (1) established and broad partnerships across the academic-clinical sector divide and stakeholder engagement; (2) the living guidelines program; (3) national data infrastructure, including a national data dictionary that provides the common data framework to support standardized data capture; (4) various implementation strategies including benchmarking and feedback as well as engagement strategies targeting different levels of the health system; and (5) implementation and improvement research to advance stroke systems of care and reduce unwarranted variation in practice (Fig.  1 ). Priority opportunities now include the advancement of interoperability with electronic medical records as an area all clinical quality registry’s programs needs to be addressed, as well as providing more dynamic and interactive data dashboards tailored to the need of clinicians and health service executives.

There is a clear mandate to optimise healthcare improvement with big data offering major opportunities for change. However, we have lacked the approaches to capture evidence from the community and stakeholders, to integrate evidence from research, to capture and leverage data or evidence from practice and to generate and build on evidence from implementation using iterative system-level improvement. The LHS provides this opportunity and is shown to deliver impact. Here, we have outlined the process applied to generate an evidence-based LHS and provide a leading exemplar in stroke care. This highlights the value of moving from single-focus isolated approaches/initiatives to healthcare improvement and the benefit of integration to deliver demonstrable outcomes for our funders and key stakeholders — our community. This work provides insight into strategies that can both apply evidence-based processes to healthcare improvement as well as implementing evidence-based practices into care, moving beyond research as an endpoint, to research as an enabler, underpinning delivery of better healthcare.

Availability of data and materials

Not applicable

Abbreviations

Australian Stroke Clinical Registry

Confidence interval

  • Learning Health System

World Health Organization. Delivering quality health services . OECD Publishing; 2018.

Enticott J, Braaf S, Johnson A, Jones A, Teede HJ. Leaders’ perspectives on learning health systems: A qualitative study. BMC Health Serv Res. 2020;20:1087.

Article   PubMed   PubMed Central   Google Scholar  

Melder A, Robinson T, McLoughlin I, Iedema R, Teede H. An overview of healthcare improvement: Unpacking the complexity for clinicians and managers in a learning health system. Intern Med J. 2020;50:1174–84.

Article   PubMed   Google Scholar  

Alberto IRI, Alberto NRI, Ghosh AK, Jain B, Jayakumar S, Martinez-Martin N, et al. The impact of commercial health datasets on medical research and health-care algorithms. Lancet Digit Health. 2023;5:e288–94.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Dixon-Woods M. How to improve healthcare improvement—an essay by Mary Dixon-Woods. BMJ. 2019;367: l5514.

Enticott J, Johnson A, Teede H. Learning health systems using data to drive healthcare improvement and impact: A systematic review. BMC Health Serv Res. 2021;21:200.

Enticott JC, Melder A, Johnson A, Jones A, Shaw T, Keech W, et al. A learning health system framework to operationalize health data to improve quality care: An Australian perspective. Front Med (Lausanne). 2021;8:730021.

Dammery G, Ellis LA, Churruca K, Mahadeva J, Lopez F, Carrigan A, et al. The journey to a learning health system in primary care: A qualitative case study utilising an embedded research approach. BMC Prim Care. 2023;24:22.

Foley T, Horwitz L, Zahran R. The learning healthcare project: Realising the potential of learning health systems. 2021. Available from https://learninghealthcareproject.org/wp-content/uploads/2021/05/LHS2021report.pdf . Accessed Jan 2024.

Institute of Medicine. Best care at lower cost: The path to continuously learning health care in America. Washington: The National Academies Press; 2013.

Google Scholar  

Zurynski Y, Smith CL, Vedovi A, Ellis LA, Knaggs G, Meulenbroeks I, et al. Mapping the learning health system: A scoping review of current evidence - a white paper. 2020:63

Cadilhac DA, Bravata DM, Bettger J, Mikulik R, Norrving B, Uvere E, et al. Stroke learning health systems: A topical narrative review with case examples. Stroke. 2023;54:1148–59.

Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: The 60–30-10 challenge. BMC Med. 2020;18:1–8.

Article   Google Scholar  

King D, Wittenberg R, Patel A, Quayyum Z, Berdunov V, Knapp M. The future incidence, prevalence and costs of stroke in the UK. Age Ageing. 2020;49:277–82.

Ganesh A, Lindsay P, Fang J, Kapral MK, Cote R, Joiner I, et al. Integrated systems of stroke care and reduction in 30-day mortality: A retrospective analysis. Neurology. 2016;86:898–904.

Lowther HJ, Harrison J, Hill JE, Gaskins NJ, Lazo KC, Clegg AJ, et al. The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: A systematic review. Implement Sci. 2021;16:16.

Australian Commission on Safety and Quality in Health Care. Acute stroke clinical care standard. 2015. Available from https://www.safetyandquality.gov.au/our-work/clinical-care-standards/acute-stroke-clinical-care-standard . Accessed Jan 2024.

Australian Commission on Safety and Quality in Health Care. Acute stroke clinical care standard. Sydney: ACSQHC; 2019. Available from https://www.safetyandquality.gov.au/publications-and-resources/resource-library/acute-stroke-clinical-care-standard-evidence-sources . Accessed Jan 2024.

Ryan O, Ghuliani J, Grabsch B, Hill K, G CC, Breen S, et al. Development, implementation, and evaluation of the Australian Stroke Data Tool (AuSDaT): Comprehensive data capturing for multiple uses. Health Inf Manag. 2022:18333583221117184.

English C, Bayley M, Hill K, Langhorne P, Molag M, Ranta A, et al. Bringing stroke clinical guidelines to life. Int J Stroke. 2019;14:337–9.

English C, Hill K, Cadilhac DA, Hackett ML, Lannin NA, Middleton S, et al. Living clinical guidelines for stroke: Updates, challenges and opportunities. Med J Aust. 2022;216:510–4.

Cadilhac DA, Grimley R, Kilkenny MF, Andrew NE, Lannin NA, Hill K, et al. Multicenter, prospective, controlled, before-and-after, quality improvement study (Stroke123) of acute stroke care. Stroke. 2019;50:1525–30.

Cadilhac DA, Marion V, Andrew NE, Breen SJ, Grabsch B, Purvis T, et al. A stepped-wedge cluster-randomized trial to improve adherence to evidence-based practices for acute stroke management. Jt Comm J Qual Patient Saf. 2022.

Elliott J, Lawrence R, Minx JC, Oladapo OT, Ravaud P, Jeppesen BT, et al. Decision makers need constantly updated evidence synthesis. Nature. 2021;600:383–5.

Article   CAS   PubMed   Google Scholar  

National Stroke Foundation. National guidelines for acute stroke management. Melbourne: National Stroke Foundation; 2003.

National Stroke Foundation. Clinical guidelines for stroke rehabilitation and recovery. Melbourne: National Stroke Foundation; 2005.

Phan TG, Thrift A, Cadilhac D, Srikanth V. A plea for the use of systematic review methodology when writing guidelines and timely publication of guidelines. Intern Med J . 2012;42:1369–1371; author reply 1371–1362

Tendal B, Vogel JP, McDonald S, Norris S, Cumpston M, White H, et al. Weekly updates of national living evidence-based guidelines: Methods for the Australian living guidelines for care of people with COVID-19. J Clin Epidemiol. 2021;131:11–21.

Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7:50.

Harris D, Cadilhac D, Hankey GJ, Hillier S, Kilkenny M, Lalor E. National stroke audit: The Australian experience. Clin Audit. 2010;2:25–31.

Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M, et al. Evaluation of rural stroke services: Does implementation of coordinators and pathways improve care in rural hospitals? Stroke. 2013;44:2848–53.

Cadilhac DA, Moss KM, Price CJ, Lannin NA, Lim JY, Anderson CS. Pathways to enhancing the quality of stroke care through national data monitoring systems for hospitals. Med J Aust. 2013;199:650–1.

Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Faux S, Price C, et al. Protocol and pilot data for establishing the Australian Stroke Clinical Registry. Int J Stroke. 2010;5:217–26.

Ivers N, Jamtvedt G, Flottorp S, Young J, Odgaard-Jensen J, French S, et al. Audit and feedback: Effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev . 2012

Australian Commission on Safety and Quality in Health Care. Economic evaluation of clinical quality registries. Final report. . 2016:79

Cadilhac DA, Dalli LL, Morrison J, Lester M, Paice K, Moss K, et al. The Australian Stroke Clinical Registry annual report 2021. Melbourne; 2022. Available from https://auscr.com.au/about/annual-reports/ . Accessed 6 May 2024.

Kilkenny MF, Kim J, Andrew NE, Sundararajan V, Thrift AG, Katzenellenbogen JM, et al. Maximising data value and avoiding data waste: A validation study in stroke research. Med J Aust. 2019;210:27–31.

Eliakundu AL, Smith K, Kilkenny MF, Kim J, Bagot KL, Andrew E, et al. Linking data from the Australian Stroke Clinical Registry with ambulance and emergency administrative data in Victoria. Inquiry. 2022;59:469580221102200.

PubMed   Google Scholar  

Andrew NE, Kim J, Cadilhac DA, Sundararajan V, Thrift AG, Churilov L, et al. Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study. Int J Popul Data Sci. 2019;4:1097.

CAS   PubMed   PubMed Central   Google Scholar  

Mosalski S, Shiner CT, Lannin NA, Cadilhac DA, Faux SG, Kim J, et al. Increased relative functional gain and improved stroke outcomes: A linked registry study of the impact of rehabilitation. J Stroke Cerebrovasc Dis. 2021;30: 106015.

Ryan OF, Hancock SL, Marion V, Kelly P, Kilkenny MF, Clissold B, et al. Feedback of aggregate patient-reported outcomes (PROs) data to clinicians and hospital end users: Findings from an Australian codesign workshop process. BMJ Open. 2022;12:e055999.

Grimley RS, Rosbergen IC, Gustafsson L, Horton E, Green T, Cadigan G, et al. Dose and setting of rehabilitation received after stroke in Queensland, Australia: A prospective cohort study. Clin Rehabil. 2020;34:812–23.

Purvis T, Middleton S, Craig LE, Kilkenny MF, Dale S, Hill K, et al. Inclusion of a care bundle for fever, hyperglycaemia and swallow management in a national audit for acute stroke: Evidence of upscale and spread. Implement Sci. 2019;14:87.

Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D’Este C, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial. Lancet. 2011;378:1699–706.

Middleton S, Dale S, Cheung NW, Cadilhac DA, Grimshaw JM, Levi C, et al. Nurse-initiated acute stroke care in emergency departments. Stroke. 2019:STROKEAHA118020701.

Hood RJ, Maltby S, Keynes A, Kluge MG, Nalivaiko E, Ryan A, et al. Development and pilot implementation of TACTICS VR: A virtual reality-based stroke management workflow training application and training framework. Front Neurol. 2021;12:665808.

Bladin CF, Kim J, Bagot KL, Vu M, Moloczij N, Denisenko S, et al. Improving acute stroke care in regional hospitals: Clinical evaluation of the Victorian Stroke Telemedicine program. Med J Aust. 2020;212:371–7.

Bladin CF, Bagot KL, Vu M, Kim J, Bernard S, Smith K, et al. Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care. BMJ Open. 2022;12:e052332.

Zhao H, Coote S, Easton D, Langenberg F, Stephenson M, Smith K, et al. Melbourne mobile stroke unit and reperfusion therapy: Greater clinical impact of thrombectomy than thrombolysis. Stroke. 2020;51:922–30.

Purvis T, Cadilhac DA, Hill K, Reyneke M, Olaiya MT, Dalli LL, et al. Twenty years of monitoring acute stroke care in Australia from the national stroke audit program (1999–2019): Achievements and areas of future focus. J Health Serv Res Policy. 2023.

Cadilhac DA, Purvis T, Reyneke M, Dalli LL, Kim J, Kilkenny MF. Evaluation of the national stroke audit program: 20-year report. Melbourne; 2019.

Kim J, Tan E, Gao L, Moodie M, Dewey HM, Bagot KL, et al. Cost-effectiveness of the Victorian Stroke Telemedicine program. Aust Health Rev. 2022;46:294–301.

Kim J, Easton D, Zhao H, Coote S, Sookram G, Smith K, et al. Economic evaluation of the Melbourne mobile stroke unit. Int J Stroke. 2021;16:466–75.

Stroke Foundation. National stroke audit – rehabilitation services report 2020. Melbourne; 2020.

Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts. 2023. Webpage https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/about (accessed Jan 2024).

Download references

Acknowledgements

The following authors hold National Health and Medical Research Council Research Fellowships: HT (#2009326), DAC (#1154273), SM (#1196352), MFK Future Leader Research Fellowship (National Heart Foundation #105737). The Funders of this work did not have any direct role in the design of the study, its execution, analyses, interpretation of the data, or decision to submit results for publication.

Author information

Helena Teede and Dominique A. Cadilhac contributed equally.

Authors and Affiliations

Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia

Helena Teede, Emily Callander & Joanne Enticott

Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia

Helena Teede & Alison Johnson

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia

Dominique A. Cadilhac, Tara Purvis & Monique F. Kilkenny

Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia

Dominique A. Cadilhac, Monique F. Kilkenny & Bruce C.V. Campbell

Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia

Bruce C.V. Campbell

Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia

School of Health Sciences, Heart and Stroke Program, University of Newcastle, Hunter Medical Research Institute, University Drive, Callaghan, NSW, Australia

Coralie English

School of Medicine and Dentistry, Griffith University, Birtinya, QLD, Australia

Rohan S. Grimley

Clinical Excellence Division, Queensland Health, Brisbane, Australia

John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Sydney, NSW, Australia

Christopher Levi

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia

Sandy Middleton

Nursing Research Institute, St Vincent’s Health Network Sydney and and Australian Catholic University, Sydney, NSW, Australia

Stroke Foundation, Level 7, 461 Bourke St, Melbourne, VIC, Australia

Kelvin Hill

You can also search for this author in PubMed   Google Scholar

Contributions

HT: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. DAC: conception, design and initial draft, provided essential literature and case study examples, approved the submitted version. TP: revised the manuscript critically for important intellectual content, approved the submitted version. MFK: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. BC: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. CE: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. AJ: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. EC: revised the manuscript critically for important intellectual content, approved the submitted version. RSG: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. CL: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. SM: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. KH: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. JE: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. All authors read and approved the final manuscript.

Authors’ Twitter handles

@HelenaTeede

@DominiqueCad

@Coralie_English

@EmilyCallander

@EnticottJo

Corresponding authors

Correspondence to Helena Teede or Dominique A. Cadilhac .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests, additional information, publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Teede, H., Cadilhac, D.A., Purvis, T. et al. Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke. BMC Med 22 , 198 (2024). https://doi.org/10.1186/s12916-024-03416-w

Download citation

Received : 23 July 2023

Accepted : 30 April 2024

Published : 15 May 2024

DOI : https://doi.org/10.1186/s12916-024-03416-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Evidence-based medicine
  • Person-centred care
  • Models of care
  • Healthcare improvement

BMC Medicine

ISSN: 1741-7015

current literature data

Climate Change and Heat: Challenges for Child Health Outcomes and Inequities

  • Published: 14 May 2024

Cite this article

current literature data

  • Angela Y. Zhang 1 , 2 ,
  • Mary Beth Bennett 1 , 2 ,
  • Simona Martin 1 , 2 &
  • H. Mollie Grow 1 , 2  

Explore all metrics

Purpose of Review

As temperatures rise from human-driven climate change, adverse health outcomes will become more prominent, especially in children. Heat worsens other aspects of climate change in a vicious cycle, including air and water pollution, extreme weather events, and resource scarcity. These health outcomes are already magnified in minoritized communities globally, due to systems of power and oppression. This review summarizes research on pediatric health consequences of heat, and explores structural factors driving heat-related health inequity.

Recent Findings

There is growing literature on heat-related impacts on disease-specific outcomes that can generally be categorized by organ system. There already exists robust extra-medical literature on drivers of heat inequity in urban, rural, and global communities.

Heat impacts pediatric health across organ systems, especially as the population becomes more medically complex. This review can guide further research in pediatric-specific outcomes and emphasizes the need for multidisciplinary, community-centered efforts to mitigate health inequity in heat and climate change.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

current literature data

Similar content being viewed by others

current literature data

Association of ambient extreme heat with pediatric morbidity: a scoping review

current literature data

The health effects of hotter summers and heat waves in the population of the United Kingdom: a review of the evidence

current literature data

Racial Disparities in Climate Change-Related Health Effects in the United States

Data availability.

No datasets were generated or analysed during the current study.

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

•• Lee H, Romero J, et al. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. IPCC, Geneva. 2023:35–115.  Important governmental report on current state of climate change.

Vaidyanathan A, Gates A, Brown C, Prezzato E, Bernstein A. Heat-Related Emergency Department Visits, May-September 2023. MMWR Morb Mortal Wkly Rep. 2024;73. https://doi.org/10.15585/mmwr.mm7315a1 .

•• Perera F, Nadeau K. Climate Change, Fossil-Fuel Pollution, and Children’s Health. N Engl J Med. 2022;386:2303–14. Elegant summary of pathophysiology and specific pediatric effects.

Article   CAS   PubMed   Google Scholar  

Bernstein AS, Sun S, Weinberger KR, Spangler KR, Sheffield PE, Wellenius GA. Warm Season and Emergency Department Visits to U.S. Children’s Hospitals. Environ Health Perspect. 2022;130:017001.

Article   PubMed   PubMed Central   Google Scholar  

•• Uibel D, Sharma R, Piontkowski D, Sheffield PE, Clougherty JE. Association of ambient extreme heat with pediatric morbidity: a scoping review. Int J Biometeorol. 2022;66:1683–98. One of the only broad scoping reviews we found on heat and pediatric outcomes.

Munck A. Heat Wave and Acute Pancreatitis: Very Unusual Cystic Fibrosis Presentation. Pediatrics. 2004;113:1846.

Article   PubMed   Google Scholar  

Makrufardi F, Manullang A, Rusmawatiningtyas D, Chung KF, Lin S-C, Chuang H-C. Extreme weather and asthma: a systematic review and meta-analysis. Eur Respir Rev. 2023;32(168). https://doi.org/10.1183/16000617.0019-2023 .

Konstantinoudis G, Minelli C, Lam HCY, Fuertes E, Ballester J, Davies B, Vicedo-Cabrera AM, Gasparrini A, Blangiardo M. Asthma hospitalisations and heat exposure in England: a case–crossover study during 2002–2019. Thorax. 2023;78:875–81.

