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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of 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, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

Prevent plagiarism. Run a free check.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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Literature Review Step by Step

• Internet Sources
• Refining Your Understanding
• Parts of a Literature Review
• Choosing a Topic
• Search Terms
• Peer Review
• Social Media Sources
• Information Landscape

What Tests to Apply When Evaluating Sources

If you cannot access the above video, you can watch it here .

•Is the  author  of the information named? ​• What are the author's  qualifications  and expertise?  •Who  sponsors  the website? •Is the sponsor of the page  reputable ? How reputable? •Is there a link to  information about the author  and/or the sponsor and/or a way to contact them? •Are there links to any other organization(s) that supplies information to the website? •If the page includes neither a signature nor indicates a sponsor, is there a way to determine its origin ?

Why is this important?

• Anyone can publish  anything  on the web.
• Qualifications  can bolster confidence in the information presented.
• Authorship  and/or sponsorship can be an  indication of bias  or limited viewpoint.
• Is the page dated? 
• If so, when was the last update? 
• How current are the links? 
• Have some expired or moved?

Why is this important? When dates are not provided,  you cannot tell how "stale" the information is  and whether newer information exists that's not covered on the website. Bad links are an indication of  a site that might be abandoned  or neglected. Even if  a date  is provided, it  may have various meanings . For example,

• It may indicate when the material was first written.
• It may indicate when the material was first placed on the Web.
• It may indicate when the material was last revised.

Determining Authorship

►Is the document signed? ►Can I get more information on the author by linking from this page to other documents? ►Was there information about the author on the page from which I linked to this one?

If you can answer "Yes" to the second or third question, it's possible that you will have enough information for evaluative purposes, or at least enough information to help you find the author's telephone number or e-mail address so that you may contact him or her with questions.

If you can answer "Yes" to the first question only, you may need to find further information on the author. Start by Googling the name. This process will require some judgement on your part, but if you are quickly lead to a dead end, this should be a red flag.

Who is the Publisher?

Does the page have the following:

•  A header or footer that shows its affiliation as part of a larger web site.
•  A watermark or wallpaper that fulfills the same function.
•  A link at the bottom or top of the page that allows you to go to the home page of the web site where the document lives.
•  A link that allows you to email the site

When evaluating a website there are several things to take into consideration, one of the first things to look at is the URL (Uniform Resource Locator: a protocol for specifying addresses on the Internet) this can often tell you several things about the website, the creator, the audience, the purpose and sometimes even the country of origin.  The URL is the address you type in to get to a web site, for example, https://www.uml.edu/library/ (our library’s address) or https://www.google.se/ (Sweden’s Google search).

A domain name is like a website’s proper name (the part after the www.), businesses and organizations often have a domain name that is their corporate name (for example Microsoft’s domain name is Microsoft.com).  The domain suffix is the end of the domain name (the .com part) and can offer insight into the type of organization the site is linked to.  For example, any commercial enterprise or corporation that has a web site will have a domain suffix of .com, which means it is a commercial entity. Popular domain suffixes include ".com," ".net," ".gov," and ".org," but there are dozens of domain suffixes.  However, since any entity can register domain names with these suffixes, the domain suffix does not always represent the type of website that uses the domain name. For example, many individuals and organizations register ".com" domain names for non-commercial purposes, since the ".com" domain is the most recognized.

The domain suffix might also give you a clue about the geographic origin of a web site, each country also has a unique domain suffix that is meant to be used for websites within the country. For example, Brazilian websites may use the ".br" domain suffix, Chinese websites may use the ".cn" suffix, and Australian websites may use the ".au" suffix. These country-based TLDs, sometimes referred to as "country codes," are also used to specify different versions of an international website. For example, the German home page for Google is "www.google.de" instead of "www.google.com."

http://agriculture. sc . gov /divisions/agency-services/state-farmers-markets/

From the web address above, you can tell it is a Government site (.gov) and it is for the state of South Carolina (.sc) the domain name is for the Department of Agriculture. The page is for a listing of state farmers markets, you can see the path to the filename after each backslash (/).

Recognizing a Personal Website

A personal web page is one published by an individual who may or may not be affiliated with a larger institution. Although the URL address of the page may have a variety of endings (e.g. .com, .edu, etc.), a tilde (~) is frequently embedded somewhere in the URL

Consider the following:

• Is it clear what individual is responsible for the contents of the page?
• Does the individual responsible for the page indicate his or her qualifications for writing on this topic?
• Is there a way of verifying the legitimacy of this individual? (Because it is difficult to verify the legitimacy of an individual, personal home pages may be a useful source for personal opinion but use extreme caution when using them as a source for factual information.)
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A systematic literature review on Internet of things in education: Benefits and challenges

• Engineering Division (Great Valley)
• Institute for Computational and Data Sciences (ICDS)

Research output : Contribution to journal › Article › peer-review

With close to 20.4 billion devices connected to the Internet to be deployed by 2020, Internet of things (IoT) is already being leveraged in diverse sectors. Now, because of the ubiquitous nature of IoT devices, schools and academic institutions are looking to incorporate IoT in educational activities. With the increased use of IoT in the education domain, it is of utmost importance to study how this technology with its distinguished system functions such as sensing and decision making can support and challenge the pedagogical processes for all interrelated actors (faculty, students, and staff) as well as all involved assets (e.g., libraries, classrooms, and labs). Although there have been several contributions on the inclusion of IoT into the education domain, there is still a lack of consolidated and coherent views on this subject. Hence, we are motivated to close the gap of knowledge and embarked on mapping out the published studies available. This study presents the results of a systematic literature review focusing on the benefits and the challenges faced in education in integrating IoT into the curriculum and educational environments. Different mapping views of the extracted studies are provided as long as a summary of the already implemented tools and a list of gap research questions yet to be investigated.

All Science Journal Classification (ASJC) codes

• Computer Science Applications

Access to Document

• 10.1111/jcal.12383

Other files and links

• Link to publication in Scopus
• Link to the citations in Scopus

Fingerprint

• Education Engineering & Materials Science 100%
• Internet of things Engineering & Materials Science 98%
• Internet Social Sciences 73%
• literature Social Sciences 49%
• education Social Sciences 36%
• Curricula Engineering & Materials Science 20%
• educational activities Social Sciences 17%
• Students Engineering & Materials Science 14%

T1 - A systematic literature review on Internet of things in education

T2 - Benefits and challenges

AU - Kassab, Mohamad

AU - DeFranco, Joanna

AU - Laplante, Phillip

N1 - Publisher Copyright: © 2019 John Wiley & Sons, Ltd

PY - 2020/4/1

Y1 - 2020/4/1

N2 - With close to 20.4 billion devices connected to the Internet to be deployed by 2020, Internet of things (IoT) is already being leveraged in diverse sectors. Now, because of the ubiquitous nature of IoT devices, schools and academic institutions are looking to incorporate IoT in educational activities. With the increased use of IoT in the education domain, it is of utmost importance to study how this technology with its distinguished system functions such as sensing and decision making can support and challenge the pedagogical processes for all interrelated actors (faculty, students, and staff) as well as all involved assets (e.g., libraries, classrooms, and labs). Although there have been several contributions on the inclusion of IoT into the education domain, there is still a lack of consolidated and coherent views on this subject. Hence, we are motivated to close the gap of knowledge and embarked on mapping out the published studies available. This study presents the results of a systematic literature review focusing on the benefits and the challenges faced in education in integrating IoT into the curriculum and educational environments. Different mapping views of the extracted studies are provided as long as a summary of the already implemented tools and a list of gap research questions yet to be investigated.

AB - With close to 20.4 billion devices connected to the Internet to be deployed by 2020, Internet of things (IoT) is already being leveraged in diverse sectors. Now, because of the ubiquitous nature of IoT devices, schools and academic institutions are looking to incorporate IoT in educational activities. With the increased use of IoT in the education domain, it is of utmost importance to study how this technology with its distinguished system functions such as sensing and decision making can support and challenge the pedagogical processes for all interrelated actors (faculty, students, and staff) as well as all involved assets (e.g., libraries, classrooms, and labs). Although there have been several contributions on the inclusion of IoT into the education domain, there is still a lack of consolidated and coherent views on this subject. Hence, we are motivated to close the gap of knowledge and embarked on mapping out the published studies available. This study presents the results of a systematic literature review focusing on the benefits and the challenges faced in education in integrating IoT into the curriculum and educational environments. Different mapping views of the extracted studies are provided as long as a summary of the already implemented tools and a list of gap research questions yet to be investigated.

