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Approaches to community needs assessment: a literature review

Affiliation.

1 Department of Nursing Studies, Kings College London, England.
PMID: 8708192
DOI: 10.1046/j.1365-2648.1995.22040721.x

In the light of the growing awareness of professionals in the community of the need to undertake health needs assessments of the population, this literature review sets out to explore, delineate and critically analyse the various approaches to community needs assessment, to facilitate a greater understanding of their strengths and weaknesses. The review commences by highlighting its complex nature, and attempting to define what is meant by 'needs assessment' from the differing perspectives of three dominant approaches, namely sociology, epidemiology and health economics. It continues by putting forward an argument for the use of the community health profile, being a multi-focal approach to needs assessment, combining quantitative with qualitative data, and proceeds with a discussion of strengths and weaknesses related to its compilation, in particular factors relating to reliability and validity of data sources. The consumer perspective is also reviewed, as are issues surrounding the ethics of data collection and problems concerning aggregation of the numerous data sources into meaningful policy. Throughout the review, issues are discussed with reference to the current political context in the United Kingdom. Equally important is the community nurse perspective, which is integrated into the arguments where appropriate.

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Approaches to community needs assessment: a literature review

1995, Journal of Advanced Nursing

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Approaches to community needs assessment: a literature review.

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Published in Journal of Advanced Nursing 1 October 1995
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77 Citations

A community health needs assessment using principles of community-based participatory research in a mississippi delta community: a novel methodological approach, a public health approach to health needs assessment at the interface of primary care and community development: findings from an action research study, a scoping review of community health needs and assets assessment: concepts, rationale, tools and uses, a needs assessment to develop community partnerships, a public health approach to health needs assessment at the interface of primary care and community development : ndings from an action research study, a taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice., responding to rural health needs through community participation: addressing the concerns of children and young adults., the effect of population-based health needs assessment on health visitor practice, postcards from the people: a dialogue model for community needs assessment.

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Contradictory agendas in health visitor needs assessment. A discussion paper of its use for prioritizing, targeting and promoting health

51 references, needs assessment needs assessment...., community development approaches to health needs assessment., assessing population needs in primary health care: the problem of gp attachment, public opinion and the national health service: patterns and perspectives in consumer satisfaction, public opinion and purchasing., measuring morbidity for resource allocation., the analysis of small area statistics and planning for health, inequalities in health in the city of bristol: a preliminary review of statistical evidence, community nursing and the new public health., territorial need indicators: a new approach part ii, related papers.

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HLTH 4609: Needs Assessment and Program Planning: Literature Review

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Literature Review
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Choosing a Topic

Choosing your topic is one of the most important steps for a graduate student, and should be done in consultation with your faculty advisor. Some of the tips presented in the video below can help you get started.

The Literature Review

This tutorial from NCSU gives a good overview of the process of the literature review.

Types of Literature Reviews

Completing Literature Reviews

Links to Further Help You...

UNC Writing Center Handout for Writing a Lit Review
Purdue Online Writing Lab Social Work Literature Review Guidelines (Not only for Social Work!)
UW-Madison Writing Center Learn How to Write a Review of Literature
University of Toronto The Literature Review: A Few Tips on Conducting It
Mindmap The Literature Review in Under 5 Minutes
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Last Updated: Aug 21, 2024 12:18 PM
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Through Extension, we aim to improve people’s lives by responding to their needs through research and education-based efforts. The first step in offering effective and efficient educational programs that address people’s needs is identifying and prioritizing the community’s needs, which we call a needs assessment. A needs assessment allows you to construct a more objective picture of needs than you would receive depending on one person’s perspective. As Extension professionals (agents and specialists), a needs assessment is crucial for informing your educational program decisions and enhancing their effectiveness and value.

This publication aims to help Extension professionals get started with needs assessments, illustrated through practical examples.

Needs Assessment Step-by-Step

1. clarify the reasons for conducting the needs assessment..

Outline the purpose and planned use of the results.

The purpose of conducting a needs assessment is to identify topics for 4-H programs and activities. The results will be used to determine the three programs that will be implemented during summer break.

Keep in mind!

What is the purpose?
What do you aim to accomplish?
Who will use the results?

2. Identify the individuals who play a significant role before, during, and after conducting the needs assessment.

Identify individuals who: a) share their perspectives on current issues; b) hold decision-making power; c) assist in prioritizing the gathered needs; d) aid in reaching out to the community or target audience and share the findings from the assessment; and e) communicate results to key stakeholders.

Create a list of individuals, sponsors, administrators, interest groups (Farm Bureau, CREATE Foundation, United Way, or the Minority Farmers Alliance), and the county advisory board. These groups or individuals need to be included because they can share their perspectives on current situations, communicate the results of the assessments, directly influence the community’s priorities, and be part of the decision-making process.

Identify the stakeholders.
Build your networks.
Reach out to your community.

3. Gather existing information to decide if a needs assessment is warranted.

Understand the history of the problem and what information/data already exists in your county by seeking expert advice, visiting the area (if possible), establishing local contacts, and building community relations (attending local events and town hall meetings, partnering with local organizations, forming an advisory council, etc.).

Consider attending a community event such as a farmers market; observe the participants, meet people, and collect information from as many individuals as possible.

A needs assessment takes time, energy, money, and other resources.

4. Identify secondary data (what is known) and pinpoint what you still want to know.

Secondary data will give you a quick sense of what is going on in your community.

Agriculture and natural resources agents rely on county data from the Agricultural Census, where data such as age, race, and sex are listed for all the counties in Mississippi. The Agricultural Census is a helpful source for assessing needs in your county. However, primary data should be collected directly from those individuals connected to the community problems, ranging from clients and advisory groups to opinion leaders, to enhance an understanding of community needs. Example sources of secondary data include the following:

U.S. Bureau of Labor Statistics
Census of Agriculture
U.S. Fish and Wildlife Service
National Center for Education Statistics
Food and Nutrition Information Center
USDA Economic Research Service
Centers for Disease Control and Prevention
Mississippi State University Extension Service
National Oceanic and Atmospheric Administration
Mississippi Department of Education
United States Department of the Interior
Mississippi State Department of Health
World Factbook
Mississippi Department of Agriculture and Commerce
Health and nutrition statistics
Local and regional media reports that have stories that impact your communities
Regional and county level data at local libraries or chambers of commerce
Using a mix of primary and secondary sources provides a rich and comprehensive assessment.
Secondary data provide detailed information from a large sample size that would be difficult and unrealistic for you to collect independently. They also provide information over several years, helping to identify trends.
It is important to look at county-level statistics and not just statewide data because each county might have hidden issues.

5. Determine the data-collection technique to gather the needed data.

Choose methods that help discover more specific issues and gain different perspectives from various sources.

Use techniques you are comfortable with and that are applicable to the target audience. An older population may prefer a written survey or an interview, while a younger population may prefer an online survey using a QR code. The information you are attempting to gather may also determine the method. A roundtable discussion may be more successful for Extension agents when collecting data from their advisory council. A roundtable discussion is a more personal method of gathering data, helping to establish group relationships.

Keep in mind

A needs assessment must consist of several methods. Looking at only one dataset will not accurately reflect what is happening in a community.
Many methods can be used to gather data, including individual methods (surveys and key informant interviews) and group methods (focus groups, advisory committees, and the Delphi method). The key is to be aware of the pros and cons of each technique to ensure their effective use.

6. Analyze the data you collected and prioritize needs.

Analyzing data means breaking down the collected information to identify key findings, areas of agreement or disagreement, and agreed-upon conclusions about the identified needs. Sorting and prioritizing needs means organizing and ranking each identified need and determining which ones to address first.

Participants in the prioritization process should include volunteer staff, community leaders, legislative leaders, and representatives of funding organizations.
Establish and develop criteria to evaluate each issue, and then determine the priority issue (e.g., using propriety, economics, acceptability, resources, and legality—the PEARL test).

7. Use the data to set program priorities, create an action plan to address the needs, and share the results.

According to a review of secondary data, beekeeping is a growing industry in Lee County, Mississippi. County residents also reported that it is a growing hobby and expressed interest in both beginner and advanced beekeeping. To address and identify the needs of Lee County residents, we planned two different beekeeping workshops. We created priorities related to beekeeping topics of interest and implemented a program to address them. We selected speakers based on the education necessary for each group, chose dates for each workshop, made promotional materials, ordered complementary publications for the topic, and secured a location at the back of our office. After promoting the workshops, we waited for individuals to sign up, effectively putting our plan into action.

A needs assessment is only completed once the results are shared and used.
Create an action plan, accept that plans may change, and be prepared to adapt and modify the action plan as needed.
There are several ways to share the results with stakeholders, including a detailed report or executive summary. These could be sent via email or posted on the organization’s website for everyone to see.

When considering needs assessments in your community, listen closely, be observant, and be diligent. Set your goals and act with enthusiasm. Feel free to ask for help. Including your community increases the likelihood of buy-in regarding the action plan.

Benge, M., & Warner, L. (2019). Conducting a needs assessment #2: Using needs assessments in extension programming .

Caffarella, R. S., & Daffron, S. R. (2013). Planning programs for adult learners: A practical guide ( 3rd ed.) Jossey-Bass.

Israel, G., Harder, A., & Brodeur, C. W. (2021). What is an Extension program? EDIS .

Jimenez-Marty, B. (2018). Community resources: Why use community resources ?

Mississippi Department of Agriculture and Commerce. (2023). Mississippi Agriculture Snapshot .

United States Department of Agriculture, Economic Research Service. (2023). Agriculture and its related industries provide 10.4 percent of U.S. employment .

Publication 3983 (POD-03-24)

By Warner Creekmore, Extension Agent, Lee County, and Nesma Osman, PhD, Assistant Professor, School of Human Sciences.

The Mississippi State University Extension Service is working to ensure all web content is accessible to all users. If you need assistance accessing any of our content, please email the webteam or call 662-325-2262.

Select Your County Office

Ms. Mildred Warner Poindexter Creekmore

Dr. Nesma Osama Abdelrahm Osman

A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

Hamid Ravaghi 1 ,
Ann-Lise Guisset 2 ,
Samar Elfeky 3 ,
Naima Nasir 4 ,
Sedigheh Khani 5 ,
Elham Ahmadnezhad 6 &
Zhaleh Abdi 7

BMC Health Services Research volume 23 , Article number: 44 ( 2023 ) Cite this article

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Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment.

We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021.

A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process.

Our findings highlight the need for having holistic approaches to assess community’s health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal–assessment of the community health needs assessment impacts.

Peer Review reports

The population-based health approach aims to improve the population’s health, promote community resilience and reduce health inequities across the socioeconomic gradient via inter-sectoral partnerships among community groups, government, healthcare systems, and other stakeholders [ 1 ]. One key feature for adopting a population-based health approach is to ensure that it is grounded on a solid understanding of community health needs and assets by triangulating evidence from service providers and community members on services availability, accessibility, utilization and experience [ 2 , 3 ]. The process of identification of unmet health needs in a population is crucial for local authorities seeking to plan appropriate and effective programmes to meet these needs [ 3 , 4 ]. If these needs are ignored, then there is a risk of a top-down approach for providing health services, reflecting what a few people perceive to be the needs of the population rather than what they actually are [ 4 , 5 ].

In this context, community health needs assessment is a means of developing a comprehensive understanding of a community’s health and health needs as well as designing interventions to improve community health [ 6 ]. Though the process of community health needs assessment can be conducted in several ways, the primary purpose is to provide community leaders or healthcare providers with an overview of local policy, systems, and environmental change strategies currently in place and help to identify areas for improvement [ 7 ]. Community health needs assessment can provide them with a more nuanced understanding of the communities they serve, making them aware of pressing issues that require system-level changes and support their efforts for resource mobilization to initiate innovative programmes [ 8 , 9 ]. The process to gather evidence on community health needs can also serve as a springboard to strengthen community engagement [ 10 ].

In general, needs assessments are usually designed to evaluate gaps between current situations and desired outcomes, along with possible solutions to address the gaps. Recently, there has been a trend to move away from framing a community with a deficit perspective (need-based approach) to focus on community assets and resources, called community health needs and assets assessment [ 11 , 12 ]. In contrast to a need-based perspective which focuses on local deficits and resources outside the community, an asset-based perspective focuses on honing and leveraging existing strengths within the community to address community needs [ 12 , 13 , 14 ].

Studies have shown that community health needs assessment is used widely by different users and across different settings [ 15 , 16 ]. However, these studies varied widely in terms of purpose, process and methods of conducting community health needs assessment. Furthermore, the extent to which an asset-based approach is used is unclear, beyond the inclusion in guidance and recommendations. Thus, to support national or local decision-makers to make informed choices about the scope, tools, methods and use of community health needs and assets assessment, this scoping review of the literature aimed at: 1) Providing conceptual clarity on community health needs and assets assessment, 2) Determining for what purpose and with what methods community health needs and assets assessment are used globally, 3) Drawing the lessons learnt from previous experience with community health needs and assets assessment: what works in what context and under what conditions, 4) Documenting evidence of impact of community health needs and assets assessment, 5) Consolidating tools and methods used to collect evidence/data underpinning community health needs and assets assessment processes.

Search strategy

Ten databases, including PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library were searched in February and March 2021. The search strategy was developed through discussion with experts in the field of population health, a research librarian, and a narrative review of the literature. Preliminary search terms were developed by the research team to reflect a number of core concepts including needs, population, needs assessment, assets assessment and participation. The search process was performed by a librarian with expertise in the use of literature databases (SK). The search terms were pilot-tested and agreed upon within the research team. The PubMed database search strategy presented in Additional file 1 .

Inclusion and exclusion criteria

Studies that focus on community health needs and assets assessment in terms of concepts, rationale, uses and tools were considered in both high-income countries (HICs) and low-and middle-income counties (LIMCs). We included studies in the review if they met the following criteria: 1) Papers providing conceptual clarity and explaining rationale for community health needs and (assets) assessment (This can be articles describing community health needs assessment or community assets assessment or community health needs and assets assessments at the same time or separately). The terms capabilities/ strengths/ resources can be used in place of assets and were considered.); 2) Papers describing or evaluating experiences implementing community health needs (and assets) assessment in a single site or multiple sites; 3) Methodological papers describing tools/approaches for community health needs (and assets) assessment; 4) Review of the literature on community health needs (and assets) assessment.

Types of papers not include in the review were: 1) Studies without a clear description of the community health needs and (assets) assessment methods, 2) Studies assessed a single dimension (i.e. health outcomes only, or healthcare providers’ capabilities only such as patient surveys, health outcomes dashboard, health facility assessment), 3) Studies related to a single disease or programme, 4) Studies focused only on engaging individual patient in their own care, and 5) Studies were not in English.

Three reviewers participated in the selection of the relevant studies (HR, ZA, NN). The eligibility and relevance of the articles were determined by two reviewers independently using the above predefined criteria. In the event of disagreement, a consensus was found between all the reviewers about the status of the article.