Lee AS, Aguilera J, Efobi JA, et al. Climate change and public health. EMBO Rep. 2023;24:e56821.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Manser CN, Paul M, Rogler G, Held L, Frei T. Heat Waves, Incidence of Infectious Gastroenteritis, and Relapse Rates of Inflammatory Bowel Disease: A Retrospective Controlled Observational Study. Off J Am Coll Gastroenterol ACG. 2013;108:1480.

Article   Google Scholar  

Lee YC, Kim TJ, Kim J-H, Lee E, Park W-Y, Kim K, Son HJ. Short-term effects of ambient temperature on acute exacerbation of inflammatory bowel disease: A nationwide case-crossover study with external validation. PLOS ONE. 2023;18:e0291713.

Lee GJ, Dotson JL, Kappelman MD, King E, Pratt JM, Colletti RB, Bistrick S, Burkam JL, Crandall WV, ImproveCareNow Network. Seasonality and pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2014;59:25–8.

Ni Y, Szpiro AA, Young MT, et al. Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort. Environ Health Perspect. 2021;129:047004.

Liu J, Varghese BM, Hansen A, Zhang Y, Driscoll T, Morgan G, Dear K, Gourley M, Capon A, Bi P. Heat exposure and cardiovascular health outcomes: a systematic review and meta-analysis. Lancet Planet Health. 2022;6:e484–95.

Alahmad B, Khraishah H, Royé D, et al. Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries. Circulation. 2023;147:35–46.

• Souilla L, Amedro P, Morrison SA. Children With Cardiac Disease and Heat Exposure: Catastrophic Converging Consequences? Pediatr Exerc Sci. 2024;1:1–5. The only study we found to speculate on heat effects on congenital cardiac disease.

Stingone JA, Luben TJ, Sheridan SC, et al. Associations between fine particulate matter, extreme heat events, and congenital heart defects. Environ Epidemiol Phila Pa. 2019;3:e071.

Risk of Congenital Heart Defects after Ambient Heat Exposure Early in Pregnancy - PubMed. https://pubmed.ncbi.nlm.nih.gov/27494594/ . Accessed 20 Apr 2024.

Kidd SA, Gong J, Massazza A, Bezgrebelna M, Zhang Y, Hajat S. Climate change and its implications for developing brains – In utero to youth: A scoping review. J Clim Change Health. 2023;13:100258.

Chersich MF, Pham MD, Areal A, et al. Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis. BMJ. 2020;371:m3811.

McElroy S, Ilango S, Dimitrova A, Gershunov A, Benmarhnia T. Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries. Environ Int. 2022;158:106902.

Ye T, Guo Y, Huang W, Zhang Y, Abramson MJ, Li S. Heat Exposure, Preterm Birth, and the Role of Greenness in Australia. JAMA Pediatr. 2024;178:376–83.

Sun X, Ren G, You Q, Ren Y, Xu W, Xue X, Zhan Y, Zhang S, Zhang P. Global diurnal temperature range (DTR) changes since 1901. Clim Dyn. 2019;52:3343–56.

Bátiz LF, Illanes SE, Romero R, del Valle Barrera M, Mattar CN, Choolani MA, Kemp MW. Climate change and preterm birth: A narrative review. Environ Adv. 2022;10:100316.

Qu Y, Zhang W, Boutelle A-YM, Ryan I, Deng X, Liu X, Lin S. Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease. Am J Kidney Dis. 2023;81:507–516.e1.

Kaufman J, Vicedo-Cabrera AM, Tam V, Song L, Coffel E, Tasian G. The impact of heat on kidney stone presentations in South Carolina under two climate change scenarios. Sci Rep. 2022;12:369.

The Lancet Infectious Diseases. Save our only planet. Lancet Infect Dis. 2021;21:1613.

Ebi KL, Hess JJ. Health Risks Due To Climate Change: Inequity In Causes And Consequences. Health Aff (Millwood). 2020;39:2056–62.

Mordecai EA, Ryan SJ, Caldwell JM, Shah MM, LaBeaud AD. Climate change could shift disease burden from malaria to arboviruses in Africa. Lancet Planet Health. 2020;4:e416–23.

Lian X, Huang J, Li H, He Y, Ouyang Z, Fu S, Zhao Y, Wang D, Wang R, Guan X. Heat waves accelerate the spread of infectious diseases. Environ Res. 2023;231:116090.

Kaseya J, Dereje N, Tajudeen R, Ngongo AN, Ndembi N, Fallah MP. Climate change and malaria, dengue and cholera outbreaks in Africa: a call for concerted actions. BMJ Glob Health. 2024;9:e015370.

Culver A, Rochat R, Cookson ST. Public health implications of complex emergencies and natural disasters. Confl Health. 2017;11:32.

Zarzeczny A, Kahar P. Vaccine Trends in Pakistan: A Review of Immunization Challenges and Setbacks Prompted by Inadequate Disaster Management. Cureus. 2024;16:e55357.

PubMed   PubMed Central   Google Scholar  

Zhang Y, Xu R, Ye T, et al. Heat exposure and hospitalisation for epileptic seizures: A nationwide case-crossover study in Brazil. Urban Clim. 2023;49:101497.

Kim SH, Kim JS, Jin MH, Lee JH. The effects of weather on pediatric seizure: A single-center retrospective study (2005–2015). Sci Total Environ. 2017;609:535–40.

Sisodiya SM, Fowler HJ, Lake I, Nanji RO, Gawel K, Esguerra CV, Newton C, Foley A. Climate change and epilepsy: Time to take action. Epilepsia Open. 2019;4:524–36.

Hickman C, Marks E, Pihkala P, Clayton S, Lewandowski RE, Mayall EE, Wray B, Mellor C, van Susteren L. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. Lancet Planet Health. 2021;5:e863–73.

Walinski A, Sander J, Gerlinger G, Clemens V, Meyer-Lindenberg A, Heinz A. The Effects of Climate Change on Mental Health. Dtsch Arzteblatt Int. 2023;120:117–24.

Google Scholar  

Basu R, Gavin L, Pearson D, Ebisu K, Malig B. Examining the Association Between Apparent Temperature and Mental Health-Related Emergency Room Visits in California. Am J Epidemiol. 2018;187:726–35.

Niu L, Girma B, Liu B, Schinasi LH, Clougherty JE, Sheffield P. Temperature and mental health–related emergency department and hospital encounters among children, adolescents and young adults. Epidemiol Psychiatr Sci. 2023;32:e22.

Sugg MM, Dixon PG, Runkle JD. Crisis support-seeking behavior and temperature in the United States: Is there an association in young adults and adolescents? Sci Total Environ. 2019;669:400–11.

Wargocki P, Wyon DP. The Effects of Moderately Raised Classroom Temperatures and Classroom Ventilation Rate on the Performance of Schoolwork by Children (RP-1257). HVACR Res. 2007;13:193–220.

Salthammer T, Uhde E, Schripp T, et al. Children’s well-being at schools: Impact of climatic conditions and air pollution. Environ Int. 2016;94:196–210.

Park RJ, Goodman J, Hurwitz M, Smith J. Heat and Learning. Am Econ J Econ Policy. 2020;12:306–39.

Sandquist M, Davenport T, Monaco J, Lyon ME. The Transition to Adulthood for Youth Living with Rare Diseases. Child Basel Switz. 2022;9:710.

Zambrana RE, Williams DR. The Intellectual Roots Of Current Knowledge On Racism And Health: Relevance To Policy And The National Equity Discourse. Health Aff (Millwood). 2022;41:163–70.

Berberian AG, Gonzalez DJX, Cushing LJ. Racial Disparities in Climate Change-Related Health Effects in the United States. Curr Environ Health Rep. 2022;9:451–64.

Egede LE, Walker RJ, Campbell JA, Linde S, Hawks LC, Burgess KM. Modern Day Consequences of Historic Redlining: Finding a Path Forward. J Gen Intern Med. 2023;38:1534–7.

Glantz A, Emmanuel M (2018) Modern-day redlining: Banks discriminate in lending. In: Reveal News. https://revealnews.org/article/for-people-of-color-banks-are-shutting-the-door-to-homeownership/ . Accessed 30 Mar 2024.

Jones BL, Hoffman M, Kane N. “Redlining” to “Hot Spots”: The Impacts of a Continued Legacy of Structural and Institutional Racism and Bias on Asthma in Children. J Allergy Clin Immunol Pract. 2022;10:992–3.

Shupler M, Huybrechts K, Leung M, Wei Y, Schwartz J, Li L, Koutrakis P, Hernández-Díaz S, Papatheodorou S. Short-Term Increases in NO2 and O3 Concentrations during Pregnancy and Stillbirth Risk in the U.S.: A Time-Stratified Case-Crossover Study. Environ Sci Technol. 2024;58:1097–108.

•• Hoffman JS, Shandas V, Pendleton N. The Effects of Historical Housing Policies on Resident Exposure to Intra-Urban Heat: A Study of 108 US Urban Areas. Climate. 2020;8:12. First paper studying heat in redlined areas.

Yang L, Qian F, Song D-X, Zheng K-J. Research on Urban Heat-Island Effect. Procedia Eng. 2016;169:11–8.

Fedor T, Hofierka J. Comparison of Urban Heat Island Diurnal Cycles under Various Atmospheric Conditions Using WRF-UCM. Atmosphere. 2022;13:2057.

Azevedo JA, Chapman L, Muller CL. Quantifying the Daytime and Night-Time Urban Heat Island in Birmingham, UK: A Comparison of Satellite Derived Land Surface Temperature and High Resolution Air Temperature Observations. Remote Sens. 2016;8:153.

Hsu A, Sheriff G, Chakraborty T, Manya D. Disproportionate exposure to urban heat island intensity across major US cities. Nat Commun. 2021;12:2721.

Malin SA, Ryder S, Lyra MG. Environmental justice and natural resource extraction: intersections of power, equity and access. Environ Sociol. 2019;5:109–16.

Fischer AP. Pathways of adaptation to external stressors in coastal natural-resource-dependent communities: Implications for climate change. World Dev. 2018;108:235–48.

Nichols M, Stein AD, Wold JL. Health Status of Children of Migrant Farm Workers: Farm Worker Family Health Program, Moultrie, Georgia. Am J Public Health. 2014;104:365–70.

Tugjamba N, Walkerden G, Miller F. Adapting nomadic pastoralism to climate change. Clim Change. 2023;176(4):28. https://doi.org/10.1007/s10584-023-03509-0 .

Thoman R, Walsh J. Alaska’s changing environment: documenting Alaska’s physical and biological changes through observations. International Arctic Research Center, University of Alaska Fairbanks; 2019.

Hahn MB, Kuiper G, Magzamen S. Association of Temperature Thresholds with Heat Illness– and Cardiorespiratory-Related Emergency Visits during Summer Months in Alaska. Environ Health Perspect. 2023;131:057009.

The White House. Report on the Impact of Climate Change on Migration. Washington, DC. Library of Congress. 2021;1–37. https://www.whitehouse.gov/wp-content/uploads/2021/10/Report-on-the-Impact-of-Climate-Change-on-Migration.pdf . 

Althor G, Watson JEM, Fuller RA. Global mismatch between greenhouse gas emissions and the burden of climate change. Sci Rep. 2016;6:20281.

Mishra SK, Upadhyaya P, Fasullo JT, Keshri NP, Salunke P, Ghosh A, Sainudeen AB, Kang I-S. A need for actionable climate projections across the Global South. Nat Clim Change. 2023;13:883–6.

• Issa R, van Daalen KR, Faddoul A, et al. Human migration on a heating planet: A scoping review. PLOS Clim. 2023;2:e0000214. Detailed review of factors in climate change driving migration.

Kumari Rigaud K, de Sherbinin A, Jones B, et al. Groundswell: Preparing for Internal Climate Migration. Washington, DC: The World Bank; 2018.

Book   Google Scholar  

Schwerdtle PN, McMichael C, Mank I, Sauerborn R, Danquah I, Bowen KJ. Health and migration in the context of a changing climate: a systematic literature assessment. Environ Res Lett. 2020;15:103006.

Kien C, Sommer I, Faustmann A, et al. Prevalence of mental disorders in young refugees and asylum seekers in European Countries: a systematic review. Eur Child Adolesc Psychiatry. 2019;28:1295–310.

Ramsaroop C. Pushing climate refugees into migrant worker programs: As climate change displaces millions worldwide, the Canadian government is expanding temporary foreign worker programs and funnelling migrants back onto the front lines of the crisis. Briarpatch. 2023;52:14–9.

Sultana F. The unbearable heaviness of climate coloniality. Polit Geogr. 2022;99:102638.

Marchand S. The colonial origins of deforestation: an institutional analysis. Environ Dev Econ. 2016;21:318–49.

Intergovernmental Panel On Climate Change (Ipcc) (2023) Climate Change 2022 – Impacts, Adaptation and Vulnerability: Working Group II Contribution to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, 1st ed. https://doi.org/10.1017/9781009325844 .

(PDF) A global assessment of the impact of climate change on water scarcity. https://www.researchgate.net/publication/255968819_A_global_assessment_of_the_impact_of_climate_change_on_water_scarcity . Accessed 20 Apr 2024.

Fanzo J, Davis C, McLaren R, Choufani J. The effect of climate change across food systems: Implications for nutrition outcomes. Glob Food Secur. 2018;18:12–9.

Callaghan M, Schleussner C-F, Nath S, et al. Machine-learning-based evidence and attribution mapping of 100,000 climate impact studies. Nat Clim Change. 2021;11:966–72.

Mercer H, Simpson T. Imperialism, colonialism, and climate change science. WIREs Clim Change. 2023;14:e851.

US EPA O (2015) Ground-level Ozone Basics. https://www.epa.gov/ground-level-ozone-pollution/ground-level-ozone-basics . Accessed 7 Apr 2024.

Kalashnikov DA, Schnell JL, Abatzoglou JT, Swain DL, Singh D. Increasing co-occurrence of fine particulate matter and ground-level ozone extremes in the western United States. Sci Adv. 2022;8:eabi9386.

Rahman MM, McConnell R, Schlaerth H, et al. The Effects of Coexposure to Extremes of Heat and Particulate Air Pollution on Mortality in California: Implications for Climate Change. Am J Respir Crit Care Med. 2022;206:1117–27.

US EPA O (2023) What is Superfund? https://www.epa.gov/superfund/what-superfund . Accessed 7 Apr 2024.

Powell DL, Stewart V. CHILDREN: The Unwitting Target of Environmental Injustices. Pediatr Clin North Am. 2001;48:1291–305.

Witze A. Racism is magnifying the deadly impact of rising city heat. Nature. 2021;595:349–51.

Lee J, Drysdale W. WMO Air Quality and Climate Bulletin. World Meteorologic Organization, Geneva. 2023;1–14. https://library.wmo.int/records/item/62090-no-3-september-2023 .

Vujovic S, Haddad B, Karaky H, Sebaibi N, Boutouil M. Urban Heat Island: Causes, Consequences, and Mitigation Measures with Emphasis on Reflective and Permeable Pavements. CivilEng. 2021;2:459–84.

Agache I, Sampath V, Aguilera J, et al. Climate change and global health: A call to more research and more action. Allergy. 2022;77:1389–407.

U.S. EPA, Office of Land and Emergency Management (2022) superfund.pdf. https://www.epa.gov/system/files/documents/2021-10/superfund.pdf . Accessed 7 Apr 2024.

Gomez A. Superfund: EPA should take additional actions to manage risks from climate change. United States Government Accountability Office; 2019.

Anawar HM. Impact of climate change on acid mine drainage generation and contaminant transport in water ecosystems of semi-arid and arid mining areas. Phys Chem Earth Parts ABC. 2013;58–60:13–21.

US EPA O MIDNITE MINE Site Profile. https://cumulis.epa.gov/supercpad/CurSites/srchsites.cfm . Accessed 7 Apr 2024.

Brugge D, Buchner V. Health effects of uranium: new research findings, vol. 26; 2011. p. 231–49.

Magdo HS, Forman J, Graber N, Newman B, Klein K, Satlin L, Amler RW, Winston JA, Landrigan PJ. Grand Rounds: Nephrotoxicity in a Young Child Exposed to Uranium from Contaminated Well Water. Environ Health Perspect. 2007;115:1237–41.

(2020) Alaska Metal Mines. In: Earthworks. https://earthworks.org/resources/alaskametalminesreport/ . Accessed 7 Apr 2024.

Lakshman S. More Critical Minerals Mining Could Strain Water Supplies in Stressed Regions. In: World Resour Inst. 2024. https://www.wri.org/insights/critical-minerals-mining-water-impacts . Accessed 21 Apr 2024.

Lewandowski AA, Sheffield PE, Ahdoot S, Maibach EW. Patients value climate change counseling provided by their pediatrician: The experience in one Wisconsin pediatric clinic. J Clim Change Health. 2021;4:100053.

Retirements of Coal and Oil Power Plants in California: Association With Reduced Preterm Birth Among Populations Nearby | American Journal of Epidemiology | Oxford Academic. https://academic.oup.com/aje/article/187/8/1586/4996680 . Accessed 20 Apr 2024.

Currie J, Walker R. Traffic Congestion and Infant Health: Evidence from E-ZPass. Am Econ J Appl Econ. 2011;3:65–90.

South EC, Hohl BC, Kondo MC, MacDonald JM, Branas CC. Effect of Greening Vacant Land on Mental Health of Community-Dwelling Adults: A Cluster Randomized Trial. JAMA Netw Open. 2018;1:e180298.

Ulrich RS. View Through a Window May Influence Recovery from Surgery. Science. 1984;224:420–421.  https://doi.org/10.1126/science.6143402 .

Connolly R, Lipsitt J, Aboelata M, Yañez E, Bains J, Jerrett M. The association of green space, tree canopy and parks with life expectancy in neighborhoods of Los Angeles. Environ Int. 2023;173:107785.

Abbinett J, Schramm P, Widerynski S, et al. Heat Response Plans: Summary of Evidence and Strategies for Collaboration and Implementation. Centers for Disease Control and Prevention. 2020;1–60. https://stacks.cdc.gov/view/cdc/93705/cdc_93705_DS1.pdf .

Baudon P, Jachens L. A Scoping Review of Interventions for the Treatment of Eco-Anxiety. Int J Environ Res Public Health. 2021;18:9636.

Harrington E, Cole A. Typologies of Mutual Aid in Climate Resilience: Variation in Reciprocity, Solidarity, Self-Determination, and Resistance. Environ Justice. 2022;15:160–9.

Spade D. Solidarity Not Charity: Mutual Aid for Mobilization and Survival. Soc Text. 2020;38:131–51.

Sherman JD, Chesebro BB. Inhaled anaesthesia and analgesia contribute to climate change. BMJ. 2022;377:o1301.

Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health Care Pollution And Public Health Damage In The United States: An Update. Health Aff (Millwood). 2020;39:2071–9.

Thiel CL, Park S, Musicus AA, Agins J, Gan J, Held J, Horrocks A, Bragg MA. Waste generation and carbon emissions of a hospital kitchen in the US: Potential for waste diversion and carbon reductions. PLOS ONE. 2021;16:e0247616.

Samantha Ahdoot MD. Updated climate change policy emphasizes practice, advocacy, justice. In: AAP News. 2024. https://publications.aap.org/aapnews/news/28177/Updated-climate-change-policy-emphasizes-practice . Accessed 21 Apr 2024.

Gage R, Wilson N, Signal L, Thomson G. Shade in playgrounds: findings from a nationwide survey and implications for urban health policy. J Public Health. 2019;27:669–74.

Olsen H, Kennedy E, Vanos J. Shade provision in public playgrounds for thermal safety and sun protection: A case study across 100 play spaces in the United States. Landsc Urban Plan. 2019;189:200–11.

Foderaro LW. Three Ways Schoolyards Address Climate Change. Trust Public Land; 2024.

Bedi NS, Adams QH, Hess JJ, Wellenius GA. The Role of Cooling Centers in Protecting Vulnerable Individuals from Extreme Heat. Epidemiology. 2022;33:611.

Lebel ED, Finnegan CJ, Ouyang Z, Jackson RB. Methane and NOx Emissions from Natural Gas Stoves, Cooktops, and Ovens in Residential Homes. Environ Sci Technol. 2022;56:2529–39.

Jee S, Friedman E, Etzel R, Nguyen V, Sack T, Kemper K. Climate Change Imperils Pediatric Health: Child Advocacy Through Fossil Fuel Divestment. Yale J Biol Med. 2023;96:233–9.

•• Ahdoot S, Baum CR, Cataletto MB, Hogan P, Wu CB, Bernstein A, Council On Environmental Health And Climate Change, Council On Children And Disasters, Section On Pediatric Pulmonology And Sleep Medicine, Section On Minority Health E And Inclusion. Climate Change and Children’s Health: Building a Healthy Future for Every Child. Pediatrics. 2024;153:e2023065504. Important statement from a leading pediatric medicine society.

Nik VM, Perera ATD, Chen D. Towards climate resilient urban energy systems: a review. Natl Sci Rev. 2021;8:nwaa134.  https://doi.org/10.1093/nsr/nwaa134 .

Zadkovic S, Lombardo N, Cole DC. Breastfeeding and Climate Change: Overlapping Vulnerabilities and Integrating Responses. J Hum Lact. 2021;37:323–30.

Rice L, Jennifer, Long J, Levenda A. Against climate apartheid: Confronting the persistent legacies of expendability for climate justice. Environ Plan E Nat Space. 2022;5:625–45.

Klein N. This Changes Everything: Capitalism Vs. The Climate. Simon and Schuster; 2015.

Download references

Acknowledgements

The authors would like to acknowledge the following individuals for their expertise and review of the manuscript: Indi Trehan, MD, MPH, DTM and H; Jonathan Cogen, MD, MPH; Alexandra Perkins, MD, MPH; Zho Ragen, PhD.

Author information

Authors and affiliations.

Department of Pediatrics, University of Washington, Seattle, Washington, USA

Angela Y. Zhang, Mary Beth Bennett, Simona Martin & H. Mollie Grow

Seattle Children’s Hospital, Seattle, WA, USA

You can also search for this author in PubMed   Google Scholar

Contributions

A.Y.Z., M.B.B., and S.M. wrote the main manuscript text. A.Y.Z. prepared Tables 1 and 2 , and Fig. 1 . H.M.G.G. provided supervision and direction. All authors reviewed the manuscript.

Corresponding author

Correspondence to Angela Y. Zhang .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Zhang, A.Y., Bennett, M.B., Martin, S. et al. Climate Change and Heat: Challenges for Child Health Outcomes and Inequities. Curr Pediatr Rep (2024). https://doi.org/10.1007/s40124-024-00314-w

Download citation

Accepted : 29 April 2024

Published : 14 May 2024

DOI : https://doi.org/10.1007/s40124-024-00314-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Climate Change
  • Health Inequity
  • Environmental Health
  • Planetary Health
  • Environmental Racism

Advertisement

  • Find a journal
  • Publish with us
  • Track your research

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

  • Advanced Search
  • Journal List
  • Lippincott Open Access

Logo of lwwopen

Integrity of Databases for Literature Searches in Nursing

The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines.

Research, evidence-based practice, quality improvement studies, and other scholarly projects typically begin with a literature review. In research, the review of the literature describes existing knowledge about the topic, reveals gaps and further research questions to be answered, and provides a rationale for engaging in a new study. In evidence-based practice, the literature review provides evidence to answer clinical questions and make informed decisions. Quality improvement studies also begin with a search of the literature to gather available knowledge about a problem and explore interventions used in other settings. The appearance of journals that are published by predatory publishers has introduced the danger that reviews of the literature include inadequate, poorly designed, and low-quality information being used as “evidence”—raising the possibility of risky and harmful practice. Researchers and authors should be confident in the literature they cite; readers should have assurance that the literature review is based on sound, authoritative sources. When predatory journals are cited, that trust is eroded. No matter what type of study or project is being done, the quality of literature is critical for the development of nursing knowledge and for providing up-to-date information, concepts, theories, and approaches to care. 1

An effective literature review requires searching various reliable and credible databases such as MEDLINE (through PubMed or Ovid) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), among others that are relevant to the topic. The ease of searching using a web browser (now commonly referred to as “googling”) has increased the risk of finding sources published in predatory and low-quality journals that have not met the standards of research and scholarship that can be trusted as credible and reliable evidence.

The purpose of this article is to present an analysis of the extent to which predatory nursing journals are included in MEDLINE, CINAHL, and Scopus databases, used by nurse researchers and other nurses when searching for information, and in the Directory of Open Access Journals. This directory indexes “high-quality, open access, peer-reviewed journals” and should not include any predatory journals. 2

Statement of Significance

What is known or assumed to be true about this topic?

The quality of nursing literature used is vital for the development of research studies, application of evidence in clinical settings, and other scholarly projects. Nurse scholars need to be confident as they search the literature that they are accessing sound information sources and not articles from predatory nursing journals, which do not adhere to quality and ethical publishing standards. Citations of articles in predatory nursing journals may be found when searching Google and Google Scholar, making these citations easy to access but potentially resulting in the integration of poor quality research into the nursing literature. On the other hand, searches through credible databases—MEDLINE, CINAHL, and Scopus—are less likely to yield citations from predatory publications.

What this article adds:

This study helps validate the trustworthiness of these databases for conducting searches in nursing.

PREDATORY JOURNALS

Many studies have documented the problem of predatory journals. These journals do not adhere to quality and ethical publishing standards, often use deceptive language in emails to encourage authors to submit their manuscripts to them, are open access but may not be transparent with the article processing charge, may have quick but questionable peer review, and may publish inaccurate information on their Web sites such as impact factor and indexing. 3 – 6 Predatory publishing is an issue in many fields including nursing. In a recent study, 127 predatory journals were identified in nursing. 7

Citations acknowledge the ideas of others and give credit to the authors of the original work. When articles are cited in a subsequent publication, those citations disseminate the information beyond the original source, and the article in which it is cited might in turn be referenced again, transferring knowledge from one source to yet another. When articles in predatory journals are cited, the same process occurs. Those citations transfer knowledge from the predatory publication beyond that source. Studies have found that authors are citing articles published in predatory journals in nursing as well as other fields. 7 – 10 Nurse scholars need to be confident as they search the literature that they are accessing sound information sources and not articles from predatory journals.

NATIONAL LIBRARY OF MEDICINE INFORMATION RESOURCES

The National Library of Medicine (NLM) supports researchers and clinicians through its multiple health information resources including PubMed, MEDLINE, and PubMed Central (PMC). PubMed serves as the search engine to access the MEDLINE database, PMC, and books, chapters, and other documents that are indexed by the NLM. PubMed is free and publicly available: by using PubMed, researchers can search more than 30 million citations to the biomedical literature. 11 The majority of records in PubMed are from MEDLINE, which has citations from more than 5200 scholarly journals. For inclusion in MEDLINE, journals are assessed for their quality by the Literature Selection Technical Review Committee. 12 Five areas are included in this assessment: scope of the journal (ie, in a biomedical subject); quality of the content (validity, importance of the content, originality, and contribution of the journal to the coverage of the field); editorial standards and practices; production quality (eg, layout and graphics); and audience (content addresses health care professionals).

PMC includes journal citations and full-text articles that are selected by the NLM for digital archiving. To be included in PMC, journals are evaluated for their scope and scientific, editorial, and technical quality. 13 Journals considered for inclusion are evaluated by independent individuals both inside and outside PMC. 14 PMC serves as the repository for articles to meet the compliance requirements of the National Institutes of Health (NIH) and other funding agencies for public access to funded research. About 12% of the articles in PMC are deposited by individual authors to be in compliance with funders and 64% by publishers, scholarly societies, and other groups. 15 Beginning in June 2020, as a pilot program, preprints reporting research funded by the NIH also can be deposited in PMC. 16

CINAHL AND SCOPUS

The journal assessment and indexing processes for CINAHL and Scopus are similar to those used by the NLM. However, as private corporations, EBSCO (CINAHL) and Elsevier (Scopus) are not required to make journal selection processes publicly available or explicit. CINAHL has an advisory board for journal selection. A CINAHL representative provided the following criteria for indexing of journals in CINAHL: high impact factor; usage in reputable subject indexes (eg, the NLM catalog); peer-reviewed journals covered by other databases (eg, Web of Science and Scopus); top-ranked journals by industry studies; and article quality (avoiding low-quality journals) (personal communication, October 19, 2020).

Elsevier's Scopus provides a webpage referring to the journal selection and assessment processes. Journals being considered for indexing in Scopus are evaluated by the Content Selection and Advisory Board and must meet the following criteria: peer-reviewed with a publicly available description of the peer review process; published on a regular basis; has a registered International Standard Serial Number (ISSN); includes references in Roman (Latin) script; has English language titles and abstracts; and has publicly available publication ethics and publication malpractice statements. 17

LITERATURE REVIEW

Studies have shown that in health care fields, researchers, clinicians, faculty, and students regularly search MEDLINE for their research and other scholarly and clinical information. 18 – 21 De Groote et al 18 found that 81% of health science faculty used MEDLINE to locate articles for their research. MEDLINE was used by the majority of faculty in each individual health care field including nursing (75%) and medicine (87.5%) for searching the literature and finding articles. In another study of 15 different resources, medical faculty and residents reported that PubMed was used most frequently for searching the databases of the NLM, primarily MEDLINE. 20 Few studies have focused on the search practices of nurses. In a review of the literature, Alving et al 22 found that hospital nurses primarily searched Google for information on evidence-based nursing. They used Google more than bibliographic databases.

The quality of content that is retrieved when using PubMed as a search engine is important considering its widespread use for accessing scholarly and clinical information in nursing and other fields. Manca et al 23 reported that articles published in predatory journals were being retrieved when conducting searches using PubMed and were a concern for researchers. Based on their studies of predatory journals in neurology 24 and rehabilitation, 25 they concluded that predatory journals “leaked into PubMed” through PMC because of less stringent criteria for inclusion of journals. 23 Citations to articles from predatory journals then could be found using the PubMed search engine. However, in a letter to the editor, Topper et al 26 from the NLM clarified that individual articles published in predatory journals might be deposited in PMC to meet the requirements of research funding and be searchable in PubMed. Topper and colleagues make a clear distinction between journals indexed in MEDLINE or PMC and citations of individual articles that were deposited in PMC to meet funder requirements.

The aim of this study was to determine whether predatory nursing journals were included in databases used by nurse researchers and other nurses when searching for information. These databases included MEDLINE (searched via PubMed), CINAHL (EBSCO), and Scopus (Elsevier) and in the Directory of Open Access Journals.

In an earlier study, 127 predatory nursing journals were identified and assessed for characteristics of predatory publications. That dataset was used for the current study. For each predatory nursing journal, information was retrieved from the NLM Catalog, Ulrichsweb, and journal and publisher Web sites. Ulrichsweb 27 provides bibliographic and publisher information on academic and scholarly journals, open access journals, peer-reviewed titles, magazines, newspapers, and other publications. Journal titles of the predatory journals were often similar to nonpredatory journals and could be easily mistaken. To ensure accuracy, the information for each journal was checked for consistency between these sources using the ISSN, exact journal title, and publisher name. The purpose of an ISSN is to identify a publication and distinguish it from other publications with similar names. An ISSN is mandatory for all publications in many countries and having one assigned is considered a journal best practice. 28 For each predatory journal, the following data were collected if available: complete journal title; abbreviated journal title; acronym; ISSN (electronic and/or print); DOI prefix; publisher name and Web site URL; NLM index status; number of predatory journal articles cited in MEDLINE and PMC (when searching using PubMed), in CINAHL, and in Scopus; if the journal was indexed in the Directory of Open Access Journals; status in Ulrichsweb; and Google Scholar profile URL.

Counts of articles cited were checked individually by journal title, publisher, and/or ISSN. Once ISSNs (both electronic and print where available) were assembled, a search algorithm was created, which included all retrieved journal ISSNs. MEDLINE was searched via PubMed using a combination of NLM journal title abbreviations and ISSNs. CINAHL, Scopus, and the Directory of Open Access Journals were searched using a combination of ISSN, journal title abbreviation, full title, and publisher. Results were visually inspected for accuracy and alignment with dataset fields.

Data analysis

Data were collected between January and April 2020. Data were entered into an Excel spreadsheet and organized by predatory journal name; abbreviated journal title; acronym; ISSN (electronic, print); DOI prefix; Web site URL; entry in NLM Catalog (yes/no); index status; number of articles cited in PubMed, CINAHL, and Scopus; Directory of Open Access Journals (included/not included); Ulrichsweb status (active/ceased); publisher; and Google Scholar profile URL. Frequencies and medians are reported.

Of the 127 predatory nursing journals in the dataset, only 102 had ISSNs to use for the search. Eighteen of the journals had records in the NLM Catalog, but only 2 of those had ever been indexed in MEDLINE, and neither are currently indexed. These 2 journals had been published earlier by a reputable publisher but then were sold to one of the large predatory publishers. The NLM Catalog record for these journals indicates that citations of articles from them appeared in MEDLINE through 2014 for one of the journals and 2018 for other, but following their transition to the new publisher are no longer included. Consistent with the MEDLINE results, these same 2 journals had been indexed in Scopus as well. Citations of articles from one of these journals were added to Scopus up to 2014, with no articles cited thereafter. Articles from the second journal continue to be added through 2020. One additional journal from the predatory journal dataset is currently in Scopus, however, only through 2014. None of the predatory nursing journals were indexed in CINAHL based on full journal title, title abbreviation, ISSN, or publisher. Two journals in the dataset were found in the Directory of Open Access Journals.

When searching PubMed, we found citations of articles from 16 predatory nursing journals. The number of citations ranged from 1 to 372 citations (from one of the journals indexed earlier in MEDLINE but sold to a predatory publisher). The second highest number of citations (n = 168) was of articles from a predatory nursing journal that had been depositing articles in PMC (and thus were retrievable when searching PubMed) but is no longer adding new material to PMC. The other citations were of articles deposited in PMC to meet requirements of NIH and other research funding. The predatory journals in which these articles were published, however, are not indexed in MEDLINE or PMC.

There were no articles from predatory nursing journals cited in CINAHL. Scopus has citations from the 2 predatory nursing journals that are no longer indexed there: 616 that were published in one of the journals and 120 from the other. Articles from a third predatory nursing journal in the study dataset, which is currently indexed in Scopus, totaled 173 (see Table).

Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

a Predatory nursing journals with 3 or more citations to articles.

b Search using PubMed.

This analysis documented that none of the predatory nursing journals in the study dataset were currently indexed in MEDLINE or CINAHL, and only one journal is still in Scopus. Most of the citations of articles from predatory journals found in a search of these databases are from earlier years before the journals were sold to one of the large predatory publishers. Other citations are to articles deposited in PMC in compliance with research funder requirements.

By using PubMed as a search engine and entry point to the databases of the NLM, researchers can search millions of records included in MEDLINE, or in process for inclusion, and articles from PMC deposited by publishers or authors for compliance with funders. Six million records, and about 5500 journals, can be searched in CINAHL Complete, 29 and Scopus, the largest of the proprietary databases, provides access to 24000 journals and 60 million records. 30 Results from this study show that very few articles published in predatory nursing journals find their way into a search done using PubMed and Scopus and none into CINAHL.

In a prior study, 814 citations of articles in predatory nursing journals were found in articles published in nonpredatory nursing journals. 7 Based on this current study, the conclusion can be made that these citations are not coming from searches in MEDLINE/PubMed, CINAHL, or Scopus and are likely from searches done using Google or Google Scholar as the search engine. The databases examined in this study are curated by organizations with a vested interest in maintaining and improving the quality of the research literature in those databases.

Searching multiple databases using different search engines can be frustrating and time consuming. There is overlap among MEDLINE, CINAHL, and Scopus. However, these are curated databases and, as this study found, are unlikely to return many, if any, predatory citations as part of the search results. Still, it falls on the searcher to eliminate duplicates and redundant citations. Further, certain types of literature, such as theses, dissertations, and fugitive (or “gray” literature), 31 are unlikely to be found in any of these databases, even though those citations may be important or relevant sources. Given this, it is easy to understand the intuitive appeal of Google Scholar, which provides “one stop shopping”: “From one place, you can search across many disciplines and sources: articles, theses, books, abstracts and court opinions, from academic publishers, professional societies, online repositories, universities and other web sites. Google Scholar helps you find relevant work across the world of scholarly research.” 32 Google and Google Scholar were founded with a mission to become the most comprehensive search engines in the world. While this allows someone to scour the World Wide Web and Internet for some of the most obscure facts available, at the same time, little is done to verify or validate the results that are returned. Thus, it falls on the searcher to be diligent and evaluate the results of a Google or Google Scholar search, which will include citations of articles in predatory journals. This is easily confirmed by the fact that many predatory journal Web sites promote the Google Scholar logo as a sign of indexing or a badge of legitimacy.