UR - http://www.scopus.com/inward/record.url?scp=85074992670&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074992670&partnerID=8YFLogxK

U2 - 10.1111/jcal.12383

DO - 10.1111/jcal.12383

M3 - Article

AN - SCOPUS:85074992670

SN - 0266-4909

JO - Journal of Computer Assisted Learning

JF - Journal of Computer Assisted Learning

An Internet of Things and Smart Cities Frameworks Implementation in Municipalities: A Systematic Literature Review

• Conference paper
• First Online: 29 June 2024
• Cite this conference paper

• Moabi Kompi 18  

Part of the book series: Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering ((LNICST,volume 520))

Included in the following conference series:

• International Conference on Emerging Technologies for Developing Countries

Recent years have seen an exponential growth in Internet of Things (IoT) frameworks and smart city frameworks. In many countries, local governments are seeking smart solutions, particularly in these frameworks where IoT innovation, development, and implementation profoundly influence the environment, economy, people, living, governance, and mobility. Internet of Things (IoT) frameworks and smart city implementation in municipalities are comprehensively reviewed and analyzed in this paper. This review is designed to identify, describe, and synthesize research findings on IoT and smart cities frameworks deployments in various municipalities. Databases such as Google Scholar and Web of science were utilized to acquire articles relevant to this study's objectives by scanning their titles, abstracts, introductions, and conclusions. To obtain related data, skimming and reading full texts were used to conduct a comprehensive literature review. For a more comprehensive understanding of current research and practice, 39 relevant studies were systematically reviewed. A variety of IoT technologies, communication protocols, and machine learning applications are discussed in this study. In addition to exploring smart city implementation frameworks adopted globally, the study sheds light on a variety of key areas of interest, including mobility, governance, economy, people, living, and the environment. The findings indicate that digital technologies play an increasingly important role in both providing insights into the evolving IoT and smart city landscape within municipalities globally as well as influencing and improving the quality of life for citizens.

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Kompi, M. (2024). An Internet of Things and Smart Cities Frameworks Implementation in Municipalities: A Systematic Literature Review. In: Masinde, M., Möbs, S., Bagula, A. (eds) Emerging Technologies for Developing Countries. AFRICATEK 2023. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 520. Springer, Cham. https://doi.org/10.1007/978-3-031-63999-9_2

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People who used the internet reported higher scores for outcomes like community well-being and life satisfaction.

Scrolling your phone sounds like the opposite of self-care, but new research suggests that internet use and access actually boost one’s happiness. 

In a massive new study published in the journal Technology, Mind, and Behavior , researchers examined what kind of effect the internet has on psychological well-being. They found that people who had access to the internet scored 8% higher on well-being measures than those who lacked web access. The effect was similar to the benefit associated with taking a walk in nature. 

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How can the internet possibly be good for us?

The study doesn’t provide specific answers about why going online could make us happier, but other research has found that the internet can be a source of social support and community for people living with physical disabilities, create a sense of belonging among adolescents and spur a reduction in depression among older adults .  

The internet is increasingly linked with health when it comes to treatment, too -- particularly for mental health . One study published by the American Medical Association found that 88% of mental health treatment facilities offered telehealth services in September 2022 compared with 39.4% of facilities in April 2019.

Because the internet touches so many parts of our lives, organizations like the Federal Communications Commission and SAMHSA have even called broadband a "super-determinant" of health because of its influence on education, employment and health care access.

"The delivery of clinical services only contributes 20% to health outcomes. 40% is what we call socioeconomic status," Carole Myers, a professor at the University of Tennessee in Knoxville who studies health care access and disparities, told CNET. "It's things like your income level, your education level and the resources that are available in your community." 

"Broadband access is really important for telehealth," Myers said, "but it's important for economic development, for attracting businesses -- it's important for education. And in turn those things drive health." 

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It doesn’t have to be as severe as a weeklong detox, either. Taking periodic breaks from your phone throughout the day can add up to bigger changes, like improved sleep quality . CNET writer Jessica Fierro also suggests taking advantage of the Focus modes on your iPhone or Android phone .

The internet has become vital to our work, health and social lives, and, shockingly, it even makes us happier. But like most things in life, it’s still best when done in moderation. 

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Correction: Machine learning in internet financial risk management: A systematic literature review

• ZongYi Tian,
• Saleh F. A. Khatib,
• Xu Tian, 
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• https://doi.org/10.1371/journal.pone.0306364
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There are errors in the Funding statement. The correct Funding statement is as follows: Open Fund Project of Science and Technology Finance Key Laboratory of Hebei Province (STFCIC202213; STFCIC202102); S&T Program of Hebei (22567630H); Hebei Social Science Fund (HB22YJ026); Baoding Science and Technology Bureau science and technology plan soft science project (2340ZZ013).

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Citation: Tian X, Tian Z, Khatib SFA, Wang Y (2024) Correction: Machine learning in internet financial risk management: A systematic literature review. PLoS ONE 19(6): e0306364. https://doi.org/10.1371/journal.pone.0306364

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Parenthood, information and support on the internet. A literature review of research on parents and professionals online

Lars plantin.

1 Department of Social Work, Faculty of Health and Society, Malmö University, Sweden

Kristian Daneback

2 Department of Social Work, University of Gothenburg, Sweden

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim of this article was to address questions on how parents use the internet to find information and support regarding children, health and family life. Another aim was to find out how professionals use the internet to provide support and information to parents. This was done by a literature review.

Articles were searched for in five databases with a search strategy called "building block" approach.

The review showed that the majority of today's parents search for both information and social support on the internet. However, there are considerable differences due to gender, age and socio-economic differences. First time middle class mothers aged 30–35 are most active in looking up health and parent information on the internet. In the same time, several studies report diminishing class differences on parent web sites. An important reason to the increasing number of parents who turn to the internet for information and interaction has shown to be the weakened support many of today's parents experience from their own parents, relatives and friends. Professionals have recognized the parents' great interest for going online and offer both information and support on the net.

Many benefits are reported, for example the possibility to reach out to a wider audience and to increase access to organisations without an increase in costs. Other benefits include the possibility for parents to remain anonymous in their contacts with professionals and that parents' perceived need for information can be effectively met around the clock. Interventions for wider groups of parents, such as parent training on the net, are still very rare and more research is needed to evaluate different types of interventions on the net. However, most studies were empirical and lacked theoretical frameworks which leave questions on how we can more fully understand this phenomenon unanswered.

Today the possibilities to find information on children, health and parenthood on the internet are immense. When entering the term "parent and health" on the search engine Google it renders more than 90 million hits. If the search term is narrowed to the combination "parent, health and children" more than 50 million hits appear (as of 2009-05-12). Thus, parents are offered huge resources of information on topics ranging from children's diseases, deliveries and breast-feeding to more interactive web pages displaying ordinary problems in every day life, such as sore breasts, the upbringing of children or marital conflicts [ 1 ]. Statistical analyses of how different groups act and navigate on the internet have shown that many parents use the net as an important source for information. For example, market-research from the online network company Yahoo! showed that 86% of new parents-to-be used the internet to search for information on pregnancy and more than half of them claimed this to influence and simplify their lives [ 2 ]. But what do we know from the research on this relatively new phenomenon and what has been the scope of the research in the last decade?

In a prior study we investigated the who , when , where , how and, to some extent, what in the field of parenthood and the internet [ 3 ]. In addition, our aim was to identify dominating themes and trends in the existing body of research. This study, which was based on a systematic search for literature in 5 different databases, showed that the bulk of the articles were published after the year 2000 and that most studies were conducted in North America. The majority of articles were also empirical and conducted within the medical sciences. The analysis showed a fragmented field of research comprising few areas. Most studies focused on professionals' use of the internet in terms of education, information or interventions directed to parents, but some also discussed parents' information seeking on the net. It was concluded that in relation to the popularity of the internet among parents and professionals, relatively few studies have been conducted so far.

But, what do we know more specifically about parents' activities on the internet? To what extent do they use the internet to search for information about parenthood and children and how do they describe the benefits or limitations? What topics do they search for and how do they experience the social support on the internet? Overall, what are the advantages and disadvantages of using the internet in finding information and support about parenthood and children? The purpose of this study is to investigate these questions more closely and also to focus on how parents use the internet to find information and support regarding children, health and family life.

Literature reviews can have different focuses and be conducted, methodologically, in many different ways. Some reviews claim to be "fully systematic" or "a meta analysis" with a strong focus on quality assessment of the selected research. Others are "traditional reviews" or "scope oriented" and more focused on the research findings themselves. This literature review can be related to the latter category, scope oriented, as it mainly focuses on what we know about "parenthood and internet"; thus it does not discuss the quality of the included studies [ 4 ].

Search strategy

The literature review was based on a search strategy called the "building block" approach, a widely used search strategy that builds on similar and related terms combined in blocks [ 5 ]. Five databases were considered relevant for this topic. These were PubMed, ERIC, PsycINFO, Sociological Abstracts, and Social Services Abstracts. The databases were searched from inception until September 14, 2007, and the search was limited to human subjects, English and abstracts in PubMed and to peer-reviewed articles in English in the database platform CSA.

The search strategy was to build two blocks that would include terms (descriptors/MeSH terms) related to the internet and parenthood respectively and to combine the two blocks to capture the most relevant articles.