Data extraction

Separate data extraction forms were developed for the extraction of the three main categories of papers: conceptual, empirical and review papers. Totally, 121 empirical papers (including 6 review papers) and 48 conceptual and methodological papers were reviewed. Following topics were extracted for empirical papers: 1) General characteristics including author(s), year of publication, country of implementation, study objective(s) and study method; 2) Community health needs and (assets) assessment framing including rational, definitions of community health needs and (assets) assessment/ needs/ assets/ community, initiator(s) or user(s) of the process; 3) Key steps of the process, collected data, data collection tools; 4) Community engagement and the level of engagement; 5) Use of community health needs and (assets) assessment findings, impact of community health needs and (assets) assessment; 6) Facilitators and barriers. Data extraction forms are presented in Additional file 2 .

Data extraction forms were pilot-tested prior to the implementation. Two authors (ZA, HR) independently performed a pilot data extraction of a random sample of ten original articles. After piloting, the authors assessed the extracted data in relation to the scoping review questions and revised them accordingly. The content of the form was finalized by discussion within the team. Regarding conceptual papers, two authors (NN and ZA) initially extracted data from three randomly selected papers and subsequently refined and amended the form having research team inputs.

Four reviewers extracted included studies independently. The data extracted were cross-checked by one of the authors and mutual consensus resolved discrepancies. Individual data extraction forms of empirical papers were then merged into a single, unifying document used for the interpretation and presentation of the results. Following typical scoping review methods, the methodological quality of the included articles was not assessed systematically, however, only peer-reviewed articles were included in our review process [ 17 ].

Synthesis of results

Following reading and extracting conceptual papers, a preliminary conceptual framework (Fig. 1 ) was developed and discussed and agreed upon by team members. The integrative synthesis of the evidence was employed. Specifically, it involved the narrative description of concepts and definitions, key steps of the community health needs assessment and barriers and facilitators of the implementing community health needs assessment.

Conceptual framework of the review

The study selection process is summarized in Fig. 2 . Just over 12,000 records were obtained from the ten databases searched. Articles with obviously irrelevant titles were excluded, as were news items, letters, editorials, book reviews, and articles appearing in newsletters or magazines rather than peer review journals. The remaining abstracts were retrieved, read and assessed. A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. A list of all studies with a short description, including the year of publication, key focus, study period, and methods, is presented in Additional files 3 and 4 . The first part of the results section focuses on definitions and concepts of community health needs assessment using both conceptual and empirical papers. In the second part of the results section, we describe key steps of the community health needs assessment and tools and methods used to collect data through content analysis of 121 included empirical papers. We also report some important challenges and facilitators faced by included studies while performing community health needs assessment. Role of community participation in the process and the spectrum and types of the participation is discussed in the last part.

Information flow in scoping review

General characteristics of the included studies

The review showed that community health needs assessment is used widely by different users and across different settings in both HICs and LMICs. Among included empirical studies, 81 (out of 121) were conducted in the United States (US). There were papers from Australia ( n = 4), South Africa ( n = 3), Kenya ( n = 3), Uinted Kingdom (UK) ( n = 2), Canada ( n = 2), China ( n = 2), Dominican Republic ( n = 2), Republic of Ireland ( n = 2), Iran ( n = 2), India (2), Honduras ( n = 1), Netherland ( n = 1), Vietnam ( n = 1), Sudan ( n = 1), New Zealand ( n = 1), Madagascar ( n = 1), Malaysia ( n = 1), Ecuador ( n = 1), Indonesia ( n = 1), Uganda ( n = 1), Taiwan ( n = 1), Kyrgyzstan ( n = 1), Saudi Arabia ( n = 1), Haiti ( n = 1), Honduras ( n = 1) and Korea ( n = 1).

Definition of needs

The review showed “need” was a multi-faceted concept with no universal definition. There was a differentiation between “health need” and “healthcare need” in the reviewed literature. Healthcare needs can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation and terminal care). Healthcare providers usually consider needs in terms of healthcare services that they can supply. However, health needs incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education and employment. This broader definition allows looking beyond the confines of the medical model based on health services, to the wider influences on health [ 3 ].

In this review, relatively few empirical studies focus narrowly on healthcare needs, without attention to other determinants of health that can affect health [ 18 , 19 , 20 , 21 , 22 , 23 ]. Most of the included empirical studies looked beyond “physical health needs” to consider wider “social determinants of health” or non-medical factors that can affect a person’s overall health and health outcomes as the conditions—shaped by political, social, and economic forces—in which people are born, grow, live, work, and age [ 24 ]. Notably, the need was recognised as a “dynamic concept” whose definition will vary with time according to context and resources available to address these needs [ 16 ].

Definition of community

In general, “community” has been defined as “people with a basis of common interests and network of personal interactions grouped either based on locality or on a specific shared concerns or both” [ 25 ]. Shared common interests are particularly important as they can be assessed and, hopefully, met at a community level [ 26 ]. Importantly, community is a dynamic concept as individuals can belong to several communities at various times. In our review, community was defined by included studies, particularly those initiated by local authorities or healthcare providers (e.g., hospitals), based on geographical indicators such as county designations or based on the location of the hospital’s/facility’s/authority’s existing or potential service users. Some included empirical studies considered community based on shared interests or characteristics such as race/ethnicity, sexual orientation, or occupation. Medically underserved populations including rural areas [ 27 , 28 , 29 , 30 ], impoverished urban sectors [ 31 ], the homeless [ 32 , 33 , 34 , 35 ], persons in poverty or of low socioeconomic status, vulnerable children and families [ 18 , 28 , 36 , 37 , 38 ], the elderly [ 8 , 39 , 40 , 41 , 42 ], women and girls [ 43 , 44 , 45 , 46 , 47 ], LGBT (Lesbian, gay, bisexual, and transgender) individuals [ 48 , 49 , 50 , 51 ], displaced populations, immigrants and racial, ethnic and religious minority groups [ 12 , 19 , 36 , 42 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] and persons with severe and chronic health problems [ 79 ] were considered as a “community” by a number of included studies.

While defining community, a number of its characteristics were determined by included studies including: history, existing groups, physical aspects (i.e. geographic location, community size, its topography and etc.), infrastructure (i.e. health and social care facilities, public transportation, roads, bridges, electricity, mobile telephone services and etc.), demographics (i.e. age, gender, race and ethnicity, marital status, education, number of people in household, first language and etc.), economic conditions, deprivation and/or inequalities, government/politics, community leaders (formal and informal), community culture (formal and informal), existing institutions, crime and community safety, lifestyle and leisure, general health problems and epidemiology.

In our review, community health needs and assets assessment were performed by different organizations as the first step in community health promotion planning, including local health authorities (district/local), community entities [i.e. non-governmental organizations (NGOs), civil society organizations (CSOs), faith-based organizations (FBOs), community-based organizations (CBOs)] and hospitals (public/private). Included studies mostly conducted health needs assessment at the local level (e.g. cities, counties, or other municipalities). The broader understanding of health and its determinants suggests that many public and private entities have a stake in or can affect the community’s health. To engage stakeholders in the process, a number of included empirical studies ( n = 56, 49%) sought representatives from the community that were best positioned to speak about community health based on their specific knowledge or line of work. These stakeholders were individuals from community and entities who may explicitly be concerned with health or not, which varied by the community context and culture. To have a comprehensive overview of a community needs, it was asserted that defining communities needs to be dynamic and socially constructed to take into account all voices and members, especially those not ordinarily included [ 80 ]. Community should be defined in a manner that does not exclude medically underserved, low-income, or minority populations. Integrating community voices is especially important in designing plans and programmes aimed at reducing health disparities in the community [ 58 , 81 , 82 ].

Definition of assets

Overall, there were limited definitions for “community assets” in the reviewed literature. Assets were described as resources, places, businesses, organizations, and people that can be mobilized to improve the community [ 11 , 83 ]. This includes members of the community themselves and their capabilities. Assets can therefore be described as the collective resources which individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status [ 83 , 84 ].

Of 115 included empirical studies, 30 studies addressed community assets while performing community health needs assessment. A wide range of assets, from tangible resources to intangible ones, were considered that can be classified into seven broad categories as follows:

Community demographic characteristics: Literacy rates [ 13 ], youth population [ 58 , 68 ], and elderly population [ 68 ];

Natural capitals: Geographical location and natural resources [ 21 , 81 , 85 ];

Economic and financial capitals: Community business [ 12 , 81 ] community members’ income [ 21 ], and housing land ownership [ 13 ];

Community infrastructure: Level of technology/mobile phone coverage [ 13 , 21 ], transportation [ 86 ], parks and sidewalks [ 12 ], sport and recreational facilities [ 31 , 87 , 88 ], public libraries and community centres [ 88 ];

Community social and educational facilities: Non-profit and non-governmental organizations [ 59 , 87 ], media [ 89 ], educational institutions [ 12 , 31 , 81 , 90 ], faith communities [ 58 , 81 , 90 ], and community associations [ 31 ];

Community health and social facilities: Health and social facilities and providers [ 72 , 81 , 85 , 86 , 89 ], traditional medicine providers [ 72 ], and ongoing health programmes [ 13 , 87 ];

Community’s social and cultural values and resources: Tribal and community culture [ 58 , 68 , 74 , 91 ], cultural diversity [ 81 ], spirituality and religion [ 58 , 74 ], strong family bonds and values [ 59 , 74 ], strong community connections, teamwork and willingness to volunteer [ 21 , 81 , 86 , 91 ], mutual support, social support and networks [ 45 , 58 , 81 , 85 ], unity, community cohesion and collectivity [ 21 , 59 , 74 ], community capacity [ 58 ], community-led activities [ 86 , 91 ], and community values and traditions [ 68 , 74 , 86 ], resiliency [ 58 ], unifying power of communities [ 13 ], community administration units e.g. women’s committees [ 13 ], an existing group of dedicated healthcare providers [ 39 ], a group of concerned citizens [ 39 ], community safety [ 12 ], the knowledge base of the community members themselves [ 39 ] and members’ desire to be healthy [ 58 ].

Various qualitative methods such as individual interviews (one-on-one structured conversations) or focus groups (guided, structured, small group discussions) with community members, or key informants’ interviews (formal and informal conversations with leaders and stakeholder groups) or a combination of these methods were reported as the main methods to collect information on community’s assets among reviewed studies. Of these, focus group was the widely used method in community assets assessment [ 8 , 21 , 31 , 45 , 58 , 59 , 67 , 81 , 82 , 85 , 87 , 90 , 92 , 93 ].

Definition of community health needs (and assets) assessment

The terms “Community Needs Assessment (CNA)”, “Community Health Needs Assessment (CHNA)”, and “Community Health Needs and Assets Assessment (CHNAA)” were used interchangeably in the literature referring to the process of identifying health needs (and assets) of a given community. Since this review focuses on both community needs and assets, we will use the CHNAA term for the description of the process in this paper.

None of the papers reviewed provided a specific definition for CHNAA. In general, reviewed papers defined CHNAA as: A collaborative, community-engaged, systematic, ongoing, continuous, proactive, comprehensive, cyclical, regular, modifying method or process [ 28 , 33 , 69 , 92 , 94 , 95 , 96 , 97 , 98 ]; For the identification, collection, assembly, analysis, distribution, and dissemination of information on key health needs, social needs, concerns, problems, gaps, issues, factors, capabilities, strengths, assets, resources; About communities (or individuals) [ 21 , 23 , 28 , 31 , 33 , 37 , 41 , 45 , 54 , 79 , 89 , 94 , 95 , 96 , 97 , 99 , 100 , 101 , 102 ]; To achieve agreed priorities, create a shared vision, plan actions, garner resources, engage stakeholders, work collaboratively, establish relationships, implement culturally appropriate, multi-sectoral/multilevel intervention strategies, empower residents and enhance community capacity and participation in decision-making process [ 12 , 13 , 20 , 27 , 28 , 37 , 45 , 70 , 79 , 89 , 91 , 92 , 94 , 95 , 97 , 98 , 99 , 101 , 102 , 103 , 104 ]; Towards improving health and wellbeing, building and transforming health of the communities, increasing community benefits, reducing inequalities; Through which primary/secondary healthcare can respond to local and national priorities [ 20 , 23 , 28 , 40 , 51 , 59 , 69 , 97 , 103 , 105 , 106 ].

The included studies listed a number of reasons as the rationale for conducting CHNAA. Legislative requirements were most cited as the main rational for conducting CHNAA, particularly among studies conducted in the UK and US. Since the late 1980s, the concept of health needs assessment has gained increasing prominence within the National Health Service (NHS) in the UK. This has been prompted by a series of policy initiatives requiring health facilities to assess needs of their populations and to use these assessments to set priorities to improve the health of their local population [ 107 , 108 ]. In the US, several national, federal, state, and local funding sources require entities to conduct CHNAA to demonstrate a significant need for their services and programmes to be funded. The most important one is Patient Protection and Affordable Care Act (ACA-2010), requiring non-profit hospitals as tax-exempt entities to perform CHNAAs to maintain non-profit status regularly [ 92 ]. Other reasons were mentioned by included studies as the rationales for conducting CHNAA were: lack of information of health needs of a specific community, to facilitate health research and related interventions in a community, to inform the design of contextually relevant programmes and policies, to develop community health improvement plans or health promotion interventions, to develop or update strategic plans, and to receive resources and funds.

Key steps to conduct CHNAA

The number and nature of CHNAA process steps varied among reviewed studies. However, broadly CHNAAs involved six main steps as follow:

Formulation of a leadership team

Forming a leadership team, which was called by different names such as the steering committee/ the research advisory committee (RAC)/ the collaborative task force/ or the community advisory board (CAB), was known as the preliminary step of a CHNAA process. The steering committee was usually composed of local representatives from local agencies and organizations (e.g. non-profit organizations, community service agencies, media outlets, county and municipal governments, colleges and universities, faith-based organizations, and healthcare providers), community members, community stakeholders and leaders, academic partners, health and social officials, and representatives from the investigator body to help guide the development of the CHNAA project.

Leadership team responsibilities were reported as providing inputs on the research purpose, selecting and verifying study methodology and design, providing inputs and feedback on initial survey/topic content and selecting final survey/ topic guide questions, reviewing survey/topic guide length, and ensuring culturally relevant and resonant wording, comprehension and face validity, and monitoring the progress of the data collection. Feedback and recommendations from the steering committee were incorporated throughout the CHNAA process as well. Steering committees usually met on a regular basis.

Identification of needs, assets and prioritisation

To collect information on community health, needs and assets, both primary and secondary data were utilized by included studies. Secondary data included information on community socio-demographic and indicators on health status, access, utilization and satisfaction with health and social services at different levels (e.g. community, sub-national and national) to develop a picture of the overall community health. Primary data were collected through quantitative and qualitative methods and mixed-methods approaches.

Quantitative studies

Some empirical studies used individual/household surveys as the only source to identify community needs and concerns ( n = 28, 24.%). Surveys were a popular method of gathering opinions, preferences and perceptions of needs. Needs assessment surveys typically have written, closed-ended questions filled through the interview (face to face/telephone) or self-completion (paper or online) by community members. Generally, two main kinds of surveys were used by included studies: a) community health assessment survey, and b) community concerns survey. A number of included studies used health assessment surveys as the key data sources of the CHNAA process ( n = 22, 19%) or along with other types of data, mainly qualitative data ( n = 21, 18.%). Health assessment surveys typically collected information on demographics, socio-economic variables, respondents’ health status, choice of healthcare providers, and healthcare access issues among community members. Survey questionnaires were mostly developed with inputs from the literature review (similar health assessment surveys conducted at the local or national level), community members and project team discussions. Additional file 5 shows the most important data and indicators collected by included studies through conducting community health assessment surveys.