Another vexing issue that was revealed in this study is that of reputable journals that have been bought by predatory publishers. This study found 2 journals in this category. Brown 33 reported on 16 medical specialty journals that were purchased from 2 Canadian commercial publishers by a predatory publisher. In all these cases, it is the same predatory publisher, although some of the purchases were made under a different business imprint, adding further confusion to an already muddied situation. Jeffrey Beall, who coined the term “predatory publisher” and maintained the blog “Scholarly Open Access” for almost a decade, was quoted by Brown 33 : “[The company] is not only buying journals, it is buying metrics and indexing, such as the journals' impact factors and listing in Scopus and PubMed, in order to look legitimate.” One positive finding from this study was that the 2 purchased journals that were identified were quickly de-accessioned by the NLM and are no longer indexed in MEDLINE, although citations from their pre-predatory era remain intact.

Recommendations

All of this presents a confusing picture, but it is possible to make some specific recommendations to aid researchers, clinicians, faculty, and students in their literature searches. First, become familiar with the journals and publications in your field. This is a basic foundation of scholarship. As you read articles, remember where they were published, learn journal titles, and focus on sources as well as the content. As you come across predatory journals in nursing and health care, make note of them and learn their titles too. Remember that many predatory journals adopt names that are intended to be confusing and may differ from a legitimate journal by only one letter, such as “Africa” and “African.”

Second, consider carefully how to approach your search from the outset. If you choose to start with MEDLINE (searched via PubMed), CINAHL, or Scopus, then you can have some assurance that the results will not return citations from predatory journals—although you should still verify every citation that you receive. On the other hand, Google and Google Scholar can be a “quick and easy” way to get started but will require that you carefully review and evaluate the results. If you need to venture to other more specialized databases, such as PsycInfo or ERIC (Education Resources Information Center), it is important to carefully inspect the results that you receive. To reduce the risk of including a predatory journal article in research, nursing scholars should use reputable bibliographic databases, which have clear criteria for journal indexing, for their searches.

Third, when you come across a journal title that is not familiar, take time to research it, visit the journal Web site and evaluate the information at the Web site, and determine whether it is a credible source to include in your results. If something seems irregular, then it is worth your time to do more investigating—either on your own or by enlisting the help of a knowledgeable colleague or librarian. Journals change publishers all the time, and while most of these business transfers are benign and probably will not impact you as an end consumer of the literature, that is not always the case. Likewise, the major publishers in the world today are large, multinational conglomerates that regularly spin off or purchase other companies. While this probably will not impact you on a day-to-day basis, it is important to investigate any irregularities when conducting a search of the literature.

Last, because these issues are complex and multifaceted, it is always wise to consult with a librarian who can assist you in every step of the search process. Their knowledge and expertise in information literacy, data sources, and searching techniques can help to ensure that you find the information you need from sources that are reliable and credible.

Researchers, clinicians, faculty, and students need to be careful not to include citations from predatory sources in their literature searches and articles. Predatory journals publish low-quality studies and citing this work erodes the scholarly literature in nursing. The findings of this study offer some reassurance to those who search the professional nursing literature: if you begin a search in a database such as MEDLINE, CINAHL, or Scopus, then the results will probably not include citations to predatory publications. Google and Google Scholar searches, however, may very well include predatory citations, and in that case, it is the searcher's responsibility to carefully evaluate the output and discard findings from nonlegitimate sources. Enlisting the help of a librarian is always beneficial and highly recommended.

Peggy L. Chinn, PhD, RN, FAAN, Editor, Advances in Nursing Science , is a member of our research team and contributed to the study and preparation of the manuscript.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • View all journals
  • My Account Login
  • Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • Open access
  • Published: 08 May 2024

Exploring the dynamics of consumer engagement in social media influencer marketing: from the self-determination theory perspective

  • Chenyu Gu   ORCID: orcid.org/0000-0001-6059-0573 1 &
  • Qiuting Duan 2  

Humanities and Social Sciences Communications volume  11 , Article number:  587 ( 2024 ) Cite this article

404 Accesses

2 Altmetric

Metrics details

  • Business and management
  • Cultural and media studies

Influencer advertising has emerged as an integral part of social media marketing. Within this realm, consumer engagement is a critical indicator for gauging the impact of influencer advertisements, as it encompasses the proactive involvement of consumers in spreading advertisements and creating value. Therefore, investigating the mechanisms behind consumer engagement holds significant relevance for formulating effective influencer advertising strategies. The current study, grounded in self-determination theory and employing a stimulus-organism-response framework, constructs a general model to assess the impact of influencer factors, advertisement information, and social factors on consumer engagement. Analyzing data from 522 samples using structural equation modeling, the findings reveal: (1) Social media influencers are effective at generating initial online traffic but have limited influence on deeper levels of consumer engagement, cautioning advertisers against overestimating their impact; (2) The essence of higher-level engagement lies in the ad information factor, affirming that in the new media era, content remains ‘king’; (3) Interpersonal factors should also be given importance, as influencing the surrounding social groups of consumers is one of the effective ways to enhance the impact of advertising. Theoretically, current research broadens the scope of both social media and advertising effectiveness studies, forming a bridge between influencer marketing and consumer engagement. Practically, the findings offer macro-level strategic insights for influencer marketing.

Similar content being viewed by others

current literature data

Exploring the effects of audience and strategies used by beauty vloggers on behavioural intention towards endorsed brands

current literature data

COBRAs and virality: viral campaign values on consumer behaviour

current literature data

Exploring the impact of beauty vloggers’ credible attributes, parasocial interaction, and trust on consumer purchase intention in influencer marketing

Introduction.

Recent studies have highlighted an escalating aversion among audiences towards traditional online ads, leading to a diminishing effectiveness of traditional online advertising methods (Lou et al., 2019 ). In an effort to overcome these challenges, an increasing number of brands are turning to influencers as their spokespersons for advertising. Utilizing influencers not only capitalizes on their significant influence over their fan base but also allows for the dissemination of advertising messages in a more native and organic manner. Consequently, influencer-endorsed advertising has become a pivotal component and a growing trend in social media advertising (Gräve & Bartsch, 2022 ). Although the topic of influencer-endorsed advertising has garnered increasing attention from scholars, the field is still in its infancy, offering ample opportunities for in-depth research and exploration (Barta et al., 2023 ).

Presently, social media influencers—individuals with substantial follower bases—have emerged as the new vanguard in advertising (Hudders & Lou, 2023 ). Their tweets and videos possess the remarkable potential to sway the purchasing decisions of thousands if not millions. This influence largely hinges on consumer engagement behaviors, implying that the impact of advertising can proliferate throughout a consumer’s entire social network (Abbasi et al., 2023 ). Consequently, exploring ways to enhance consumer engagement is of paramount theoretical and practical significance for advertising effectiveness research (Xiao et al., 2023 ). This necessitates researchers to delve deeper into the exploration of the stimulating factors and psychological mechanisms influencing consumer engagement behaviors (Vander Schee et al., 2020 ), which is the gap this study seeks to address.

The Stimulus-Organism-Response (S-O-R) framework has been extensively applied in the study of consumer engagement behaviors (Tak & Gupta, 2021 ) and has been shown to integrate effectively with self-determination theory (Yang et al., 2019 ). Therefore, employing the S-O-R framework to investigate consumer engagement behaviors in the context of influencer advertising is considered a rational approach. The current study embarks on an in-depth analysis of the transformation process from three distinct dimensions. In the Stimulus (S) phase, we focus on how influencer factors, advertising message factors, and social influence factors act as external stimuli. This phase scrutinizes the external environment’s role in triggering consumer reactions. During the Organism (O) phase, the research explores the intrinsic psychological motivations affecting individual behavior as posited in self-determination theory. This includes the willingness for self-disclosure, the desire for innovation, and trust in advertising messages. The investigation in this phase aims to understand how these internal motivations shape consumer attitudes and perceptions in the context of influencer marketing. Finally, in the Response (R) phase, the study examines how these psychological factors influence consumer engagement behavior. This part of the research seeks to understand the transition from internal psychological states to actual consumer behavior, particularly how these states drive the consumers’ deep integration and interaction with the influencer content.

Despite the inherent limitations of cross-sectional analysis in capturing the full temporal dynamics of consumer engagement, this study seeks to unveil the dynamic interplay between consumers’ psychological needs—autonomy, competence, and relatedness—and their varying engagement levels in social media influencer marketing, grounded in self-determination theory. Through this lens, by analyzing factors related to influencers, content, and social context, we aim to infer potential dynamic shifts in engagement behaviors as psychological needs evolve. This approach allows us to offer a snapshot of the complex, multi-dimensional nature of consumer engagement dynamics, providing valuable insights for both theoretical exploration and practical application in the constantly evolving domain of social media marketing. Moreover, the current study underscores the significance of adapting to the dynamic digital environment and highlights the evolving nature of consumer engagement in the realm of digital marketing.

Literature review

Stimulus-organism-response (s-o-r) model.

The Stimulus-Response (S-R) model, originating from behaviorist psychology and introduced by psychologist Watson ( 1917 ), posits that individual behaviors are directly induced by external environmental stimuli. However, this model overlooks internal personal factors, complicating the explanation of psychological states. Mehrabian and Russell ( 1974 ) expanded this by incorporating the individual’s cognitive component (organism) into the model, creating the Stimulus-Organism-Response (S-O-R) framework. This model has become a crucial theoretical framework in consumer psychology as it interprets internal psychological cognitions as mediators between stimuli and responses. Integrating with psychological theories, the S-O-R model effectively analyzes and explains the significant impact of internal psychological factors on behavior (Koay et al., 2020 ; Zhang et al., 2021 ), and is extensively applied in investigating user behavior on social media platforms (Hewei & Youngsook, 2022 ). This study combines the S-O-R framework with self-determination theory to examine consumer engagement behaviors in the context of social media influencer advertising, a logic also supported by some studies (Yang et al., 2021 ).

Self-determination theory

Self-determination theory, proposed by Richard and Edward (2000), is a theoretical framework exploring human behavioral motivation and personality. The theory emphasizes motivational processes, positing that individual behaviors are developed based on factors satisfying their psychological needs. It suggests that individual behavioral tendencies are influenced by the needs for competence, relatedness, and autonomy. Furthermore, self-determination theory, along with organic integration theory, indicates that individual behavioral tendencies are also affected by internal psychological motivations and external situational factors.

Self-determination theory has been validated by scholars in the study of online user behaviors. For example, Sweet applied the theory to the investigation of community building in online networks, analyzing knowledge-sharing behaviors among online community members (Sweet et al., 2020 ). Further literature review reveals the applicability of self-determination theory to consumer engagement behaviors, particularly in the context of influencer marketing advertisements. Firstly, self-determination theory is widely applied in studying the psychological motivations behind online behaviors, suggesting that the internal and external motivations outlined within the theory might also apply to exploring consumer behaviors in influencer marketing scenarios (Itani et al., 2022 ). Secondly, although research on consumer engagement in the social media influencer advertising context is still in its early stages, some studies have utilized SDT to explore behaviors such as information sharing and electronic word-of-mouth dissemination (Astuti & Hariyawan, 2021 ). These behaviors, which are part of the content contribution and creation dimensions of consumer engagement, may share similarities in the underlying psychological motivational mechanisms. Thus, this study will build upon these foundations to construct the Organism (O) component of the S-O-R model, integrating insights from SDT to further understand consumer engagement in influencer marketing.

Consumer engagement

Although scholars generally agree at a macro level to define consumer engagement as the creation of additional value by consumers or customers beyond purchasing products, the specific categorization of consumer engagement varies in different studies. For instance, Simon and Tossan interpret consumer engagement as a psychological willingness to interact with influencers (Simon & Tossan, 2018 ). However, such a broad definition lacks precision in describing various levels of engagement. Other scholars directly use tangible metrics on social media platforms, such as likes, saves, comments, and shares, to represent consumer engagement (Lee et al., 2018 ). While this quantitative approach is not flawed and can be highly effective in practical applications, it overlooks the content aspect of engagement, contradicting the “content is king” principle of advertising and marketing. We advocate for combining consumer engagement with the content aspect, as content engagement not only generates more traces of consumer online behavior (Oestreicher-Singer & Zalmanson, 2013 ) but, more importantly, content contribution and creation are central to social media advertising and marketing, going beyond mere content consumption (Qiu & Kumar, 2017 ). Meanwhile, we also need to emphasize that engagement is not a fixed state but a fluctuating process influenced by ongoing interactions between consumers and influencers, mediated by the evolving nature of social media platforms and the shifting sands of consumer preferences (Pradhan et al., 2023 ). Consumer engagement in digital environments undergoes continuous change, reflecting a journey rather than a destination (Viswanathan et al., 2017 ).

The current study adopts a widely accepted definition of consumer engagement from existing research, offering operational feasibility and aligning well with the research objectives of this paper. Consumer engagement behaviors in the context of this study encompass three dimensions: content consumption, content contribution, and content creation (Muntinga et al., 2011 ). These dimensions reflect a spectrum of digital engagement behaviors ranging from low to high levels (Schivinski et al., 2016 ). Specifically, content consumption on social media platforms represents a lower level of engagement, where consumers merely click and read the information but do not actively contribute or create user-generated content. Some studies consider this level of engagement as less significant for in-depth exploration because content consumption, compared to other forms, generates fewer visible traces of consumer behavior (Brodie et al., 2013 ). Even in a study by Qiu and Kumar, it was noted that the conversion rate of content consumption is low, contributing minimally to the success of social media marketing (Qiu & Kumar, 2017 ).

On the other hand, content contribution, especially content creation, is central to social media marketing. When consumers comment on influencer content or share information with their network nodes, it is termed content contribution, representing a medium level of online consumer engagement (Piehler et al., 2019 ). Furthermore, when consumers actively upload and post brand-related content on social media, this higher level of behavior is referred to as content creation. Content creation represents the highest level of consumer engagement (Cheung et al., 2021 ). Although medium and high levels of consumer engagement are more valuable for social media advertising and marketing, this exploratory study still retains the content consumption dimension of consumer engagement behaviors.

Theoretical framework

Internal organism factors: self-disclosure willingness, innovativeness, and information trust.

In existing research based on self-determination theory that focuses on online behavior, competence, relatedness, and autonomy are commonly considered as internal factors influencing users’ online behaviors. However, this approach sometimes strays from the context of online consumption. Therefore, in studies related to online consumption, scholars often use self-disclosure willingness as an overt representation of autonomy, innovativeness as a representation of competence, and trust as a representation of relatedness (Mahmood et al., 2019 ).

The use of these overt variables can be logically explained as follows: According to self-determination theory, individuals with a higher level of self-determination are more likely to adopt compensatory mechanisms to facilitate behavior compared to those with lower self-determination (Wehmeyer, 1999 ). Self-disclosure, a voluntary act of sharing personal information with others, is considered a key behavior in the development of interpersonal relationships. In social environments, self-disclosure can effectively alleviate stress and build social connections, while also seeking societal validation of personal ideas (Altman & Taylor, 1973 ). Social networks, as para-social entities, possess the interactive attributes of real societies and are likely to exhibit similar mechanisms. In consumer contexts, personal disclosures can include voluntary sharing of product interests, consumption experiences, and future purchase intentions (Robertshaw & Marr, 2006 ). While material incentives can prompt personal information disclosure, many consumers disclose personal information online voluntarily, which can be traced back to an intrinsic need for autonomy (Stutzman et al., 2011 ). Thus, in this study, we consider the self-disclosure willingness as a representation of high autonomy.

Innovativeness refers to an individual’s internal level of seeking novelty and represents their personality and tendency for novelty (Okazaki, 2009 ). Often used in consumer research, innovative consumers are inclined to try new technologies and possess an intrinsic motivation to use new products. Previous studies have shown that consumers with high innovativeness are more likely to search for information on new products and share their experiences and expertise with others, reflecting a recognition of their own competence (Kaushik & Rahman, 2014 ). Therefore, in consumer contexts, innovativeness is often regarded as the competence dimension within the intrinsic factors of self-determination (Wang et al., 2016 ), with external motivations like information novelty enhancing this intrinsic motivation (Lee et al., 2015 ).

Trust refers to an individual’s willingness to rely on the opinions of others they believe in. From a social psychological perspective, trust indicates the willingness to assume the risk of being harmed by another party (McAllister, 1995 ). Widely applied in social media contexts for relational marketing, information trust has been proven to positively influence the exchange and dissemination of consumer information, representing a close and advanced relationship between consumers and businesses, brands, or advertising endorsers (Steinhoff et al., 2019 ). Consumers who trust brands or social media influencers are more willing to share information without fear of exploitation (Pop et al., 2022 ), making trust a commonly used representation of the relatedness dimension in self-determination within consumer contexts.

Construction of the path from organism to response: self-determination internal factors and consumer engagement behavior

Following the logic outlined above, the current study represents the internal factors of self-determination theory through three variables: self-disclosure willingness, innovativeness, and information trust. Next, the study explores the association between these self-determination internal factors and consumer engagement behavior, thereby constructing the link between Organism (O) and Response (R).

Self-disclosure willingness and consumer engagement behavior

In the realm of social sciences, the concept of self-disclosure willingness has been thoroughly examined from diverse disciplinary perspectives, encompassing communication studies, sociology, and psychology. Viewing from the lens of social interaction dynamics, self-disclosure is acknowledged as a fundamental precondition for the initiation and development of online social relationships and interactive engagements (Luo & Hancock, 2020 ). It constitutes an indispensable component within the spectrum of interactive behaviors and the evolution of interpersonal connections. Voluntary self-disclosure is characterized by individuals divulging information about themselves, which typically remains unknown to others and is inaccessible through alternative sources. This concept aligns with the tenets of uncertainty reduction theory, which argues that during interpersonal engagements, individuals seek information about their counterparts as a means to mitigate uncertainties inherent in social interactions (Lee et al., 2008 ). Self-disclosure allows others to gain more personal information, thereby helping to reduce the uncertainty in interpersonal relationships. Such disclosure is voluntary rather than coerced, and this sharing of information can facilitate the development of relationships between individuals (Towner et al., 2022 ). Furthermore, individuals who actively engage in social media interactions (such as liking, sharing, and commenting on others’ content) often exhibit higher levels of self-disclosure (Chu et al., 2023 ); additional research indicates a positive correlation between self-disclosure and online engagement behaviors (Lee et al., 2023 ). Taking the context of the current study, the autonomous self-disclosure willingness can incline social media users to read advertising content more attentively and share information with others, and even create evaluative content. Therefore, this paper proposes the following research hypothesis:

H1a: The self-disclosure willingness is positively correlated with content consumption in consumer engagement behavior.

H1b: The self-disclosure willingness is positively correlated with content contribution in consumer engagement behavior.

H1c: The self-disclosure willingness is positively correlated with content creation in consumer engagement behavior.