We included all terms that were related to parenthood in each database to build the first block. We then repeated this step for terms related to the internet to build the second block. The third block was simply a combination of all parenthood related terms and all internet related terms. Consequently, at least one term in the first block had to be matched with at least one term in the second block for an article to be considered relevant in this search. In the first and the second block terms were separated by OR and in the third block by AND.

Inclusion and exclusion criteria

All of the matching references from the literature search were analyzed by the researchers to assess their relevance according to the topic parenthood and the internet.

The criteria for inclusion were that the articles had to be in English and peer-reviewed or, in the case of PubMed, have an abstract. They also had to focus on parenthood and the internet. We defined parenthood and the internet as when parents use the internet to seek support and information about pregnancy, babies/children and parenthood. By contrast, our definition also included professionals using the internet to reach parents or parents-to-be with information on web sites or direct interventions such as online counselling, support groups in web chat rooms or educational programs.

The criteria for exclusion were if the references were editorials or not focusing on our above mentioned definition of parenthood and the internet.

Results of the database searches

The database searches yielded a total of 484 articles, the vast majority were found in PubMed. Of these articles, 109 articles were included by the researchers as relevant to the topic of parenthood and internet. Again, the majority of the articles were sourced from PubMed. In addition, we found that 15 articles were indexed in multiple databases, thus the actual number of relevant articles was lower, 94 articles in all.

A more detailed presentation of the method has been published elsewhere [ 3 ].

Results and discussion

Parents go online – needs and motives.

We already know that parents and parents-to-be consume a vast amount of information about their own and their children's health and development [ 6 ]. This is done, for example, via television, magazines and books and this demand is reflected in the large array of baby-literature, lifestyle magazines based around parenthood and TV-programs such as Baby-boom or Super Nanny, that discuss child-rearing and the parenthood. According to many theorists and researchers, the underlying cause of this trend can be traced to the changing circumstances of the parenthood under post-modernism and an increased risk-awareness coupled with a reduction of support from parents' immediate friends and family [ 7 ]. O'Connor and Madge point to the fact that women traditionally have turned to their own mothers for support in their new parental role, but the increased mobilisation of the population has made close maternal-support more difficult to realize [ 8 ]. Mothers have, so to say, become more isolated and have, to a great extent, lost the daily support that they previously received from their families and other close relations [ 9 ]. Many women also highlight another form of problem coupled to the fast pace-of-change in modern society, namely that the information that they receive from their own mothers or elderly relations is 'out-of-date'. Their experiences are not valid any more [ 8 ]. Instead, parents are forced to trust the information they receive from various experts, in books, in parent magazines and on TV-shows et cetera.

At the same time, many researchers point to the fact that today's parents are no longer satisfied with simple descriptions of parenthood, but instead require more experience-based information, in other words, knowledge that conveys the experiences of others in similar situations as themselves. For example, how does it actually feel giving birth, and how do other parents cope with the challenges of breast-feeding? In parallel to this development, many researchers in family sociology also point to the fact that 'family' as a form of living and as a collective-noun is also changing over time [ 10 , 11 ]. Bäck-Wiklund discusses, for example, how the post-modern family can no longer be described as a closed social unit, but rather as a network of close relationships [ 12 ]. Globalisation, an increasing divorce-rate and increasing numbers of re-built families or stepfamilies, have contributed to the trend of an increased number of family members and a wider geographic spread of close family members. It is here that modern information technology has played an increasingly important role in terms of how it can facilitate the maintenance of emotional ties and the communication of 'nearness' that are so important in day-to-day relations. Today's parents are more accustomed to finding companionship and communication closeness via the internet. Researchers also point out that a further fact influencing modern parents' need for information may be due to the increasingly shorter stay in hospital after giving birth. Prior studies highlight the importance of both support and information in order to have the parents, who have just returned home with their newborn baby, feel secure in their new roles [ 13 , 14 ]. Otherwise, there is a risk that many parents, especially first-time parents, are left alone with their questions and in need of information [ 15 ].

Bylund's study of a website where parents, mothers in particular, post their experiences of delivery, shows that there are primarily four main driving forces which dominate the need to share birthing-stories on the internet; firstly that they have an entertainment value for the individual concerned, secondly that they create a possibility of making contact with other women/mothers who have had similar experiences, thirdly that childbirth is a 'rite-of-passage' and finally that it is an important way to come to terms with the traumatic experience of childbirth [ 16 ]. Similar driving-forces, especially the need for positive affirmation and the chance to measure or share experiences of one's parenthood with others, have been confirmed in other studies. Bernhardt and Felter's interviews with mothers, who were online for health-related information, reveal that they primarily did so to learn more about fetal and child development, to find out more about diagnosing and treating specific paediatric health conditions and to find experience-based support for a variety of parental issues [ 17 ].

Similarly, many of the women in Madge and O'Connor's study reported that the social support from other mothers relieved or neutralised the feeling of isolation and a shrinking life-world that can be experienced during maternity leave [ 18 ].

To use the internet as an information source or to establish contact with others in similar situations is of particular importance for parents whose children are suffering from different varieties of illnesses or whose children are handicapped. Unexpected occurrences can also trigger a strong desire for support and information. For example, in their study of parents with premature babies, Brazy, Andersson, Becker and Becker state that the respondents "made a transition from being passive recipients of information to actively seeking it", especially during the time that the child remained in hospital care [[ 19 ], p.41]. This is also confirmed in studies of parents whose children are suffering from mental illness, neurological disorders or autism, showing that parents value highly the social and emotional support they receive via the internet [ 20 - 23 ].

Lawton, Roberts and Gibb claim that parents of children suffering from a chronic skin disease not only wanted to find professional experts' advice on the internet, but also wished to share their own experience-based expertise that they had built-up over time [ 24 ]. There is, thus, a substantial need for many parents to both receive and share information about children and parenthood, which, to quote O'Connor and Madge, probably suggests:

"that the internet does offer an important source of advice and support for groups such as new mothers, in particular by providing a 'safe', non-judgmental forum in which to share experiences. However, this does not replace face-to-face communication or more traditional support mechanisms such as family, friends, and health careers; rather it serves to supplement these by providing an additional resource" [[ 8 ], p.351].

Searching for information and support – parent's online behaviour

In the light of the developments mentioned above, it is not difficult to understand parents increased use of information provided by the internet regarding children, health and parenthood. A report on American parents' online behaviours show, for example, that close to 70% of parents had gone online to look for health-related and medical information [ 25 ]. A similar market-research study by the online network company Yahoo! showed that 86% of parents-to-be use the internet to search for information about pregnancy [ 2 ]. This is also confirmed in Bernhardt and Felter's qualitative study of how pregnant mothers and mothers of young children seek and process online paediatric information [ 17 ]. It reports that a majority of mothers used the internet in their search for health-related information. For younger first-time mothers, the internet is often the primary source of information, whilst older first-time parents and parents with older children either used books or direct doctor contact as their primary source of information, before turning to the internet.

The majority of parents who use the internet report that they find health-related information online primarily by using search engines. Others find the information they require either via recommendations from friends or through adverts in various parental magazines [ 26 ].

The search for health-related and medical information is often the primary reason for men and women to start using parental web sites [ 27 ]. There has been a phenomenal increase in the number of such sites and today many sites are entirely dedicated to parents and parents-to-be. These sites often contain a mix of activities and offers, ranging from commercial products to health-related information and the possibility to establish social contacts. Bernhardt and Felter describe parent web sites as places where parents can "shop, socialize, and research a wide range of topics" [ 17 ]. The British parental web site "Netmums" serves as a typical example of this virtual environment for parents. It provides links to web pages about everything from morning sickness remedies, information on vaccines, coughs and colds, to the Netmums own "coffeehouse" where members can chat with other parents and get support or advice on anything to do with being a parent – "from little gripes to big issues" [ 28 ]. Additionally, there are also more specialised chat rooms and online groups for parents suffering from postnatal depression. These interactive web sites, where parents quickly at any time of the day and night can get experience-based information from many people in situations similar to their own, are valued by many parents on the internet [ 1 , 8 , 29 - 31 ].

This is evidenced by the steadily increasing number of visits to parental web sites. Russell point out that in 2006, Netmums had around 140,000 members [ 32 ]. Today the number of members has doubled to over 550,000 (19-03-2009). It is possible to see a similar development on the Swedish parental website FöräldraNätet (English translation: The Parenting Network). In 2004 the researchers Sarkadi and Bremberg reported that the site had between 50,000 and 60,000 unique visitors per month [ 33 ]. According to the Swedish Advertising Association, the corresponding figure for the site today, in March 2009, is closer to 242,000 unique visitors per month.

