systematic literature review master thesis

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Can a literature review be a "master's thesis"?

I have selected a single question for my master's thesis, within my field of Foreign Language Teaching. Most papers I have read contain just short literature reviews providing some background for a research study that occupied most of the writer's time. I think I could understand my question better if I focusing all of my effort on creating a 100-200 page literature review, examining and critiquing all existing literature on the subject, rather than on trying to come up with some new results.

Can a master's thesis be comprised of just a literature review? Do journals publish literature reviews on their own?

• literature-review

• What is your area of study? –  earthling Commented Jan 28, 2014 at 13:01

3 Answers 3

At least in my Faculty (of Computer Science), a master thesis can be "just" a literature review. A literature review can be an important contribution, and is part of what is usually called secondary research .

However, you should consider performing a systematic literature review , which is a literature review comprising several analytic and precise steps to enhance the reliability of the study. A systematic literature review is a time consuming research activity but a very useful one. Please verify that such a review has not already been conducted recently, before starting it by your own.

Systematic reviews are publishable research and often get many citations. As for thesis, I think that any publishable research activity can be a student's master thesis. However, ask your (potential) advisor .

• (+1) Yes, I strongly appreciate literature reviews. It is not a trivial contribution to accurately summarize the history, state of the art, and current challenges of a discipline. Doing a systematic literature helps with the quality and feasibility of producing the literature review. –  Galen Commented Jan 17, 2022 at 19:15

You're asking two different questions here.

Yes, you can publish a high-quality literature review in some, but not all, journals. However, many journals also solicit such reviews rather than take them automatically, and many will have length restrictions associated with them. So check with the journal before you start working!

As for a master's thesis, that depends a lot on the requirements of your field. In the humanities, you would probably have to do some searches for primary references, but a large-scale literature review is an important part of such a work. In the sciences and engineering, however, you are much less likely to be able to submit such a thesis. The usual standards there require more original work than can typically be accomplished with a literature review.

A literature review with well-defined research questions that provides a synthesis of high-quality literature is considered very useful research. Generally, such reviews present a taxonomy of the domain, summarize the contributions and furnish them in an abstract manner from different aspects involved. A good quality review gets many citations, and it provides a very useful stepping stone for new researchers in a given area. Thus, it can certainly be considered as an MS thesis.

• 4 But it depends, of course, on what an advisor or a university will permit. –  Buffy Commented Jan 17, 2022 at 18:43
• 1 Though there are different contexts and meanings of the word, often when people say "research" they mean "original research". Reviews are certainly useful to the research process, but may not be considered themselves research . –  Bryan Krause ♦ Commented Jan 17, 2022 at 19:06

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Doing a Systematic Review: A Student's Guide

Student resources, chapter 1: carrying out a systematic review as a master's thesis.

What Is The Difference Between A Systematic Review And A Meta-Analysis?

What Is The Difference Between A Narrative Review And A Systematic Review With Narrative Synthesis?

Structured literature reviews – A guide for students

This is a step-by-step guide aimed at Master's students undertaking a structured literature review as part of their Master's thesis.

There are several different kinds of literature reviews, but any literature review typically includes an extensive literature search. Whenever a systematic approach is used, the literature search features a methodical step-by-step procedure. However, as a Master's student, it might not be possible to fulfill all the criteria of a systematic review when writing a literature review-based thesis; you should rather do a structured literature review, which will include only certain aspects of the systematic review methodology.

In this guide we will go through the different steps of a structured literature review and provide tips on how to make your search strategy more structured and extensive. Additionally, make sure to follow any programme and course specific requirements.

Step 1: Formulate and delimit your research question

• It will be much easier for you to perform a structured information search if you first define and delimit your research question in a clear way.
• One way to define and structure your question is to break it down into different parts .
• PICO and PEO are two different frameworks that can be used for breaking down a research question into different parts.
• You also need to define the most important key concepts of your research question.

The formulation of your research question is partly connected to what kind of literature review you are doing. This article by Maria J. Grant and Andrew Booth usefully compares different kinds of reviews . While a systematic literature review is usually grounded in a clearly delimited and structured question, a scoping review may, for instance, feature a wider problem formulation. The wider a research question is, the larger number of search hits it tends to generate.

To be able to perform a literature review, you need to consider a subject area in which there seems to be a sufficiently large number of original research studies. Therefore, it may be a good idea to test search a database for previous research on the subject while you are trying to formulate and delimit your research question.

One way to structure your research question is to break it down into different parts. A well-delimited question often consists of three to four different parts. PICO and PEO are two examples of frameworks that can help you identify and define your research question.

• PICO ( P opulation, I ntervention, C omparison, O utcome) is primarily used for quantitative research questions.
• PEO ( P opulation, E xposure, O utcome) is primarily used for qualitative research questions.

Structuring your research question in accordance with a framework, such as PICO or PEO, will also help you decide on the inclusion and exclusion criteria of your literature review.

PICO & PEO

After you have delimited your research question, you also need to identify the key concepts that make up your question. Based on these key concepts, you will create " search blocks " that you will use to organise your search terms.

Step 2: Find search terms and create search blocks

• Test searching is a good way to investigate the terminology of a subject area and find search terms.
• Reading key articles can help you gather additional search terms for your final search strategy.
• Find subject headings  for PubMed with the help of the US National Library of Medicine's MeSH database.
• Find& free-text search terms by investigating what words that occur in the title and abstract of relevant articles.
• A good way of achieving a structured final search query is to arrange your search terms into search blocks ; these blocks should arise from the key concepts of your research question.

While working on a literature review-based thesis, you will need to search for articles on several occasions. In the beginning of your project, it is often good to do a couple of unstructured and simple search queries, so-called test searches, in academic databases. This way you are off to a good start, as test searching helps you investigate the terminology of your subject area and find relevant search terms. While the final search strategy is typically reported in full, you don't need to present your test queries in your thesis.

Try to find a couple of key articles, that is, articles that correspond to the type of studies that you are planning to include in your review. Use key articles to gather additional search terms for your final search strategy. Analyse the terminology of your key articles by examining what subject headings (MeSH terms, etc.) that the articles have been tagged with and what words that occur in the titles and abstracts.

Test search - find keywords and narrow down your topic

Test search in pubmed & cinahl.

To retrieve as many relevant studies as possible, you will need to include free-text search terms as well as subject headings in your final search strategy. Free-text search terms are words that occur in the article's title and abstract – words used by the authors themselves. Subject headings are subject-related words that an article is tagged with when the article is added to the database.

• In PubMed , articles are tagged with MeSH terms ( Me dical  S ubject  H eadings). You can look up and browse MeSH terms in the US National Library of Medicine's  MeSH database .
• Databases such as CINAHL , PsycInfo , ERIC , and Sociological Abstracts  have their own subject heading lists; look up subject headings in each database's subject heading list.
• There are also so-called free-text databases, such as Web of Science . These databases lack subject heading lists. Hence, when searching a free-text database, you can only use free-text search terms.

Find subject headings

An effective way to increase the structure of your final search strategy is to arrange your search terms in so-called  search blocks . Create your search blocks based on the key concepts of your research question.

Create search blocks

This search strategy worksheet might help you document and organise your search terms.

Download worksheet

• Worksheet for search terms (Word, 30.54 KB)

Step 3: Search in a structured way

• To get a comprehensive search result, you will need to search for articles in  several different databases .
• Your search strategy should be as uniform as possible in every database, but you may have to  adapt your use of subject headings .
• As you search the databases, combine your search terms and blocks with the help of  AND  and  OR .
• Save time by  documenting your search queries .