Innovativeness and consumer engagement behavior

Innovativeness represents an individual’s propensity to favor new technologies and the motivation to use new products, associated with the cognitive perception of one’s self-competence. Individuals with a need for self-competence recognition often exhibit higher innovativeness (Kelley & Alden, 2016 ). Existing research indicates that users with higher levels of innovativeness are more inclined to accept new product information and share their experiences and discoveries with others in their social networks (Yusuf & Busalim, 2018 ). Similarly, in the context of this study, individuals, as followers of influencers, signify an endorsement of the influencer. Driven by innovativeness, they may be more eager to actively receive information from influencers. If they find the information valuable, they are likely to share it and even engage in active content re-creation to meet their expectations of self-image. Therefore, this paper proposes the following research hypotheses:

H2a: The innovativeness of social media users is positively correlated with content consumption in consumer engagement behavior.

H2b: The innovativeness of social media users is positively correlated with content contribution in consumer engagement behavior.

H2c: The innovativeness of social media users is positively correlated with content creation in consumer engagement behavior.

Information trust and consumer engagement

Trust refers to an individual’s willingness to rely on the statements and opinions of a target object (Moorman et al., 1993 ). Extensive research indicates that trust positively impacts information dissemination and content sharing in interpersonal communication environments (Majerczak & Strzelecki, 2022 ); when trust is established, individuals are more willing to share their resources and less suspicious of being exploited. Trust has also been shown to influence consumers’ participation in community building and content sharing on social media, demonstrating cross-cultural universality (Anaya-Sánchez et al., 2020 ).

Trust in influencer advertising information is also a key predictor of consumers’ information exchange online. With many social media users now operating under real-name policies, there is an increased inclination to trust information shared on social media over that posted by corporate accounts or anonymously. Additionally, as users’ social networks partially overlap with their real-life interpersonal networks, extensive research shows that more consumers increasingly rely on information posted and shared on social networks when making purchase decisions (Wang et al., 2016 ). This aligns with the effectiveness goals of influencer marketing advertisements and the characteristics of consumer engagement. Trust in the content posted by influencers is considered a manifestation of a strong relationship between fans and influencers, central to relationship marketing (Kim & Kim, 2021 ). Based on trust in the influencer, which then extends to trust in their content, people are more inclined to browse information posted by influencers, share this information with others, and even create their own content without fear of exploitation or negative consequences. Therefore, this paper proposes the following research hypotheses:

H3a: Information trust is positively correlated with content consumption in consumer engagement behavior.

H3b: Information trust is positively correlated with content contribution in consumer engagement behavior.

H3c: Information trust is positively correlated with content creation in consumer engagement behavior.

Construction of the path from stimulus to organism: influencer factors, advertising information factors, social factors, and self-determination internal factors

Having established the logical connection from Organism (O) to Response (R), we further construct the influence path from Stimulus (S) to Organism (O). Revisiting the definition of influencer advertising in social media, companies, and brands leverage influencers on social media platforms to disseminate advertising content, utilizing the influencers’ relationships and influence over consumers for marketing purposes. In addition to consumer’s internal factors, elements such as companies, brands, influencers, and the advertisements themselves also impact consumer behavior. Although factors like the brand image perception of companies may influence consumer behavior, considering that in influencer marketing, companies and brands do not directly interact with consumers, this study prioritizes the dimensions of influencers and advertisements. Furthermore, the impact of social factors on individual cognition and behavior is significant, thus, the current study integrates influencers, advertisements, and social dimensions as the Stimulus (S) component.

Influencer factors: parasocial identification

Self-determination theory posits that relationships are one of the key motivators influencing individual behavior. In the context of social media research, users anticipate establishing a parasocial relationship with influencers, resembling real-life relationships. Hence, we consider the parasocial identification arising from users’ parasocial interactions with influencers as the relational motivator. Parasocial interaction refers to the one-sided personal relationship that individuals develop with media characters (Donald & Richard, 1956 ). During this process, individuals believe that the media character is directly communicating with them, creating a sense of positive intimacy (Giles, 2002 ). Over time, through repeated unilateral interactions with media characters, individuals develop a parasocial relationship, leading to parasocial identification. However, parasocial identification should not be directly equated with the concept of social identification in social identity theory. Social identification occurs when individuals psychologically de-individualize themselves, perceiving the characteristics of their social group as their own, upon identifying themselves as part of that group. In contrast, parasocial identification refers to the one-sided interactional identification with media characters (such as celebrities or influencers) over time (Chen et al., 2021 ). Particularly when individuals’ needs for interpersonal interaction are not met in their daily lives, they turn to parasocial interactions to fulfill these needs (Shan et al., 2020 ). Especially on social media, which is characterized by its high visibility and interactivity, users can easily develop a strong parasocial identification with the influencers they follow (Wei et al., 2022 ).

Parasocial identification and self-disclosure willingness

Theories like uncertainty reduction, personal construct, and social exchange are often applied to explain the emergence of parasocial identification. Social media, with its convenient and interactive modes of information dissemination, enables consumers to easily follow influencers on media platforms. They can perceive the personality of influencers through their online content, viewing them as familiar individuals or even friends. Once parasocial identification develops, this pleasurable experience can significantly influence consumers’ cognitions and thus their behavioral responses. Research has explored the impact of parasocial identification on consumer behavior. For instance, Bond et al. found that on Twitter, the intensity of users’ parasocial identification with influencers positively correlates with their continuous monitoring of these influencers’ activities (Bond, 2016 ). Analogous to real life, where we tend to pay more attention to our friends in our social networks, a similar phenomenon occurs in the relationship between consumers and brands. This type of parasocial identification not only makes consumers willing to follow brand pages but also more inclined to voluntarily provide personal information (Chen et al., 2021 ). Based on this logic, we speculate that a similar relationship may exist between social media influencers and their fans. Fans develop parasocial identification with influencers through social media interactions, making them more willing to disclose their information, opinions, and views in the comment sections of the influencers they follow, engaging in more frequent social interactions (Chung & Cho, 2017 ), even if the content at times may be brand or company-embedded marketing advertisements. In other words, in the presence of influencers with whom they have established parasocial relationships, they are more inclined to disclose personal information, thereby promoting consumer engagement behavior. Therefore, we propose the following research hypotheses:

H4: Parasocial identification is positively correlated with consumer self-disclosure willingness.

H4a: Self-disclosure willingness mediates the impact of parasocial identification on content consumption in consumer engagement behavior.

H4b: Self-disclosure willingness mediates the impact of parasocial identification on content contribution in consumer engagement behavior.

H4c: Self-disclosure willingness mediates the impact of parasocial identification on content creation in consumer engagement behavior.

Parasocial identification and information trust

Information Trust refers to consumers’ willingness to trust the information contained in advertisements and to place themselves at risk. These risks include purchasing products inconsistent with the advertised information and the negative social consequences of erroneously spreading this information to others, leading to unpleasant consumption experiences (Minton, 2015 ). In advertising marketing, gaining consumers’ trust in advertising information is crucial. In the context of influencer marketing on social media, companies, and brands leverage the social connection between influencers and their fans. According to cognitive empathy theory, consumers project their trust in influencers onto the products endorsed, explaining the phenomenon of ‘loving the house for the crow on its roof.’ Research indicates that parasocial identification with influencers is a necessary condition for trust development. Consumers engage in parasocial interactions with influencers on social media, leading to parasocial identification (Jin et al., 2021 ). Consumers tend to reduce their cognitive load and simplify their decision-making processes, thus naturally adopting a positive attitude and trust towards advertising information disseminated by influencers with whom they have established parasocial identification. This forms the core logic behind the success of influencer marketing advertisements (Breves et al., 2021 ); furthermore, as mentioned earlier, because consumers trust these advertisements, they are also willing to share this information with friends and family and even engage in content re-creation. Therefore, we propose the following research hypotheses:

H5: Parasocial identification is positively correlated with information trust.

H5a: Information trust mediates the impact of parasocial identification on content consumption in consumer engagement behavior.

H5b: Information trust mediates the impact of parasocial identification on content contribution in consumer engagement behavior.

H5c: Information trust mediates the impact of parasocial identification on content creation in consumer engagement behavior.

Influencer factors: source credibility

Source credibility refers to the degree of trust consumers place in the influencer as a source, based on the influencer’s reliability and expertise. Numerous studies have validated the effectiveness of the endorsement effect in advertising (Schouten et al., 2021 ). The Source Credibility Model, proposed by the renowned American communication scholar Hovland and the “Yale School,” posits that in the process of information dissemination, the credibility of the source can influence the audience’s decision to accept the information. The credibility of the information is determined by two aspects of the source: reliability and expertise. Reliability refers to the audience’s trust in the “communicator’s objective and honest approach to providing information,” while expertise refers to the audience’s trust in the “communicator being perceived as an effective source of information” (Hovland et al., 1953 ). Hovland’s definitions reveal that the interpretation of source credibility is not about the inherent traits of the source itself but rather the audience’s perception of the source (Jang et al., 2021 ). This differs from trust and serves as a precursor to the development of trust. Specifically, reliability and expertise are based on the audience’s perception; thus, this aligns closely with the audience’s perception of influencers (Kim & Kim, 2021 ). This credibility is a cognitive statement about the source of information.

Source credibility and self-disclosure willingness

Some studies have confirmed the positive impact of an influencer’s self-disclosure on their credibility as a source (Leite & Baptista, 2022 ). However, few have explored the impact of an influencer’s credibility, as a source, on consumers’ self-disclosure willingness. Undoubtedly, an impact exists; self-disclosure is considered a method to attempt to increase intimacy with others (Leite et al., 2022 ). According to social exchange theory, people promote relationships through the exchange of information in interpersonal communication to gain benefits (Cropanzano & Mitchell, 2005 ). Credibility, deriving from an influencer’s expertise and reliability, means that a highly credible influencer may provide more valuable information to consumers. Therefore, based on the social exchange theory’s logic of reciprocal benefits, consumers might be more willing to disclose their information to trustworthy influencers, potentially even expanding social interactions through further consumer engagement behaviors. Thus, we propose the following research hypotheses:

H6: Source credibility is positively correlated with self-disclosure willingness.

H6a: Self-disclosure willingness mediates the impact of Source credibility on content consumption in consumer engagement behavior.

H6b: Self-disclosure willingness mediates the impact of Source credibility on content contribution in consumer engagement behavior.

H6c: Self-disclosure willingness mediates the impact of Source credibility on content creation in consumer engagement behavior.

Source credibility and information trust

Based on the Source Credibility Model, the credibility of an endorser as an information source can significantly influence consumers’ acceptance of the information (Shan et al., 2020 ). Existing research has demonstrated the positive impact of source credibility on consumers. Djafarova, in a study based on Instagram, noted through in-depth interviews with 18 users that an influencer’s credibility significantly affects respondents’ trust in the information they post. This credibility is composed of expertise and relevance to consumers, and influencers on social media are considered more trustworthy than traditional celebrities (Djafarova & Rushworth, 2017 ). Subsequently, Bao and colleagues validated in the Chinese consumer context, based on the ELM model and commitment-trust theory, that the credibility of brand pages on Weibo effectively fosters consumer trust in the brand, encouraging participation in marketing activities (Bao & Wang, 2021 ). Moreover, Hsieh et al. found that in e-commerce contexts, the credibility of the source is a significant factor influencing consumers’ trust in advertising information (Hsieh & Li, 2020 ). In summary, existing research has proven that the credibility of the source can promote consumer trust. Influencer credibility is a significant antecedent affecting consumers’ trust in the advertised content they publish. In brand communities, trust can foster consumer engagement behaviors (Habibi et al., 2014 ). Specifically, consumers are more likely to trust the advertising content published by influencers with higher credibility (more expertise and reliability), and as previously mentioned, consumer engagement behavior is more likely to occur. Based on this, the study proposes the following research hypotheses:

H7: Source credibility is positively correlated with information trust.

H7a: Information trust mediates the impact of source credibility on content consumption in consumer engagement behavior.

H7b: Information trust mediates the impact of source credibility on content contribution in consumer engagement behavior.

H7c: Information trust mediates the impact of source credibility on content creation in consumer engagement behavior.

Advertising information factors: informative value

Advertising value refers to “the relative utility value of advertising information to consumers and is a subjective evaluation by consumers.” In his research, Ducoffe pointed out that in the context of online advertising, the informative value of advertising is a significant component of advertising value (Ducoffe, 1995 ). Subsequent studies have proven that consumers’ perception of advertising value can effectively promote their behavioral response to advertisements (Van-Tien Dao et al., 2014 ). Informative value of advertising refers to “the information about products needed by consumers provided by the advertisement and its ability to enhance consumer purchase satisfaction.” From the perspective of information dissemination, valuable advertising information should help consumers make better purchasing decisions and reduce the effort spent searching for product information. The informational aspect of advertising has been proven to effectively influence consumers’ cognition and, in turn, their behavior (Haida & Rahim, 2015 ).

Informative value and innovativeness

As previously discussed, consumers’ innovativeness refers to their psychological trait of favoring new things. Studies have shown that consumers with high innovativeness prefer novel and valuable product information, as it satisfies their need for newness and information about new products, making it an important factor in social media advertising engagement (Shi, 2018 ). This paper also hypothesizes that advertisements with high informative value can activate consumers’ innovativeness, as the novelty of information is one of the measures of informative value (León et al., 2009 ). Acquiring valuable information can make individuals feel good about themselves and fulfill their perception of a “novel image.” According to social exchange theory, consumers can gain social capital in interpersonal interactions (such as social recognition) by sharing information about these new products they perceive as valuable. Therefore, the current study proposes the following research hypothesis:

H8: Informative value is positively correlated with innovativeness.

H8a: Innovativeness mediates the impact of informative value on content consumption in consumer engagement behavior.

H8b: Innovativeness mediates the impact of informative value on content contribution in consumer engagement behavior.

H8c: Innovativeness mediates the impact of informative value on content creation in consumer engagement behavior.

Informative value and information trust

Trust is a multi-layered concept explored across various disciplines, including communication, marketing, sociology, and psychology. For the purposes of this paper, a deep analysis of different levels of trust is not undertaken. Here, trust specifically refers to the trust in influencer advertising information within the context of social media marketing, denoting consumers’ belief in and reliance on the advertising information endorsed by influencers. Racherla et al. investigated the factors influencing consumers’ trust in online reviews, suggesting that information quality and value contribute to increasing trust (Racherla et al., 2012 ). Similarly, Luo and Yuan, in a study based on social media marketing, also confirmed that the value of advertising information posted on brand pages can foster consumer trust in the content (Lou & Yuan, 2019 ). Therefore, by analogy, this paper posits that the informative value of influencer-endorsed advertising can also promote consumer trust in that advertising information. The relationship between trust in advertising information and consumer engagement behavior has been discussed earlier. Thus, the current study proposes the following research hypotheses:

H9: Informative value is positively correlated with information trust.

H9a: Information trust mediates the impact of informative value on content consumption in consumer engagement behavior.

H9b: Information trust mediates the impact of informative value on content contribution in consumer engagement behavior.

H9c: Information trust mediates the impact of informative value on content creation in consumer engagement behavior.

Advertising information factors: ad targeting accuracy

Ad targeting accuracy refers to the degree of match between the substantive information contained in advertising content and consumer needs. Advertisements containing precise information often yield good advertising outcomes. In marketing practice, advertisers frequently use information technology to analyze the characteristics of different consumer groups in the target market and then target their advertisements accordingly to achieve precise dissemination and, consequently, effective advertising results. The utility of ad targeting accuracy has been confirmed by many studies. For instance, in the research by Qiu and Chen, using a modified UTAUT model, it was demonstrated that the accuracy of advertising effectively promotes consumer acceptance of advertisements in WeChat Moments (Qiu & Chen, 2018 ). Although some studies on targeted advertising also indicate that overly precise ads may raise concerns about personal privacy (Zhang et al., 2019 ), overall, the accuracy of advertising information is effective in enhancing advertising outcomes and is a key element in the success of targeted advertising.

Ad targeting accuracy and information trust

In influencer marketing advertisements, due to the special relationship recognition between consumers and influencers, the privacy concerns associated with ad targeting accuracy are alleviated (Vrontis et al., 2021 ). Meanwhile, the informative value brought by targeting accuracy is highlighted. More precise advertising content implies higher informative value and also signifies that the advertising content is more worthy of consumer trust (Della Vigna, Gentzkow, 2010 ). As previously discussed, people are more inclined to read and engage with advertising content they trust and recognize. Therefore, the current study proposes the following research hypotheses:

H10: Ad targeting accuracy is positively correlated with information trust.

H10a: Information trust mediates the impact of ad targeting accuracy on content consumption in consumer engagement behavior.

H10b: Information trust mediates the impact of ad targeting accuracy on content contribution in consumer engagement behavior.

H10c: Information trust mediates the impact of ad targeting accuracy on content creation in consumer engagement behavior.

Social factors: subjective norm

The Theory of Planned Behavior, proposed by Ajzen ( 1991 ), suggests that individuals’ actions are preceded by conscious choices and are underlain by plans. TPB has been widely used by scholars in studying personal online behaviors, these studies collectively validate the applicability of TPB in the context of social media for researching online behaviors (Huang, 2023 ). Additionally, the self-determination theory, which underpins this chapter’s research, also supports the notion that individuals’ behavioral decisions are based on internal cognitions, aligning with TPB’s assertions. Therefore, this paper intends to select subjective norms from TPB as a factor of social influence. Subjective norm refers to an individual’s perception of the expectations of significant others in their social relationships regarding their behavior. Empirical research in the consumption field has demonstrated the significant impact of subjective norms on individual psychological cognition (Yang & Jolly, 2009 ). A meta-analysis by Hagger, Chatzisarantis ( 2009 ) even highlighted the statistically significant association between subjective norms and self-determination factors. Consequently, this study further explores its application in the context of influencer marketing advertisements on social media.

Subjective norm and self-disclosure willingness

In numerous studies on social media privacy, subjective norms significantly influence an individual’s self-disclosure willingness. Wirth et al. ( 2019 ) based on the privacy calculus theory, surveyed 1,466 participants and found that personal self-disclosure on social media is influenced by the behavioral expectations of other significant reference groups around them. Their research confirmed that subjective norms positively influence self-disclosure of information and highlighted that individuals’ cognitions and behaviors cannot ignore social and environmental factors. Heirman et al. ( 2013 ) in an experiment with Instagram users, also noted that subjective norms could promote positive consumer behavioral responses. Specifically, when important family members and friends highly regard social media influencers as trustworthy, we may also be more inclined to disclose our information to influencers and share this information with our surrounding family and friends without fear of disapproval. In our subjective norms, this is considered a positive and valuable interactive behavior, leading us to exhibit engagement behaviors. Based on this logic, we propose the following research hypotheses:

H11: Subjective norms are positively correlated with self-disclosure willingness.