Another form of surveys, used alone or in combination with qualitative methods ( n = 15, 13.5%), was the community concerns survey in which people (community members and/or key informants) are asked to help identify what they see as the most important issues facing their community leading to an inventory of their health priorities [ 12 , 20 , 23 , 27 , 29 , 55 , 69 , 74 , 101 , 103 , 109 , 110 , 111 , 112 , 113 ]. A straightforward way to estimate the needs of a community was to simply ask residents their opinion on what particular services are most needed in the community. The focus of this methodology was to create an agenda based on the perceived needs and concerns of community residents. The concerns surveys were based on either focus group discussion with community members and experts or literature review by the researchers or both. Generally, while filling community concerns survey, individuals were asked to rate the importance of each issue in their community on a scale (e.g. 0 = not important, 5 = extremely important) [ 23 , 27 , 29 , 55 , 74 , 110 ]. Participants could also add and rate concerns or service needs that were not listed. Finally, each health problem identified by the community was weighted based on the frequency it was selected on the survey.

General coverage of the surveys was the population aged 18 or over currently residing in the community for a minimum period of time (at least a few months) and able to provide consent for participation. Most surveys were written, closed-ended questions filled through face to face or telephone interviews or self-completion by community members. In addition to the paper-form survey, some studies used email and social media platforms to allow residents to anonymously complete online surveys [ 29 , 51 , 57 , 96 , 103 , 110 , 114 ]. A few studies reported that residents received monetary or nonmonetary incentives for their participation upon survey completion [ 19 , 71 , 74 , 77 , 110 ]. Sampling techniques commonly used are those that promote participation in CHNAAs such as convenience sampling [ 20 , 35 , 40 , 51 , 52 , 57 , 64 , 65 , 71 , 74 , 75 , 77 , 86 , 96 , 101 , 103 , 104 , 110 , 114 , 115 ]. Only a few studies used random sampling or demonstrated the representativeness of their samples. Their response rates varied between 8 to 95.5%. Most surveys recruited local surveyors and provided them with research training to ensure consistent survey administration to attract community participation. Some studies that assessed health needs among immigrant communities or minority groups recruited bilingual surveyors or/and provided participants with two versions of the instruments, one in the native language to maximize community engagement [ 12 , 27 , 52 , 65 , 71 , 86 , 103 ]. Surveys that took a participatory approach to the design, content, terminology, and language level, were reported more understandable and culturally relevant to the community members [ 52 , 65 , 75 ].

Health needs assessment surveys (both concerns surveys and health assessment surveys) reported limitations to data collection based on the assessment timing, data availability, and sample response. As said earlier, using a convenience sampling and non-representative samples, small sample size and inter-rater reliability between surveyors were among some important methodological limitations reported by these studies, which limited the generalisability of the study findings to the entire community population [ 35 , 57 , 65 , 71 , 74 , 75 , 77 , 96 , 106 , 116 ]. Convenience sampling method and using community events as sampling sites led to sampling bias in some studies (e.g., an over-representation of some specific groups of the population such as women and low –income or high-income groups) [ 57 , 63 , 65 , 66 , 71 , 74 , 75 , 78 , 103 , 114 , 115 ].

Qualitative studies

Among included studies, about 34% ( n = 39) used qualitative methods as the main source of data collection on community needs and assets. Some of these studies justified the use of qualitative approach by explaining how the overreliance on quantitative, population-level data resulted in CHNAAs failing to identify health needs and interests of all community members, particularly those of vulnerable population and underrepresented marginalized segments of the community. In addition, these studies concluded that integrating qualitative methods into the CHNAA process has the potential to involve community members in a more participatory fashion, perhaps improving future collaborations between communities and service providers. Such collaborations can help to design focused initiatives, making them more meaningful and culturally appropriate [ 12 , 59 , 91 , 102 ].

Key informant interviews, individual interviews with community members, focus groups with community members and community forums were among the qualitative data collection techniques used individually or in combination with each other by these studies to collect data on community needs and assets. They asserted that qualitative techniques specifically targeted to underrepresented segments of the population proved to be effective mechanisms to explore the participants’ perceptions on issues surrounding community health needs and assets. The most used technique to elicit community members’ opinions were focus group discussions and key informant interviews.

Small sample size and single-site setting were mentioned as the most cited limitations of the qualitative CHNAAs that limit these studies generalisability. Because the studied communities were unique communities with unique assets, constraints, and health needs, the CHNAA findings cannot be generalised to other communities [ 32 , 39 , 62 , 70 , 72 , 73 , 91 , 117 , 118 ]. Another limitation mentioned by some studies was that the demographic composition of the focus group participants, specifically with regards to race, gender, socio-economic status and age group, did not fully reflect the population of studied community as a whole [ 13 , 61 , 62 , 72 , 97 , 119 ]. Some studies reported that they could not include all influencing key informants in the community to facilitate broader understandings of health needs [ 13 , 120 ].

Mixed- methods studies

A variety of data collection methods were used in a number of included studies to ensure that a comprehensive picture of community health needs and resources was obtained ( n = 48, 42%). Some of these studies were two-phase explanatory mixed-methods studies, with the quantitative phase preceding the qualitative phase ( n = 14, 12%). They conducted targeted focus groups or community listening sessions or interview with community members/key informants following needs assessment survey to supplement the findings from the survey and provide further information about health status, needs of daily living, barrier to health and access to community resources [ 8 , 21 , 41 , 53 , 55 , 66 , 67 , 93 , 94 , 95 , 99 , 113 , 114 , 121 ]. In addition to these studies, some studies used triangulation mixed-method design to obtain complementary qualitative and quantitative data on community health needs and issues ( n = 13, 11%). These studies confirmed that using multiple data sources ensured researchers obtain a complete picture of the community health needs. Applying qualitative methods in the form of focus groups and semi-structured interviews enabled exploration of problems and needs within their social context and provided a wider perspective on issues raised. However, to conduct such studies CHNAA teams had to have members who have qualitative and quantitative expertise. There were some limitations specific to the mixed-method studies, including lack of rigor in integrating qualitative and quantitative findings, relying heavily on quantitative data for health need determination, and absence of the voices of the communities most in need [ 69 , 91 ].

Data analysis and interpretation

Qualitative data from focus group discussions and key informant interviews were mainly audio-recorded and transcribed verbatim by the research team and all identifying information was removed. Different analytical approaches, mostly content analysis and thematic analysis, were used to identify main themes related to assets, needs and gaps in the service system and priority populations.

Quantitative data from surveys were analysed using statistical software. Descriptive statistics were used to describe the sample in terms of socioeconomic background and present the prevalence of chronic diseases, risk factors, and health behaviours. Statistical analytical tests were also used to compare results between different groups of community members. Results also were compared by those at the state/ national level or from a similar community. Those diseases or risk factors that had a high prevalence among community members are regarded as priorities that to be addressed further.

Formulation of recommendations across various levels (individual, institution, community, policy levels)

Following analysis of the quantitative and qualitative data, the studies included in the review provided a thorough list of health needs and assets of the community. Included studies mainly used CHNAA outputs: 1) as a resource to provide baseline data of community’s health; 2) as a resource to prioritize and plan services; 3) as a resource for writing grant applications; 4) as a resource to guide a comprehensive health promotion strategy.

Not all included CHNAAs proposed interventions to address identified needs and issues. Some of the included studies ( n = 45, 39%) just provided a snapshot of the most important issues faced by the studied community. They demonstrated several areas where CHNAAs provide more information to researchers, community organizations, and policy-makers. On the other hand, not all identified issues and needs were addressed by those studies performed CHNAA in order to implement interventions or strategies. In practice, specific populations or a number of specific health conditions or health risks, or overarching issues such as health inequality and disparities were prioritized by these studies.

In most cases, decisions on implementation were carried out by the CHNAA steering committees or the research teams. Only a number of studies used a clear and explicit set of criteria for deciding the importance of each issue [ 22 , 27 , 43 , 67 , 94 , 118 , 122 ]. A wide range of criteria were used by included studies such as: impact, urgency, community concern, achievability within the set time [ 94 ], seriousness, urgency, solvability, and financial burden of the problems [ 27 ], perception of survey participants on importance of the identified issues and feasibility of intervention, prevalence, fatality, social and cultural stigma [ 22 ], possible interventions, organizational capacity, and community assets and resources [ 13 ], importance and possibility of the effecting change [ 43 ], prevalence, impact on the duration of sickness, impact on mortality, and the availability of treatment [ 122 ], impact of the problem on the overall wellness, quality of life, and resources of their community [ 118 ], factors of health issue, size, seriousness, and effectiveness of available interventions [ 101 ], importance and feasibility [ 67 ].

Different techniques for ranking priorities were applied by included studies such as: 1) Multi-voting technique (decide on priorities by agreeing or disagreeing in group discussions and continuing process/rounds until a final list is developed), 2) Strategy lists (determine if the health needs are of “high or low importance” by placing emphasis on problems whose solutions have maximum impact, with the possibility of limited resource), 3) Nominal group technique (rate health problems from 1 to 10 through group discussion), and 4) Prioritization matrix (weigh and rank multiple criteria for prioritization with numeric values to determine health needs with high importance).

Overall, health priority types were categorized into four main categories by included studies:

Medical conditions (e.g. obesity, diabetes, heart diseases, asthma, mental health disorders, substance abuse, vision/ dental problems, HIV/AIDS and sexually transmitted diseases, injuries and health consultations).

Health behaviours (e.g. physical activity, eating habits/ nutrition, tobacco consumption, teen pregnancy and violence/gangs).

Community conditions (e.g. poverty and unemployment, environmental and infrastructural conditions, such as air quality/pollution, transportation, access to clean water and sanitation, community collaboration, and access to healthy food, exercise facilities and occupational concerns).

Health systems priorities (e.g. access to care, including primary care and higher levels of care, specialty care, mental/ behavioural health care and dental care, quality and acceptability of health services, lack of cultural competence in health systems, flexible hours and waiting time).

However, guided by a community-based participatory research (CBPR) approach, a number of studies involved community members and stakeholders in priority identification or ranking [ 12 , 21 , 22 , 23 , 27 , 29 , 31 , 36 , 41 , 43 , 49 , 53 , 55 , 56 , 58 , 59 , 60 , 62 , 63 , 68 , 70 , 74 , 86 , 87 , 88 , 90 , 92 , 99 , 100 , 103 , 104 , 110 , 114 , 117 , 118 , 119 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ], in potential strategy selection [ 13 , 19 , 67 , 82 , 89 , 130 ], and in carrying out strategies [ 8 , 37 , 69 , 81 , 93 , 105 , 113 ]. They asserted that by involving the perspectives of the relevant stakeholders, a comprehensive overview of the issues and possible effective solutions was created.

Planning of programmes and interventions, implementation and evaluation

The results of CHNAA were used in various ways by included studies. In some studies, particularly researcher-led studies with limited support or involvement of the local authorities, CHNAA just led to the identification of new, locally relevant issues and priorities without any further actions ( n = 45, 39%). The results of these CHNAAs provided more information to researchers, community organizations, and local policy-makers. Their results also may guide further research agenda in the community [ 18 , 21 , 23 , 29 , 35 , 39 , 40 , 42 , 44 , 48 , 49 , 50 , 52 , 54 , 55 , 62 , 64 , 65 , 66 , 69 , 70 , 71 , 72 , 73 , 76 , 77 , 78 , 85 , 96 , 106 , 122 , 123 , 131 , 132 , 133 , 134 , 135 ]. Some of these studies tried to present their results to the local authorities through various channels in the hope that it would modify existing programmes or implement new ones to meet the needs of the community residents. In addition to identification of relevant issues and priorities, included studies listed at least one outcome associated with the reported CHNAA activity as follows:

Development or modification of health and social policy and programmes: The knowledge provided by CHNAAs helped develop better tailored, and thereby potentially more effective interventions by a number of studies. Further, the information gathered from the CHNAA process was used as the baseline against which to measure future targets for assessment efforts and progress in areas were targeted ( n = 36).

Formation of new partnership: In some cases, a new partnership among entities involved in CHNAA was formed to address health issues. One of the partnerships reported successful was the community–academic partnership in which communities used the research capacity of academic institutions to conduct the CHNAAs ( n = 20). Another type of the partnership reported by some studies was the collaboration among healthcare organizations serving the same geographic area to conduct CHNAA jointly. Conducting a joint CHNAA may avoid duplication of planning efforts and obviate the creation of multiple community health needs assessments for the same population ( n = 5).

Development of new recommendations: Several suggestions were proposed to be considered while designing health improvement interventions in the future by some of the included studies ( n = 18).

Setting or altering strategic direction: Strategic agency direction was established or altered in some cases, which might indicate that the CHNAA was used to redirect resources better to meet the needs of the community ( n = 4).

Raising awareness about health issues: One of the most important insights brought by CHNAA findings was the recognition of the health priorities and contributing factors by the community members, leaders and researchers, leading to an increased awareness of community issues among them ( n = 8).

Engaging and motivating policy-makers and stakeholders: A few studies reported that CHNAAs provided health organizations with the opportunity to identify and interact with key policy-makers, community leaders, and key stakeholders about health priorities and concerns, which might foster a sense of collective ownership and trust in the results and increase the likelihood that the CHNAA will be used ( n = 5).

Having an impact on obtaining resources and resource allocation: The CHNAAs provided the community partners with locally relevant information regarding the current status of health and perceived community needs to inform resource allocation and applications for new grants for the initiation of new programmes ( n = 14)

Contribution to the development of CHNAA process: Some studies reported that the specific methods used in their CHNAA processes could contribute to more relevant and effective community health need assessment process ( n = 10).

Dissemination of findings

Disseminating of the findings and knowledge gained to all partners involved was a foremost step of CHNAAs. The most cited product of the CHNAA process in the included studies was the community needs assessment report. This report includes information about the health of the community as well as the community’s capacity to improve the lives of residents. The report provides the basis for discussion and future actions. In addition to the final report, other channels to disseminate CHNAAs findings were reported as: publishing CHNAA main results in local newspapers, communicating research results with community members and stakeholders in public forums or meetings, presentation results to the steering committee and various stakeholders, posting the report on the local authorities websites, individual meetings with community leaders and stakeholders, posters, and presentation of findings in academic conferences.

Community participation

Among included studies, around 50 studies (44%) reported using participatory approaches and techniques to encourage community members' participation in CHNAA process. Unlike traditional approaches to health needs assessment, participatory approaches aimed to incorporate community inputs at all stages of the research process to enhance capacity building and overcome barriers to research raised by matters of trust, communication, cultural differences, power and representation. A variety of participatory approaches (e.g. community based participatory research (CBPR), participatory rural appraisal, participatory action research (PAR), rapid participatory appraisal (RPA), tribal participatory research, community-based collaborative action research (CBCAR), precede-proceed model, concept mapping and photovoice) were used by these studies to ensure that communities participate in CHNAA, from defining the community to identifying needs and assets and developing new interventions.