When doing a literature review-based thesis it is often wise to use at least two different databases. Many databases overlap, but may also contain unique content. At KI it is common for Master's students to use PubMed and Web of Science when doing a structured literature review as part of their Master's thesis. Depending on your research question, other databases may also be appropriate and useful. Read more about the most frequently used databases at KI .

Your search strategy should be as uniform as possible in every database. However, as mentioned in Step 2, databases may use different subject headings, and some databases only let you use free-text search terms. This means that you need to adapt your use of subject headings depending on the database.

Example: How subject headings may differ between databases 

If you want to search for articles about day surgery in PubMed, you should use the MeSH term Ambulatory Surgical Procedures . However, if you also want to perform your search in a database such as CINAHL, you need to use the corresponding CINAHL Headings term instead: Ambulatory Surgery .

There are many different ways of searching databases. Most databases have one simple, basic Google-like search box and one advanced search form. One advantage of the latter is that combining search terms with AND and OR is usually easier in an advanced search form, especially if you will be using both AND and OR within the same search query. However, you can often combine search terms with AND and OR in a basic search box too, and in that case, you often isolate your different search blocks from each other by enclosing each block in parentheses.

Example: A search query that contains AND, OR, and parentheses

( inflammatory bowel diseases OR ulcerative colitis OR crohn disease) AND (adolescent OR child OR young adult OR teenager) AND (self-management OR self care OR self efficacy )

By choosing the advanced search form you will also be able to exert more control over your search process. The advanced search form lets you specify more closely and decide exactly how you want the database to interpret your search terms; this way you can make your search query more precise.

You should always document your search strategy in order to remember what search terms you have used, how these search terms have been combined, and whether you have applied any limits to your search. The easiest way to do this is to copy and paste your search history from the database into a text document. Also, academic databases often let you create a personal account, so that you may save your searches online.

How to do a structured search in PubMed

Step 4: narrowing or broadening your search.

• Briefly examine your search results to see if you need to narrow or broaden your search query.
• Investigate whether your key articles are present in the search results.
• By using the advanced search form you can improve your search.

Prepare yourself for having to modify and redo your search query several times, before deciding on your final search strategy. After you have combined all your search terms and made your very first database search, you should examine the search results and analyse whether your search query is able to generate the type of search hits that you are looking for.

Analyse your search results

• Are all your key articles present in the search results, or are there some key articles that your search query is unable to retrieve?
• Are you getting too few search hits ? Investigate why. Perhaps you need to remove one of your search blocks, add one or several synonyms within a search block, or search for parts of words by truncating one or several of your free-text search terms, in order to broaden your search ?
• Does your search strategy generate too many non-relevant search hits that have nothing to do with your research question? Investigate why. Perhaps you need to add another search block, remove one of the synonyms from one of your search blocks, or search for phrases by enclosing one or several of your free-text terms in quotation marks, in order to narrow your search ?
• More tips on how to improve your search strategy .

It is important to remember that there is nothing wrong, per se, if your search query generates irrelevant hits. This is quite normal when performing a structured literature search. What's important is that your search strategy is able to retrieve the type of articles that you are looking for, and that you are not overwhelmed by the total number of hits (given the time frame of your thesis project).

We recommend that you use the advanced search form when improving your search strategy. By using the advanced search form, you will for example be able to specify which search fields your search terms must be present in.

Narrowing your search 

Broaden your search, how to specify the field you would like to search in pubmed, step 5: select and review articles.

• After you have completed your search, you will need to go through all your search hits and select which articles to include in your review.
• When selecting articles, read through the titles and abstracts of each article to decide its relevancy .
• Check the quality of each study that you include in your review.
• When checking the quality of articles, it is common to use critical appraisal worksheets or checklists .

Selecting articles

When you have completed and feel satisfied with your search, it is time to go through all the search hits and select which studies to include in your review. All relevant studies, that is, those studies that correspond to your research question and your previously set inclusion criteria, should be included. You decide on the relevancy of a study primarily by reading through the title and abstract. If you feel unsure, go through the whole article. You can describe your selection process with the help of a flow chart, such as the frequently used PRISMA flow diagram .

One of the challenges of systematic literature searches is that the search strategy should be exhaustive, but at the same time the number of search hits also needs to be kept within reasonable boundaries. A search query needs to be broad enough to retrieve all relevant studies, but on the other hand, this also means that a large portion of the search results will be irrelevant. Hence, even though your search strategy may have generated hundreds of hits, it is fine to only include ten to twenty articles in your review in the end.

Saving articles

If you create a personal account in a database it will be easier for you to save any references that you may find there. Another way of saving and organising article references is to use reference management software. There are several different reference management software, for example Endnote Online and Zotero.

Read more about reference management and see software guides.

Reviewing articles

When you have made your selection, you should critically examine the quality of all articles included in your review. The assessment is typically performed with the help of a critical appraisal guide or checklist. The purpose is to assess the reliability of the study results and whether there are any methodological flaws that may have impacted the results. Qualitative research articles are often reviewed with a focus on authenticity, credibility, and validity.

There are many different critical appraisal worksheets and checklists. Some examples are the SBU checklists for assessing the quality of randomized studies, observational studies, and qualitative research. In the course book How to do a systematic review in nursing there is a review guide that can be used for assessing different kinds of studies (both qualitative and quantitative); the original source is Caldwell, Henshaw & Taylor, 2011 .

Review worksheets and checklists contain criteria and questions that may help you identify flaws, errors, or bias. Sometimes different aspects of the study are scored separately. Later, all scores make up a final score that indicates whether the study is of high, medium, or low quality.

Many programmes and courses provide instructions on which checklists to use when reviewing articles, so check your course guidelines.

Step 6: Report your search strategy

• Describe your search strategy in a manner that makes it possible for your readers to replicate the search and get the same results.
• The search strategy is often presented in the form of a table .
• Look at the search history to see what words and limits that you have used when searching a database.

An important aspect of doing a structured literature review is transparency. It has to be easy for your readers to follow what you did when you searched and selected the articles that you have included in your review. In the method section of your literature review you should describe how you searched different databases. This is also where you describe any manual searches that you did. Search strategies are commonly reported in the form of tables. Present one table for each database.

You can examine your search terms and any limits you have applied when searching a database by visiting its search history.

Read more about how to report your search strategy and view examples.

Checklist for search strategies

Here is a checklist to help you review your own or someone else's search strategy.

If you would like us to get back to you, please submit your contact information in the form below along with your feeback.

Reference management. Clean and simple.

How to write a systematic literature review [9 steps]

What is a systematic literature review?

Where are systematic literature reviews used, what types of systematic literature reviews are there, how to write a systematic literature review, 1. decide on your team, 2. formulate your question, 3. plan your research protocol, 4. search for the literature, 5. screen the literature, 6. assess the quality of the studies, 7. extract the data, 8. analyze the results, 9. interpret and present the results, registering your systematic literature review, frequently asked questions about writing a systematic literature review, related articles.

A systematic literature review is a summary, analysis, and evaluation of all the existing research on a well-formulated and specific question.

Put simply, a systematic review is a study of studies that is popular in medical and healthcare research. In this guide, we will cover:

• the definition of a systematic literature review
• the purpose of a systematic literature review
• the different types of systematic reviews
• how to write a systematic literature review

➡️ Visit our guide to the best research databases for medicine and health to find resources for your systematic review.