Additionally the website reports that around 30,000 comments are registered each day in their chat room. Similar results concerning the visitor frequency for parenting web sites are confirmed by Madge and O'Connor [ 18 ]. In their online survey distributed through the web site http://www.babyworld.co.uk they found that more than two thirds (67%) of the respondents visited the parenting web site at least once a week. A small group of parents, 8% of the respondents, visited the web site on a daily basis. Most of the parents in the study browsed the web site for an hour or less each time.

Bernhardt and Felter report that parenting web sites are generally regarded as easily accessible while more academic or non-commercial web sites with information on health, children and parenting often are experienced as less attractive and harder to use [ 17 ]. Pure commercial web sites, such as the corporate web sites of baby-porridge or baby-diaper companies, are the least visited web sites.

Thus, prior research draws a clear picture of both an increasing variety of web sites for parents and an increasing number of parents active on the internet. But what do we know more precisely about the parents online? Who are they and what motivates their search for information and support on the internet?

Going online – a digital divide?

Today there is an increased professional, research-based and commercial interest in finding out more about parents who are active on the internet. One of the underlying reasons is the desire to target both information and products to the different parental groups more precisely.

The demographic profile of the average internet-using parent is that of a young, white, middle class woman, who uses the internet mostly to search for health information and to visit parental web sites [ 25 , 34 ]. Although user demographics vacillate over time, the vast majority (85–95%) of parental internet users are women [ 18 , 33 ]. Similar figures apply when looking at parental internet users who are searching for health-related information, where 80% of women have at one time or another used the internet to search for health-related information [ 34 ]. Broadly speaking, it is possible to say that when it comes to searching for information about health and parenting, women's online behaviour confirms their offline behaviour as they most often take the main responsibility for the hands-on healthcare of the family [ 26 ].

The mean age of these parents is less than 35 years. In Madge and O'Connor's study on the British parenting web site 'Babyworld', 76% of the visitors were under 35 years [ 18 ]. Similar figures appeared in Sarkadi and Bremberg's study of a Swedish parenting website [ 33 ]. An important explanation to the relatively young age of the average parental website visitor is the fact that they are often first-time parents [ 33 ]. An Israeli study of an internet-based parental advice forum, reports almost all visitors to be women and that 62% of them were first-time parents [ 35 ]. Another explanation can be that younger parents are more accustomed to the daily use of the internet compared to older parents.

The main differences in parents' use of the internet can be found in disparities within income, ethnicity and education. This gap is referred to in literature as the 'digital divide', which states that internet use is more widely spread in more socio-economically advantaged groups [ 36 ]. For example, statistics on the American use of the internet show that only 29% of Latino adults have a broadband connection at home compared to almost 50% among white adults [ 37 ]. Similar differences are found in comparison with other ethnic groups as well. Brodie, Flournoy, Altman, Blendon, Benson, and Rosenbaum report, for example, that African-Americans had significantly less access to computers at home compared to white Americans [ 38 ]. The same applies to their access to the internet and their inclination to search for health and medical information. At the same time, the authors underline the fact that even if the gaps between African-Americans and white Americans are particularly pronounced in these areas they are largely a function of income and "tend to disappear once we compare blacks and whites at higher income levels" [[ 38 ], p. 257]. Similar results are shown in Cotten and Gupta's research, which demonstrates that larger societal factors such as income and education influence people's choice of where they look for health-related information [ 26 ]. Using the internet to find health-related information was more common for those with higher incomes, higher education and better health.

Social class is an important factor in our understanding of internet-usage and the search for health-related information, and this is just as valid for parents' usage. In their study of parents with a handicapped child, Blackburn, Read and Hughes claim that "a significant number of carers may not currently be internet users and that age, gender, socio-economic status and caring responsibilities shape the internet in particular ways" [[ 36 ], p. 201]. They draw the conclusion that, "it is important to address the digital divide among carers and to continue to develop other services and information systems to meet the needs of those who do not access the internet." But despite the fact that prior research shows that social inequalities affect parents' opportunities to search for information or to receive social support through the internet, it is by no means conclusive.

Dunham, Hurshman, Litwin, Gusella, Ellsworth and Dodd report in their study of a web-based project aimed at 42 single mothers that no differences in internet-usage could be attributed to either educational level or to social class [ 1 ]. Instead, it was possible to conclude that those most socially isolated with the fewest friends were the most prevalent internet users. There are similar results in studies of more 'general' parenting sites. Russell reports around 40% of the visitors at Netmums to be from families with lower incomes [ 32 ]. Sarkadi and Bremberg show in their Swedish research of a similar parenting site that, even if the respondents' educational level were slightly higher than the national average, 68% had income levels under the national average (some were on maternity leave, studying et cetera) [ 33 ]. In line with Dunham's study, they report factors such as living without a partner and having low educational and income levels to increase the need for support to these parents (mothers). It is possible that the increased availability of computers and the internet can be seen as an explanation to why more parents from less privileged socio-economic groups use internet-based parental sites in their search for support and information. In Sweden alone, internet availability for citizens 16–74 years old increased from 73% in 2003 to 84% in 2007 [ 39 ]. A similar tendency is seen in all the member states within the European Union [ 40 ]. The internet accessibility in EU increased 5% overall in 2007, but in some of the new membership countries, like Romania and Slovakia, it increased for example by 57% and 70% respectively.

The readability of the information one can find on the internet is another important factor when it comes to explaining differences according to socio-economic position in using the internet to seek health information. Several studies show that the readability level is often too high for the majority of people [ 35 ]. For example, examining 25 health web sites, Berland et al found that almost all of the sites required high school level or greater reading ability [ 41 ].

When parents go online, what kind of information do they look for? We have previously mentioned that they look for information on health and child development [ 17 ], but more specifically, what topics are discussed and what kind of information is sought after? Do parents trust the information they find? Do they rely on it?

Topics and the quality of information

Health-related information during pregnancy is a topic of high interest for many soon-to-be parents and many seek information regarding fetal development, labor and delivery. To be more precise, Mankuta, Vinker, Shapira, Laufer and Shveiky claim that many soon-to-be parents search for information about pregnancy complications such as pre-eclampsia, pregnancy-related diabetes, fetal diagnostics and information regarding different forms of delivery [ 42 ]. They also report that parents of newborn babies are often less active in their search for information, probably as a direct result of the fact that they are preoccupied with the newborn baby and have less time to use the computer. But for those who did use the internet, their questions were on topics ranging from bleeding and other post-delivery complications, through to post-natal depression, stress and anxiety of first-time parents.

Other studies also demonstrate that parents of young children primarily seek information regarding the diagnosis and treatment of childhood illnesses [ 17 ]. In most cases this revolves around the need for complementary information, to get a second opinion, to complement the information already provided by their doctor or to confirm what they are already thinking [ 8 ]. Many parents also seek advice and confirmation regarding the upbringing of their children and seek reassurance that their children's behaviour is regarded as 'normal' [ 8 , 36 , 43 ]. In Sarkadi and Bremberg's Swedish study the results are the opposite [ 33 ]. There the majority of parents used parental web sites as their primary source for information and advice about children and parenthood. Corresponding results are shown in another similar study [ 17 ].

The questions and subjects of conversation in the interactive chat forum tend to be even more diversified. Dunham, Hurshman, Litwin, Gusella, Ellsworth and Dodd analyse the topics of the online conversations on a web site's public discussion forum [ 1 ]. They show that women discussed and sought support on a variety of day-to-day issues such as aching breasts, the need to find larger and better apartments, disputes over child care, advice on upbringing, parental conflicts, the best way to treat ear infections, allergies, sleeping problems or toothache, how best to handle the bureaucracy within social services or primary health care, how to use a breast pump or where to buy the cheapest nappies. The sheer variety of conversational topics discussed in the discussion forum was striking and led the researchers to conclude that "it is difficult to imagine any single community service providing, in such a timely manner, the diverse amount of information and support that these women exchanged on a daily basis" [[ 1 ], p. 299].

However, many studies report that health-related information available to parents on the internet can be misleading and occasionally, utterly wrong [ 44 , 45 ]. For example, in a survey of 41 parent-oriented web pages relating to taking care of fever-ridden children at home, Impicciatore, Pandolfini, Casella and Bonati indicate that only a few (four web pages) provided complete information according to the recommendations in the general guidelines [ 46 ]. The remaining web pages gave advice and recommendations that deviated to a varying degree from the recommendations stipulated in the general guidelines. In addition, Dornan and Oermann and Shaikh and Scott analyse large numbers of web sites containing information on breastfeeding and conclude that there is great variation in the details of the information and its practical usability [ 47 , 48 ].

Dornan and Oermann's research claim that only 7 out of 40 web sites matched all of the quality criteria in the model they had developed for testing the quality of information provided. In many cases these web sites are created and maintained by individuals or self-help groups with possibly fewer resources to enable them to uphold the quality of the information. The results from Hardwick and MacKenzie's study would point in this direction [ 49 ]. When analysing 19 web sites containing information about early onset miscarriage they found that the majority of web sites were maintained by either individuals or self-help groups and that the quality of the information was generally poor when compared to the guidelines stipulated by the Royal Collage of Obstetricians and Gynaecologists. In most cases the web sites lacked basic information and in some cases the information provided directly contravened the aforementioned guidelines.