Pennel and colleagues classified the depth of the community participation in CHNAA activities into four main categories [ 136 ]. In this classification, depth of the community participation was assessed by the types of activities in which participants were involved throughout the assessment and planning process as follows:

No participation: No attempt to engage community stakeholders or members;

Consultation-only: Engagement of health-related stakeholders, broader community stakeholders, and/or community members to identify health needs through surveys, interviews, and/or focus groups; verified or validated health needs/priorities with local experts;

Moderate participation: Involvement of community stakeholders/ or community members in priority identification; involvement of community stakeholders in strategy selection;

Extensive participation: Involvement of community stakeholders/or community members to develop and carry out strategies.

The above classification was used to assess the depth of the community participation by included studies. Based on the content analysis, community participation in CHNAA process varied considerably across the included empirical studies, from minimal to in-depth participation (Table 1 ). Around 65% of the included studies were involved in consultation-only to identify health needs through one-way communication using tools such as surveys, interviews, and focus group to identify community needs and resources. Around 22% of the included studies solicited moderate participation from the community by involving community in verifying needs and final priority selection and only about 10% of the included studies reported a broad and deep community participation including community involvement in designing and implementing strategies to improve community health.

Three categories of challenges were cited by the reviewed studies while performing CHNAA projects.

Methodological challenges: These are mainly associated with quantitative and qualitative data collection methods, which were discussed earlier. Other methodological challenges cited were: difficulties in aggregating and making sense of data collected from various sources (triangulation), non-generalisability of site-specific data and limitations of the use of existing epidemiological data alone, which does not provide a comprehensive view of health needs, yet is often the most available source of information. Traditional approaches to data collection were challenging where language and literacy barriers existed [ 12 , 52 , 65 , 71 ]. Another major challenge reported by studies used community-based participatory research approaches was the challenge of involving the community in decisions related to research design and data collection methods while maintaining an appropriate level of methodological validity and reliability [ 56 , 81 , 121 ]. In addition, participation was not without challenges. Including the perspectives of stakeholders and residents can lead to differing accounts of what services are seen as essential, and each party may push their own agenda based on their personal or professional interests. Further, linguistic and cultural barriers may be a major factor among minority groups hindering participation in such endeavors [ 81 , 137 ].

Logistical challenges: The major logistical challenges reported were the need for a considerable amount of time (often inadequate), and resources required to conduct a comprehensive assessment [ 80 , 138 ]. Good quality local data on the needs and utilization of health services are usually difficult to obtain [ 9 ]. Financial costs are considerable and the depth of information obtained will ultimately depend upon the methods employed [ 139 , 140 ]. In addition, health professionals, managers and others involved in health services planning and delivery may not have the requisite skills to conduct CHNAAs. This goes beyond technical skills and places an emphasis on soft skills and flexibility including good listening skills, the ability to establish trusting relationships, empathy, working with diverse groups and reflexivity [ 140 , 141 ]. Moreover, limited health information infrastructure and systems in developing countries settings may have hindered the availability of good quality information to conduct CHNAAs [ 13 , 28 , 30 , 142 ].

Ethical challenges: Concerns were raised about the ethical issues associated with community consultation about felt needs followed by priority setting process that leaves many needs unaddressed and the bulk of expectations dashed. Labelling, stigma and stereo- typing are other problems raised by needs assessment [ 143 ]. Needs assessment results may not be utilised, leaving unmet expectations and may require extensive financial and political support to lead to changes in health service planning and delivery [ 9 ]. Comprehensive health needs assessment is likely to produce different, potentially conflicting needs, exposing hidden conflicts and tensions in communities without any mechanisms to address these issues [ 5 ]. Further, local participation may only allow those who are able to voice their needs to do so, leaving behind the silent or hidden voices [ 81 ]. Involvement of the community in the needs assessment process also impacts upon possible outcomes of the project especially since it is likely that expectations of changes to programmes and service delivery may have arisen from local participation [ 144 ].

Facilitators and enablers

CHNAA projects need to be organized in such a way that they have clear objectives, and are adequately resourced by experienced staff. In addition, factors such as clear objectives, decisive leadership, teamwork, communication, sound study design, adequate resourcing, skilled staff, sufficient time and ownership by stakeholders are among those factors that contribute to the successful implementation of CHNAAs [ 15 , 145 ]. Most studies cited community participation as a major facilitator of the CHNAA process and outcomes. Participation was shown to foster bidirectional learning and communications, where both health authorities and the community learnt about needs and priorities. Different benefits for community engagement were mentioned by reviewed literature including, improved participants’ recruitment, enhanced capacity among stakeholders, productive conflict resolution, increased quality of outputs and outcomes, increased sustainability of project goals beyond funding and timelines and development of linguistically and culturally appropriate measures. In addition, incorporating community voices has the potential to inform the development of sound measures to tackle health disparities in the basis of race, social class and ethnicity [ 12 , 27 , 30 , 91 , 103 , 110 , 126 , 146 ].

The main objective of our scoping review was to provide an overview of why and how community health needs and assets assessments (CHNAAs) have been used globally. Substantial variation was found among the studies reviewed concerning definitions, process, participants, methods, goals, and products, yet there were many common characteristics.

Some CHNAAs focused narrowly on health care in assessing needs, with scant attention to other community issues that can affect health. However, most of the included studies looked beyond health needs and considered social and environmental conditions influencing community health. We argue all CHNAAs should approach community health needs assessment holistically, focusing on both individual physical and mental wellbeing as well as casting a social determinants of health lens on the population health.

The review showed that community health needs assessment is used widely by different users and across different settings in both HICs and LMICs. However, in countries such as the US it has become institutionalized and has accordingly been developed, as service providers, particularly hospitals, are mandated to perform CHNAA to compliance with legislative mandates. However, though federal and state laws impose requirements on hospitals to conduct CHNAAs, the methods for needs assessments are generally left to the discretion of each hospital [ 147 ]. As a result, assessment methods vary widely. US-based CHNAAs either develop their own CHNAA processes or utilize a process developed at the state or national level to guide their efforts. A number of toolkits have been provided by different organizations across US to help healthcare providers to conduct CHNAA projects [ 6 , 148 , 149 ]. This highlights the need for consensus guidance across many countries and settings while maintaining the responsiveness to contextual needs, assets and priorities.

Both qualitative and quantitative approaches were employed to collect data on community health needs and assets. Overall, there has been a growing use of mixed-methods approaches to conduct CHNAA in recent years, owing to the recognition in the literature that using qualitative and quantitative approaches simultaneously can provide complementary insights determining community health needs and assets [ 69 , 91 , 104 ]. Although quantitative approaches yield concrete evidence of community needs and assets, qualitative approaches provide a context for how these issues can be addressed using available resources [ 91 , 102 ]. Using qualitative methods in conjunction with more traditional quantitative approaches is especially appropriate for studying complex public health issues and promotes the alignment of implementation plans with the local needs of community members [ 59 , 69 , 91 ]. The growing use of mixed-methods approaches has practical implications for research training and capacity building within entities performing CHNAAs. Organizations who wish to conduct CHNAAs will need to ensure that the competencies and expertise required for mixed-methods studies are available.

Although only a small number of studies provided definitions of assets, there is a growing interest in the literature in asset-based assessment, which examines and mobilizes community assets, instead of focusing on only the needs of communities [ 11 , 84 ]. Unlike need-based or deficit approaches, asset-based approaches document resources and focus on strengths to enhance and preserve rather than deficits to be remedied. Related to principles of empowerment, it postulates that solutions to community problems already exist within a community’s assets. By recognizing existing capacity, communities can become empowered to take ownership of their health and improve as a population [ 11 , 31 , 125 ]. An asset-based approach was recognized as essential for enhancing trust and community coalitions [ 83 ]. Further, it is more participatory in nature through involving community stakeholders throughout the needs assessment process [ 82 , 83 ]. In particular, it highlights community resilience, resources, and opportunities for positive growth rather than focusing solely on health problems or other concerns [ 14 , 84 , 88 ]. In developing countries, assets identified from within the community are crucial for later use in the implementation of health programmes. The shift from a traditional needs-based perspective to an asset-based perspective to health needs assessment can help to address resource constraints in these countries [ 13 , 30 , 150 ].

There was a growing interest in the use of participatory approaches and in their value in identifying and addressing community health needs over recent years among included studies. About half of the reviewed studies applied CBPR or other community-engaged approaches to perform CHNAA. There are several opportunities to fully engage patients, families, and communities in healthcare delivery redesign to ensure that they are provided in a way that address the community members’ needs and preferences. The CHNAA process is one mechanism for this engagement—and a good precursor to deeper engagement and collaboration [ 91 , 97 , 123 ]. Integrating community voices into CHNAA process may be crucially important for confronting health disparities at the community level, which stemming from socio-historical processes, including racial and ethnic discrimination and economic inequality [ 33 , 74 , 86 , 91 ]. To eliminate health disparities, it is critical first to understand social, cultural, and economic determinants of health. CHNAAs, particularly when they include the voices of community residents, can provide an opportunity to understand local processes contributing to health disparities. This knowledge can then be used to inform health and equity initiatives [ 91 , 110 , 126 ]. The development process and implementation of a CHNAA project is an important example of evidence-based public health practice. It is a way to address health and health care disparities experienced by medically underserved populations [ 86 , 92 , 126 ]. Those studies used a participatory approach reported that by having community participation, concerns and issues of the most marginalized and vulnerable populations were voiced. The inclusion of these voices allowed for a broader and deeper understanding of the concerns of those who are typically marginalized and that may be missed in traditional health needs assessment methodologies [ 33 , 56 , 58 , 74 , 86 , 110 , 137 , 146 ]. Hence, defining communities while performing CHNAA needs to be dynamic and socially constructed to take into account all voices and members especially those not ordinarily included. This deeper understanding is critical to move public health practice and research upstream to address structural and social determinants of health necessary for population-level reductions in health inequities [ 80 , 91 ].

Although there is widespread theoretical recognition of the importance of in-depth community participation in CHNAA, this has not been fully embraced in practice based on our review. Included studies reported community involvement in various stages of CHNAA with varying depth reflecting a continuum from no participation to extensive participation, in which most studies were located at the middle of the participation continuum. The literature review suggests while certain community stakeholders were engaged in the CHNAA process, most studies did not involve a broad range of stakeholders through adopting a full participation approach. One reason for this could be that for most studies conducted in the US, CHNAA was performed to comply with ACA requirements, which requires hospitals to incorporate inputs of the population served as part of the CHNAA process. Since community inputs as well as the process as a whole is not well-defined by these regulations [ 20 ], it seems that the majority of included US-based studies tried to meet legislative requirements by incorporating a minimum level of community and stakeholders’ participation in CHNAA process. In addition, the concept of community engagement in health services planning and implementation has evolved over recent years, from one-way consultative processes to bi-directional collaboration and shared leadership. Although undertaking an in-depth participatory approach through extensive participation of community stakeholders in CHNAAs may pose certain challenges for healthcare providers including requiring additional time and other resources to collaborate with community residents, we argue the benefits to this approach are important to improve health, as reported by some included studies [ 80 , 118 , 151 ].

A notable gap in the existing literature is the lack of long-term or longitudinal–assessment of CHNAA. The review showed that additional research into CHNAA implementation and outcomes is needed. Currently, there are limited data describing the impact of CHNAAs on health outcomes. However, there is ample evidence on different short-term impacts associated with CHNAA implementation, including, the development of health and social interventions, forming the new partnership, raising awareness on health issues, engaging policy-makers, and facilitating obtaining resources. In other words, it is unclear how CHNAA projects are linked directly to health outcomes. Furthermore, the mechanisms between the conduct and use of CHNAA remain largely unknown in the literature [ 152 , 153 ]. Clearly, not all CHNAA projects result in changes to policies or programmes, and conversely, many programme and policy decisions are made in the absence of CHNAA data [ 154 , 155 ]. Still, further research to understand these mechanisms and the long term impact of CHNAA is needed to support evidence of its use and value in addressing individual and population health needs.

This scoping review aimed to provide clarity and supplement the evidence on the key concepts, rationale, methods, tools and outcomes of community health needs and assets assessments (CHNAAs). Importantly, it highlights the need for holistic approaches to needs assessments to focus on physical, mental and social wellbeing, along with considering wider systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize the inclusion of community assets in community health assessments, beginning foremost with community capabilities and knowledge. It is encouraging to see the use of pragmatic approaches including both qualitative and quantitative methods in CHNAA process in the literature. This will help to ensure that a robust and in-depth exploration of needs and assets is available to guide decision making. Although we recognize the challenges with providing consensus on definitions, processes and tools for CHNAA, we argue that more clarity is needed on the key considerations, steps and outcomes for this process across various settings. This study attempts to provide some theoretical insights and empirical information concerning the process, which hopefully will provide useful guidance to community organizations, policy- makers, health service providers and researchers seeking to develop and implement community health needs and assets assessment.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Acknowledgements

We acknowledge contribution of the research assistants helped with data extraction.

This work was funded by department of UHC Life course/Integrated Health Services (IHS), World Health Organization (WHO) headquarter (HQ). ZA received the research grant. The authors HR, AS, and SE from WHO commissioned the study, contributed to the direction of the work, and commented on the drafts.

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AG, HR and SE conceived the study and participated in its design. SK conducted the literature search and prepared the search results for analysis. NN developed the study framework, the data abstraction forms and the manuscript outline. The literature was analysed by ZA, EA and NN under the supervision of HR and AG. ZA drafted the final version of the manuscript and HR, NN, AG and SE reviewed it. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1..

PubMed database search strategy.

Additional file 2.

Content of the extraction forms.

Additional file 3.

List of included empirical papers [ 156 – 159 ].

Additional file 4.

List of included non-empirical papers [ 160 -– 175 ] .

Additional file 5.

Health indicators collected by community health assessment surveys.

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Ravaghi, H., Guisset, AL., Elfeky, S. et al. A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses. BMC Health Serv Res 23 , 44 (2023). https://doi.org/10.1186/s12913-022-08983-3

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Steps in Conducting a Literature Review

What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question. That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment. Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

Explains the background of research on a topic.
Demonstrates why a topic is significant to a subject area.
Discovers relationships between research studies/ideas.
Identifies major themes, concepts, and researchers on a topic.
Identifies critical gaps and points of disagreement.
Discusses further research questions that logically come out of the previous studies.

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1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question. The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

Make sure your research question is not too broad or too narrow. Is it manageable?
Begin writing down terms that are related to your question. These will be useful for searches later.
If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover?

This may depend on your assignment. How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search.

Where to find databases:

use the tabs on this guide
Find other databases in the Nursing Information Resources web page
More on the Medical Library web page
... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
Review the abstracts of research studies carefully. This will save you time.
Use the bibliographies and references of research studies you find to locate others.
Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
Ask your librarian for help at any time.
Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

What was the research question of the study you are reviewing? What were the authors trying to discover?
Was the research funded by a source that could influence the findings?
What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
If there are conflicting studies, why do you think that is?
How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips:

Review the abstracts carefully.
Keep careful notes so that you may track your thought processes during the research process.
Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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How to Write a Literature Review | Guide, Examples, & Templates

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

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

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

There are five key steps to writing a literature review:

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

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

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What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

Quick Run-through
Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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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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Literature reviews

A literature review is a research task that finds, evaluates and discusses information on a particular topic. You need to analyse multiple texts, and discuss key ideas that you find in the reading.