Systematic literature reviews can be utilized in various contexts, but they’re often relied on in clinical or healthcare settings.

Medical professionals read systematic literature reviews to stay up-to-date in their field, and granting agencies sometimes need them to make sure there’s justification for further research in an area. They can even be used as the starting point for developing clinical practice guidelines.

A classic systematic literature review can take different approaches:

• Effectiveness reviews assess the extent to which a medical intervention or therapy achieves its intended effect. They’re the most common type of systematic literature review.
• Diagnostic test accuracy reviews produce a summary of diagnostic test performance so that their accuracy can be determined before use by healthcare professionals.
• Experiential (qualitative) reviews analyze human experiences in a cultural or social context. They can be used to assess the effectiveness of an intervention from a person-centric perspective.
• Costs/economics evaluation reviews look at the cost implications of an intervention or procedure, to assess the resources needed to implement it.
• Etiology/risk reviews usually try to determine to what degree a relationship exists between an exposure and a health outcome. This can be used to better inform healthcare planning and resource allocation.
• Psychometric reviews assess the quality of health measurement tools so that the best instrument can be selected for use.
• Prevalence/incidence reviews measure both the proportion of a population who have a disease, and how often the disease occurs.
• Prognostic reviews examine the course of a disease and its potential outcomes.
• Expert opinion/policy reviews are based around expert narrative or policy. They’re often used to complement, or in the absence of, quantitative data.
• Methodology systematic reviews can be carried out to analyze any methodological issues in the design, conduct, or review of research studies.

Writing a systematic literature review can feel like an overwhelming undertaking. After all, they can often take 6 to 18 months to complete. Below we’ve prepared a step-by-step guide on how to write a systematic literature review.

• Decide on your team.
• Formulate your question.
• Plan your research protocol.
• Search for the literature.
• Screen the literature.
• Assess the quality of the studies.
• Extract the data.
• Analyze the results.
• Interpret and present the results.

When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

You may also need to team up with a librarian to help with the search, literature screeners, a statistician to analyze the data, and the relevant subject experts.

Define your answerable question. Then ask yourself, “has someone written a systematic literature review on my question already?” If so, yours may not be needed. A librarian can help you answer this.

You should formulate a “well-built clinical question.” This is the process of generating a good search question. To do this, run through PICO:

• Patient or Population or Problem/Disease : who or what is the question about? Are there factors about them (e.g. age, race) that could be relevant to the question you’re trying to answer?
• Intervention : which main intervention or treatment are you considering for assessment?
• Comparison(s) or Control : is there an alternative intervention or treatment you’re considering? Your systematic literature review doesn’t have to contain a comparison, but you’ll want to stipulate at this stage, either way.
• Outcome(s) : what are you trying to measure or achieve? What’s the wider goal for the work you’ll be doing?

Now you need a detailed strategy for how you’re going to search for and evaluate the studies relating to your question.

The protocol for your systematic literature review should include:

• the objectives of your project
• the specific methods and processes that you’ll use
• the eligibility criteria of the individual studies
• how you plan to extract data from individual studies
• which analyses you’re going to carry out

For a full guide on how to systematically develop your protocol, take a look at the PRISMA checklist . PRISMA has been designed primarily to improve the reporting of systematic literature reviews and meta-analyses.

When writing a systematic literature review, your goal is to find all of the relevant studies relating to your question, so you need to search thoroughly .

This is where your librarian will come in handy again. They should be able to help you formulate a detailed search strategy, and point you to all of the best databases for your topic.

➡️ Read more on on how to efficiently search research databases .

The places to consider in your search are electronic scientific databases (the most popular are PubMed , MEDLINE , and Embase ), controlled clinical trial registers, non-English literature, raw data from published trials, references listed in primary sources, and unpublished sources known to experts in the field.

➡️ Take a look at our list of the top academic research databases .

Tip: Don’t miss out on “gray literature.” You’ll improve the reliability of your findings by including it.

Don’t miss out on “gray literature” sources: those sources outside of the usual academic publishing environment. They include:

• non-peer-reviewed journals
• pharmaceutical industry files
• conference proceedings
• pharmaceutical company websites
• internal reports

Gray literature sources are more likely to contain negative conclusions, so you’ll improve the reliability of your findings by including it. You should document details such as:

• The databases you search and which years they cover
• The dates you first run the searches, and when they’re updated
• Which strategies you use, including search terms
• The numbers of results obtained

➡️ Read more about gray literature .

This should be performed by your two reviewers, using the criteria documented in your research protocol. The screening is done in two phases:

• Pre-screening of all titles and abstracts, and selecting those appropriate
• Screening of the full-text articles of the selected studies

Make sure reviewers keep a log of which studies they exclude, with reasons why.

➡️ Visit our guide on what is an abstract?

Your reviewers should evaluate the methodological quality of your chosen full-text articles. Make an assessment checklist that closely aligns with your research protocol, including a consistent scoring system, calculations of the quality of each study, and sensitivity analysis.

The kinds of questions you'll come up with are:

• Were the participants really randomly allocated to their groups?
• Were the groups similar in terms of prognostic factors?
• Could the conclusions of the study have been influenced by bias?

Every step of the data extraction must be documented for transparency and replicability. Create a data extraction form and set your reviewers to work extracting data from the qualified studies.

Here’s a free detailed template for recording data extraction, from Dalhousie University. It should be adapted to your specific question.

Establish a standard measure of outcome which can be applied to each study on the basis of its effect size.

Measures of outcome for studies with:

• Binary outcomes (e.g. cured/not cured) are odds ratio and risk ratio
• Continuous outcomes (e.g. blood pressure) are means, difference in means, and standardized difference in means
• Survival or time-to-event data are hazard ratios

Design a table and populate it with your data results. Draw this out into a forest plot , which provides a simple visual representation of variation between the studies.

Then analyze the data for issues. These can include heterogeneity, which is when studies’ lines within the forest plot don’t overlap with any other studies. Again, record any excluded studies here for reference.

Consider different factors when interpreting your results. These include limitations, strength of evidence, biases, applicability, economic effects, and implications for future practice or research.

Apply appropriate grading of your evidence and consider the strength of your recommendations.

It’s best to formulate a detailed plan for how you’ll present your systematic review results. Take a look at these guidelines for interpreting results from the Cochrane Institute.

Before writing your systematic literature review, you can register it with OSF for additional guidance along the way. You could also register your completed work with PROSPERO .

Systematic literature reviews are often found in clinical or healthcare settings. Medical professionals read systematic literature reviews to stay up-to-date in their field and granting agencies sometimes need them to make sure there’s justification for further research in an area.

The first stage in carrying out a systematic literature review is to put together your team. You should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

Your systematic review should include the following details:

A literature review simply provides a summary of the literature available on a topic. A systematic review, on the other hand, is more than just a summary. It also includes an analysis and evaluation of existing research. Put simply, it's a study of studies.

The final stage of conducting a systematic literature review is interpreting and presenting the results. It’s best to formulate a detailed plan for how you’ll present your systematic review results, guidelines can be found for example from the Cochrane institute .

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Methodology

• 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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See an example

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.

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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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Systematic Literature Review Dissertation (937C8)

60 credits, Level 7 (Masters)

Spring and summer teaching

The literature review-based dissertation module is a comprehensive, research-intensive component. It challenges you to deeply engage with existing scholarly works in the chosen area of psychological study. This module is designed to develop advanced critical thinking, analytical and synthesis skills. It guides you to critically examine and integrate a wide range of  scholarly articles, books and other relevant sources.