Similarly, Ernst and Schmidt conclude in their study of web sites provided by 'medical herbalists' for pregnant women that "the advice offered was misleading at the best and dangerous at the worst" [[ 50 ], p. 190]. One of the most exhaustive studies of the quality of health-related information available on the internet is done by Eysenbach, Powell, Kuss and Sa [ 45 ]. The study comprises 79 separate studies, which in turn comprise the analyses of 5941 web sites and 1329 web pages. The conclusion reached in 70% of the studies is that quality is a problem on the web.

At the same time, one should be aware that in the majority of studies the quality of information is assessed from a medical point of view. Other perspectives, like the point of view of a patient or a lay person, would likely render a slightly different view of the 'quality' of the information [ 51 ].

Given this background, it is not surprising that many parents are sceptical of much information that they find on the internet [ 52 ]. According to Bernhardt and Felter parents use a wide variety of non-scientific verification methods when trying to ascertain the quality of the information on a given web site [ 17 ]. Typically they begin by trying to deduce the underlying motive of the web site where they find the information. This can be done, for example, by asking the question; is there someone who is making money from this information? They also try to ascertain whether the original source of the information is trustworthy, that is to say that the information comes from a trustworthy organisation or source. The most valued sources, as shown by other research, include links to governmental organisations, universities and volunteer organisations. In addition, they have a professional layout, understandable language and good references to other sources of information [ 45 , 47 ]. Moreover, parents weigh the information they find. This means that if the information found is corroborated by several independent web sites, the validity increases. Finally, many parents feel that the quality of the information increases if it is verified by other parents. However, one of the few observational studies available on this topic shows that many internet users most often do not check the motives and the "about us" section of the web sites [ 53 ]. Thus this indicates a gap between theory and practice on this matter.

O'Connor and Madge claim that many parents, especially first-time parents, feel generally positive about the information they find on the internet [ 8 ]. In many cases they find it easier to access and to be more up-to-date compared to the information provided by healthcare professionals, for example within maternity care. Some studies show that there are gender differences in the need to verify information found via the internet. For example, Cotten and Gupta mean that men are less concerned about the credibility of online health information than women [ 26 ].

In response to the fact that there is such a vast amount of misleading health-related information on the internet, there is a number of different organisations today that offer help to find health-related web sites with valid information. The "Health On the Net Foundation" is one example of an organisation that guides around half a million visitors each month to web sites with "useful and reliable online medical and health information" [ 54 ].

We are able to see that many parents and parents-to-be use the internet in order to find health-related information and to exchange experiences around pregnancy, children and daily life as a parent. Many parents choose the internet as their first point-of-reference over other sources of information including professionals in offline settings. The amount of information available, however, is vast and there is a considerable risk that the information is inaccurate and unreliable. In that case, how do professionals and support organisations that work with parents and parents-to-be use the opportunities provided by the internet? Do they target their information to parents via different web sites or do they use the internet to work directly with parents, individually or on a group basis? In the next section we will take a closer look at the research on how professionals and organisations use the internet in terms of education, information or interventions directed to parents.

Directing information and interventions to parents on the internet

As we were able to conclude in a prior study, a large number of studies have evaluated the possibilities for institutions and organisations to reach parents with information or various interventions over the internet [ 3 ]. This development is partly due to the fact that today's parents are more active in their use of the internet as a source of information and partly due to the fact that research suggests the internet to be an effective medium for providing support to a large number of parents [ 47 , 55 , 56 ]. Also, to use the internet is considered by many institutions as a way to increase the efficiency of their support to parents, a way to reduce the pressure on their ordinary treatment centres and a way to reach out to sparsely populated areas as well as to be able to provide a more unilateral form of support for parents. In addition, the internet is shown to provide a good way to increase cooperation with parents and to reduce organisational expenses [ 43 , 57 , 58 ].

As most of the research within this area has been conducted within the medical sciences, most of the studies are clinical and linked to or carried out in hospital settings [ 3 ]. This is the reason why many of these studies focus on support to parents whose children suffer from diseases or are disabled. More specifically, these studies revolve around the development of support in the form of informative web sites comprising internet support groups for parents of children with, for example, brain injuries [ 59 ], cancer [ 52 , 60 ], deformities [ 61 ], neurological disorders [ 22 ], skin diseases [ 24 ] and asthma [ 62 ].

In addition, many studies also focus on more general information and support provided online to parents and parents-to-be. Some examples are maternal and child healthcare services that wish to provide information in the form of parental education [ 56 , 63 ], spread information about prenatal genetic counselling [ 64 ], C-sections [ 65 ], breast feeding [ 31 ] or paediatric clinics that wish to establish a web site with the purpose to help families cope with ordinary childhood diseases [ 66 ].

A majority of the intervention studies are based not only on the provision of information via web sites, but also on interactive support of parents via discussion fora and internet support groups. Then what experiences do professionals have of using the internet to provide support and how do parents respond to the support offered to them?

Experiences and interventions on the internet

Despite the numerous possibilities of giving and receiving valuable support and information via the internet, some studies show that both professionals and parents also have negative experiences. Referring to the previous discussion on the digital divide, one of the primary problems can be that many parents simply do not have access to internet connected computers [ 36 ]. As a result, parents from more socio-economically disadvantaged groups are at risk to be excluded from internet-based information and support. Amongst professionals and parents who have access to the internet, the negative experiences often revolve around problems with usability, such as technical problems, incompatible hardware, access difficulties or lack of technical and management support [ 33 , 67 ].

In a similar vein, many professionals and parents lack interest in using the internet and lack confidence in their perceived skills to use the internet [ 30 ]. Kouri, Turunen, and Palomaki claim that there is a resistance to use the internet as a means to provide support to parents as employees feel that they do not possess the necessary skills [ 58 ]. A number of employees also doubt whether or not parents, specifically mothers, are interested in internet-based support instead of "more personal contacts" [[ 58 ], p. 181]. Their misgivings are to a certain extent supported by parents who, in Han and Belcher's study, complain about the lack of physical contact and proximity when partaking in support groups on the internet [ 60 ]. They also point out, in similarity to parents in a variety of other studies, the negative aspects including large volumes of e-mails, off-topic chatter and occasionally intensive quarrels in the discussion groups [ 33 ]. The fact that misunderstandings and quarrels occur easily over the internet is not surprising according to Scharer, as inexperienced users easily hit the caps lock button and "as capital letters are often considered as shouting, this may give unexpected consequences" [[ 20 ], p. 31].

The risk that people are rude, disrespectful or in one way or another disrupt communication is always there, but many studies of internet-based discussion groups also show the opposite to be true, that the groups report a marked absence of disruption. Instead it is possible to conclude that discussion group users follow a sort of 'netiquette', an internet etiquette, which contains both formal and informal rules governing respectful communication on the internet [ 8 , 29 ].

Possibly, this may be the reason many parents report overwhelmingly positive experiences of support through the internet [ 1 , 8 , 17 , 29 - 31 , 68 , 69 ]. For example, Baum reports that parents of children with special healthcare needs participating in an online support group "found more than expected in terms of insight and people to trust" [[ 70 ], p. 381]. Nearly 90% of the sample considered participating in a support group again as soon as possible. Sarkadi and Bremberg report that to chat on parent web sites is important for parents and provide them with valuable space for discussions [ 33 ]. The advantages, according to the respondents, of being able to search for information on the internet and being able to participate in interactive discussion fora, include accessibility, speed of feedback, anonymity and democratic discussion climate. Especially interesting to note is that both single parents and parents with a lower level of education also experience a strong sense of support from the parental web sites.

In addition, O'Connor and Madge mean that the internet is very important for those women who use it; "it played a central role in providing virtual social support, increasing the women's ability to cope with new parenthood and the shared experience it provided was important in the transition of identity to motherhood" [[ 8 ], p. 365]. As a consequence, only a few of the participants admitted to lie about themselves or their identity. However, it needs to be underlined that a majority of parents do not feel that virtual support can entirely replace face-to-face meetings, but instead that it should be regarded as a valuable compliment.

Nevertheless, many studies focus on communication in chat rooms or support groups on the internet and describe both the proximity and the strengths of the relationships formed there [ 29 ]. Among other things Duham, Hurshman, Litwin, Gusella, Ellsworth and Dodd report that "close personal relationships and a sense of community developed in this novel social environment" [[ 1 ], p. 282], which refers to an intervention aimed at single mothers where the organisers offered a computer-mediated social support network around parenting issues. Similarly, but possibly more conclusive, Capitulo's report from a support group for parents who had lost a child show that very close relationships and even a specific 'culture' developed within the group. They shared, Capitulo says, "virtual identities and created a community where they brought meaning to their perpetual losses". They also created a collective identity, 'Mothers of Angels' which created a strong sense of belonging and the message that "you'll never be alone" [[ 71 ], p. 305].