A literature review may also identify gaps for further research. It is not a process of summarising texts separately – that is done in an annotated bibliography .

A good literature review should:

be well researched, planned and structured
discuss a relevant issue, problem or practice that relates to your subject
explain why your chosen topic is important
identify key ideas or themes in the literature
synthesise these findings into thematic paragraphs, using sufficient citations and correct referencing
demonstrate your understanding of the topic and develop your knowledge and evidence-based practice.

Literature reviews differ across disciplines, so use your assessment instructions and marking criteria as your ultimate guide.

7 steps for writing a literature review

1. analyse the task.

Read the assessment instructions and marking rubric carefully. Note how many sources you need to include in your literature review and any guidelines on selecting the literature.

Choose a topic that interests you. A topic that is important to you will help you stay focused.

2. Establish a clear research question

A good research question will help you narrow down your topic so that it is manageable. If your question is too broad, you may be overwhelmed by the reading. If it is too narrow, you won’t find enough literature.

3. Search for relevant literature

Use keywords from your research question to begin searching .

In the research question "What factors impact student learning when on nursing placement?", the keywords are: student, learning, nursing and placement.

4. Read and review the literature, and take notes

When reading the literature, consider the following:

Is the article relevant to your topic? For journal articles, read the abstract. For other sources, scan quickly and discard if you can’t see anything useful.
Who is the author/s and what is their expertise?
Is the source credible and scholarly ? Use any evaluation tools provided by your subject.
What is the main topic and what themes are discussed?

Pay attention to important information, such as the abstract, introduction, headings/subheadings, graphs/tables and conclusion.

Take notes using the Cornell method or a note-taking grid. Keeping notes that help you remember the content and relevance of each source is vital for writing a literature review.

Example note-taking grid for a literature review [Word - 14KB]

5. Identify common themes or areas for further research

It's important to understand the relationships between the sources you've read. Look out for:

themes: what questions, ideas or topics recur across the literature? Where do authors agree or disagree?
areas for further research: what is missing from the literature? Are there any weaknesses?

6. Plan the structure of the literature review

Before you start writing, plan how your literature review will be organised.

Literature reviews are usually organised thematically, meaning they discuss one theme after another. You can also organise your ideas chronologically (from past to present) or by methodology (e.g. comparing findings from qualitative and quantitative research).

7. Write, edit, proofread, submit

It's easy to get lost in the reading and not leave enough time for polishing your writing. Use the Assessment Planner to make a clear study plan that includes time for writing, editing and proofreading.

Structure of a literature review

Introduction.

The introduction should include:

context or background : give a brief summary of the context for your research question and explain why it is important
purpose (thesis statement): state the purpose of the literature review. This is a statement generated from the research question
scope (roadmap): outline the specific themes the literature review will focus on and give the reader a sense of how your writing is organised.

Each body paragraph focuses on a specific theme and draws on several pieces of literature.

Paragraphs should include:

topic sentence: start with the theme of the paragraph
synthesis of evidence: make connections between multiple sources by comparing and contrasting their views. Use summaries, paraphrases and quotes , and don't forget to properly reference your sources
analysis or evaluation: add your own interpretation of the findings and comment on any strengths, weaknesses, gaps or areas for further research in the literature
link: end the paragraph by either linking back to your main topic or to the following paragraph.

Conclusions should include:

restate the purpose of the review
summary of the main findings : remind your reader of the main points. Make sure you paraphrase your ideas, so you don’t use the same wording as elsewhere in the literature review
implications of the findings: suggest how the findings might be important for practice in your field
areas for further research : provide suggestions for future research to address the problem, issue or question.

The conclusion is followed by a Reference list or Bibliography. Consult the Style notes page of the Academic Referencing Tool for examples.

For complete sample literature reviews with further annotations, see the Word and PDF documents below.

Example Literature Review - Allied Health [PDF 245KB]
Example Literature Review - Allied Health [Word 69KB]
Example Literature Review - Education [PDF 283KB]
Example Literature Review - Education [Word 104KB]

Further resources

Using a reading to choose a research topic worksheet
Manchester Academic Phrasebank - Phrases for academic writing and reporting on research
Turn a stack of papers into a literature review: Useful tool for beginners (Journal article)

Pathfinder link

Still have questions? Do you want to talk to an expert? Peer Learning Advisors or Academic Skills and Language Advisors are available.

Cant R., Ryan, C., Hughes, L., Luders, E., & Cooper, S. (2021). What helps, what hinders? Undergraduate nursing students’ perceptions of clinical placements based on a thematic synthesis of literature. SAGE Open Nursing, 7, 1-20. https://doi.org/10.1177/23779608211035845 Adapted and used under CC BY-NC 4.0 license

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Ten Simple Rules for Writing a Literature Review

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

keep track of the search items you use (so that your search can be replicated [10] ),
keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

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The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

discussing in your review the approaches, limitations, and conclusions of past reviews,
trying to find a new angle that has not been covered adequately in the previous reviews, and
incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

be thorough,
use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

the major achievements in the reviewed field,
the main areas of debate, and
the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

Reliability and validity assessment of instrument to measure sustainability practices at shipping ports in India

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Volume 5 , article number 236 , ( 2024 )

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L. Kishore 1 ,
Yogesh P. Pai 2 &
Parthesh Shanbhag 3

Sustainability has emerged as one of the most critical factors influencing the competitiveness of maritime shipping ports. This emergence has led to a surge in research publications on port sustainability-related topics. However, despite the increasing awareness and adoption of sustainability practices, documented literature on empirical studies with survey and interview data is very limited. Moreover, the existence of validated instruments to objectively assess sustainability through sustainability practices for shipping ports in India needs to be traced. This study contributes by validating an instrument to evaluate objectively sustainability practices in shipping ports by adopting a four-stage process, starting with item identification based on an extensive literature review, instrument evaluation by subject matter experts, assessing of the instrument with suitable content validation indices, and finally evaluating the validity and reliability of the hypothesized theoretical model. For content validation, Content Validity Index, Cohens Kappa coefficient, and Lawshe’s Content Validity Ratio were computed with the assessment by a subject matter expert panel comprising six members from the port industry as well as academicians cum researchers in the field of shipping ports. The content-validated instrument was administered to 200 samples comprising officer category port employees. The measurement model was evaluated and validated using the Confirmatory Factor Analysis to assess the extent to which the measured variables represent the theoretical construct of the study and ascertain the factor structure. The empirically validated instrument met the required guidelines of model fit, reliability, and construct validity measures and was found to be a confirmed model for measuring sustainability practices in shipping ports. Structural Equation Modeling methodology was adopted to explain the variance and the path relationship between the higher-order and lower-order constructs of sustainability. The results indicate that the economic dimensions are the major contributors to the overall sustainability of the port as they drive investments in environmental and social dimensions, leading to overall sustainable development. The study’s findings will be helpful for researchers, academicians, policymakers, and industry practitioners working towards sustainability practices that contribute to sustainable growth and development in the shipping industry.

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1 Introduction

Sustainability has increasingly been considered one of society and industry’s most significant focus areas [ 1 ] along with regulatory bodies in recent times, although only partially new [ 2 ]. Sustainable development is generally quoted as the one that “satisfies the needs and wants of the present generation” simultaneously without compromising the future generation’s needs and aspirations” [ 3 ]. Moreover, the challenge is balancing sustainability and economic growth [ 4 ]. This prerequisite has led organizations to look beyond mere economic performance and build social and environmentally friendly business models by integrating sustainability principles and practices [ 5 , 6 , 7 ] targeting competitive advantages [ 8 , 9 ]. Against this backdrop, Lun et al. [ 3 ] highlighted the importance of shipping ports in a country’s sustainable growth and development in the long run as they generate employment along with the export–import trade. It is widely accepted that port-led economic growth and development have been the backbone of many developed and developing countries. For instance, the Indian maritime sector, which is one of the most promising, emerging, developing, dynamic markets in the world, has received a facelift with one of the significant mega-initiatives of the government, “ Sagarmala ”, which is focused on “port-led economic development” [ 10 ]. 95% of India’s overall goods trade volume is through shipping ports, contributing about 14% of the GDP [ 11 ]. The impact of the subdued port performance is reflected in a country’s economic development [ 12 ]. Shipping ports are vital nodes that link other modes of transportation in global trade and are considered strategic assets demanding significant attention in maritime and transportation research and practice [ 4 , 13 , 14 ].

Lee et al. [ 15 ] flagged the concern of less attention given to sustainability in the shipping, port, and maritime industries, unlike the aviation and road transport sectors. Many studies [ 14 , 16 , 17 , 18 , 19 ] have emphasized sustainability as one of the most crucial aspects influencing the competitiveness and long-term sustenance of shipping ports; however, it is not fully incorporated into a strategic decision that demands a long-term view when deciding on port development and management. Further, coastal lines are densely populated, leading to higher levels of economic activity and rapid urbanization; however, they face the consequences that come along as the byproduct of development in the form of environmental, economic, and social concerns [ 14 , 20 ]. Some of the substantial problems in the ports discussed in many studies [ 14 , 18 , 19 , 21 , 22 , 23 , 24 , 25 ] include the depletion of the marine ecosystem and biodiversity due to dredging and reclamation works, water pollution due to ballast operations, oil spillage during ship anchoring and cargo operations, wastewater spillage from ships, air pollution due to various pollutants and particulate matters, dust and smoke pollution by a heavy vehicle, climate change effects, increased energy consumption for operations and the cost of energy, uncertainty in future economic returns of investment in the port, employment and diversity of jobs, employee productivity, displacement of local community along with impact on their livelihood, loss of agricultural land, steep increase in cost of living and land revenue rate due to swift urbanization, industrial and special economic zone development, inclusivity of community in developmental projects, safety and security in the port vicinity, social working environment, trade union interference and many more. These challenges, complemented by the growing importance and focus on the sustainable development of shipping ports, have led to a surge in research publications on sustainability-related topics that concentrate on environmental, economic, and social aspects [ 26 , 27 ].

A literature review gives insight into the focus of extant studies related to port sustainability, which is more on quantifying and measuring various dimensions of sustainability against benchmarks and developing indexes for multiple sizes of sustainability. However, qualitative studies need to be conducted to understand the extent to which sustainability measures are adopted and the interaction between the measures, directing towards empirical data-driven studies [ 27 , 28 ]. Alamoush et al. [ 2 ], in their port sustainability framework development study, found that only 16 percent of the articles published were empirical and were based on questionnaire surveys and personal interview data. At the same time, the majority, 40 percent, was conceptual and theoretical review, and the remaining was equally distributed among simulation and case studies. Empirical data-driven research on sustainability-related topics and port performance will be critical to the growing body of knowledge [ 28 ]. Further, the empirical studies on port sustainability [ 2 , 27 , 29 , 30 , 31 , 32 , 33 ] have adopted various indicators of sustainability and criteria for sustainability evaluation based on available scales from studies not directly related to port, rather context-adjusted for port industry. Moreover, despite the increasing number of empirical studies on sustainability in the port sector, in line with the claim made by Ayre et al. [ 34 ] on the hardly ever reporting of content validation by researchers, the existence of any content validation process adopted in any studies and the validated instrument so developed to measure sustainability and sustainability practices objectively for shipping ports is not traceable in the extant literature, especially for exponentially developing economy like India. The study of Ashrafi et al. [ 17 ], which pointed out their pilot study for validation, only assessed the perception of port sustainability in the US and Canada through an online survey to identify the primary factors and challenges in adopting and implementing sustainability strategies. However, the instrument needed to be more generic in capturing the overall sustainability barriers and influencing factors and needed a specific macro-level assessment of the three dimensions of sustainability.

There are studies [ 35 , 36 , 37 ] that discuss the importance of content validity to determine whether the measurement item used in the tool and the extent to which the tool is satisfactorily representing and addressing the domain of interest along with its relevance when measured. Thus, the need for precise, validated measurement tools for sustainability practices at shipping ports indicates a critical knowledge gap in the existing literature. It should also be noted that most seaport-related studies in the scholarly database concentrated on specific geographical areas in Europe [ 32 , 38 ] but not on the leading and growing economies like India. Another concern is that although sustainability is a widely discussed topic, there still needs to be a single universally acceptable and established definition for sustainability [ 39 , 40 , 41 ]. According to Maletič et al. [ 40 ], even though many have attempted to define and measure sustainability, there is an ongoing debate in the literature [ 42 ] on the existence of multiple ways to measure sustainability practices. Therefore, there is a vital need to have clarity and substantial justification on the dimensions and indicators that define the sustainability construct and standardize the assessment of sustainability to a greater extent, especially for seaports. Further to developing policies and schemes for sustainability, the implementations are essential for guaranteed sustainable development [ 28 , 43 ] and measuring the extent to which the port has focused on various sustainability practices can be a tool to assess the efforts towards sustainable development of the shipping port. Alamoush et al. [ 2 ] also pointed out their primary observation on the lack of study linking the port sustainability actions with the three sustainability dimensions represented by the three sustainability practices.

Considering this existing crucial gap and challenges discussed above, the novel contribution of this study is a validated instrument for assessing the sustainability practices followed at shipping ports covering the dimensions of sustainability. The measuring instrument can act as a guideline for seaport administrators and stakeholders to evaluate sustainability in shipping ports and develop seaport sustainability policy for sustainable maritime growth and sustainable development, specifically for an empirical and objective evaluation of sustainability practices adopted in shipping ports in India. Given this compelling necessity to have a content and construct validated instrument for sustainability assessment and strategy development, specifically in the context of Indian seaports, this study aims to explore, design, and develop an instrument for objectively assessing sustainability practices in shipping ports through a well-established content validation process. To achieve the aim of the study, the objectives are:

To identify the comprehensive list of dimensions of sustainability practice for shipping ports through an extensive literature survey

To validate the content of the measurement tool using globally accepted content validation indices viz Content Validity Index, Kohens Kappa coefficient, and Content Validity Ratio

To ascertain the factor structure of the measurement model using Confirmatory Factor Analysis

To estimate the relationship and contribution of three dimensions of sustainability practices to the higher-order sustainability practices construct

The study is structured into the following three major sections. The following section explores the theoretical foundations of sustainability construct and the related conceptual framework that shapes shipping ports’ sustainability dimensions. The following section covers the research methodology for achieving the study’s objectives. It outlines the steps followed in item identification through literature review, instrument development, and instrument assessment based on globally accepted indices and measurement model structure evaluation for validity and reliability using confirmatory factor analysis leading to Partial Least Square-Structural Equation Modeling (PLS-SEM) methods for relationship estimation and prediction of the relationship among the variables. Finally, the results are critically discussed, with the findings of the study highlighting the implications leading to a conclusion along with future research directions.