H11a: Self-disclosure willingness mediates the impact of subjective norms on content consumption in consumer engagement behavior.

H11b: Self-disclosure willingness mediates the impact of subjective norms on content contribution in consumer engagement behavior.

H11c: Self-disclosure willingness mediates the impact of subjective norms on content creation in consumer engagement behavior.

Subjective norm and information trust

Numerous studies have indicated that subjective norms significantly influence trust (Roh et al., 2022 ). This can be explained by reference group theory, suggesting people tend to minimize the effort expended in decision-making processes, often looking to the behaviors or attitudes of others as a point of reference; for instance, subjective norms can foster acceptance of technology by enhancing trust (Gupta et al., 2021 ). Analogously, if a consumer’s social network generally holds positive attitudes toward influencer advertising, they are also more likely to trust the endorsed advertisement information, as it conserves the extensive effort required in gathering product information (Chetioui et al., 2020 ). Therefore, this paper proposes the following research hypotheses:

H12: Subjective norms are positively correlated with information trust.

H12a: Information trust mediates the impact of subjective norms on content consumption in consumer engagement behavior.

H12b: Information trust mediates the impact of subjective norms on content contribution in consumer engagement behavior.

H12c: Information trust mediates the impact of subjective norms on content creation in consumer engagement behavior.

Conceptual model

In summary, based on the Stimulus (S)-Organism (O)-Response (R) framework, this study constructs the external stimulus factors (S) from three dimensions: influencer factors (parasocial identification, source credibility), advertising information factors (informative value, Ad targeting accuracy), and social influence factors (subjective norms). This is grounded in social capital theory and the theory of planned behavior. drawing on self-determination theory, the current study constructs the individual psychological factors (O) using self-disclosure willingness, innovativeness, and information trust. Finally, the behavioral response (R) is constructed using consumer engagement, which includes content consumption, content contribution, and content creation, as illustrated in Fig. 1 .

figure 1

Consumer engagement behavior impact model based on SOR framework.

Materials and methods

Participants and procedures.

The current study conducted a survey through the Wenjuanxing platform to collect data. Participants were recruited through social media platforms such as WeChat, Douyin, Weibo et al., as samples drawn from social media users better align with the research purpose of our research and ensure the validity of the sample. Before the survey commenced, all participants were explicitly informed about the purpose of this study, and it was made clear that volunteers could withdraw from the survey at any time. Initially, 600 questionnaires were collected, with 78 invalid responses excluded. The criteria for valid questionnaires were as follows: (1) Respondents must have answered “Yes” to the question, “Do you follow any influencers (internet celebrities) on social media platforms?” as samples not using social media or not following influencers do not meet the study’s objective, making this question a prerequisite for continuing the survey; (2) Respondents had to correctly answer two hidden screening questions within the questionnaire to ensure that they did not randomly select scores; (3) The total time taken to complete the questionnaire had to exceed one minute, ensuring that respondents had sufficient time to understand and thoughtfully answer each question; (4) Respondents were not allowed to choose the same score for eight consecutive questions. Ultimately, 522 valid questionnaires were obtained, with an effective rate of 87.00%, meeting the basic sample size requirements for research models (Gefen et al., 2011 ). Detailed demographic information of the study participants is presented in Table 1 .

Measurements

To ensure the validity and reliability of the data analysis results in this study, the measurement tools and scales used in this chapter were designed with reference to existing established research. The main variables in the survey questionnaire include parasocial identification, source credibility, informative value, ad targeting accuracy, subjective norms, self-disclosure willingness, innovativeness, information trust, content consumption, content contribution, and content creation. The measurement scale for parasocial identification was adapted from the research of Schramm and Hartmann, comprising 6 items (Schramm & Hartmann, 2008 ). The source credibility scale was combined from the studies of Cheung et al. and Luo & Yuan’s research in the context of social media influencer marketing, including 4 items (Cheung et al., 2009 ; Lou & Yuan, 2019 ). The scale for informative value was modified based on Voss et al.‘s research, consisting of 4 items (Voss et al., 2003 ). The ad targeting accuracy scale was derived from the research by Qiu Aimei et al., 2018 ) including 3 items. The subjective norm scale was adapted from Ajzen’s original scale, comprising 3 items (Ajzen, 2002 ). The self-disclosure willingness scale was developed based on Chu and Kim’s research, including 3 items (Chu & Kim, 2011 ). The innovativeness scale was formulated following the study by Sun et al., comprising 4 items (Sun et al., 2006 ). The information trust scale was created in reference to Chu and Choi’s research, including 3 items (Chu & Choi, 2011 ). The scales for the three components of social media consumer engagement—content consumption, content contribution, and content creation—were sourced from the research by Buzeta et al., encompassing 8 items in total (Buzeta et al., 2020 ).

All scales were appropriately revised for the context of social media influencer marketing. To avoid issues with scoring neutral attitudes, a uniform Likert seven-point scale was used for each measurement item (ranging from 1 to 7, representing a spectrum from ‘strongly disagree’ to ‘strongly agree’). After the overall design of the questionnaire was completed, a pre-test was conducted with 30 social media users to ensure that potential respondents could clearly understand the meaning of each question and that there were no obstacles to answering. This pre-test aimed to prevent any difficulties or misunderstandings in the questionnaire items. The final version of the questionnaire is presented in Table 2 .

Data analysis

Since the model framework of the current study is derived from theoretical deductions of existing research and, while logically constructed, does not originate from an existing research model, this study still falls under the category of exploratory research. According to the analysis suggestions of Hair and other scholars, in cases of exploratory research model frameworks, it is more appropriate to choose Smart PLS for Partial Least Squares Path Analysis (PLS) to conduct data analysis and testing of the research model (Hair et al., 2012 ).

Measurement of model

In this study, careful data collection and management resulted in no missing values in the dataset. This ensured the integrity and reliability of the subsequent data analysis. As shown in Table 3 , after deleting measurement items with factor loadings below 0.5, the final factor loadings of the measurement items in this study range from 0.730 to 0.964. This indicates that all measurement items meet the retention criteria. Additionally, the Cronbach’s α values of the latent variables range from 0.805 to 0.924, and all latent variables have Composite Reliability (CR) values greater than the acceptable value of 0.7, demonstrating that the scales of this study have passed the reliability test requirements (Hair et al., 2019 ). All latent variables in this study have Average Variance Extracted (AVE) values greater than the standard acceptance value of 0.5, indicating that the convergent validity of the variables also meets the standard (Fornell & Larcker, 1981 ). Furthermore, the results show that the Variance Inflation Factor (VIF) values for each factor are below 10, indicating that there are no multicollinearity issues with the scales in this study (Hair, 2009 ).

The current study then further verified the discriminant validity of the variables, with specific results shown in Table 4 . The square roots of the average variance extracted (AVE) values for all variables (bolded on the diagonal) are greater than the Pearson correlation coefficients between the variables, indicating that the discriminant validity of the scales in this study meets the required standards (Fornell & Larcker, 1981 ). Additionally, a single-factor test method was employed to examine common method bias in the data. The first unrotated factor accounted for 29.71% of the variance, which is less than the critical threshold of 40%. Therefore, the study passed the test and did not exhibit serious common method bias (Podsakoff et al., 2003 ).

To ensure the robustness and appropriateness of our structural equation model, we also conducted a thorough evaluation of the model fit. Initially, through PLS Algorithm calculations, the R 2 values of each variable were greater than the standard acceptance value of 0.1, indicating good predictive accuracy of the model. Subsequently, Blindfolding calculations were performed, and the results showed that the Stone-Geisser Q 2 values of each variable were greater than 0, demonstrating that the model of this study effectively predicts the relationships between variables (Dijkstra & Henseler, 2015 ). In addition, through CFA, we also obtained some indicator values, specifically, χ 2 /df = 2.528 < 0.3, RMSEA = 0.059 < 0.06, SRMR = 0.055 < 0.08. Given its sensitivity to sample size, we primarily focused on the CFI, TLI, and NFI values, CFI = 0.953 > 0.9, TLI = 0.942 > 0.9, and NFI = 0.923 > 0.9 indicating a good fit. Additionally, RMSEA values below 0.06 and SRMR values below 0.08 were considered indicative of a good model fit. These indices collectively suggested that our model demonstrates a satisfactory fit with the data, thereby reinforcing the validity of our findings.

Research hypothesis testing

The current study employed a Bootstrapping test with a sample size of 5000 on the collected raw data to explore the coefficients and significance of the paths in the research model. The final test data results of this study’s model are presented in Table 5 .

The current study employs S-O-R model as the framework, grounded in theories such as self-determination theory and theory of planned behavior, to construct an influence model of consumer engagement behavior in the context of social media influencer marketing. It examines how influencer factors, advertisement information factors, and social influence factors affect consumer engagement behavior by impacting consumers’ psychological cognitions. Using structural equation modeling to analyze collected data ( N  = 522), it was found that self-disclosure willingness, innovativeness, and information trust positively influence consumer engagement behavior, with innovativeness having the largest impact on higher levels of engagement. Influencer factors, advertisement information factors, and social factors serve as effective external stimuli, influencing psychological motivators and, consequently, consumer engagement behavior. The specific research results are illustrated in Fig. 2 .

figure 2

Tested structural model of consumer engagement behavior.

The impact of psychological motivators on different levels of consumer engagement: self-disclosure willingness, innovativeness, and information trust

The research analysis indicates that self-disclosure willingness and information trust are key drivers for content consumption (H1a, H2a validated). This aligns with previous findings that individuals with a higher willingness to disclose themselves show greater levels of engagement behavior (Chu et al., 2023 ); likewise, individuals who trust advertisement information are more inclined to engage with advertisement content (Kim, Kim, 2021 ). Moreover, our study finds that information trust has a stronger impact on content consumption, underscoring the importance of trust in the dissemination of advertisement information. However, no significant association was found between individual innovativeness and content consumption (H3a not validated).

Regarding the dimension of content contribution in consumer engagement, self-disclosure willingness, information trust, and innovativeness all positively impact it (H1b, H2b, and H3b all validated). This is consistent with earlier research findings that individuals with higher self-disclosure willingness are more likely to like, comment on, or share content posted by influencers on social media platforms (Towner et al., 2022 ); the conclusions of this paper also support that innovativeness is an important psychological driver for active participation in social media interactions (Kamboj & Sharma, 2023 ). However, at the level of consumer engagement in content contribution, while information trust also exerts a positive effect, its impact is the weakest, although information trust has the strongest impact on content consumption.

In social media advertising, the ideal outcome is the highest level of consumer engagement, i.e., content creation, meaning consumers actively join in brand content creation, seeing themselves as co-creators with the brand (Nadeem et al., 2021 ). Our findings reveal that self-disclosure willingness, innovativeness, and information trust all positively influence content creation (H1c, H2c, and H3c all validated). The analysis found that similar to the impact on content contribution, innovativeness has the most significant effect on encouraging individual content creation, followed by self-disclosure willingness, with information trust having the least impact.

In summary, while some previous studies have shown that self-disclosure willingness, innovativeness, and information trust are important factors in promoting consumer engagement (Chu et al., 2023 ; Nadeem et al., 2021 ; Geng et al., 2021 ), this study goes further by integrating and comparing all three within the same research framework. It was found that to trigger higher levels of consumer engagement behavior, trust is not the most crucial psychological motivator; rather, the most effective method is to stimulate consumers’ innovativeness, thus complementing previous research. Subsequently, this study further explores the impact of different stimulus factors on various psychological motivators.

The influence of external stimulus factors on psychological motivators: influencer factors, advertisement information factors, and social factors

The current findings indicate that influencer factors, such as parasocial identification and source credibility, effectively enhance consumer engagement by influencing self-disclosure willingness and information trust. This aligns with prior research highlighting the significance of parasocial identification (Shan et al., 2020 ). Studies suggest parasocial identification positively impacts consumer engagement by boosting self-disclosure willingness and information trust (validated H4a, H4b, H4c, and H5a), but not content contribution or creation through information trust (H5b, H5c not validated). Source credibility’s influence on self-disclosure willingness was not significant (H6 not validated), thus negating the mediating effect of self-disclosure willingness (H6a, H6b, H6c not validated). Influencer credibility mainly affects engagement through information trust (H7a, H7b, H7c validated), supporting previous findings (Shan et al., 2020 ).

Advertisement factors (informative value and ad targeting accuracy) promote engagement through innovativeness and information trust. Informative value significantly impacts higher-level content contribution and creation through innovativeness (H8b, H8c validated), while ad targeting accuracy influences consumer engagement at all levels mainly through information trust (H10a, H10b, H10c validated).

Social factors (subjective norms) enhance self-disclosure willingness and information trust, consistent with previous research (Wirth et al., 2019 ; Gupta et al., 2021 ), and further promote consumer engagement across all levels (H11a, H11b, H11c, H12a, H12b, and H12c all validated).

In summary, influencer, advertisement, and social factors impact consumer engagement behavior by influencing psychological motivators, with influencer factors having the greatest effect on content consumption, advertisement content factors significantly raising higher-level consumer engagement through innovativeness, and social factors also influencing engagement through self-disclosure willingness and information trust.

Implication

From a theoretical perspective, current research presents a comprehensive model of consumer engagement within the context of influencer advertising on social media. This model not only expands the research horizon in the fields of social media influencer advertising and consumer engagement but also serves as a bridge between two crucial themes in new media advertising studies. Influencer advertising has become an integral part of social media advertising, and the construction of a macro model aids researchers in understanding consumer psychological processes and behavioral patterns. It also assists advertisers in formulating more effective strategies. Consumer engagement, focusing on the active role of consumers in disseminating information and the long-term impact on advertising effectiveness, aligns more closely with the advertising effectiveness measures in the new media context than traditional advertising metrics. However, the intersection of these two vital themes lacks comprehensive research and a universal model. This study constructs a model that elucidates the effects of various stimuli on consumer psychology and engagement behaviors, exploring the connections and mechanisms through different mediating pathways. By differentiating levels of engagement, the study offers more nuanced conclusions for diverse advertising objectives. Furthermore, this research validates the applicability of self-determination theory in the context of influencer advertising effectiveness. While this psychological theory has been utilized in communication behavior research, its effectiveness in the field of advertising requires further exploration. The current study introduces self-determination theory into the realm of influencer advertising and consumer engagement, thereby expanding its application in the field of advertising communication. It also responds to the call from the advertising and marketing academic community to incorporate more psychological theories to explain the ‘black box’ of consumer psychology. The inclusion of this theory re-emphasizes the people-centric approach of this research and highlights the primary role of individuals in advertising communication studies.

From a practical perspective, this study provides significant insights for adapting marketing strategies to the evolving media landscape and the empowered role of audiences. Firstly, in the face of changes in the communication environment and the empowerment of audience communication capabilities, traditional marketing approaches are becoming inadequate for new media advertising needs. Traditional advertising focuses on direct, point-to-point effects, whereas social media advertising aims for broader, point-to-mass communication, leveraging audience proactivity to facilitate the viral spread of content across online social networks. Secondly, for brands, the general influence model proposed in this study offers guidance for influencer advertising strategy. If the goal is to maximize reach and brand recognition with a substantial advertising budget, partnering with top influencers who have a large following can be an effective strategy. However, if the objective is to maximize cost-effectiveness with a limited budget by leveraging consumer initiative for secondary spread, the focus should be on designing advertising content that stimulates consumer creativity and willingness to innovate. Thirdly, influencers are advised to remain true to their followers. In influencer marketing, influencers attract advertisers through their influence over followers, converting this influence into commercial gain. This influence stems from the trust followers place in the influencer, thus influencers should maintain professional integrity and prioritize the quality of information they share, even when presented with advertising opportunities. Lastly, influencers should assert more control over their relationships with advertisers. In traditional advertising, companies and brands often exert significant control over the content. However, in the social media era, influencers should negotiate more creative freedom in their advertising partnerships, asserting a more equal relationship with advertisers. This approach ensures that content quality remains high, maintaining the trust influencers have built with their followers.

Limitations and future directions

while this study offers valuable insights into the dynamics of influencer marketing and consumer engagement on social media, several limitations should be acknowledged: Firstly, constrained by the research objectives and scope, this study’s proposed general impact model covers three dimensions: influencers, advertisement information, and social factors. However, these dimensions are not limited to the five variables discussed in this paper. Therefore, we call for future research to supplement and explore more crucial factors. Secondly, in the actual communication environment, there may be differences in the impact of communication effectiveness across various social media platforms. Thus, future research could also involve comparative studies and explorations between different social media platforms. Thirdly, the current study primarily examines the direct effects of various factors on consumer engagement. However, the potential interaction effects between these variables (e.g., how influencers’ credibility might interact with advertisement information quality) are not extensively explored. Future research could investigate these complex interrelationships for a more holistic understanding. Lastly, our study, being cross-sectional, offers preliminary insights into the complex and dynamic nature of engagement between social media influencers and consumers, yet it does not incorporate the temporal dimension. The diverse impacts of psychological needs on engagement behaviors hint at an underlying dynamism that merits further investigation. Future research should consider employing longitudinal designs to directly observe how these dynamics evolve over time.

The findings of the current study not only theoretically validate the applicability of self-determination theory in the field of social media influencer marketing advertising research but also broaden the scope of advertising effectiveness research from the perspective of consumer engagement. Moreover, the research framework offers strategic guidance and reference for influencer marketing strategies. The main conclusions of this study can be summarized as follows.

Innovativeness is the key factor in high-level consumer engagement behavior. Content contribution represents a higher level of consumer engagement compared to content consumption, as it not only requires consumers to dedicate attention to viewing advertising content but also to share this information across adjacent nodes within their social networks. This dissemination of information is a pivotal factor in the success of influencer marketing advertisements. Hence, companies and brands prioritize consumers’ content contribution over mere viewing of advertising content (Qiu & Kumar, 2017 ). Compared to content consumption and contribution, content creation is considered the highest level of consumer engagement, where consumers actively create and upload brand-related content, and it represents the most advanced outcome sought by enterprises and brands in advertising campaigns (Cheung et al., 2021 ). The current study posits that to pursue better outcomes in social media influencer advertising marketing, enhancing consumers’ willingness for self-disclosure, innovativeness, and trust in advertising information are effective strategies. However, the crux lies in leveraging the consumer’s subjective initiative, particularly in boosting their innovativeness. If the goal is simply to achieve content consumption rather than higher levels of consumer engagement, the focus should be on fostering trust in advertising information. There is no hierarchy in the efficacy of different strategies; they should align with varying marketing contexts and advertising objectives.