The support available via the internet has some negative aspects, but despite this the vast majority of users experience it as very positive. However, only few studies are able to claim whether or not the virtual interventions on the internet are more effective than interventions 'in real life'. This is due to the design of these studies where most have not used control groups. One of the notable exceptions, however, is Hudson, Campbell-Grossman, Fleck, Elek and Shipma who compare two different groups of fathers, one taking internet-based parental guidance classes and the other taking the standard parental guidance classes provided by the maternal and child healthcare services [ 56 ]. A total of 34 first-time fathers took part in the research, evenly divided between the two groups. The group of fathers partaking in the internet-based parental guidance classes used the website 'New Fathers Network' where they had access to a virtual library containing literature on children and parenthood. They also had access to a discussion forum where they could meet and interact with other parents. In addition, it was possible to e-mail their questions to a midwife. The study focuses on the fathers' competence and trust in their own parenting abilities and measured this both 4 weeks and 8 weeks after the birth of their child. The study reports more positive results for the group taking part in the internet-based parental guidance classes compared to the fathers in the control group. The fathers in the internet group reported a marked increase in both their competence and their trust in their own parenting abilities during the test period.

This is particularly interesting in comparison with the notion that regular maternal and child health services have experienced difficulties in reaching and interesting fathers-to-be [ 70 , 72 ]. It clearly points to the fact that one needs to look at alternative methods to reach fathers and break the traditional gender division in matters relating to reproductive health. To facilitate discussion groups and parental guidance classes on the internet may be good alternatives to the more traditional discussion groups common within maternal and child healthcare services. Maternal and child healthcare services have previously been criticised for leaving men at a disadvantage as women are more used to talking about pregnancy, birth and parenting [ 73 ].

Nevertheless, many of the parental web sites on the internet are still traditionally gender-biased and are more oriented towards mothers' needs. The parental web site Sarkadi and Bremberg refer to in their study is a typical example of this. Many of the fathers included in their study complain that they feel marginalised due to the discussion groups being dominated by women and centred on motherhood [ 33 ]. One conclusion is that more specific discussion fora are necessary to better cater for the specific needs of men/fathers. Rashly identify and criticise the fact that many web sites encompass a traditional gender bias towards mothers [ 27 ]. She specifically refers to commercial web sites, which at first appear to be progressive and strive for greater equality in the parental role, but which at closer inspection simply reproduce traditional gender roles and values. Virtual life, in this case, seems not to differ much from real life.

As this review of literature shows, the majority of today's parents search for both information and social support on the internet [ 8 , 25 ]. Their questions cover many topics, from pregnancy and birth complications to child discipline and child illness. It is not only a desire for facts and information but an interest in more experience-based advice as well as interacting with other parents [ 1 ]. The reasons for this development are often related to the increase in accessibility to information through the internet as well as in the parents' use of the internet for communication. [ 25 ]. A number of articles indicate that parents of today experience diminished support from their own parents, relatives and friends and, consequently, turn to the internet for information and interaction [ 8 , 18 ]. However, most of the studies are empirical and lack theoretical frameworks which can help to understand this phenomenon of parents' increasing pursuit of information. How can we understand this phenomenon in parallel to other changes which occur in the late-modern society, for example increased individualisation, reflexivity and awareness of risks? So far, questions of this kind are rarely discussed in the body of research on parenthood and the internet. Moreover, there is a lack of longitudinal studies that focus on parents' internet use over time and in different phases of their parenthood.

At the same time the empirical knowledge-base of parents' use of the internet is quite comprehensive and detailed. It is known, for example, that women are more active than men in looking up health and parent information on the internet, and that the majority of visitors to web sites on parenthood are first-time parents in the age group 30–35 [ 33 ]. Many studies also discuss class and ethnicity from the concept of the digital divide which states that the internet is less used in more socio-economically disadvantaged groups and in certain ethnic groups [ 36 , 37 ]. However, most discussions of ethnicity are more about access to economic resources since differences due to ethnicity often tend to disappear at higher income levels [ 38 ]. In addition, many studies report diminished or negligible class differences among visitors to various web sites directed to parents. This means that huge class differences among participants on parental web sites cannot be automatically assumed, but observed as the field develops.

Due to the increasing access to the internet and the success in reaching out to a wider group of users, an increasing number of professionals have been encouraged to use the internet to disseminate information and to initiate discussions around parenthood and health. There are many benefits to be found and the possibility to reach out to a wider audience and to increase access to organisations without an increase in costs are examples of important arguments for using the internet presented in many studies. Other benefits include the possibility for parents to remain anonymous in their contacts with professionals and that parents' perceived need for information can be effectively met around the clock.

Research in this area, however, has been dominated by the medical sciences and subsequently the majority of direct interventions – and their evaluations – on the internet are first and foremost directed to parents with very specific needs. Interventions for wider groups of parents, such as parent training on the net, are still very rare and more research is needed to evaluate different types of interventions on the net. However, in a broader perspective, the interest for many parents to use the internet in their parenthood may also stimulate many professionals to find new possibilities provided by the internet in their work with parents and families.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

LP and KD designed the study, made the database searches, and analysed the retrieved articles. LP drafted the paper and KD contributed to later versions. Both authors read and approved the final manuscript.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2296/10/34/prepub

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This paper is in the following e-collection/theme issue:

Published on 25.6.2024 in Vol 26 (2024)

Potential Roles of Large Language Models in the Production of Systematic Reviews and Meta-Analyses

Authors of this article:

• Xufei Luo 1, 2, 3, 4, 5   ; 
• Fengxian Chen 6 , PhD   ; 
• Di Zhu 7 , MPH   ; 
• Ling Wang 7 , MPH   ; 
• Zijun Wang 1, 2, 3, 4, 5   ; 
• Hui Liu 1, 2, 3, 4, 5   ; 
• Meng Lyu 7 , MPH   ; 
• Ye Wang 7 , MPH   ; 
• Qi Wang 8, 9 , PhD   ; 
• Yaolong Chen 1, 2, 3, 4, 5 , MD, PhD  

1 Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

2 World Health Organization Collaboration Center for Guideline Implementation and Knowledge Translation, Lanzhou, China

3 Institute of Health Data Science, Lanzhou University, Lanzhou, China

4 Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China

5 Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

6 School of Information Science & Engineering, Lanzhou University, Lanzhou, China

7 School of Public Health, Lanzhou University, Lanzhou, China

8 Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

9 McMaster Health Forum, McMaster University, Hamilton, ON, Canada

Corresponding Author:

Yaolong Chen, MD, PhD

Evidence-Based Medicine Center

School of Basic Medical Sciences

Lanzhou University

No 199 Donggang West Road

Chengguan District

Lanzhou, 730000

Phone: 86 13893104140

Email: [email protected]

Large language models (LLMs) such as ChatGPT have become widely applied in the field of medical research. In the process of conducting systematic reviews, similar tools can be used to expedite various steps, including defining clinical questions, performing the literature search, document screening, information extraction, and language refinement, thereby conserving resources and enhancing efficiency. However, when using LLMs, attention should be paid to transparent reporting, distinguishing between genuine and false content, and avoiding academic misconduct. In this viewpoint, we highlight the potential roles of LLMs in the creation of systematic reviews and meta-analyses, elucidating their advantages, limitations, and future research directions, aiming to provide insights and guidance for authors planning systematic reviews and meta-analyses.

Introduction

A systematic review is the result of a systematic and rigorous evaluation of evidence, which may or may not include a meta-analysis [ 1 ]. Owing to the strict methodology and comprehensive summary of evidence, high-quality systematic reviews are considered the highest level of evidence, positioned at the top of the evidence pyramid [ 2 ]. Additionally, high-quality systematic reviews and meta-analyses are often used to support the development of clinical practice guidelines, aid clinical decision-making, and inform health care policy formulation [ 3 ]. Currently, the methods of systematic reviews and meta-analyses are applied in various disciplines in medicine and beyond such as law [ 4 ], management [ 5 ], and economics [ 6 ], and have yielded positive results, contributing to the continuous advancement of these fields [ 7 ].

The process of conducting systematic reviews demands a substantial investment in terms of time, resources, human effort, and financial capital [ 8 ]. To expedite the development of systematic reviews and meta-analyses, various automated or semiautomated tools such as Covidence have been developed [ 9 , 10 ]. However, the emergence of large language models (LLMs), particularly chatbots such as GPT, presents a set of both challenges and opportunities in the realm of systematic reviews and meta-analyses [ 11 ]. Based on the emerging literature in this field, we here provide our perspectives on the potential for harnessing the capabilities of LLMs to accelerate the production of systematic reviews and meta-analyses, while also scrutinizing the potential impacts and delineating the crucial steps involved in this process.