2 Theoretical background

Although certain sustainability practices are compelled by regulatory compliance, organizations are fortified to adopt and engage voluntarily and proactively in other sustainability practices to meet the needs of the broader society within which they operate [ 44 ]. Extant studies on sustainability [ 7 , 14 , 16 , 17 , 18 , 45 , 46 ] have discussed the need to integrate sustainability efforts into organizational goals, processes, and initiatives and link them with organizational strategy, without which the efforts are likely to fail. The goal for any firm is to secure a competitive advantage over its competitors, create wealth, capture the highest possible market share, and add value to the stakeholders while maintaining a balance between sustainability and economic growth [ 4 ]. Studies [ 16 , 47 ] have opined sustainability to be one of the most crucial aspects that influence the competitiveness of ports. Moreover, to achieve and sustain competitive advantage, organizations have been increasingly grappling with sustainability practices [ 8 ]. Simpson et al. [ 48 ] define practices as “the customary, habitual, or expected procedure or way of doing something. “The practices focused on sustainability could differ from industry to industry, and the shipping industry could concentrate on various practices, and relevant systems would be in place to support sustainable growth and development. Kang et al. [ 31 ] highlight the best practices that embrace sustainability and suggest many practices related to operations, resource optimization, safety and security, finance, risk, infrastructure upgradation, stakeholder management, environmental management systems, and the Port’s eco-friendly and social work environment.

Discussions in prior studies indicate mixed responses regarding the definition of sustainability. There is no universally acceptable definition [ 39 , 42 , 49 , 50 ], but a more generic definition emphasizes sustainability as the set of business strategies, policies, and associated practices or activities where the requirement of the present is satisfied without impacting the requirements of the future in the best interests of the port and related stakeholders. Different schools of thought have a general opinion that sustainability encompasses the three significant dimensions popularly termed as the triple bottom line (TBL) dimensions of “economic, social, and environmental practices,” which comprehend the broad framework of sustainable development [ 39 , 49 , 50 , 51 ]. Elkington [ 51 , 52 ] introduced the triple-bottom-line approach (TBL) incorporating these interrelated three dimensions—“environmental sustainability, economic sustainability, and social sustainability,” advocating organizations to adopt the TBL approach for long-term success [ 53 , 54 , 55 ], rather than short-term success focusing only on the economic dimension. The TBL aspects are considered the critical dimensions of sustainability [ 56 ]. Environmental dimensions concentrate on policies, initiatives, and practices that promote environmental management. In contrast, economic dimensions focus on policies, initiatives, and practices related to investments, economic benefits, and returns from those investments [ 57 ]. Social sustainability focuses on policies, initiatives, and practices that promote the overall improvement of society at large, including all other stakeholders [ 58 ]. Bansal [ 59 ] asserted that the three pillars, i.e., environmental integrity, economic prosperity, and social equity, should intersect for sustainability. Alamoush et al. [ 2 ] further related these dimensions of TBL to the planet, profit, and people as synonyms for environment, economic, and social sustainability.

In the context of ports-related studies, various environmental, economic, and social dimensions were adopted to assess the sustainability of the ports using different methodologies [ 2 , 27 ]. Oh et al. [ 29 ] adopted the importance-performance analysis technique to evaluate the sustainability of South Korean ports using 27 vital measures of the sustainability of ports adapted from the findings and discussions of previous research and found that those measures are essential from a port sustainability point of view. Their study classified the indicators of port sustainability in the three dimensions of sustainability as opined in the TBL concept. In contrast to this empirical quantitative approach, Vejvar et al. [ 33 ] adopted a case-study-based approach to study the institutional forces that compel organizations to adopt sustainability practices. However, they adopted open-ended questions to probe the sustainability practices adopted in the selected shipping ports. They performed a cross-case analysis to make the study more generalizable and increase the validity of the findings [ 32 ]. A thematic analysis of the sustainability performance of seaports was conducted, followed by semi-structured interviews. Later, a fuzzy analytical hierarchy process was applied to compute the weight for each port sustainability performance indicator. Their study also categorized the indicators into three dimensions of sustainability performance, namely social, environmental, and economic sustainability performance practices. Another multi-dimensional framework of sustainability practices was empirically tested by Maletič et al. [ 40 ], and they defined sustainability exploitation and exploration as two different sustainability practices. According to them, sustainability exploitation practices aim at incremental improvement in organizational processes, and sustainability exploration challenges current practices with innovative concepts in developing competencies and capabilities for sustainability. However, they also acknowledged the suitability of more objective measures, such as the TBL practices for sustainability studies. Sustainability practices aid organizations in developing opportunities while managing the three dimensions of organizational processes—economic, environmental, and social aspects in value creation over the long term [ 51 ]. In that definition given, profitability is the focus of economic sustainability, protection and concern towards the environment is the focus of environmental sustainability [ 60 , 61 ], and social sustainability focuses on sustained relations with all the stakeholders, including suppliers, customers, employees, and the community as well [ 62 ].

Regarding developing an index related to sustainability, Laxe et al. [ 43 ] developed the “Port Sustainability Synthetic Index” covering economic and environmental indicators using a sample of 16 ports in Spain. Molavi et al. [ 25 ] developed a novel framework for the smart port index for achieving sustainability using key performance indicators (KPI) that can assist in strategy development and policy framing. Their study indicated several sub-domains of environmental domains in the smart port index study, along with other domains such as operations, energy, safety, and security. However, their study mentioned environment-related quantitative KPIs and other domains that can be used to evaluate the smart port index. Still, it did not mention economic and social, although the sub-domain can be related to economic and social dimensions. In contrast, Stanković et al. [ 63 ] developed a novel composite index for assessing the sustainability of seaports covering environmental, economic, and social dimensions through its indicators based on the secondary data available in the Eurostat and the Organization for Economic Co-operation and Development database. However, the environmental dimension captured only air pollution particulate matter value as the only indicator. Their study also mentioned the limitations of not covering many indicators, including social inclusion and waste management, due to the unavailability of the database. These limitations of quantitative data available in secondary databases for index inclusion are also challenging. The data collection across ports is not yet standardized, and the diverse type of cargo handled in ports makes the index not universally adaptable. Mori et al. [ 64 ] had the same opinion about avoiding a synthesized composite index due to the chances of offset in evaluation [ 65 ]. Although indices have benefits, standard data availability limitations for computing indexes are another added concern that limits index adoption for benchmarking and assessment, thus making sustainability index adoption with caveats.

Therefore, following the justifications and proven theoretical foundations discussed above, this study is grounded on sustainability theory orchestrated by the TBL view, which incorporates the three interrelated dimensions of sustainability—“environmental sustainability, economic sustainability, and social sustainability” and the relevant sustainability practices focused on shipping ports. Therefore, based on previous studies on sustainability and sustainability practices, this study considers sustainability constructs, namely environmental sustainability practices (EnvSP), economic sustainability (EcoSP), and social sustainability practices (SocSP). The indicators thus identified would be used as the measurement scales to empirically measure through survey instruments and objectively evaluate sustainability practices adopted in shipping ports in India.

3 Methodology

The authors adopted the content validation process prescribed by Barbosa et al. [ 35 ]. The process starts with item identification based on an extensive literature review, instrument assessment by subject matter experts, and instrument evaluation with suitable content validation indices. This was followed by assessing the validity and reliability of the hypothesized model to confirm the theory established in the literature using Confirmatory Factor Analysis (CFA) [ 66 ]. CFA is the most widely adopted statistical technique that helps to determine the underlying structure among a set of latent variables and confirm the reliability of how well the scale measures the proposed concept. Hair et al. [ 67 ] elucidated on CFA as a technique to assess the contribution of each scale of item on the latent variable, which later can be incorporated into the estimation of the relationships in the structural model along with accounting for associated measurement error using the variance-based Partial Least Squares-Structural Equation Modelling (PLS-SEM) framework. Explaining the relationship between the exogenous and endogenous variables and predicting the variation in the relationship is the primary focus of PLS-SEM. The five-stage procedure adopted in the study is shown in the flow chart Fig. 1 below.

Content validation process for the study (Author’s own)

3.1 Stage #1. Item identification and face validation

In the first stage, an extensive review of relevant articles related to port studies was performed to compile a comprehensive list of items related to the three dimensions of sustainability viz environmental, economic, and sustainability practices, with the help of a relevant keyword search in the Scopus database in the context of shipping ports. Multiple iterations with different combinations of keywords were performed to see the diversity of articles that can be traced in the scholarly database and the final set of keywords as [(“sustainability”) OR (“sustainability practices”)] AND [(“shipping ports”) OR (“maritime ports”) OR (“container ports”)] AND (scale OR items OR measurement OR indicators OR SEM) were adopted in article identification and followed by screening of articles for item identification and compilation of the list of items related to sustainability practices. The final set of related articles was critically reviewed to identify the relevant items for sustainability practices at shipping ports. Following the recommendation of Boateng et al. [ 68 ], face validation of the instrument was conducted with review and inputs from two senior academicians and experts with theoretical and practical knowledge of sustainability practices.

3.2 Stage #2. Instrument assessment

A subject matter expert panel selection followed this in the second phase of the content validation process to perform instrument assessment. Typically, experts evaluate the content validity, and for that, the recommended minimum number of experts is three and can go up to a maximum of 10 [ 68 , 69 , 70 ]. Following this study’s prescribed expert number requirement, a panel comprising six experts from academic and Port industry backgrounds assessed and validated items. Barbosa and Cansino [ 35 ] claim no unique formula or approach for selecting an expert panel exists. However, it points out the need for a heterogenous panel to mitigate the risk of biases in the validation. Therefore, the study included subject experts from the port industry and academicians with experience in port-related research studies.

The relevance of the items identified through literature review from various sources and the essentiality of these items are supposed to be assessed and content validated through the instrument assessment by the panel of experts. For content validation and evaluation, the Content Validity Index (CVI), Cohens Kappa coefficient, and Lawshe’s Content Validity Ratio (CVR) were adopted as they are the most widely adopted content validation tools for quantifying the opinions of experts [ 69 , 71 , 72 , 73 , 74 ]. The items were assessed for relevance on a 4-point Likert scale. The 4-point Likert scale for relevance captured the response as “1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, and 4 = very relevant” for every item in the measurement instrument. Further, the items were assessed on a 3-point Likert scale to capture the extent of essentiality. Moreover, the 3-point Likert scale for essentiality captured the response as “1 = not essential; 2 = useful, but not essential; and 3 = essential”. Further, an additional comments column for each item was also provided to add feedback and remarks by the expert against each item.

3.3 Stage #3. Content validation using CVI, Cohen’s Kappa, and CVR index

Following the recommendation of [ 75 ], the validity of the instrument content was assessed using CVI, Cohen’s Kappa coefficient, and CVR indices. CVI is a straightforward computation of the agreement among the panelists and can be computed at both the individual item level and the overall scales [ 71 , 72 , 73 , 76 ]. Accordingly, I-CVI is the validity index for each item of the constructs of the study, whereas S-CVI is for the overall scale, which is calculated as the average of I-CVI. I-CVI can be determined as the ratio of several panelists’ ratings on a scale of 3 and above for each measurement item and the total panelists evaluating the relevance. Along similar lines, S-CVI can be computed using the number of measurement items in the assessment tool with a rating of 3 and above for each measurement item. To complement and increase the strength of assessment of relevance through CVI, Barbosa and Cansino [ 35 ] highlight the benefit of Cohen’s Kappa coefficient for evaluation of content validation with due consideration of the degree of agreement on the measurement item beyond certain chance along with the associated probability of inflated scales of agreement merely due to chance agreement. The formula to compute Cohen’s Kappa coefficient is as follows:

where the total number of experts is denoted as N, and it indicates the total number of subject matter experts indicating “essential,” P c is the probability of chance agreement and computed as:

According to Lawshe (1975), the CVR index can be computed using the formula:

The formulas described above were entered in a spreadsheet for the computation of CVR, Cohen’s Kappa coefficient, and CVI based on the rating given by the experts for the items identified. The scale of relevance and necessity of items marked by each expert was recorded and coded into the spreadsheet to facilitate the computation of indices for every item and the entire scale.

3.4 Stage #4. Reliability and validity using confirmatory factor analysis

3.4.1 sampling and data collection.

The content-validated questionnaire instrument was administered online through Microsoft Forms as well as offline to port employees working at the mid and senior management (Officer Category) level employees of various significant ports located in both the western and eastern coastal belts of India for data collection to test the validity and reliability of the measurement model. The instrument captured the respondents’ demographics and perceptions of how much the Port focuses on the three pillars of sustainability practices adopted in their respective ports. Many authors have opined the choice of sample size determination in business management and social science based on G-power [ 77 , 78 , 79 , 80 ]. As per the calculation, for an effect size at a medium level, implied as 0.15, a 5% significance level, and a power level of eighty percent, the recommended minimum sample size was 166. Further, Hair et al. [ 67 ] have outlined the guideline for the minimum sample size for a model structure with less than or equal to seven constructs as 150. However, to avert any possible statistical loss, the rationalized sample size was determined to be 20 percent over 166, thereby establishing the sample size required for the study to be 200. The respondents had to indicate their level of agreement on each item on a Likert scale of 1 to 5, 1 indicating “Strongly Disagree” and five indicating “Strongly Agree”. The data collection activity was carried out between January and December 2023 until the required sample usable data was received for further analysis.

3.4.2 Reliability and validity of the measurement model

Confirmatory factor analysis (CFA) was performed to check the factor structure confirmation of the sustainability practices dimensions using the sample data collected with IBM AMOS. In contrast to measurement error, reliability is the indicator of the “degree to which the observed variable measures the true value and is error-free [ 66 ]. It is also an “assessment of the degree of consistency between multiple measurements of a variable and the set of variables being measured.” Model fit, reliability, and construct validity indices were assessed based on the recommendations by [ 81 , 82 ]. Construct reliabilities were evaluated using Cronbach’s alpha, Composite reliability, and Average Variance Extracted (AVE) values. Construct validity was assessed using convergent validity and discriminant validity measures.

3.5 Stage #5. Structural equation modeling

SEM methodology facilitates the indirect measurement of unobserved latent variables with the measurement of indicator items for the variables in the model structure [ 82 ]. SEM methodology assesses how the latent variables in the model are related to one another and accounts for any errors in the measurement of the observed variables. Therefore, we adopted the PLS-SEM technique to estimate the relationship between the three dimensions of sustainability and their contribution to the overall sustainability construct through different item indicators for each of the dimensions of sustainability. Further, as per the recommendation of Hair et al. [ 83 ], the variance-based PLS-SEM framework is more suitable for our study because the sample size is comparatively less, and the normal distribution assumption is not significant for our study due to the innate nature of the items measuring the dimensions of sustainability. To specify the model parameters and estimate the relationship between the higher and lower-order constructs, we used SmartPLS [ 84 ], the most popular tool for PLS-SEM.

In the first stage of the analysis, items were identified based on an extensive literature review and face validation, instrument assessment by subject matter experts later, and instrument evaluation with suitable content validation indices. This was followed by assessing the validity and reliability of the hypothesized model to confirm the theory using CFA, leading to path relationship assessment using PLS-SEM methodology.