Throughout the module, you are expected to identify and define a specific psychological research question or problem, demonstrating a thorough understanding of its context and significance within the broader field. The literature review forms the backbone of the dissertation. It requires you to methodically search, select and appraise relevant research, while critically analysing themes, methodologies, findings and theoretical frameworks. This process:

• familiarises you with the current state of research in your chosen topic
• helps you identify gaps in existing knowledge and potential avenues for future research.

Emphasis is placed on developing a coherent, logically structured narrative that weaves together various strands of research into a comprehensive overview. You learn to balance the presentation of data with critical interpretation, culminating in a dissertation that demonstrates your ability to engage with complex ideas and contribute meaningfully to academic discussions in psychology.

This module is essential for those aiming to pursue further research or a professional career in psychology, providing a solid foundation in literature analysis and academic writing.

Contact hours and workload

We regularly review our modules to incorporate student feedback, staff expertise, as well as the latest research and teaching methodology. We’re planning to run these modules in the academic year 2024/25. However, there may be changes to these modules in response to feedback, staff availability, student demand or updates to our curriculum. We’ll make sure to let you know of any material changes to modules at the earliest opportunity.

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• Literature Review Guidelines

Making sense of what has been written on your topic.

Goals of a literature review:.

Before doing work in primary sources, historians must know what has been written on their topic.  They must be familiar with theories and arguments–as well as facts–that appear in secondary sources.

Before you proceed with your research project, you too must be familiar with the literature: you do not want to waste time on theories that others have disproved and you want to take full advantage of what others have argued.  You want to be able to discuss and analyze your topic.

Your literature review will demonstrate your familiarity with your topic’s secondary literature.

GUIDELINES FOR A LITERATURE REVIEW:

1) LENGTH:  8-10 pages of text for Senior Theses (485) (consult with your professor for other classes), with either footnotes or endnotes and with a works-consulted bibliography. [See also the  citation guide  on this site.]

2) NUMBER OF WORKS REVIEWED: Depends on the assignment, but for Senior Theses (485), at least ten is typical.

3) CHOOSING WORKS:

Your literature review must include enough works to provide evidence of both the breadth and the depth of the research on your topic or, at least, one important angle of it.  The number of works necessary to do this will depend on your topic. For most topics, AT LEAST TEN works (mostly books but also significant scholarly articles) are necessary, although you will not necessarily give all of them equal treatment in your paper (e.g., some might appear in notes rather than the essay). 4) ORGANIZING/ARRANGING THE LITERATURE:

As you uncover the literature (i.e., secondary writing) on your topic, you should determine how the various pieces relate to each other.  Your ability to do so will demonstrate your understanding of the evolution of literature.

You might determine that the literature makes sense when divided by time period, by methodology, by sources, by discipline, by thematic focus, by race, ethnicity, and/or gender of author, or by political ideology.  This list is not exhaustive.  You might also decide to subdivide categories based on other criteria.  There is no “rule” on divisions—historians wrote the literature without consulting each other and without regard to the goal of fitting into a neat, obvious organization useful to students.

The key step is to FIGURE OUT the most logical, clarifying angle.  Do not arbitrarily choose a categorization; use the one that the literature seems to fall into.  How do you do that?  For every source, you should note its thesis, date, author background, methodology, and sources.  Does a pattern appear when you consider such information from each of your sources?  If so, you have a possible thesis about the literature.  If not, you might still have a thesis.

Consider: Are there missing elements in the literature?  For example, no works published during a particular (usually fairly lengthy) time period?  Or do studies appear after long neglect of a topic?  Do interpretations change at some point?  Does the major methodology being used change?  Do interpretations vary based on sources used?

Follow these links for more help on analyzing  historiography  and  historical perspective .

5) CONTENTS OF LITERATURE REVIEW:

The literature review is a research paper with three ingredients:

a) A brief discussion of the issue (the person, event, idea). [While this section should be brief, it needs to set up the thesis and literature that follow.] b) Your thesis about the literature c) A clear argument, using the works on topic as evidence, i.e., you discuss the sources in relation to your thesis, not as a separate topic.

These ingredients must be presented in an essay with an introduction, body, and conclusion.

6) ARGUING YOUR THESIS:

The thesis of a literature review should not only describe how the literature has evolved, but also provide a clear evaluation of that literature.  You should assess the literature in terms of the quality of either individual works or categories of works.  For instance, you might argue that a certain approach (e.g. social history, cultural history, or another) is better because it deals with a more complex view of the issue or because they use a wider array of source materials more effectively. You should also ensure that you integrate that evaluation throughout your argument.  Doing so might include negative assessments of some works in order to reinforce your argument regarding the positive qualities of other works and approaches to the topic.

Within each group, you should provide essential information about each work: the author’s thesis, the work’s title and date, the author’s supporting arguments and major evidence.

In most cases, arranging the sources chronologically by publication date within each section makes the most sense because earlier works influenced later ones in one way or another.  Reference to publication date also indicates that you are aware of this significant historiographical element.

As you discuss each work, DO NOT FORGET WHY YOU ARE DISCUSSING IT.  YOU ARE PRESENTING AND SUPPORTING A THESIS ABOUT THE LITERATURE.

When discussing a particular work for the first time, you should refer to it by the author’s full name, the work’s title, and year of publication (either in parentheses after the title or worked into the sentence).

For example, “The field of slavery studies has recently been transformed by Ben Johnson’s The New Slave (2001)” and “Joe Doe argues in his 1997 study, Slavery in America, that . . . .”

Your paper should always note secondary sources’ relationship to each other, particularly in terms of your thesis about the literature (e.g., “Unlike Smith’s work, Mary Brown’s analysis reaches the conclusion that . . . .” and “Because of Anderson’s reliance on the president’s personal papers, his interpretation differs from Barry’s”). The various pieces of the literature are “related” to each other, so you need to indicate to the reader some of that relationship.  (It helps the reader follow your thesis, and it convinces the reader that you know what you are talking about.)

7) DOCUMENTATION:

Each source you discuss in your paper must be documented using footnotes/endnotes and a bibliography.  Providing author and title and date in the paper is not sufficient.  Use correct Turabian/Chicago Manual of Style form.  [See  Bibliography  and  Footnotes/Endnotes  pages.]

In addition, further supporting, but less significant, sources should be included in  content foot or endnotes .  (e.g., “For a similar argument to Ben Johnson’s, see John Terry, The Slave Who Was New (New York: W. W. Norton, 1985), 3-45.”)

8 ) CONCLUSION OF LITERATURE REVIEW:

Your conclusion should not only reiterate your argument (thesis), but also discuss questions that remain unanswered by the literature.  What has the literature accomplished?  What has not been studied?  What debates need to be settled?

Additional writing guidelines

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What a Thesis Paper is and How to Write One

From choosing a topic and conducting research to crafting a strong argument, writing a thesis paper can be a rewarding experience.

It can also be a challenging experience. If you've never written a thesis paper before, you may not know where to start. You may not even be sure exactly what a thesis paper is. But don't worry; the right support and resources can help you navigate this writing process.

What is a Thesis Paper?

A thesis paper is a type of academic essay that you might write as a graduation requirement for certain bachelor's, master's or honors programs. Thesis papers present your own original research or analysis on a specific topic related to your field.