The greatest role of social media influencers lies in attracting online traffic. information trust is the core element driving content consumption, and influencer factors mainly affect consumer engagement behaviors through information trust. Therefore, this study suggests that the primary role of influencers in social media advertising is to attract online traffic, i.e., increase consumer behavior regarding ad content consumption (reducing avoidance of ad content), and help brands achieve the initial goal of making consumers “see and complete ads.” However, their impact on further high-level consumer engagement behaviors is limited. This mechanism serves as a reminder to advertisers not to overestimate the effects of influencers in marketing. Currently, top influencers command a significant portion of the ad budget, which could squeeze the budget for other aspects of advertising, potentially affecting the overall effectiveness of the campaign. Businesses and brands should consider deeper strategic implications when planning their advertising campaigns.

Valuing Advertising Information Factors, Content Remains King. Our study posits that in the social media influencer marketing context, the key to enhancing consumer contribution and creation of advertising content lies primarily in the advertising information factors. In other words, while content consumption is important, advertisers should objectively assess the role influencers play in advertising. In the era of social media, content remains ‘king’ in advertising. This view indirectly echoes the points made in the previous paragraph: influencers effectively perform initial ‘online traffic generation’ tasks in social media, but this role should not be overly romanticized or exaggerated. Whether it’s companies, brands, or influencers, providing consumers with advertisements rich in informational value is crucial to achieving better advertising outcomes and potentially converting consumers into stakeholders.

Subjective norm is an unignorable social influence factor. Social media is characterized by its network structure of information dissemination, where a node’s information is visible to adjacent nodes. For instance, if user A likes a piece of content C from influencer I, A’s follower B, who may not follow influencer I, can still see content C via user A’s page. The aim of marketing in the social media era is to influence a node and then spread the information to adjacent nodes, either secondarily or multiple times (Kumar & Panda, 2020 ). According to the Theory of Planned Behavior, an individual’s actions are influenced by significant others in their lives, such as family and friends. Previous studies have proven the effectiveness of the Theory of Planned Behavior in influencing attitudes toward social media advertising (Ranjbarian et al., 2012 ). Current research further confirms that subjective norms also influence consumer engagement behaviors in influencer marketing on social media. Therefore, in advertising practice, brands should not only focus on individual consumers but also invest efforts in groups that can influence consumer decisions. Changing consumer behavior in the era of social media marketing doesn’t solely rely on the company’s efforts.

As communication technology advances, media platforms will further empower individual communicative capabilities, moving beyond the era of the “magic bullet” theory. The distinction between being a recipient and a transmitter of information is increasingly blurred. In an era where everyone is both an audience and an influencer, research confined to the role of the ‘recipient’ falls short of addressing the dynamics of ‘transmission’. Future research in marketing and advertising should thus focus more on the power of individual transmission. Furthermore, as Marshall McLuhan famously said, “the medium is the extension of man.” The evolution of media technology remains human-centric. Accordingly, future marketing research, while paying heed to media transformations, should emphasize the centrality of the ‘human’ element.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to privacy issues. Making the full data set publicly available could potentially breach the privacy that was promised to participants when they agreed to take part, and may breach the ethics approval for the study. The data are available from the corresponding author on reasonable request.

Abbasi AZ, Tsiotsou RH, Hussain K, Rather RA, Ting DH (2023) Investigating the impact of social media images’ value, consumer engagement, and involvement on eWOM of a tourism destination: a transmittal mediation approach. J Retail Consum Serv 71:103231. https://doi.org/10.1016/j.jretconser.2022.103231

Article   Google Scholar  

Ajzen I (2002) Perceived behavioral control, self‐efficacy, locus of control, and the theory of planned behavior 1. J Appl Soc Psychol 32(4):665–683. https://doi.org/10.1111/j.1559-1816.2002.tb00236.x

Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50(2):179–211. https://doi.org/10.1016/0749-5978(91)90020-T

Altman I, Taylor DA (1973) Social penetration: the development of interpersonal relationships. Holt, Rinehart & Winston

Anaya-Sánchez R, Aguilar-Illescas R, Molinillo S, Martínez-López FJ (2020) Trust and loyalty in online brand communities. Span J Mark ESIC 24(2):177–191. https://doi.org/10.1108/SJME-01-2020-0004

Astuti BA, Hariyawan A (2021) Perspectives of social capital and self-determination on e-WOM at millennial generation in Yogyakarta. Integr J Bus Econ 5(1):399475. https://doi.org/10.33019/ijbe.v5i1.338

Bao Z, Wang D (2021) Examining consumer participation on brand microblogs in China: perspectives from elaboration likelihood model, commitment–trust theory and social presence. J Res Interact Mark 15(1):10–29. https://doi.org/10.1108/JRIM-02-2019-0027

Barta S, Belanche D, Fernández A, Flavián M (2023) Influencer marketing on TikTok: the effectiveness of humor and followers’ hedonic experience. J Retail Consum Serv 70:103149. https://doi.org/10.1016/j.jretconser.2022.103149

Bond BJ (2016) Following your “friend”: social media and the strength of adolescents’ parasocial relationships with media personae. Cyberpsych Behav Soc Netw 19(11):656–660. https://doi.org/10.1089/cyber.2016.0355

Breves P, Amrehn J, Heidenreich A, Liebers N, Schramm H (2021) Blind trust? The importance and interplay of parasocial relationships and advertising disclosures in explaining influencers’ persuasive effects on their followers. Int J Advert 40(7):1209–1229. https://doi.org/10.1080/02650487.2021.1881237

Brodie RJ, Ilic A, Juric B, Hollebeek L (2013) Consumer engagement in a virtual brand community: an exploratory analysis. J Bus Res 66(1):105–114. https://doi.org/10.1016/j.jbusres.2011.07.029

Buzeta C, De Pelsmacker P, Dens N (2020) Motivations to use different social media types and their impact on consumers’ online brand-related activities (COBRAs). J Interact Mark 52(1):79–98. https://doi.org/10.1016/j.intmar.2020.04.0

Chen KJ, Lin JS, Shan Y (2021) Influencer marketing in China: The roles of parasocial identification, consumer engagement, and inferences of manipulative intent. J Consum Behav 20(6):1436–1448. https://doi.org/10.1002/cb.1945

Chetioui Y, Benlafqih H, Lebdaoui H (2020) How fashion influencers contribute to consumers’ purchase intention. J Fash Mark Manag 24(3):361–380. https://doi.org/10.1108/JFMM-08-2019-0157

Cheung ML, Pires GD, Rosenberger III PJ, De Oliveira MJ (2021) Driving COBRAs: the power of social media marketing. Mark Intell Plan 39(3):361–376. https://doi.org/10.1108/MIP-11-2019-0583

Cheung MY, Luo C, Sia CL, Chen H (2009) Credibility of electronic word-of-mouth: Informational and normative determinants of on-line consumer recommendations. Int J Electron Comm 13(4):9–38. https://doi.org/10.2753/JEC1086-4415130402

Chung S, Cho H (2017) Fostering parasocial relationships with celebrities on social media: Implications for celebrity endorsement. Psychol Mark 34(4):481–495. https://doi.org/10.1002/mar.21001

Chu SC, Choi SM (2011) Electronic word-of-mouth in social networking sites: a cross-cultural study of the United States and China. J Glob Mark 24(3):263–281. https://doi.org/10.1080/08911762.2011.592461

Chu SC, Kim Y (2011) Determinants of consumer engagement in electronic word-of-mouth (eWOM) in social networking sites. Int J Advert 30(1):47–75. https://doi.org/10.2501/IJA-30-1-047-075

Chu TH, Sun M, Crystal Jiang L (2023) Self-disclosure in social media and psychologicalwell-being: a meta-analysis. J Soc Pers Relat 40(2):576–599. https://doi.org/10.1177/02654075221119429

Cropanzano R, Mitchell MS (2005) Social exchange theory: an interdisciplinary review. J Manag 31(6):874–900. https://doi.org/10.1177/0149206305279602

Della Vigna S, Gentzkow M (2010) Persuasion: empirical evidence. Annu Rev Econ 2(1):643–669. https://doi.org/10.1146/annurev.economics.102308.124309

Dijkstra TK, Henseler J (2015) Consistent and asymptotically normal PLS estimators for linear structural equations. Comput Stat Data 81:10–23. https://doi.org/10.1016/j.csda.2014.07.008

Article   MathSciNet   Google Scholar  

Djafarova E, Rushworth C (2017) Exploring the credibility of online celebrities’ Instagram profiles in influencing the purchase decisions of young female users. Comput Hum Behav 68:1–7. https://doi.org/10.1016/j.chb.2016.11.009

D Horton D, Richard Wohl R (1956) Mass communication and para-social interaction: Observations on intimacy at a distance. Psychiatry 19(3):215–229. https://doi.org/10.1080/00332747.1956.11023049

Ducoffe RH (1995) How consumers assess the value of advertising. J Curr Issues Res Adver 17(1):1–18. https://doi.org/10.1080/10641734.1995.10505022

Fornell C, Larcker DF (1981) Structural equation models with unobservable variables and measurement error: Algebra and statistics. J Mark Res 18(3):382–388. https://doi.org/10.1177/002224378101800313

Gefen D, Straub DW, Rigdon EE (2011) An update and extension to SEM guidelines for administrative and social science research. Mis Quart 35(2):iii–xiv. https://doi.org/10.2307/23044042

Geng S, Yang P, Gao Y, Tan Y, Yang C (2021) The effects of ad social and personal relevance on consumer ad engagement on social media: the moderating role of platform trust. Comput Hum Behav 122:106834. https://doi.org/10.1016/j.chb.2021.106834

Giles DC (2002) Parasocial interaction: a review of the literature and a model for future research. Media Psychol 4(3):279–305. https://doi.org/10.1207/S1532785XMEP0403_04

Gräve JF, Bartsch F (2022) # Instafame: exploring the endorsement effectiveness of influencers compared to celebrities. Int J Advert 41(4):591–622. https://doi.org/10.1080/02650487.2021.1987041

Gupta R, Ranjan S, Gupta A (2021) Consumer’s perceived trust and subjective norms as antecedents of mobile wallets adoption and continuance intention: a technology acceptance approach. Recent Adv Technol Accept Models Theor 211–224. https://doi.org/10.1007/978-3-030-64987-6_13

Habibi MR, Laroche M, Richard MO (2014) The roles of brand community and community engagement in building brand trust on social media. Comput Hum Behav 37:152–161. https://doi.org/10.1016/j.chb.2014.04.016

Hagger MS, Chatzisarantis NL (2009) Integrating the theory of planned behaviour and self‐determination theory in health behaviour: a meta‐analysis. Brit J Health Psych 14(2):275–302. https://doi.org/10.1348/135910708X373959

Haida A, Rahim HL (2015) Social media advertising value: A Study on consumer’s perception. Int Acad Res J Bus Technol 1(1):1–8. https://www.researchgate.net/publication/280325676_Social_Media_Advertising_Value_A_Study_on_Consumer%27s_Perception

Google Scholar  

Hair JF (2009) Multivariate data analysis. Prentice Hall, Upper Saddle River

Hair JF, Ringle CM, Gudergan SP, Fischer A, Nitzl C, Menictas C (2019) Partial least squares structural equation modeling-based discrete choice modeling: an illustration in modeling retailer choice. Bus Res 12(1):115–142. https://doi.org/10.1007/s40685-018-0072-4

Hair JF, Sarstedt M, Ringle CM, Mena JA (2012) An assessment of the use of partial least squares structural equation modeling in marketing research. Acad Mark Sci 40:414–433. https://doi.org/10.1007/s11747-011-0261-6

Heirman W, Walrave M, Ponnet K (2013) Predicting adolescents’ disclosure of personal information in exchange for commercial incentives: An application of an extended theory of planned behavior. Cyberpsych Behav Soc Netw16(2):81–87. https://doi.org/10.1089/cyber.2012.0041

Hewei T, Youngsook L (2022) Factors affecting continuous purchase intention of fashion products on social E-commerce: SOR model and the mediating effect. Entertain Comput 41:100474. https://doi.org/10.1016/j.entcom.2021.100474

Hovland CI, Janis IL, Kelley HH (1953) Communication and persuasion. Yale University Press

Hsieh JK, Li YJ (2020) Will you ever trust the review website again? The importance of source credibility. Int J Electron Commerce 24(2):255–275. https://doi.org/10.1080/10864415.2020.1715528

Huang YC (2023) Integrated concepts of the UTAUT and TPB in virtual reality behavioral intention. J Retail Consum Serv 70:103127. https://doi.org/10.1016/j.jretconser.2022.103127

Hudders L, Lou C (2023) The rosy world of influencer marketing? Its bright and dark sides, and future research recommendations. Int J Advert 42(1):151–161. https://doi.org/10.1080/02650487.2022.2137318

Itani OS, Kalra A, Riley J (2022) Complementary effects of CRM and social media on customer co-creation and sales performance in B2B firms: The role of salesperson self-determination needs. Inf Manag 59(3):103621. https://doi.org/10.1016/j.im.2022.103621

Jang W, Kim J, Kim S, Chun JW (2021) The role of engagement in travel influencer marketing: the perspectives of dual process theory and the source credibility model. Curr Issues Tour 24(17):2416–2420. https://doi.org/10.1080/13683500.2020.1845126

Jin SV, Ryu E, Muqaddam A (2021) I trust what she’s# endorsing on Instagram: moderating effects of parasocial interaction and social presence in fashion influencer marketing. J Fash Mark Manag 25(4):665–681. https://doi.org/10.1108/JFMM-04-2020-0059

Kamboj S, Sharma M (2023) Social media adoption behaviour: consumer innovativeness and participation intention. Int J Consum Stud 47(2):523–544. https://doi.org/10.1111/ijcs.12848

Kaushik AK, Rahman Z (2014) Perspectives and dimensions of consumer innovativeness: a literature review and future agenda. J Int Consum Mark 26(3):239–263. https://doi.org/10.1080/08961530.2014.893150

Kelley JB, Alden DL (2016) Online brand community: through the eyes of self-determination theory. Internet Res 26(4):790–808. https://doi.org/10.1108/IntR-01-2015-0017

K Kim DY, Kim HY (2021) Trust me, trust me not: A nuanced view of influencer marketing on social media. J Bus Res 134:223–232. https://doi.org/10.1016/j.jbusres.2021.05.024

Koay KY, Ong DLT, Khoo KL, Yeoh HJ (2020) Perceived social media marketing activities and consumer-based brand equity: Testing a moderated mediation model. Asia Pac J Mark Logist 33(1):53–72. https://doi.org/10.1108/APJML-07-2019-0453

Kumar S, Panda BS (2020) Identifying influential nodes in Social Networks: Neighborhood Coreness based voting approach. Phys A: Stat Mech Appl 553:124215. https://doi.org/10.1016/j.physa.2020.124215

Lee D, Hosanagar K, Nair HS (2018) Advertising content and consumer engagement on social media: evidence from Facebook. Manag Sci 64(11):5105–5131. https://doi.org/10.1287/mnsc.2017.2902

Lee DH, Im S, Taylor CR (2008) Voluntary self‐disclosure of information on the Internet: a multimethod study of the motivations and consequences of disclosing information on blogs. Psychol Mark 25(7):692–710. https://doi.org/10.1002/mar.20232

Lee J, Rajtmajer S, Srivatsavaya E, Wilson S (2023) Online self-disclosure, social support, and user engagement during the COVID-19 pandemic. ACM Trans Soc Comput 6(3-4):1–31. https://doi.org/10.1145/3617654

Lee Y, Lee J, Hwang Y (2015) Relating motivation to information and communication technology acceptance: self-determination theory perspective. Comput Hum Behav 51:418–428. https://doi.org/10.1016/j.chb.2015.05.021

Leite FP, Baptista PDP (2022) The effects of social media influencers’ self-disclosure on behavioral intentions: The role of source credibility, parasocial relationships, and brand trust. J Mark Theory Pr 30(3):295–311. https://doi.org/10.1080/10696679.2021.1935275

Leite FP, Pontes N, de Paula Baptista P (2022) Oops, I’ve overshared! When social media influencers’ self-disclosure damage perceptions of source credibility. Comput Hum Behav 133:107274. https://doi.org/10.1016/j.chb.2022.107274

León SP, Abad MJ, Rosas JM (2009) Giving contexts informative value makes information context-specific. Exp Psychol. https://doi.org/10.1027/1618-3169/a000006

Lou C, Tan SS, Chen X (2019) Investigating consumer engagement with influencer-vs. brand-promoted ads: The roles of source and disclosure. J Interact Advert 19(3):169–186. https://doi.org/10.1080/15252019.2019.1667928

Lou C, Yuan S (2019) Influencer marketing: how message value and credibility affect consumer trust of branded content on social media. J Interact Advert 19(1):58–73. https://doi.org/10.1080/15252019.2018.1533501

Luo M, Hancock JT (2020) Self-disclosure and social media: motivations, mechanisms and psychological well-being. Curr Opin Psychol 31:110–115. https://doi.org/10.1016/j.copsyc.2019.08.019

Article   PubMed   Google Scholar  

Mahmood S, Khwaja MG, Jusoh A (2019) Electronic word of mouth on social media websites: role of social capital theory, self-determination theory, and altruism. Int J Space-Based Situat Comput 9(2):74–89. https://doi.org/10.1504/IJSSC.2019.104217

Majerczak P, Strzelecki A (2022) Trust, media credibility, social ties, and the intention to share towards information verification in an age of fake news. Behav Sci 12(2):51. https://doi.org/10.3390/bs12020051

Article   PubMed   PubMed Central   Google Scholar  

McAllister DJ (1995) Affect-and cognition-based trust as foundations for interpersonal cooperation in organizations. Acad Manag J 38(1):24–59. https://doi.org/10.5465/256727

Mehrabian A, Russell JA (1974). An approach to environmental psychology. The MIT Press

Minton EA (2015) In advertising we trust: Religiosity’s influence on marketplace and relational trust. J Advert 44(4):403–414. https://doi.org/10.1080/00913367.2015.1033572

Moorman C, Deshpande R, Zaltman G (1993) Factors affecting trust in market research relationships. J Mark 57(1):81–101. https://doi.org/10.1177/002224299305700106

Muntinga DG, Moorman M, Smit EG (2011) Introducing COBRAs: Exploring motivations for brand-related social media use. Int J Advert 30(1):13–46. https://doi.org/10.2501/IJA-30-1-013-046

Nadeem W, Tan TM, Tajvidi M, Hajli N (2021) How do experiences enhance brand relationship performance and value co-creation in social commerce? The role of consumer engagement and self brand-connection. Technol Forecast Soc 171:120952. https://doi.org/10.1016/j.techfore.2021.120952