The Process and Challenges of Performing a Systematic Review and Meta-Analysis

The procedures and workflows for conducting systematic reviews and meta-analyses are well-established. Currently, researchers often refer to the Cochrane Handbooks recommended by the Cochrane Library for intervention or diagnostic reviews [ 12 , 13 ]. In addition, some scholars and institutions have developed detailed guidelines on the steps and methodology for performing systematic reviews and meta-analyses [ 14 - 17 ]. Generally speaking, researchers should take the following steps to produce a high-quality systematic review and meta-analysis: determine the clinical question, register and draft a protocol, set inclusion and exclusion criteria, develop and implement a search strategy, screen the literature, extract data from included studies, assess the quality and risk of bias of included studies, analyze and processed data, write up the full text of the manuscript, and submit the manuscript for publication, as illustrated in Figure 1 . These different steps contain many subtasks; therefore, conducting a complete systematic review and meta-analysis requires fairly complex and time-consuming work.

Although systematic reviews and meta-analyses have been widely applied and play an important role in developing guidelines and informing clinical decision-making, their production process faces many challenges. One of these challenges is the long production time and large resource requirements. The average estimated time to complete and publish a systematic review is 67.3 weeks, requiring 5 researchers and costing approximately US $140,000 [ 18 , 19 ]. More recently, the development of automated and semiautomated tools using natural language processing and machine learning have accelerated systematic review and meta-analysis production to some extent [ 20 ], with studies showing that such tools can help to produce a systematic review and meta-analysis within 2 weeks [ 21 ]. However, these tools also have some limitations. First, no single tool can fully accelerate the entire production process of systematic reviews and meta-analyses. Second, these tools cannot process and analyze literature written in different languages. Finally, the reliability of the results generated by these automated and semiautomated tools needs further validation as they are not yet widely adopted for this purpose.

Applications of LLMs in Medical Research

Chatbots based on LLMs such as ChatGPT, Google Gemini, and Claude have become widely applied in medical research. These chatbots have proven to be valuable in tasks ranging from knowledge retrieval, language refinement, content generation, and medical exam preparation to literature assessment. ChatGPT has been shown to excel in accuracy, completeness, nuance, and speed when generating responses to clinical inquiries in psychiatry [ 22 ]. Moreover, LLMs such as ChatGPT play a pivotal role in automating the evaluation of medical literature, facilitating the identification of accurately reported research findings [ 23 ]. Despite their significant contributions, these chatbots are not without limitations. Challenges such as the potential for generating misleading content and susceptibility to academic deception necessitate further scholarly discourse on effective mitigation strategies. Standardized reporting practices may contribute to delineating the applications of ChatGPT and mitigating research biases [ 24 ].

ChatGPT has also demonstrated significant application potential and promise in the process of conducting systematic reviews and meta-analyses. Various studies [ 11 , 25 - 32 ] indicate that ChatGPT can play a pivotal role in formulating clinical questions, determining inclusion and exclusion criteria, screening literature, assessing publications, generating meta-analysis code, and assisting the full-text composition, among other relevant tasks. The details of these capabilities are summarized in Table 1 .

Potential Roles of LLMs in Producing Systematic Reviews and Meta-Analyses

Determine the research topic/question.

Determining the clinical question of interest represents the initial and paramount step in the process of conducting systematic reviews and meta-analyses. At this juncture, it is crucial to ascertain whether comparable systematic reviews and meta-analyses have already been published and to delineate the scope of the forthcoming review and meta-analysis. Generally, for interventional systematic reviews, the Patient, Intervention, Comparison, and Outcome (PICO) framework is considered for defining the scope and objectives of the research question [ 60 ]. In this context, ChatGPT serves a dual role. On the one hand, it expeditiously aids in searching for published systematic reviews and meta-analyses related to the relevant topics (see Multimedia Appendix 1 and Multimedia Appendix 2 ) [ 34 ]. On the other hand, ChatGPT assists in refining the clinical question that needs to be addressed (see Multimedia Appendix 3 ), facilitating prompt determination of the feasibility of undertaking the proposed study. However, it is important to be cautious of the retrieval of false literature [ 35 ].

Register and Write a Research Proposal

The registration and proposal writing process constitutes a pivotal preparatory phase for conducting systematic reviews and meta-analyses. Registration enhances research transparency, fosters collaboration among investigators, and mitigates the redundancy of research endeavors. Drafting a proposal helps in elucidating the research objectives and methods, providing robust support for the smooth execution of the study. For LLMs, generating preliminary registration information and initial proposal content is remarkably convenient and facile (see Multimedia Appendix 4 and Multimedia Appendix 5 ). For example, ChatGPT can assist researchers in generating the statistical methods for a research proposal [ 37 ]. However, considering that LLMs often generate fictitious literature, the content they produce may be inaccurate; thus, discernment and validation of the generated content remain essential considerations.

Define Inclusion and Exclusion Criteria

The inclusion and exclusion criteria for systematic reviews and meta-analyses are instrumental in determining the screening standards for studies. Therefore, strict and detailed inclusion and exclusion criteria contribute to the smooth and high-quality conduct of preparing systematic reviews and meta-analyses. The use of a chatbot based on LLMs can help in establishing the inclusion and exclusion criteria (see Multimedia Appendix 6 ) [ 38 ]; however, the inclusion criteria need to be optimized and adjusted according to the specific research objectives and the exclusion criteria should be based on the foundation of the inclusion criteria. Therefore, manual adjustments and optimizations are also necessary.

Develop a Search Strategy and Conduct Searches

ChatGPT can assist in formulating search strategies, using PubMed as an example [ 40 ]. Researchers can simply list their questions using the PICO framework and a search strategy can be quickly generated ( Multimedia Appendix 1 and Multimedia Appendix 2 ). Based on the generated search strategy, one method is to copy the strategy from ChatGPT and paste it into the PubMed search box for direct retrieval [ 40 , 41 ]. Another approach involves using the OpenAI application programming interfaces (APIs) to invoke PubMed APIs with the search strategy generated by ChatGPT. This facilitates searching the PubMed database, obtaining search results, and applying predetermined inclusion and exclusion criteria. Subsequently, ChatGPT can be used to filter the search results, exporting and recording the filtered results in JSON format. This integrated process encompasses search strategy formulation, retrieval, and filtering. However, the direct use of LLMs to generate search strategies and complete the one-stop process of searching and screening may not yet be mature, and this poses a significant challenge for generating the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart. Therefore, we suggest using LLMs to generate search strategies, which should then be optimized and modified by librarians and computer experts (specializing in LLMs) before manually searching the databases. Additionally, to use search strategies transparently and reproducibly, the detailed prompts used should be reported [ 40 , 42 ].

Screen the Literature

Literature screening is one of the most time-consuming steps in the creation of systematic reviews and meta-analyses. Prior to the advent of ChatGPT, there were already many automated and semiautomated tools available for literature screening, such as Covidence, EPPI-Reviewer, DistillerSR, and others [ 39 ]. With the emergence of ChatGPT, researchers can now train the model based on predefined inclusion criteria. Subsequently, ChatGPT can be used to automatically screen records retrieved from databases and obtain the filtered results. Previous studies suggested that using ChatGPT in the literature selection process for a meta-analysis substantially diminishes the workload while preserving a recall rate on par with that of manual curation [ 28 , 44 - 47 ].

Extract the Data

Data extraction involves obtaining information from primary studies and serves as a primary source for systematic reviews and meta-analyses. Generally, when conducting systematic reviews and meta-analyses, basic information must be extracted from the original studies, such as publication date, country of conduct, and the journal of publication. Additionally, characteristics of the population, such as patient samples, age, gender/sex, and outcome data, are also extracted, including event occurrences, mean change values, and total sample size. Currently, tools based on natural language processing and LLMs, such as ChatGPT and Claude, demonstrate high accuracy in extracting information from PDF documents (see Multimedia Appendix 7 for an example) [ 47 - 50 ]. However, it is important to note that despite their promising capabilities, manual verification remains a necessary step in the data extraction process when using these artificial intelligence (AI) tools [ 61 ]. Using LLMs to extract data can help avoid random errors; however, caution is still required when extracting data from figures or tables [ 47 - 50 ].

Assess the Risk of Bias

Assessing the bias of risk involves evaluating the internal validity of studies included in research. For randomized controlled trials, tools such as Risk of Bias (RoB) [ 62 ] or its updated version RoB 2 [ 63 ] are typically used, with an estimated review time of 10-15 minutes per trial. However, automated tools such as RobotReviewer can streamline the extraction and evaluation process in batches [ 51 - 53 ], thereby improving efficiency, although manual verification is still necessary. Additionally, chatbots based on LLMs can aid in risk of bias assessment (see Multimedia Appendix 8 ), and their accuracy appears to be comparable to that of human evaluations [ 23 ].