“In some ways, a thesis paper can look a lot like a novella,” said Shana Chartier , director of information literacy at Southern New Hampshire University (SNHU). “It’s too short to be a full-length novel, but with the standard size of 40-60 pages (for a bachelor’s) and 60-100 pages (for a master’s), it is a robust exploration of a topic, explaining one’s understanding of a topic based on personal research.”

Chartier has worked in academia for over 13 years and at SNHU for nearly eight. In her role as an instructor and director, Chartier has helped to guide students through the writing process, like editing and providing resources.

Chartier has written and published academic papers such as "Augmented Reality Gamifies the Library: A Ride Through the Technological Frontier" and "Going Beyond the One-Shot: Spiraling Information Literacy Across Four Years." Both of these academic papers required Chartier to have hands-on experience with the subject matter. Like a thesis paper, they also involved hypothesizing and doing original research to come to a conclusion.

“When writing a thesis paper, the importance of staying organized cannot be overstated,” said Chartier. “Mapping out each step of the way, making firm and soft deadlines... and having other pairs of eyes on your work to ensure academic accuracy and clean editing are crucial to writing a successful paper.”

How Do I Choose a Topic For My Thesis Paper?

What your thesis paper is for will determine some of the specific requirements and steps you might take, but the first step is usually the same: Choosing a topic.

“Choosing a topic can be daunting," said Rochelle Attari , a peer tutor at SNHU. "But if (you) stick with a subject (you're) interested in... choosing a topic is much more manageable.”

Similar to a thesis, Attari recently finished the capstone  for her bachelor’s in psychology . Her bachelor’s concentration is in forensics, and her capstone focused on the topic of using a combined therapy model for inmates who experience substance abuse issues to reduce recidivism.

“The hardest part was deciding what I wanted to focus on,” Attari said. “But once I nailed down my topic, each milestone was more straightforward.”

In her own writing experience, Attari said brainstorming was an important step when choosing her topic. She recommends writing down different ideas on a piece of paper and doing some preliminary research on what’s already been written on your topic.

By doing this exercise, you can narrow or broaden your ideas until you’ve found a topic you’re excited about. " Brainstorming is essential when writing a paper and is not a last-minute activity,” Attari said.

How Do I Structure My Thesis Paper?

Thesis papers tend to have a standard format with common sections as the building blocks.

While the structure Attari describes below will work for many theses, it’s important to double-check with your program to see if there are any specific requirements. Writing a thesis for a Master of Fine Arts, for example, might actually look more like a fiction novel.

According to Attari, a thesis paper is often structured with the following major sections:

Introduction

• Literature review
• Methods, results

Now, let’s take a closer look at what each different section should include.

Your introduction is your opportunity to present the topic of your thesis paper. In this section, you can explain why that topic is important. The introduction is also the place to include your thesis statement, which shows your stance in the paper.

Attari said that writing an introduction can be tricky, especially when you're trying to capture your reader’s attention and state your argument.

“I have found that starting with a statement of truth about a topic that pertains to an issue I am writing about typically does the trick,” Attari said. She demonstrated this advice in an example introduction she wrote for a paper on the effects of daylight in Alaska:

In the continental United States, we can always count on the sun rising and setting around the same time each day, but in Alaska, during certain times of the year, the sun rises and does not set for weeks. Research has shown that the sun provides vitamin D and is an essential part of our health, but little is known about how daylight twenty-four hours a day affects the circadian rhythm and sleep.

In the example Attari wrote, she introduces the topic and informs the reader what the paper will cover. Somewhere in her intro, she said she would also include her thesis statement, which might be:

Twenty-four hours of daylight over an extended period does not affect sleep patterns in humans and is not the cause of daytime fatigue in northern Alaska .

Literature Review

In the literature review, you'll look at what information is already out there about your topic. “This is where scholarly articles  about your topic are essential,” said Attari. “These articles will help you find the gap in research that you have identified and will also support your thesis statement."

Telling your reader what research has already been done will help them see how your research fits into the larger conversation. Most university libraries offer databases of scholarly/peer-reviewed articles that can be helpful in your search.

In the methods section of your thesis paper, you get to explain how you learned what you learned. This might include what experiment you conducted as a part of your independent research.

“For instance,” Attari said, “if you are a psychology major and have identified a gap in research on which therapies are effective for anxiety, your methods section would consist of the number of participants, the type of experiment and any other particulars you would use for that experiment.”

In this section, you'll explain the results of your study. For example, building on the psychology example Attari outlined, you might share self-reported anxiety levels for participants trying different kinds of therapies. To help you communicate your results clearly, you might include data, charts, tables or other visualizations.

The discussion section of your thesis paper is where you will analyze and interpret the results you presented in the previous section. This is where you can discuss what your findings really mean or compare them to the research you found in your literature review.

The discussion section is your chance to show why the data you collected matters and how it fits into bigger conversations in your field.

The conclusion of your thesis paper is your opportunity to sum up your argument and leave your reader thinking about why your research matters.

Attari breaks the conclusion down into simple parts. “You restate the original issue and thesis statement, explain the experiment's results and discuss possible next steps for further research,” she said.

Find Your Program

Resources to help write your thesis paper.

While your thesis paper may be based on your independent research, writing it doesn’t have to be a solitary process. Asking for help and using the resources that are available to you can make the process easier.

If you're writing a thesis paper, some resources Chartier encourages you to use are:

• Citation Handbooks: An online citation guide or handbook can help you ensure your citations are correct. APA , MLA and Chicago styles have all published their own guides.
• Citation Generators: There are many citation generator tools that help you to create citations. Some — like RefWorks — even let you directly import citations from library databases as you research.
• Your Library's Website: Many academic and public libraries allow patrons to access resources like databases or FAQs. Some FAQs at the SNHU library that might be helpful in your thesis writing process include “ How do I read a scholarly article? ” or “ What is a research question and how do I develop one? ”

It can also be helpful to check out what coaching or tutoring options are available through your school. At SNHU, for example, the Academic Support Center offers writing and grammar workshops , and students can access 24/7 tutoring and 1:1 sessions with peer tutors, like Attari.

"Students can even submit their papers and receive written feedback... like revisions and editing suggestions," she said.

If you are writing a thesis paper, there are many resources available to you. It's a long paper, but with the right mindset and support, you can successfully navigate the process.

“Pace yourself,” said Chartier. “This is a marathon, not a sprint. Setting smaller goals to get to the big finish line can make the process seem less daunting, and remember to be proud of yourself and celebrate your accomplishment once you’re done. Writing a thesis is no small task, and it’s important work for the scholarly community.”

A degree can change your life. Choose your program  from 200+ SNHU degrees that can take you where you want to go.

Meg Palmer ’18 is a writer and scholar by trade who loves reading, riding her bike and singing in a barbershop quartet. She earned her bachelor’s degree in English, language and literature at Southern New Hampshire University (SNHU) and her master’s degree in writing, rhetoric and discourse at DePaul University (’20). While attending SNHU, she served as the editor-in-chief of the campus student newspaper, The Penmen Press, where she deepened her passion for writing. Meg is an adjunct professor at Johnson and Wales University, where she teaches first year writing, honors composition, and public speaking. Connect with her on LinkedIn .

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Academic Referencing: How to Cite a Research Paper

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Founded in 1932, and online since 1995, we’ve helped countless students reach their goals with flexible, career-focused programs . Our 300-acre campus in Manchester, NH is home to over 3,000 students, and we serve over 135,000 students online. Visit our about SNHU  page to learn more about our mission, accreditations, leadership team, national recognitions and awards.