Oestreicher-Singer G, Zalmanson L (2013) Content or community? A digital business strategy for content providers in the social age. MIS Quart 37(2):591–616. https://www.jstor.org/stable/43825924

Okazaki S (2009) Social influence model and electronic word of mouth: PC versus mobile internet. Int J Advert 28(3):439–472. https://doi.org/10.2501/S0265048709200692

Piehler R, Schade M, Kleine-Kalmer B, Burmann C (2019) Consumers’ online brand-related activities (COBRAs) on SNS brand pages: an investigation of consuming, contributing and creating behaviours of SNS brand page followers. Eur J Mark 53(9):1833–1853. https://doi.org/10.1108/EJM-10-2017-0722

Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP (2003) Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 88(5):879. https://doi.org/10.1037/0021-9010.88.5.879

Pop RA, Săplăcan Z, Dabija DC, Alt MA (2022) The impact of social media influencers on travel decisions: The role of trust in consumer decision journey. Curr Issues Tour 25(5):823–843. https://doi.org/10.1080/13683500.2021.1895729

Pradhan B, Kishore K, Gokhale N (2023) Social media influencers and consumer engagement: a review and future research agenda. Int J Consum Stud 47(6):2106–2130. https://doi.org/10.1111/ijcs.12901

Qiu A, Chen M (2018) 基于UTAUT修正模型的微信朋友圈广告接受意愿分析 [Analysis of WeChat moments advertising acceptance intention based on a modified UTAUT model]. Stat Decis 34(12):99–102. https://doi.org/10.13546/j.cnki.tjyjc.2018.12.024

Qiu L, Kumar S (2017) Understanding voluntary knowledge provision and content contribution through a social-media-based prediction market: a field experiment. Inf Syst Res 28(3):529–546. https://doi.org/10.1287/isre.2016.0679

Racherla P, Mandviwalla M, Connolly DJ (2012) Factors affecting consumers’ trust in online product reviews. J Consum Behav 11(2):94–104. https://doi.org/10.1002/cb.385

Ranjbarian B, Gharibpoor M, Lari A (2012) Attitude toward SMS advertising and derived behavioral intension, an empirical study using TPB (SEM method). J Am Sci 8(7):297–307. https://www.ceeol.com/search/article-detail?id=466212

Robertshaw GS, Marr NE (2006) The implications of incomplete and spurious personal information disclosures for direct marketing practice. J Database Mark Custom Strategy Manag. 13:186–197. https://doi.org/10.1057/palgrave.dbm.3240296

Roh T, Seok J, Kim Y (2022) Unveiling ways to reach organic purchase: Green perceived value, perceived knowledge, attitude, subjective norm, and trust. J Retail Consum Serv 67:102988. https://doi.org/10.1016/j.jretconser.2022.102988

Schivinski B, Christodoulides G, Dabrowski D (2016) Measuring consumers’ engagement with brand-related social-media content: Development and validation of a scale that identifies levels of social-media engagement with brands. J Advert Res 56(1):64–80. https://doi.org/10.2501/JAR-2016-004

Schouten AP, Janssen L, Verspaget M (2021) Celebrity vs. Influencer endorsements in advertising: the role of identification, credibility, and product-endorser fit. Leveraged marketing communications, Routledge. pp. 208–231

Schramm H, Hartmann T (2008) The PSI-Process Scales. A new measure to assess the intensity and breadth of parasocial processes. Communications. https://doi.org/10.1515/COMM.2008.025

Shan Y, Chen KJ, Lin JS (2020) When social media influencers endorse brands: the effects of self-influencer congruence, parasocial identification, and perceived endorser motive. Int J Advert 39(5):590–610. https://doi.org/10.1080/02650487.2019.1678322

Shi Y (2018) The impact of consumer innovativeness on the intention of clicking on SNS advertising. Mod Econ 9(2):278–285. https://doi.org/10.4236/me.2018.92018

Article   CAS   Google Scholar  

Simon F, Tossan V (2018) Does brand-consumer social sharing matter? A relational framework of customer engagement to brand-hosted social media. J Bus Res 85:175–184. https://doi.org/10.1016/j.jbusres.2017.12.050

Steinhoff L, Arli D, Weaven S, Kozlenkova IV (2019) Online relationship marketing. J Acad Mark Sci 47:369–393. https://doi.org/10.1007/s11747-018-0621-6

Stutzman F, Capra R, Thompson J (2011) Factors mediating disclosure in social network sites. Comput Hum Behav 27(1):590–598. https://doi.org/10.1016/j.chb.2010.10.017

Sun T, Youn S, Wu G, Kuntaraporn M (2006) Online word-of-mouth (or mouse): An exploration of its antecedents and consequences. J Comput-Mediat Comm 11(4):1104–1127. https://doi.org/10.1111/j.1083-6101.2006.00310.x

Sweet KS, LeBlanc JK, Stough LM, Sweany NW (2020) Community building and knowledge sharing by individuals with disabilities using social media. J Comput Assist Lear 36(1):1–11. https://doi.org/10.1111/jcal.12377

Tak P, Gupta M (2021) Examining travel mobile app attributes and its impact on consumer engagement: An application of SOR framework. J Internet Commer 20(3):293–318. https://doi.org/10.1080/15332861.2021.1891517

Towner E, Grint J, Levy T, Blakemore SJ, Tomova L (2022) Revealing the self in a digital world: a systematic review of adolescent online and offline self-disclosure. Curr Opin Psychol 45:101309. https://doi.org/10.1016/j.copsyc.2022.101309

Vander Schee BA, Peltier J, Dahl AJ (2020) Antecedent consumer factors, consequential branding outcomes and measures of online consumer engagement: current research and future directions. J Res Interact Mark 14(2):239–268. https://doi.org/10.1108/JRIM-01-2020-0010

Van-Tien Dao W, Nhat Hanh Le A, Ming-Sung Cheng J, Chao Chen D (2014) Social media advertising value: The case of transitional economies in Southeast Asia. Int J Advert 33(2):271–294. https://doi.org/10.2501/IJA-33-2-271-294

Viswanathan V, Hollebeek LD, Malthouse EC, Maslowska E, Jung Kim S, Xie W (2017) The dynamics of consumer engagement with mobile technologies. Serv Sci 9(1):36–49. https://doi.org/10.1287/serv.2016.0161

Voss KE, Spangenberg ER, Grohmann B (2003) Measuring the hedonic and utilitarian dimensions of consumer attitude. J Mark Res 40(3):310–320. https://doi.org/10.1509/jmkr.40.3.310.19238

Vrontis D, Makrides A, Christofi M, Thrassou A (2021) Social media influencer marketing: A systematic review, integrative framework and future research agenda. Int J Consum Stud 45(4):617–644. https://doi.org/10.1111/ijcs.12647

Wang T, Yeh RKJ, Chen C, Tsydypov Z (2016) What drives electronic word-of-mouth on social networking sites? Perspectives of social capital and self-determination. Telemat Inf 33(4):1034–1047. https://doi.org/10.1016/j.tele.2016.03.005

Watson JB (1917) An Attempted formulation of the scope of behavior psychology. Psychol Rev 24(5):329. https://doi.org/10.1037/h0073044

Wehmeyer ML (1999) A functional model of self-determination: Describing development and implementing instruction. Focus Autism Dev Dis 14(1):53–61. https://www.imdetermined.org/wp-content/uploads/2018/06/SD5_A-Functional-Model-of.pdf

Wei X, Chen H, Ramirez A, Jeon Y, Sun Y (2022) Influencers as endorsers and followers as consumers: exploring the role of parasocial relationship, congruence, and followers’ identifications on consumer–brand engagement. J Interact Advert 22(3):269–288. https://doi.org/10.1080/15252019.2022.2116963

Wirth J, Maier C, Laumer S (2019) Subjective norm and the privacy calculus: explaining self-disclosure on social networking sites. Paper presented at the 27th European Conference on Information Systems (ECIS). Stockholm & Uppsala, Sweden, 8–14, June 2019 https://aisel.aisnet.org/ecis2019_rp

Xiao L, Li X, Zhang Y (2023) Exploring the factors influencing consumer engagement behavior regarding short-form video advertising: a big data perspective. J Retail Consum Serv 70:103170. https://doi.org/10.1016/j.jretconser.2022.103170

Yang J, Peng MYP, Wong S, Chong W (2021) How E-learning environmental stimuli influence determinates of learning engagement in the context of COVID-19? SOR model perspective. Front Psychol 12:584976. https://doi.org/10.3389/fpsyg.2021.584976

Yang K, Jolly LD (2009) The effects of consumer perceived value and subjective norm on mobile data service adoption between American and Korean consumers. J Retail Consum Serv 16(6):502–508. https://doi.org/10.1016/j.jretconser.2009.08.005

Yang S, Zhou S, Cheng X (2019) Why do college students continue to use mobile learning? Learning involvement and self‐determination theory. Brit J Educ Technol 50(2):626–637. https://doi.org/10.1111/bjet.12634

Yusuf AS, Busalim AH (2018) Influence of e-WOM engagement on consumer purchase intention in social commerce. J Serv Mark 32(4):493–504. https://doi.org/10.1108/JSM-01-2017-0031

Zhang G, Yue X, Ye Y, Peng MYP (2021) Understanding the impact of the psychological cognitive process on student learning satisfaction: combination of the social cognitive career theory and SOR model. Front Psychol 12:712323. https://doi.org/10.3389/fpsyg.2021.712323

Zhang J, Liu J, Zhong W (2019) 广告精准度与广告效果:基于隐私关注的现场实验 [Ad targeting accuracy and advertising effectiveness: a field experiment based on privacy concerns]. Manag Sci 32(06):123–132

CAS   Google Scholar  

Download references

Acknowledgements

The authors thank all the participants of this study. The participants were all informed about the purpose and content of the study and voluntarily agreed to participate. The participants were able to stop participating at any time without penalty. Funding for this study was provided by Minjiang University Research Start-up Funds (No. 324-32404314).

Author information

Authors and affiliations.

School of Journalism and Communication, Minjiang University, Fuzhou, China

School of Journalism and Communication, Shanghai University, Shanghai, China

Qiuting Duan

You can also search for this author in PubMed   Google Scholar

Contributions

Conceptualization: CG; methodology: CG and QD; software: CG and QD; validation: CG; formal analysis: CG and QD; investigation: CG and QD; resources: CG; data curation: CG and QD; writing—original draft preparation: CG; writing—review and editing: CG; visualization: CG; project administration: CG. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Chenyu Gu .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethical approval

The questionnaire and methodology for this study were approved by the School of Journalism and Communication, Minjiang University, Committee on Ethical Research (No. MJUCER20230621). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all participants and/or their legal guardians.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Gu, C., Duan, Q. Exploring the dynamics of consumer engagement in social media influencer marketing: from the self-determination theory perspective. Humanit Soc Sci Commun 11 , 587 (2024). https://doi.org/10.1057/s41599-024-03127-w

Download citation

Received : 17 December 2023

Accepted : 23 April 2024

Published : 08 May 2024

DOI : https://doi.org/10.1057/s41599-024-03127-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

  • Explore articles by subject
  • Guide to authors
  • Editorial policies

current literature data

IMAGES

  1. Current data in literature

    current literature data

  2. The Importance of Literature Review in Scientific Research Writing

    current literature data

  3. 15 Literature Review Examples (2024)

    current literature data

  4. Data in the literature compared with our current study data

    current literature data

  5. Scholarly Literature (Databases) ARTICLES

    current literature data

  6. Biorbital width: current and literature data in various age and ethnic

    current literature data

VIDEO

  1. Research and Evidence Base Practice (Literature/ Data base search)

  2. Cognitive Interventions to Improve Math Skills

  3. Definition of Literature What is Literature? Literature of Power and Knowledge, Thomas De Quincey

  4. Manage Your Research Literature using Linked Database in Notion

  5. Literature 001 Introduction to Literature

  6. Digital Literature. Lesung und Gespräch mit Lukas Diestel und Berit Glanz

COMMENTS

  1. A practical guide to data analysis in general literature reviews

    This article is a practical guide to conducting data analysis in general literature reviews. The general literature review is a synthesis and analysis of published research on a relevant clinical issue, and is a common format for academic theses at the bachelor's and master's levels in nursing, physiotherapy, occupational therapy, public health and other related fields.

  2. How to Write a Literature Review

    Examples of literature reviews. Step 1 - Search for relevant literature. Step 2 - Evaluate and select sources. Step 3 - Identify themes, debates, and gaps. Step 4 - Outline your literature review's structure. Step 5 - Write your literature review.

  3. Guidance on Conducting a Systematic Literature Review

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

  4. Approaching literature review for academic purposes: The Literature

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

  5. Critical Analysis: The Often-Missing Step in Conducting Literature

    The key element in determining the rigor within the process of synthesizing literature is the nature of data being synthesized—its quality (accuracy in the detail and types ... Noel-Weiss J., Boersma S., Kujawa-Myles S. (2012). Questioning current definitions for breastfeeding research. International Breastfeeding Journal, 7(1), 7-9.doi:10. ...

  6. Methodological Approaches to Literature Review

    A literature review is defined as "a critical analysis of a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles." (The Writing Center University of Winconsin-Madison 2022) A literature review is an integrated analysis, not just a summary of scholarly work on a specific topic.

  7. A Systematic Literature Review of Health Information Systems for

    Thus, through a comprehensive review of the extant literature, this study presents a critique of the health information system for healthcare to supplement the gap created as a result of the lack of an in-depth outlook of the current health information system from a holistic slant. From the studies, the health information system was ascertained ...

  8. Disentangling the Linkage of Primary Care Features to Patient ...

    Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs J Gen Intern Med . 2015 Aug;30 Suppl 3(Suppl 3):S576-85. doi: 10.1007/s11606-015-3311-9.

  9. A Thematic Review of Current Literature Examining Evidence-Based ...

    The purpose of this article was to provide a thematic summary of current literature combining the topics of evidence-based practices (EBPs) and inclusive settings. We summarized findings from 27 peer-reviewed articles written in English and published between 2012-2022. A systematic, thematic literature review yielded four broad categories addressed in recent publications: using specific ...

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

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

  11. A literature review of 2019 novel coronavirus (SARS-CoV2) infection in

    Thus, due to the scarcity of data on SARS-CoV2 in children, we aimed at evaluating the current literature available to provide useful information for clinicians dealing with this particular ...

  12. 5. The Literature Review

    A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories.A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that ...

  13. Primary Care Features and Associations with Patient Outcomes

    INTRODUCTION. Increased attention is being directed toward ascertaining how to maximize the efficiency and quality of health care in the U.S. 1 Part of this effort involves bolstering the primary care infrastructure 2, 3 which plays a central role in health care provision and is an organizing feature of health care delivery systems in most Western industrialized democracies. 4 - 6 Systems ...

  14. Literature Review Research

    Literature Review is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.. Also, we can define a literature review as the collected body of scholarly works related to a topic:

  15. Economic forecasting with big data: A literature review

    Abstract. Big data technology has revolutionized the research paradigm of economic forecasting regardless of the data source, forecasting method, or forecasting result. This study evaluates the current literature on economic forecasting using big data and employs bibliometric approaches to offer a comprehensive analysis.

  16. Scientific Data

    Scientific Data is an open-access, online-only journal for descriptions of scientifically valuable datasets. ... We derive this guidance from the extant literature and our own experience in ...

  17. List of academic databases and search engines

    Education literature and resources dating back to 1966. ... Provides indexing and abstracts from current serial and non-serial titles, including content from AIAA and NASA: Subscription ... bio-bibliographic data about illustrators of published scientific works from c.1450 until 1950 in 100+ countries, with 20 search fields ...

  18. Critical Analysis of Reliability and Validity in Literature Reviews

    Critical Analysis of Reliability and Validity in Literature Reviews. Ellen Chetwynd, PhD, MPH, BSN, ... you can download article citation data to the citation manager of your choice. Select your citation manager software: Direct import ... Current Practice and Recommendations. Show details Hide details.

  19. Five tips for developing useful literature summary tables for writing

    Literature reviews offer a critical synthesis of empirical and theoretical literature to assess the strength of evidence, develop guidelines for practice and policymaking, and identify areas for future research.1 It is often essential and usually the first task in any research endeavour, particularly in masters or doctoral level education. For effective data extraction and rigorous synthesis ...

  20. Data literacy assessments: a systematic literature review

    The results can help researchers and practitioners better understand the current state of data literacy assessments in terms of issues related to 1) educational levels and audiences; 2) data ...

  21. Protocol for a scoping review study on learning plan use in

    Literature searches will be conducted using multiple databases by a librarian with expertise in scoping reviews. Through an iterative process, inclusion and exclusion criteria will be developed and a data extraction form refined. ... The current paradigm of competency-based medical education and learner-centredness requires learners to take an ...

  22. Keeping Current with the Literature

    One of the biggest challenges is keeping up with all the literature. This guide will provide instructions to creating alerts for many of the top services, and also some of the other tools to keep current with emerging research. There are several types of alerts which can be created to keep up to date on various advances; Articles. Subjects.

  23. Primary Care Features and Associations with Patient Outcomes

    Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. For a variety of reasons, however, the practice of primary care has been in decline in the U.S. This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary ...

  24. Learning together for better health using an evidence-based Learning

    The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit. ... Current core components of a ...

  25. Climate Change and Heat: Challenges for Child Health Outcomes and

    For instance, the current literature shows this association for cystic fibrosis, with increased cases of electrolyte derangements, infection, and pancreatitis [5••, 6]. ... Data specific to pediatric populations are more limited, yet point toward multiple profound health effects across human organ systems .

  26. Integrity of Databases for Literature Searches in Nursing

    The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information.

  27. Exploring the dynamics of consumer engagement in social media ...

    The current study employed a Bootstrapping test with a sample size of 5000 on the collected raw data to explore the coefficients and significance of the paths in the research model.

  28. Prostate-Specific Membrane Antigen Positron Emission Tomography ...

    The clinical integration of prostate membrane specific antigen (PSMA) positron emission tomography and computed tomography (PET/CT) scans represents potential for advanced data analysis techniques in prostate cancer (PC) prognostication. Among these tools is the use of radiomics, a computer-based method of extracting and quantitatively analyzing subvisual features in medical imaging. Within ...

  29. Current Physical Therapy for Skin Scars Management: A Scoping Review

    Background: Scar impairments impose a great economic burden and influence a subject's well-being and quality of life. Despite that, physiotherapy interventions are poorly investigated. Objective of the study: Provide a comprehensive overview of studies addressing physiotherapy and conservative non-invasive interventions for skin scar management, summarizing studies based on scar type ...