4.1 Item identification and face validation

The literature review compiled a comprehensive and exhaustive initial list comprising 48 items as indicators of sustainability practices adopted in shipping ports and the source (refer to Appendix 1 ). The initial list of items identified comprised 17 items as indicators of Environmental sustainability practices, 19 as indicators of environmental sustainability practices, and 12 as indicators of social sustainability practices adopted in shipping ports. The initial draft of the measuring instrument was subjected to face validation. The inputs from the two senior academicians and experts who carried out face validation were incorporated, which included necessary corrections such as the elimination of ambiguous terms, the inclusion of other indicators that were not included in the initial list, rephrasing of the sentences in the instrument for a better understanding of the context of the study along with the final formatting of the layout [ 68 ]. After incorporating the corrections of face validation along with their source, the items were compiled in the measurement instrument for content validation in the next stage.

4.2 Instrument assessment and content validation using CVI, Kappa, and CVR index

In the second stage, six selected subject matter experts conducted the content validation of the face-validated instrument. “Content validity is a subjective approach that evaluates the extent to which the content described through scale measures certain factors of study interest. Content validation evaluates whether the items in the questionnaire instrument are clear, readable, and relevant to the study context [ 85 ]. The relevance of the items, as well as the essentiality of these items, are supposed to be assessed and validated through the instrument assessment by the panel of subject matter experts. The assessment tool of the study instruments was administered to the six subject experts who were impaneled. Table 1 summarizes the profile of the experts who participated in validating the questionnaire items.

CVI and Kappa coefficients were calculated to assess the relevance of the items, and CVR was calculated to determine the items’ essentiality for the study context [ 74 ]. The responses of the experts on the item’s relevancy and essentiality were coded to spreadsheets for computation of CVI, Kappa coefficient, and CVR value as per the respective formulas [ 69 , 71 , 72 , 73 , 74 ]. The results after the computation of CVI, Kappa coefficient, and CVR are consolidated in Appendix 2 .

CVI indicates the proportion of experts who agreed on the tool and the measurement of the items for a given construct by considering ratings of 1 and 2 as invalid, whereas 3 and 4 are valid contents and consistent with the study conceptual framework [ 74 ]. Adopting the cut-offs suggested in previous established studies [ 69 , 74 ], items with a CVI of at least 0.84 were accepted in the validation. The validation tool indicated S-CVI as 0.86 and satisfies the minimum requirement of 0.80 per Shrotryia et al. [ 86 ] for an instrument to be considered content valid. Along with that, the Cohens Kappa coefficient was also computed with a cut-off of 0.74 to avoid any errors due to chance agreement by the expert panel [ 71 , 72 , 73 , 75 , 76 ]. According to Lawshe’s benchmark CVR index, for a panel size of 6, the cut-off CVR value prescribed is 0.99. It indicates agreement among the panel judges on the item’s necessity in the study questionnaire. Based on these inclusion criteria of CVI, Kappa, and CVR, the most essential and relevant shortlisted items and the final questionnaire were administered for construct validation. The finalized instrument for measuring the extent of the adoption of sustainability practices in shipping ports is shown in Appendix 3 .

4.3 Construct validity and reliability using confirmatory factor analysis and PLS-SEM

Empirical studies attempt to validate and justify the research framework developed with the help of primary data collected from respondents through a questionnaire instrument. Since the analysis solely depends on the data collected through the instrument and the data collected are not accurate measurements of factors of interest but observations of the respondent’s perceptions, the questionnaire should be subjected to validation and reliability checks [ 85 ]. The validation and reliability checking procedures aim to measure and address the measurement error caused by the difference in the actual scores measures from the measured or observed scores [ 66 ]. Validity exemplifies the extent to which the collected data represents the study’s primary purpose, in other words, “measuring what it proposes to measure. The content-validated measurement instrument was administered to port employees of Officer and above designation across various significant ports in India for data collection. Table 2 shows the demographic profiles of the samples who gave the responses to the questions in the instrument administered.

The goodness-of-fit indices were evaluated for the reflective measurement model considering the recommendation [ 81 , 82 ]. The model fit indexes for the hypothesized model were acceptable considering the benchmark recommended values [ 66 , 87 ]. The results [ \( \chi^{2} /\) df was 1.6, Goodness-of-fit index (GFI), Tucker Lewis Index (TLI) and Comparative Fit Index (CFI) > 0.9, Standardized Root Mean Square Residual (SRMR) = 0.053, and Root Mean Square Error of approximation (RMSEA) = 0.055] indicated acceptable model fit as per the recommendations. The standardized factor loading, construct validity, and reliability values are shown below in Table 3 .

Although Hair et al. [ 67 , p. 152–153] suggest a minimum factor loading benchmark value of 0.7 for statistical significance in general, it is also meant to consider 0.50 or above as practically significant in addition to another guideline recommending statistical significance of greater than 0.40-factor loading for a sample size of 200. Further, as per the recommendation of Chin et al. [ 88 ] and considering the practical significance of the items having more than 0.6 loadings, we believe all items with a factor loading above 0.60 are acceptable in the model structure. Therefore, all 26 items are retained in the measurement instrument. Construct reliabilities were assessed using Cronbach’s alpha and Composite reliability measures between 0.85 and 0.90, respectively. Following the reference guidelines by Hair et al. [ 89 ], the measures indicate good and acceptable internal consistency, thereby establishing the scale’s reliability in measuring the construct.

Construct validity was evaluated using convergent and discriminant validity measures except for the EcoSP construct; the other two constructs, viz. EnvSP and SocSP had AVE above the minimum benchmark of 0.50, whereas EcoSP was very close at 0.49. It can be approximated to 0.5, which is correct at the acceptable benchmark for estimating the convergent validity of the measurement model [ 90 ]. There are recommendations that marginal shortfall in AVE is adequate when Cronbach’s alpha and composite reliability are higher than 0.60 [ 89 , 90 ]. These results indicate the acceptable reliability of the scale for measuring sustainability practices in ports.

Hair et al. [ 89 ] emphasize the two established measures of discriminant validity in a model, viz., the Fornell–Larcker criterion and the Heterotrait-monotrait (HTMT) ratio. In the Fornell–Larcker criterion approach, the inter-construct correlations that measure the shared variance between latent variables are compared with the square root of average variance extracted values of the construct. The square root of AVE of the specific construct under consideration is expected to be greater than the particular construct’s highest inter-construct correlation, which signifies the shared variance with other constructs of the model under study. The square root of the AVE of all the constructs was compared with the correlation measures for every build. It was found to be greater than the respective correlation values of the construct under consideration, thereby ascertaining the discriminant validity of the construct. In the HTMT ratio approach, the estimated correlations measured are also termed unattenuated correlation, and the value of unattenuated correlation close to 1 implies an absence of discriminant validity. The benchmark value for the HTMT ratio is 0.90, and any measures above this threshold imply the absence of discriminant validity of the constructs [ 91 , 92 ]. All the measures of discriminant validity assessment indicated HTMT ratio values to be less than 0.9, thus satisfying the discriminant validity requirement of the measurement scale.

Variance-inflation-factor (VIF) was checked for the possibility of multi-collinearity issues [ 89 , 91 , 93 , 94 ]. Multi-collinearity was ruled out as all the VIF values were less than three. The above results support the reliability and validity of the sustainability constructs as collective indicators of the three dimensions of sustainability viz economic, environmental, and social sustainability, and confirm the relationship. Further, the bootstrapping procedure was run to test the significance of the path. The standardized path coefficient values, T-statistics, and p-values shown in Table 4 explain the variance of the three dimensions of the sustainability practice construct. The p-values (< 0.05) indicate that all the structural model relationships are statistically significant.

5 Discussion and implications of the study

The authors followed the systematic procedure of compiling a comprehensive list of related items for the three sustainability practices constructs through an extensive literature review followed by face validation and content validation to assess the relevance and essentiality of the items in the context of shipping ports in India. Empirical studies attempt to validate and justify the research framework developed with the help of primary data collected from respondents through a questionnaire instrument. Since the analysis solely depends on the data collected through the instrument and the data collected are not accurate measurements of factors of interest but observations of the respondent’s perceptions, the questionnaire should be subjected to validation and reliability checks [ 85 ]. The content-validated instrument was subjected to empirical evaluation with sample data collected and using the CFA technique to ascertain the reliability and validity of the model.

Specifically, the results indicate that the subject matter experts have prioritized essential and relevant items in the contemporary business environment, giving nearly equal weightage and importance to all three dimensions of sustainability practices: environmental, economic, and social. Among the items validated, the expert panel had the minor agreement for relevance and necessity on foreign direct investment and funding items, which postulates the shipping ports in India are primarily funded by the government as the minor and significant ports that comprise most of the ports controlled and administered by state and central government respectively. The same reason can be attributed to the low relevance of job security in the context of Indian shipping ports. Further, the items related to odor and smoke also received low relevance as they indicate the low degree of industrial development in shipping ports in India. Although shown as relevant, cold-ironing power sources for vessels on the berth also received a low degree of agreement for necessity. Even recognizing requirements and supporting the community also received little agreement for necessity. However, the remarks provided by the panelist highlight that these focus areas are essentially part of corporate social responsibility, and there is no necessity to assess this separately.

Content validation evaluates whether the items in the questionnaire instrument are clear, readable, and relevant to the study context [ 85 ]. After face and content-validation of the instrument, the finalized list comprised eight items as indicators of EnvSPs, ten as indicators of EcoSPs, and eight as indicators of SocSPs adopted in shipping ports. Thus, the content-validated items for the questionnaire instrument comprised 26 items for measuring the constructs of the study, which is closer to the number of items. Oh et al. [ 29 ] had adopted in the sustainability of ports study. Their study adopted the importance-performance analysis technique to evaluate the sustainability of South Korean ports using 27 vital measures of the sustainability of ports adapted from the findings and discussions of previous research and found that those measures are essential from a port sustainability point of view. Their study classified the indicators of port sustainability in the three dimensions of sustainability as opined in the TBL concept. Along similar lines, Narasimha et al. [ 32 ] conducted a thematic analysis of the sustainability performance of seaports followed by semi-structured interviews. They later applied a fuzzy analytical hierarchy process to compute the weight for each port sustainability performance indicator. Their study categorized the indicators into three dimensions of sustainability performance, namely social, environmental, and economic sustainability performance practices. Therefore, it can be interpreted from the results that these content-validated items are reflective indicators of the sustainability practice constructs and collectively constitute latent variables for empirical studies, confirming that the measurement model reflects the construct validity.

Very Specifically, this study supports the well-established “Tripple Bottom Line” (TBL) theory of sustainability coined by Elkington [ 52 ] that these validated sustainability practice-related items in the measuring instrument adequately represent the seaport domain, and the instrument can be used for measuring the constructs through empirical studies. Even the Sustainable Development Goals (SDG) of the United Nations Development Programme (UNDP) also talks about integrated sustainable development by balancing the three pillars of sustainability: environmental, economic, and social. Chang and Kuo [ 95 ] advise organizations to look at short- and long-term sustainable practices for short-term earnings and safeguard the environment and social integrity simultaneously. Thus, at the strategic level, the TBL practices are the higher-order constructs of sustainability practices, focusing on the long term [ 96 ]. Therefore, the findings of this study contribute to the extant body of literature knowledge by providing empirical evidence on the practical and statistical relationship between the environmental, economic, and social sustainability-related practices of the sustainability construct in the TBL theory-based framework applied for shipping ports.

Yadav et al. [ 97 ] also emphasized the availability of several environmental management systems (EMS) for achieving environmental sustainability. They also recommended introducing methods promoting green culture, supporting green behavior, and improving employee commitment to achieving environmental sustainability. The social dimension of sustainability primarily focuses on facilitating and providing equitable opportunities and the well-being of the port employees and other stakeholders, including the local community, driven by the policies and practices of the port authority. Alamoush et al. [ 2 ] equated economic sustainability to generating revenue and monetary gains and considered economic sustainability to be one of the primary drivers of the other two dimensions—environmental and social sustainability. Further, the results from the PLS-SEM analysis indicate that the most significant contribution towards the overall sustainability of the port is from the economic sustainability dimension of sustainability. Like the findings of Alamoush et al. [ 2 ], the financial investments in the port are the drivers of environmental and social sustainability. Poulsen et al. [ 98 ] proved with facts and figures that air quality was improved even with an increase in cargo throughput, mainly driven by the financial investments in air quality control systems in many ports across Europe.

The improvement in air quality around the port vicinity contributes to environmental sustainability. In addition, it also contributes to social sustainability as the community and the port surroundings, including the ecosystems and the natural habitat for birds and animals, experience better living conditions around the port vicinity. This affirms the indirect benefits achieved in environmental and social dimensions by implementing economic sustainability-related strategies and policies. Our findings also emphasize the need for an integrative approach to achieving sustainability of ports, and it can be achieved only when all three dimensions intersect and contribute to complement each other for overall sustainable development.

This study contributes with both novel theoretical and practical implications. Firstly, the study provides a comprehensive list of items about the indicators of sustainability practices in shipping ports, which are available in published scholarly articles and from domain experts working in the port industry. Secondly, as the first of its kind in the seaport sector, the study adopted a scientific content validation approach of indices and procedures to assess the relevance and essentiality of items in the context of shipping ports and contemporary sustainability practices focused on shipping ports. Our study validated an instrument for assessing the sustainability practices in shipping ports, which is a significant step in formulating policies and developing strategies focusing on the sustainable development of ports. The validated instrument can be adapted to determine the extent of adoption of sustainability practices and drive the necessary implementation through policy centered around the sustainability of shipping ports. The instrument can be a guideline for practitioners, policymakers, and researchers focusing on the sustainable development of shipping ports through environmental, economic, and social sustainability practices. Ports authorities can embrace the validated instrument to assess their level of adoption and focus on these sustainability practices, which will aid in developing policies and strategies for the sustainable development of ports. Further, the Global Reporting Initiative (GRI) Standards, developed by the Global Sustainability Standards Board (GSSB) primarily for sustainability reporting, can be referred to along with our validated instrument for sustainability evaluation and reporting in compliance with the GRI standards [ 99 ]. GRI Standards assist organizations in understanding and reporting the extent to which the organization impacts sustainability and contributes to sustainable development, considering the interests of all the stakeholders, including investors, policymakers, capital markets, and civil society, thus making the organization transparent and responsible for sustainability. Sector-specific standards have been developed, of which ports are part of Group 3, which comprises various Transport, infrastructure, and tourism-related sectors. However, it is not readily available for shipping ports but can be developed and customized by the port authorities. To do so, the findings of the validated instrument of our study can be considered as a guide in assessing and preparing the sustainability report as per the applicable GRI standards.

Further, sustainability assessment should not be considered a one-time activity in the port. Instead, the port authorities should have strategies and policies to track the trends and changes taking place to the extent of adopting sustainability practices in the port and their impact on sustainable development. Each individual port must do it through its team/department or personnel responsible for the sustainability assessment and policy implementation in the port, and it also must be a continuous activity at regular intervals, maybe once in 3 months or 6 months, depending on the policy and management decision. Thus, the longitudinal assessment, which keeps track of the various aspects of sustainability, will help the port evaluate the effectiveness of sustainability interventions implemented at shipping ports.