• Open access
• Published: 02 September 2024

The effect of mode of delivery on postpartum comfort level and breastfeeding self-efficacy: a systematic review and meta-analysis

• Hava Özkan   ORCID: orcid.org/0000-0001-7314-0934 1 ,
• Elif Odabaşi Aktaş   ORCID: orcid.org/0000-0002-3435-7118 2 &
• Hafsa Kübra Işik   ORCID: orcid.org/0000-0002-2472-6987 2  

Maternal Health, Neonatology and Perinatology volume  10 , Article number:  17 ( 2024 ) Cite this article

1 Altmetric

Metrics details

This study was conducted to determine the effect of the mode of delivery on maternal postpartum comfort level and breastfeeding self-efficacy.

The study was conducted as a systematic review and a meta-analysis. Searching was performed from March to July 2022, on PubMed, National Thesis Center, Dergi Park, Google Scholar, Web of Science, and EBSCO search engines and we included studies from the last 10 years. The Joanna Briggs Institute Critical Appraisal tools used in cross-sectional studies were employed to appraise the methodological quality and performed meta-analyses using a random-effects model for all outcomes. Study data consisted of continuous variables calculated by Mean Difference.

From 3732 records received, 21 cross-sectional studies involving 5266 participants were determined to be eligible. Meta-analysis results showed that cesarean section reduced postpartum comfort, albeit not statistically significant (MD: -0.87 95%: -1.98–0.24, Z = 1.53, p  = 0.44), whereas the combined results of breastfeeding self-efficacy showed that delivery type did not affect breastfeeding self-efficacy.

The results of this review have clinical implications for postpartum caregivers, as the effects of mode of delivery on postpartum comfort and breastfeeding self-efficacy have been well documented in previous studies. The authors recommend caregivers plan maternal care to increase their comfort, taking into account the factors that may affect postpartum comfort in the light of evidence-based practices.

Introduction

Childbirth is one of the most critical stages in a woman's life and often marks the transition to a new life [ 1 ]. One of the essential factors affecting the healthy progress of this shift is delivery type, which can depend on maternal obstetric characteristics, individual preferences, and advice from family, friends, or the doctor [ 2 ]. Mode of delivery, i.e., vaginal or cesarean delivery, is an essential factor affecting the birth and postpartum period. With proper guidance during labor, the most physiologically appropriate mode of delivery for the female body is vaginal delivery. Nevertheless, cesarean delivery is performed in cases where work does not progress as it should, hence putting the mother and the fetus at risk [ 2 , 3 ]. Whether by Cesarean section or vaginal birth, postpartum is the beginning of a new period in the interaction between mother and infant. It comes with a series of psychosocial changes, adapting to which can create considerable anxiety and stress. Providing comfort to the mother is very important in facilitating her adaptation to this new period of life [ 4 ].

Kolcaba developed her comfort theory in 2003, which defined comfort as ‘the immediate experience of being strengthened through having the needs for relief, ease, or transcendence met in four contexts: environmental, social, psycho-spiritual and physical [ 5 ]. Postpartum comfort is essential for women to pinpoint and solve the problems they face during that period [ 6 ]. Midwives play a crucial role in solving the factors affecting postpartum comfort and helping mothers adapt to the postpartum period. Comfort-oriented care by midwives contributes to the individual’s quality of life and promotes quick mother-infant bonding, postpartum care, and satisfaction [ 7 ].

Quick mother-infant bonding can be facilitated through comfort and mode of delivery. A critical factor in mother-infant adhesion and the formation of a healthy society is breastfeeding [ 8 ]. According to UNICEF (UN International Children’s Emergency Fund), breastfeeding gives all children the most nutritious start. It leads to lower healthcare costs, healthier families, and a more competent workforce [ 9 ]. To promote breastfeeding, WHO (World Health Organization) notes that breastfeeding acts as a baby’s first vaccine after birth and recommends that babies be exclusively breastfed for the first six months of life and continue to be breastfed for up to 2 years and beyond [ 10 ]. Many factors such as the mother's age, education, employment and economic status, smoking, family structure, frequency of prenatal follow-up, breast milk and breastfeeding education, number of living children and births, skin-to-skin contact, postpartum depression, birth weight and birth type affects breastfeeding self-efficacy [ 6 ].

While, in general terms, the perception of self-efficacy plays a significant role in the activities that an individual will or will not do, the perception of breastfeeding self-efficacy is a mother’s confidence in her ability to breastfeed her new infant and, above all, her interest and desire for breastfeeding. High breastfeeding self-efficacy has been positively associated with the duration and exclusivity of breastfeeding [ 11 ]. Mode of delivery and perception of breastfeeding self-efficacy affect postpartum breastfeeding [ 11 , 12 ]. Some studies in the literature state those women who gave birth by cesarean delivery started breastfeeding later than those who had a vaginal delivery [ 13 , 14 ]. No systematic review or meta-analysis on the subject was found in the literature review. This study, which will be carried out due to the gap in the literature, will contribute to the field.

This systematic review and meta-analysis study aimed to determine the effect of the mode of delivery on maternal postpartum comfort level and breastfeeding self-efficacy based on primary studies. The questions that the researchers sought to answer were:

How does the mode of delivery affect maternal postpartum comfort level?

How does the mode of delivery affect maternal breastfeeding self-efficacy level?

Protocol and registration

This study is a systematic review and meta-analysis, which was performed according to the standard guideline of “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” [ 15 ]. This systematic review and meta-analysis protocol was registered in the PROSPERO database (Trial Registration Number: CRD42020191106; 26 May 2022). PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) protocols were followed for review and reporting [ 15 ].

Search strategy

Data base ( www.crd.york.ac.uk/prospero ) was explored to confirm whether systematic review or meta-analysis existed before. Two researchers, independently between March and July 2022 on PubMed, National Thesis Center, Dergi Park, Google Scholar, Medline, Web of Science, and EBSCO search engines, conducted searching within the scope of this systematic review and meta-analysis. The search was carried out using the following keywords or medical subject headings: “mode of delivery” AND “cesarean section” OR “cesarean delivery” AND “vaginal birth” OR “vaginal delivery” AND “postpartum comfort” AND “breastfeeding self-efficacy”. In addition, additional studies were independently checked against included articles by the other two authors. Using the snowball method, reference lists of included studies and previous systematic reviews were checked for additional studies. To eliminate the risk of bias in the study, two researchers searched, screened, extracted data, and appraised the articles included independently. The researchers discussed and resolved any differences of opinion arising on any aspect of the study. For discrepancies, we screened with the help of a third reviewer. Before starting the study, a pilot study was conducted with the participation of all authors agreeing on a joint roadmap, including all stages of research. We used Cohen kappa (K = 0.9) to assess inter–rater agreement.

Inclusion and exclusion criteria

The criteria for the studies to be included in this review were as follows:

Participant groups included mothers' mode of delivery, postpartum comfort levels, and breastfeeding self-efficacy levels.

Attention was paid to the fact that the studies were full-text articles published in Turkish and English between May 2012 and July 2022.

A clinical trial design was used, including cross-sectional, analytical cross-sectional, and comparative cross-sectional studies.

PECOS criteria were used to screen the eligible studies for this systematic review and meta-analysis (Table  1 ). Exclusion criteria;

Delivery type, postpartum comfort levels, and breastfeeding self-efficacy levels.

The full text was not available.

The authors could not be reached and reported unextractable or irrelevant raw data.

Published in English or other than Turkish.

Reviews, editorials, books, news, etc. were.