Analyze the Data/Meta-Analysis

Data analysis serves as the source of systematic review results, typically encompassing basic information and outcome findings. The meta-analysis may be one outcome, along with potential components such as subgroup analysis, sensitivity analysis, meta-regression, and detection of publication bias. Numerous software options are available to facilitate these data analyses, including Stata, RevMan, Rstudio, and others [ 43 ]. Currently, it appears that chatbots based on LLMs may not fully execute data analysis independently, although they can extract the relevant information. Subsequently, one can employ corresponding software for comprehensive data analysis. Alternatively, after extracting information with chatbots, the ChatGPT Code Interpreter can assist in analysis and generating graphical results, although this requires a subscription to ChatGPT Plus. Moreover, an LLM markedly accelerates the data analysis process, empowering researchers to handle larger data sets with greater efficacy [ 54 ].

Draft the Full Manuscript

The complete drafting of systematic reviews and meta-analyses should adhere to the PRISMA reporting guidelines [ 64 ]. It is not advisable to use chatbots such as ChatGPT for article composition. On the one hand, the accuracy and integrity of content generated by ChatGPT require human verification. On the other hand, various research types and journals have different requirements for full-length articles, making it challenging to achieve uniformity in the generated content. However, using tools such as GPT for language refinement and adjusting the content logic can be considered to enhance the quality and readability of the article [ 33 , 55 ]. It is important to declare the use of GPT-related tools in the methods, acknowledgments, or appendices of the article to ensure transparency [ 24 , 65 ].

Submit and Publish

Submission and publication represent the final steps in the process of conducting systematic reviews and meta-analyses, aside from subsequent updates. At this stage, the potential role of LLM-based tools is to assist authors in recommending suitable journals (see Multimedia Appendix 9 ). These tools might also aid in crafting components required along with submission of the manuscript such as cover letters and highlights [ 59 ]. However, it is imperative to emphasize that the content generated by these tools requires manual verification to ensure accuracy, and all authors should be accountable for the content generated by LLMs.

Benefits and Drawbacks of Using LLMs

Systematic reviews and meta-analyses are crucial evidence types that support the development of guidelines [ 3 ]. The benefits of employing LLM-based chatbots in the production of systematic reviews and meta-analyses include increased speed, such as in the stages of evidence searching, data extraction, and assessment of bias risk; these tools can also enhance accuracy by reducing human errors such as those made while extracting essential information and pooling data. However, there are also drawbacks of these applications of LLMs, such as the potential for generating hallucinations, the requirement for human verification owing to the poor reliability of the models, and that the entire systematic review process is not replicable. Moreover, when interacting with LLM chatbots, it is important to manage data privacy. In particular, when using LLMs to analyze data, especially when including personal patient information, ethical approval and management must be properly addressed.

Challenges and Solutions

While LLMs can assist in accelerating the production of systematic reviews and meta-analyses in some steps, enhancing accuracy and transparency, and saving resources, they also face several challenges. For instance, LLMs cannot promptly update their versions and information. For example, ChatGPT 3.5 has been trained on data available in 2021. Thus, limitations such as the length of prompts and token constraints, as well as restrictions related to context associations, may potentially impact the overall results and user experience [ 25 ]. Although LLM-based autonomous agents have made strides in tasks related to systematic reviews and meta-analyses, their applications are still associated with various issues related to personalization, updating knowledge, strategic planning, and complex problem-solving. The development of LLM-driven autonomous agents adept at systematic reviews and meta-analyses warrants further exploration [ 66 ]. The use of LLMs as centrally controlled intelligent agents encompasses the ability to handle precise literature screening, extract and analyze complex data, and assist in manuscript composition, as highlighted by proof-of-concept demonstrations such as MetaGPT [ 67 ]. Moreover, the continuous growth of the use of LLMs can pose a significant challenge in ensuring the accuracy of information provided in systematic reviews, particularly if LLMs are indiscriminately overused.

To better facilitate the use of tools such as ChatGPT in systematic reviews and meta-analyses, we believe that, first and foremost, authors should understand the scope and scenarios for applying ChatGPT, clearly defining which steps can benefit from these tools. Second, for researchers, collaboration with computer scientists and AI engineers is crucial to optimize the prompts and develop integrated tools based on LLMs, such as web applications. These tools can assist in seamless transitions between different tasks in the systematic review process. Lastly, for journal editors, collaboration with authors and reviewers is essential to adhere to reporting and ethical principles associated with the use of GPT and similar tools [ 24 , 68 ]. This collaboration aims to promote transparency and integrity, while preventing indiscriminate overuse in the application of LLMs in systematic reviews and meta-analyses.

Future Perspectives and Conclusion

The emergence of LLMs could have a significant impact on the production of systematic reviews and meta-analyses. In this process, the application of chatbots such as ChatGPT has the potential to speed up certain steps such as literature screening, data extraction, and risk of bias assessment, which are processes that typically consume a considerable amount of time. However, it is important to note that if AI methods such as GPT are employed in performing systematic reviews, disclosure and declaration of the use of these tools are essential. This includes specifying the AI tools used, their roles, and the areas of application within the review process, among other relevant information for full disclosure [ 24 ]. In this context, developing a reporting guideline is warranted to guide the application of LLM tools in systematic reviews and meta-analyses. Although the PRISMA 2020 guideline briefly addresses the use of automation technologies, its coverage is limited to steps such as screening, and there is a lack of comprehensive guidance on the broader spectrum of applications [ 64 ].

Acknowledgments

ChatGPT 3.5 designed by OpenAI was used to help with language editing. The authors take the ultimate responsibility for the content of this publication.

Authors' Contributions

XL and YC were responsible for conceptualization of the article. XL, FC, DZ, and LW generated the examples with the large language models and wrote the first draft of the article. XL, ZW, HL, ML, YW, QW, and YC reviewed and edited the manuscript. YC supervised the study, takes full responsibility for the work and conduct of the study, has access to the data, and controlled the decision to publish. All authors read the final manuscript and approved the submission.

Conflicts of Interest

None declared.

Using ChatGPT 4.0 to assist in generating PubMed search strategies for assessing systematic reviews.

The results obtained after searching the PubMed database based on the search strategy generated by ChatGPT.

Using ChatGPT 4.0 to assist in optimizing the clinical question for conducting a systematic review and meta-analysis.

Using ChatGPT 4 to generate PROSPERO (International Prospective Register of Systematic Reviews) registration information.

Proposal of a systematic review and meta-analysis related to exercises for osteoarthritis generated by Claude 3 based on the provided prompts.

The inclusion and exclusion criteria for a systematic review and meta-analysis on exercise therapy for osteoarthritis based on GPT-4.

Using Claude 3 for data extraction from PDF documents: an example with three randomized controlled trials.

Using Claude 3 for risk of bias assessment: an example with two randomized controlled trials.

Using GPT-4 to assist in selecting target journals for submission of a systematic review and meta-analysis.

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Abbreviations

Edited by G Eysenbach; submitted 20.02.24; peer-reviewed by A Jafarizadeh, M Chatzimina, AS Van Epps; comments to author 03.05.24; revised version received 21.05.24; accepted 29.05.24; published 25.06.24.

©Xufei Luo, Fengxian Chen, Di Zhu, Ling Wang, Zijun Wang, Hui Liu, Meng Lyu, Ye Wang, Qi Wang, Yaolong Chen. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.06.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

A review on lexical based malicious domain name detection methods

• Hamroun, Cherifa
• Amamou, Ahmed
• Haddadou, Kamel
• Haroun, Hayat
• Pujolle, Guy

Nowadays, domain names are becoming crucial digital assets for any business. However, the media never stopped reporting phishing and identity theft attacks held by third-party entities that rely on domain names to mislead Internet users. Thus, Palo Alto Networks revealed in their studies 20 largely cyber-squatted domain names targeting popular brands. Based on their behavior, domain names appear in public lists that objectively evaluate their reputation. Blacklists contain domain names that have previously committed suspicious acts, whereas whitelists include the most popular and trustworthy domain names. For a long time, this listing technique has been used as a reactive approach to counter domain name-based attacks. However, it suffers from the limitation of responding late to attacks. Nowadays, techniques tend to be much more proactive. They operate before any attack occurs. As part of the CSNET conference, we published a short paper that describes a plethora of domain name attacks and their associated detection techniques using their lexical features (Hamroun et al. 2022). In this paper, we present an extended version of the original one which discusses the previously mentioned points in more detail and adds some elements of understanding when it comes to malicious domain name detection. Hence, we provide a literature review of malicious domain name detection techniques that use only the lexical features of domain names. These features are available, privacy-preserving, and highly improve detection results. The review covers recent works that report relevant performance categorized according to a new taxonomy. Moreover, we introduce a new criterion for comparing all the existing works based on targeted maliciousness type before discussing the limitations and the newly emerging research directions in this field.

• Domain names;
• Lexical analysis;
• Cybersquatting;
• Predictive methods