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Health Research Literature: an Overview

A guide to types & hierarchy of medical research sources

Hierarchy of health research studies

The hierarchy of study design pyramid shows how primary medical research is continuously integrated into secondary research reviews to provide evidence based answers to medical questions. Secondary evidence is derived from the results of primary studies & is presented in various types of review articles that summarize & evaluate primary study evidence. Secondary reviews summarize & in some cases quantitatively analyse the current state of research in a specific medical area. As the pyramid indicates, the systematic review with meta-analysis is currently considered the gold standard of evidence.

Not all review types listed below are considered as systematic presentations of medical evidence.    Some  reviews are more systematic than others. For publication, systematic reviews and, increasingly, scoping reviews require a research team and creation of a protocol, e.g. Cochrane or Prisma. The table below outlines the characteristics of different types of review literature.   

Review Type Description Search Appraisal Synthesis Analysis
Critical review

Aims to show that writer has extensively searched the literature & critically evaluated its quality. Provides a degree of analysis & conceptual innovation. Often results in hypothesis or model.

Example

Seeks to identify the most significant items in the field No formal quality assessment. Attempts to evaluate according to contribution Typically narrative, may be conceptual or chronological Significant component: seeks to identify conceptual contribution to embody existing or derive new theory

Literature or Narrative  review

 
Generic term: published materials that provide examination of recent or current literature. Can cover wide range of subjects at various levels of completeness and comprehensiveness.May include research findings. May or may not include comprehensive searching May or may not include quality assessment Typically narrative  May be chronological, conceptual, thematic, etc.
Mapping review

Map out and categorize existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature.

Example

 

Completeness of search depends on time/scope constraints No formal quality assessment May be graphical and tabular Characterizes quantity of literature, perhaps by study design and other key features. May identify need for primary or secondary research
Meta-analysis

A study that systematically combines the results of quantitative studies & uses statistical analysis to provide a more precise effect of the results.

Example

Aims for exhaustive comprehensive searching. May use funnel plot to assess completeness Quality assessment may determine inclusion/exclusion and/or sensitivity analyses Graphical and tabular with narrative commentary Numerical analysis of measures of effect assuming absence of heterogeneity
Mixed methods review

Combination of methods where one significant component is a literature review (usually systematic). In a review context it refers to a combination of review approaches, e.g. combining quantitative with qualitative research.

Example

Requires either very sensitive search to retrieve all studies or separately conceived quantitative and qualitative strategies Requires either a generic appraisal instrument or separate appraisal processes with corresponding checklists Typically both components will be presented as narrative and in tables. May also employ graphical means of integrating quantitative and qualitative studies Analysis characterizes both literatures and look for correlations  between characteristics or use gap analysis to identify aspects absent in one literature but present in the other.
Qualitative Systematic review

Integrates or compares the findings from qualitative studies. Looks for themes or constructs that lie in or across individual qualitative studies.

Example

May employ selective or purposive sampling Quality assessment typically used to mediate messages not for inclusion/exclusion Qualitative narrative synthesis Thematic analysis, may include conceptual models
Rapid review

Assesses what is already known about a policy or practical issue, by using systematic review methods to search and critically appraise existing research.

Example

Completeness of searching determined by time constraints Time-limited formal quality assessment Typically narrative and tabular Quantities of literature and overall quality /direction of effect of literature
Scoping review

Preliminary investigation of potential size and scope of available research. Aims to identify nature and extent of research evidence (usually including ongoing research). Requires following a protocol, e.g. Cochrane or Prisma. 

Example

Completeness of searching  determined by time/scope constraints. May include research in progress No formal quality assessment Typically tabular with some narrative commentary Characterizes quantity and quality of literature, perhaps by study design and other key features. Attempts to specify a viable review
Systematic review

 Poses a well formulated research question to systematically search for, appraise and synthesize existing research evidence.  Requires following a protocol, e.g. Cochrane or Prisma. 

Example

Aims for exhaustive, comprehensive  searching Quality assessment may determine inclusion/ exclusion Typically narrative, may have tabular accompaniment What is known: recommendations for practice. What remains unknown; uncertainty around findings, recommendation for future research
Umbrella review

A review compiling evidence from multiple reviews into one accessible and usable document. Focuses on broad condition or problem. Useful for gathering reviews of   competing interventions. Analyses and highlights   these interventions and their results.

Example

Identification of component reviews,but no search for primary studies Quality assessment of studies within component reviews and/or of reviews themselves Graphical and tabular with narrative commentary What is known; recommendations for practice.What remains unknown; recommendations for future research

Table adapted from: Grant, M. and Booth,A.(2009) A typology of reviews: an analysis of 14 review types and associated methodologies Health Information and Libraries Journal. 26, pp.91-108.

This Decision Tree can help you determine what type of review you can do.

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