The number of studies searched for systematic review, the number of studies found eligible and included in the review, and the number of studies excluded and the reasons for exclusion are shown in Fig.  1 , in PRISMA flow diagram format.

PRISMA flow diagram

Data extraction

All articles were imported to a citation manager (Mendeley), and duplicates were removed. Two trained investigators (the first and second authors of this paper) searched the databases and independently screened the titles and abstracts. After searching, filtering by title and abstract, and removing duplicates, the authors gathered and decided on eligible studies suitable for analysis on a full-text basis. Later on, some of the studies had to be excluded from the study during the analysis, as the data they contained was unsuitable. The number of studies searched for systematic review, the number of studies found eligible and included in the review, and the number of studies excluded and the reasons for exclusion are shown in Fig.  1 , in PRISMA flow diagram format.

The researchers designed a data extraction tool (Table  2 ) to acquire study data (Table  2 ). The data extraction tool made it possible to collect data about the studies included in systematic review and meta-analysis (i.e., author details, place and year of publication, data collection dates, design, scale used, sample size, mean maternal age, and other main findings reported) (see Table  2 ).

Assessment of methodological quality

The Joanna Briggs Institute Appraisal tools for cross-sectional studies were used for the studies’ quality appraisal. The checklist consisted of eight items [ 30 ]. Each item was rated as Yes, No, Unclear or Not Applicable. Appraisal results are given in Table  2 , with the total number of items (number of Yes responses) accepted as the studies’ “Quality Score”. Quality appraisal scores for cross-sectional studies were found to be 6/8 yes in 21 studies (Table  2 ). The vast majority of the studies reviewed met the quality appraisal criteria, which represents a low risk of bias.

Data analysis

The data in this systematic review were synthesized by meta-analysis. Study data in the postpartum comfort section ( n  = 10) were synthesized by meta-analysis. In contrast, the data on breastfeeding self-efficacy ( n  = 11) were explained in tabulated form as the studies examined as part of this study found that the mode of delivery did not affect maternal breastfeeding self-efficacy scores (Table  2 ). Data obtained from cross-sectional, cross-sectional-analytical, and cross-sectional-comparative studies were synthesized by meta-analysis. There is no missing data in the study. Review Manager Version 5.4 was used for meta-analysis, and the CMA program was used for regression testing. The extent of heterogeneity in the studies was measured by Cochran’s Q and Higgins’ I 2 tests, and it was accepted that I 2 above 50% was an important indicator of heterogeneity. Accordingly, “Random Effect” results were considered when I 2 was greater than 50%, and “Fixed Effect” results if it was below. Study data consisted of continuous variables calculated by “Mean Difference.” All tests were calculated as two-tailed, and p  < 0.05 was considered statistically significant.

Study selection

After subject selection, a total of 3736 records were identified, therefrom 3732 records were found through database searching and four additional records through other sources. After removal of duplicates, the records were screened by title and abstract, and as a result, the full texts of 41 articles were accessed. These 41 full-text articles were assessed for eligibility, and as a result, 21 articles were included in the study in Fig.  1 .

Study and participant characteristics

Of the studies included in systematic review, 16 were cross-sectional, two was analytical-cross- sectional, and three were comparative cross-sectional studies [ 3 , 4 , 6 , 7 , 8 , 11 , 12 , 16 , 29 ]. The studies had been conducted in 12 different cities of Turkey: Konya (3), Ankara (1), Izmir (3), Erzurum (3), Antalya (1), Istanbul (3), Çankırı (1), Diyarbakir (1), Trabzon (1), Malatya (1), Muğla (1) and Aydın (1). Total sample size of the studies was 5266 (postpartum comfort sample group: 3847; breastfeeding self- efficacy sample group: 1429) (Table  1 ). Of the studies ( n  = 21), 3 had been published in English and 19 in Turkish. Systematic review of the studies showed that, in general terms, the mean age of postpartum women was between 23 and 28 years, while nine studies specified no mean age. It was determined that the studies included in the review and analysis were published between 2014–2022. The data collection tools, sample size and quality score of the studies and the age and group characteristics of participants are presented in Table  2 .

• Postpartum comfort

In this systematic review and meta-analysis, ten studies [ 3 , 4 , 6 , 7 , 8 , 16 , 17 , 18 , 19 , 20 ] were found to report results on the effect of mode of delivery on maternal postpartum comfort, as assessed by means of a Postpartum Comfort Questionnaire. Combined results of these studies showed that delivery by cesarean delivery reduced postpartum comfort, while in meta-analysis the outcome was found to be statistically insignificant (MD:-1.63, 95%: -5.76- 2.50, Z = 0.77, p  = 0.44, Fig.  2 ). Estimated heterogeneity as measured by I 2 was 96% ( p  < 0.00001), and asymmetric outliers were seen in funnel plot (Figs. 2 and 3 ). Egger's regression test showed that the effect of publication bias was small (t: 1, 92, p  = 0,090).

Forest plot of the effect of mode of delivery on postpartum comfort level

Funnel plot of the effect of mode of delivery on postpartum comfort level

Postpartum comfort sub-dimensions

Physical comfort sub-dimension.

Of the studies examined in this systematic review and meta- analysis, ten studies [ 3 , 4 , 6 , 7 , 8 , 16 , 17 , 18 , 19 , 20 ] reported results on the effect of mode of delivery on the physical sub- dimension of maternal postpartum comfort. Combined results of these studies showed that cesarean delivery reduced physical postpartum comfort, while in meta-analysis the outcome was found to be statistically insignificant (MD: -0,97, 95%: -4,11- 2.17, Z = 0.61, p  = 0.54, Fig.  4 ).

Forest plot of the effect of mode of delivery on postpartum comfort sub-dimensions level

Psycho-spiritual comfort sub-dimension

Of the studies examined in this systematic review and meta-analysis, ten studies [ 3 , 4 , 6 , 7 , 8 , 16 , 17 , 18 , 19 , 20 ] reported results on the effect of mode of delivery on the psycho- spiritual sub-dimension of maternal postpartum comfort. Combined results of these studies showed that vaginal delivery increased psycho-spiritual postpartum comfort, while in meta-analysis the outcome was found to be statistically insignificant (MD: 0.47 95%: -1.13–2.08, Z = 0.58, p  = 0.57, Fig.  4 ).

Socio-cultural comfort sub-dimension

Of the studies examined in this systematic review and meta-analysis, ten studies [ 3 , 4 , 6 , 7 , 8 , 16 , 17 , 18 , 19 , 20 ] reported results on the effect of mode of delivery on the socio-cultural sub-dimension of maternal postpartum comfort. Combined results of these studies showed that cesarean delivery reduced sociocultural postpartum comfort, while in meta-analysis the outcome was found to be statistically insignificant (MD: -0.87 95%: -1.98–0.24, Z = 1.53, p  = 0.13, Fig.  4 ).

• Breastfeeding self-efficacy

In the 11 studies [ 11 , 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] examined in this systematic review in terms of breastfeeding self- efficacy, one study found a significant difference between delivery mode and breastfeeding self- efficacy, but no significant difference was found in the remaining ten. When we look at the results of the said one study conducted by Işık et al. [ 29 ], in which they found that the mode of delivery affected breastfeeding self-efficacy, it can be seen that vaginal delivery was found to affect breastfeeding self- efficacy 24 h postpartum, but not by week 4. Since most of the studies included in this systematic review did not have any effect on breastfeeding self-efficacy and there were no homogeneous data, no meta-analysis was conducted on this subject.

This systematic review and meta-analysis present the combined results of 21 cross-sectional studies reporting on postpartum comfort and breastfeeding self-efficacy outcomes by mode of delivery [ 3 , 4 , 6 , 7 , 8 , 11 , 12 , 16 , 29 ]. The results of these studies are important as they can contribute to improving the follow-up and care services offered to postpartum women.

The combined results of the studies examined in the meta-analysis showed that cesarean delivery reduced postpartum comfort, and the outcome was found statistically insignificant. A survey by Şahin and Sinan [ 31 ] reported moderate maternal postpartum comfort, whereas postpartum comfort level after a cesarean section was low. The study shows parallelism with the meta-analysis findings. In this sense, factors affecting maternal postpartum comfort in the event of a cesarean section may include incision pain, nausea, vomiting, pain, breastfeeding problems, and excretory issues, suggesting that maternal comfort level is lower after a cesarean delivery. Midwives should observe the problems mothers face, regardless of their mode of delivery, and should provide adequate care to solve those problems and improve their comfort level.

The combined results of the studies examined in the meta-analysis showed that cesarean delivery reduced physical postpartum comfort, and the outcome was found statistically insignificant. Pınar et al. [ 32 ] also found that maternal physical comfort was higher in women who had given birth vaginally. Another study also determined that physical comfort was more elevated in mothers who had given birth vaginally [ 33 ]. Physical comfort is associated with bodily perceptions, including physiological factors like nutrition, excretion, rest, and hemodynamics that affect the individual's physical condition [ 34 ]. The worse a person's physical condition gets, the lower their level of physical comfort. Since mothers who gave birth by cesarean section were exposed to anesthesia at much higher rates, the side effects of anesthesia and the pain level they experienced suggest that physical comfort is lower in cesarean deliveries compared to mothers who gave vaginal birth.

The combined results of the studies examined in the meta-analysis showed that vaginal delivery increased psycho-spiritual postpartum comfort, and the outcome was found statistically insignificant. Karakaplan [ 33 ] stated in his research that the psycho-spiritual level in women with a vaginal delivery was higher than in those with a cesarean section. Psycho-spiritual comfort covers emotional concepts such as self-esteem, self-concept, and self-awareness, all of which give meaning to an individual's life. The factors affecting psycho-spiritual postpartum comfort include maternal role adaptation, emotional changes in the maternal role, mother-infant interaction, maternal stress, and anxiety [ 7 , 17 ]. Based on the results, it can be said that psycho-spiritual comfort levels are higher in mothers giving birth vaginally, which can be attributed to reasons like the higher level of pain, stress, and anxiety experienced by mothers having a cesarean delivery, along with prolonged maternal role adaptation and delayed mother-infant interaction.

The combined results of the studies examined in the meta-analysis showed that cesarean delivery reduced sociocultural postpartum comfort, and the outcome was found statistically insignificant. Factors that constitute sociocultural comfort include family traditions/customs, religious beliefs, benefiting from financial support, and interpersonal communication [ 5 , 34 ]. In this context, information and counseling should be given to the individuals to create sociocultural care, and it should be ensured that they receive care, social support, discharge, and education, taking into account their family traditions and habits [ 5 , 35 ]. Being hospitalized for delivery in an environment away from home, facing the complex structure of the hospital, being dependent on others in many activities during and after delivery, limitation of movement, and having to adapt to unfamiliar procedures in the hospital environment are all factors that disrupt sociocultural comfort [ 17 ]. Hence, the mode of delivery is one of the most important factors affecting comfort [ 7 ]. According to the results of the meta-analysis, it can be said that the sociocultural comfort of the mother after vaginal delivery is higher than after cesarean section because women who have vaginal delivery have freedom of movement, can take care of themselves, and have a shorter hospital stay.

The studies included in this systematic review, reporting findings on breastfeeding self-efficacy, found that mode of delivery did not affect breastfeeding self-efficacy. Gürol [ 36 ], Aydın, and Aba [ 37 ] said there was no significant difference in breastfeeding self-efficacy among vaginal or cesarean delivery women. In a systematic review, Işık et al. [ 29 ] reported that mothers who had given vaginal birth had a high and significant breastfeeding self-efficacy within 24 h.

According to Dennis, the mother's perception of breastfeeding self-efficacy; shows whether the mother will breastfeed, how much effort she will put into it, her thoughts about breastfeeding, and her ability to cope emotionally with the difficulties she will face during the breastfeeding process. The self-efficacy perceived by the mother regarding breastfeeding may be related to the problems experienced in different situations before [ 38 , 39 ]. Mothers with high self-efficacy encourage themselves in the face of difficulties and try to solve the events by thinking positively [ 40 ]. These mothers prefer to breastfeed more, are more courageous, and act positively when faced with difficulties. In parallel with this study, in a study conducted by Dennis, it was determined that mothers who gave birth by cesarean section had lower breastfeeding self-efficacy scores due to delayed mother-infant interaction. Regardless of the mode of delivery, starting breastfeeding within the first half hour after birth is very important for mother-infant interaction [ 41 ]. It is also concluded that mother-infant interaction is delayed due to postpartum pain, stress, anxiety, and problems adapting to a new life and that, therefore, mothers may tend to prioritize their self-care. Since midwives are direct observers of the breastfeeding behaviors of mothers, they have an active role in solving existing problems and providing breastfeeding counseling. Counseling by midwives is important for solving breastfeeding problems faced by mothers and raising their self-efficacy perceptions.

Strengths and limitations of the study

The strengths of the present study were the scores recorded in the quality appraisal of the studies reviewed in this systematic review and meta-analysis and the wide variety of additional sources available for screening. The large sample size available to review data within the scope of this study was another vital aspect that strengthened the outcomes. Analyzing and comparing the results with other studies supported the analysis even further. The weakness of this review was that the studies included in the systematic review and meta-analysis were conducted only in Türkiye and hence, cannot be generalized to the general population. Since the low homogeneity of the studies reviewed may weaken the strength of evidence, the Random Effect model was used to control this factor in studies with high heterogeneity.

Conclusion and suggestions

In this systematic review and meta-analysis, we combined the results of 21 studies to present comprehensive data on maternal postpartum comfort and breastfeeding self-efficacy by mode of delivery. Because of the review, it was seen that the mode of delivery did not affect breastfeeding self-efficacy. In addition, it was observed that the mode of delivery affected postpartum comfort and its sub-dimensions, albeit not significantly. It was seen that, regarding the impact of the mode of delivery on postpartum comfort, cesarean delivery reduced physical comfort and sociocultural comfort, while vaginal delivery increased psycho-spiritual comfort. Against the background of these results, it is recommended that:

healthcare professionals take into account the factors that may affect postpartum comfort in the light of evidence-based practices and plan maternal care to increase their comfort,

maternal postpartum comfort be improved by avoiding unnecessary procedures during normal labor, and

healthcare professionals ground maternal postpartum care on the theory of comfort,

healthcare professionals identify breastfeeding problems by observing the mother before, during, and after birth, giving counseling when necessary, and leveraging their perception of breastfeeding self-efficacy.

Availability of data and materials

No datasets were generated or analysed during the current study.

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Özkan, H., Aktaş, E.O. & Işik, H.K. The effect of mode of delivery on postpartum comfort level and breastfeeding self-efficacy: a systematic review and meta-analysis. matern health, neonatol and perinatol 10 , 17 (2024). https://doi.org/10.1186/s40748-024-00187-3

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