6 Limitation and scope for future work

Although the study achieved its objectives of a novel contribution of a content-validated sustainability measurement instrument for assessing sustainability practices in seaports, there were a few limitations, and there is also further scope for advancing the study in the future. The keywords used in the literature search were confined to published articles in the Scopus database. Future work can expand the search in other scholarly databases and increase the items’ relevance to measuring shipping ports’ sustainability practices. The study was limited to government-controlled significant ports on India’s east and west coasts. Due to permission and access-related challenges, the data collection did not cover the privately managed ports. The items of the study are generalized concerning a shipping port, and further research can consider further refinement specific to the type of cargo handled in the Port or confined to the terminal instead of a generalizable study irrespective of the kind of cargo being handled. The applications of digital technology and automation using Artificial Intelligence and Machine Learning, along with big data and blockchain technology, could be explored to assess their impact on sustainable port management and development. A different methodological approach can be adopted like the study of Yadav et al. [ 97 ], where the “multi-criteria-decision making (MCDM)” approach was used to identify the enablers of sustainability along with the determination of its intensity using “Robust-Best–Worst-method” (RBWM). Their analysis identified economic and environmental-related enablers as the high-intensity enablers of sustainability that organizations can focus on. Other stakeholders, such as customers, port users, government agencies linked with the port operations, and the local community, were not part of the panel for the validation process. In future studies, these other stakeholders can also be considered in the panel so that every aspect is covered in the evaluation. The items were based on a 5-point Likert scale in this study to capture only the perception of port employees on the sustainability practices adopted in the port. A suitable triangulation method and case studies can also be used to analyze the qualitative aspects of adopting sustainability practices in the port.

7 Conclusion

The study validated an instrument for assessing the sustainability practices in shipping ports, which is a significant step in formulating strategies focusing on the sustainable development of ports. The instrument can be a guideline for practitioners, policymakers, and researchers focusing on the sustainable development of shipping ports through environmental, economic, and social sustainability practices. The study prepared a comprehensive list comprising relevant items identified through a thorough literature review of articles published in the Scopus database. After face validation, the measurement tool was administered to six subject matter experts who evaluated its relevance and essentiality in measuring sustainability practices in shipping ports. The content validity was assessed using the most widely used and adopted indices: CVI, Cohen’s Kappa’s coefficient, and CVR. CVI and Cohen’s Kappa’s coefficient are the indices for assessing the relevance of the items in measuring sustainability practices, and CVR is the index for determining the essentiality of the items in measuring sustainability practices in shipping ports. Further, this study contributes to the extant body of literature by providing evidence on the empirical relationship between the environmental, economic, and social sustainability-related practices of the sustainability construct in the TBL theory-based framework applied for shipping ports.

Data availability

The data for analysis in the study was based on survey data collected through a questionnaire instrument administered on Likert scales, both online and offline modes of data collection. The data collection period was between December 2022 and Dec 2023. The instrument had a declaration mentioning maintaining the privacy of the participants and therefore, the data cannot be made public to protect study participant privacy. The primary data collected in the study are not publicly accessible but are available from the corresponding author upon reasonable request.

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Acknowledgements

We acknowledge the contribution of the expert panel for their reviews and feedback that enabled us to optimize the items in the instrument.

Open access funding provided by Manipal Academy of Higher Education, Manipal. This study has not received any funding from any institutions or agencies.

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Department of Commerce, Manipal Academy of Higher Education, Manipal, 576104, India

Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India

Yogesh P. Pai

T A Pai Management Institute, Yelahanka, Govindapura, Bengaluru, 560064, Karnataka, India

Parthesh Shanbhag

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Contributions

All the authors contributed to the manuscript equally K.L conceptualized the study and executed data collection All the authors jointly performed data analysis and authored the manuscript All authors reviewed the manuscript before submitting.

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Correspondence to Yogesh P. Pai .

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Appendix 1. Construct-wise list of items and source

	Source
Environmental sustainability practices
Avoiding the use of unpolluted land in the port area	[ , , , , , ]
Developing and maintaining mangroves, gardens, and landscapes
Avoiding environmental destruction during dredging
Considering environmental protection when handling cargo
Using recyclable or environment-friendly materials in port construction
Protecting the ecological environment in the port area
Reduction of noise pollution
Mitigating light influence on neighboring residents
Controlling smoke level
Maintaining air quality
Reduction of greenhouse gas
Reduction of carbon emissions
Preventing odour pollution
Optimal utilization of renewables and alternate energy sources
Facilities for wastewater and sewage treatment
Implementation of dust suppression systems
Economic sustainability practices
Facilitating economic growth and acting as a supply chain link in local and global trade	[ , , , , , ]
Investments in port infrastructure development
Establishing port development funding
Attracting foreign direct investments
Promotion and development of cruise tourism services
Employment generation and career growth opportunities
Ensuring that cargo is handled safely and effectively
Low damage or loss record for cargo delivery
Usage of energy-efficient electrical and electronic appliances like LED lamps
Optimal utilization of infrastructure, land, and space in the port area
Offering one-stop logistics solutions, including freight forwarding and additional services
Optimizing the routing of vehicles in and out of port
Mitigating congestion in the port
Providing incentives for green shipping practices
Landlord activities
Investment in climate change adaptation strategies
Sustainable supply chain policy
Investment in innovation strategy
Transshipment and storage of dangerous goods
Social sustainability practices
Recognizing the requirements of the neighboring community	[ , , , , , ]
Giving support to community social activities
Providing training and education for employees regularly
Providing employees’ welfare benefits and other facilities
Staff job security even during uncertainties of the business
Strengthening safety and security management standards and protocols of the port
Accident prevention in the port area
Social equality and gender diversity in employment
Job satisfaction of employees
Consulting various interest groups such as labor unions and community leaders when making port project decision
Strengthening port infrastructure for social contribution
Engaging in corporate social responsibility practices

Appendix 2. Results of content validity

Item code	Items description	Agree to count for CVI	i-CVI	Pc	K	Agree to count for CVR	CVR
EnvSP1	Avoiding the use of unpolluted land in the port area	4	0.67	0.23	0.56	6	1.00
EnvSP2	Developing and maintaining mangroves, gardens, and landscapes	6	1	0.02	1	6	1.00
EnvSP3	Avoiding environmental destruction during dredging	4	0.67	0.23	0.56	5	0.67
EnvSP4	Considering environmental protection when handling cargo	4	0.67	0.23	0.56	6	1.00
EnvSP5	Using recyclable or environment-friendly materials in port construction	5	0.83	0.09	0.82	5	0.67
EnvSP6	Protecting the ecological environment in the port area	6	1	0.02	1	6	1.00
EnvSP7	Reduction of noise pollution	5	0.83	0.09	0.82	5	0.67
EnvSP8	Mitigating light influence on neighboring residents	4	0.67	0.23	0.56	4	0.33
EnvSP9	Controlling smoke level	3	0.5	0.31	0.27	6	1.00
EnvSP10	Maintaining air quality	6	1	0.02	1	6	1.00
EnvSP11	Reduction of greenhouse gas	6	1	0.02	1	6	1.00
EnvSP12	Reduction of carbon emissions	6	1	0.02	1	6	1.00
EnvSP13	Preventing odour pollution	3	0.5	0.31	0.27	4	0.33
EnvSP14	Optimal utilization of renewables and alternate energy sources	6	1	0.02	1	6	1.00
EnvSP15	Facilities for wastewater and sewage treatment	6	1	0.02	1	6	1.00
EnvSP16	Implementation of dust suppression systems	6	1	0.02	1	6	1.00
EnvSP17	Cold-ironing source of power for vessels on the berth	4	0.67	0.23	0.56	4	0.33
EcoSP1	Facilitating economic growth and acting as a supply chain link in local and global trade	6	1	0.02	1	6	1.00
EcoSP2	Investments in port infrastructure development	6	1	0.02	1	6	1.00
EcoSP3	Establishing port development funding	2	0.33	0.23	0.13	4	0.33
EcoSP4	Attracting foreign direct investments	2	0.33	0.23	0.13	4	0.33
EcoSP5	Promotion and development of cruise tourism services	6	1	0.02	1	6	1.00
EcoSP6	Employment generation and career growth opportunities	6	1	0.02	1	6	1.00
EcoSP7	Ensuring that cargo is handled safely and effectively	3	0.5	0.31	0.27	6	1.00
EcoSP8	Low damage or loss record for cargo delivery	4	0.67	0.23	0.56	6	1.00
EcoSP9	Usage of energy-efficient electrical and electronic appliances	6	1	0.02	1	6	1.00
EcoSP10	Optimal utilization of infrastructure, land, and space in the port area	6	1	0.02	1	6	1.00
EcoSP11	Offering one-stop logistics solutions, including freight forwarding and additional services	6	1	0.02	1	5	0.67
EcoSP12	Optimizing the routing of vehicles in and out of port	6	1	0.02	1	6	1.00
EcoSP13	Mitigating congestion in the port	6	1	0.02	1	6	1.00
EcoSP14	Providing incentives for green shipping practices	6	1	0.02	1	5	0.67
EcoSP15	Landlord activities	6	1	0.02	1	5	0.67
EcoSP16	Investment in climate change adaptation strategies	6	1	0.02	1	6	1.00
EcoSP17	Sustainable supply chain policy	6	1	0.02	1	6	1.00
EcoSP18	Investment in innovation strategy	6	1	0.02	1	5	0.67
EcoSP19	Transshipment and storage of dangerous goods	6	1	0.02	1	4	0.33
SocSP1	Recognizing the requirements of the neighboring community	6	1	0.02	1	4	0.33
SocSP2	Giving support to community social activities	6	1	0.02	1	4	0.33
SocSP3	Providing training and education for employees regularly	6	1	0.02	1	6	1.00
SocSP4	Providing employees’ welfare benefits and other facilities	6	1	0.02	1	6	1.00
SocSP5	Staff job security even during uncertainties of the business	3	0.5	0.31	0.27	5	0.67
SocSP6	Strengthening safety and security management standards and protocols of the port	6	1	0.02	1	6	1.00
SocSP7	Accident prevention in the port area	6	1	0.02	1	6	1.00
SocSP8	Social equality and gender diversity in employment	6	1	0.02	1	6	1.00
SocSP9	Job satisfaction of employees	6	1	0.02	1	6	1.00
SocSP10	Consulting various interest groups such as labor unions and community leaders when making port project decision	6	1	0.02	1	6	1.00
SocSP11	Strengthening port infrastructure for social contribution	6	1	0.02	1	5	0.67
SocSP12	Engaging in corporate social responsibility practices	6	1	0.02	1	6	1.00

i-CVI indicates item CVI, Pc the probability of a chance occurrence, and K—the kappa statistic

Appendix 3. Instrument for data collection

4.1 section a—demographic profile.

4.2 Section B—practices related to port

Please indicate the extent to which you agree on statements related to your port on a scale of 1–5.

1—strongly disagree, 2—disagree, 3—neutral, 4—agree, 5—strongly agree.

If you are unaware of the Port’s practices, you may choose “3-Neutral.”

Environmental sustainability practices adopted in your port focusses on	1	2	3	4	5
Developing and maintaining mangroves, gardens, and landscapes
Protecting the ecological environment in the port area
Maintaining air quality
Reduction of greenhouse gas
Reduction of carbon emissions
Optimal utilization of renewables and alternate energy sources
Facilities for wastewater and sewage treatment
Implementation of dust suppression systems

Economic sustainability practices adopted in your port focusses on	1	2	3	4	5
Facilitating economic growth and acting as a supply chain link in local and global trade
Investments in port infrastructure development
Promotion and development of cruise tourism services
Employment generation and career growth opportunities
Usage of energy-efficient electrical and electronic appliances like LED lamps
Optimal utilization of infrastructure, land, and space in the port area
Optimizing the routing of vehicles in and out of port
Mitigating congestion in the port
Investment in climate change adaptation strategies
Sustainable supply chain policy

Social sustainability practices adopted in your port focusses on	1	2	3	4	5
Providing training and education for employees regularly
Providing employees’ welfare benefits and other facilities
Strengthening port safety management standards and protocols
Accident prevention in the port area
Social equality and gender diversity in employment
Job satisfaction of employees
Consulting various interests groups such as labor unions and community leaders when making port projects decision
Engaging in corporate social responsibility practices

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Kishore, L., Pai, Y.P. & Shanbhag, P. Reliability and validity assessment of instrument to measure sustainability practices at shipping ports in India. Discov Sustain 5 , 236 (2024). https://doi.org/10.1007/s43621-024-00395-z

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Toward a sustainable surimi industry: comprehensive review and future research directions of demersal fish stock assessment techniques.

1. Introduction

What are the knowledge coverage and research gaps concerning key sustainability-related concepts in the utilization of demersal fish in the surimi industry, as well as in the LB-SPR method for assessing biological length-based reproduction as a support method in the surimi industry, and how can these gaps be addressed in future research?
What aspects of implementation can enhance the quality and scope of the LB-SPR method in assessing reproduction based on biological length, and how can these steps contribute to improving sustainability in the surimi industry?

2. Materials and Methods

2.1. study design, 2.2. data collection and materials, 2.3. literature selection and mapping methods, 2.4. analytical method, 2.5. study framework, 3. results and discussion, 3.1. study selection, credibility–validity assessment, and knowledge cluster mapping.

No.	Authors	A	B	C	D	E	F	G	H	I	J
1.	[ ]	H	H	VH	V	V	V	V	V		Whitemouth croaker
2.	[ ]	VH	M	VH	V	V	V	V	V	V	Red hind
3.	[ ]	H	H	VH					V		Striped bass
4.	[ ]	M	H	H	V	V	V	V	V	V	Bottomfish
5.	[ ]	H	M	H	V	V	V	V	V	V	Red snapper
6.	[ ]	H	M	H	V	V	V	V	V		Gag fish
7.	[ ]	M	M	MH	V	V	V	V	V		Snappers and groupers
8.	[ ]	M	M	MH	V	V	V	V	V	V	Pomadasys kaakan
9.	[ ]	M	M	MH		V	V	V	V	V	Short mackerel
10.	[ ]	M	M	MH	V	V	V	V	V		Malabar snapper
11.	[ ]	M	M	MH		V	V	V	V		Yellowfin tuna
12.	[ ]	M	M	MH		V	V	V	V	V
13.	[ ]	L	H	MH	V	V	V	V	V		Cod
14.	[ ]	M	M	MH		V	V	V	V		Indian scad
15.	[ ]	M	M	MH		V	V	V	V		Madidihang
16.	[ ]	M	M	MH	V	V	V	V	V		Red drum and red snapper
17.	[ ]	M	M	MH	V	V	V	V	V	V	Alaska sablefish
18.	[ ]	M	M	MH	V	V	V	V	V	V	Upeneus sp.
19.	[ ]	M	M	MH	V	V	V	V	V		Snappers and emperors
20.	[ ]	M	M	MH	V	V	V	V	V	V	Mulloway
21.	[ ]	M	M	MH		V	V	V		V	White marlin
22.	[ ]	M	M	MH	V	V	V	V	V	V	Grouper and snapper
23.	[ ]	L	H	MH		V	V	V	V	V	Striped bass
24.	[ ]	M	M	MH	V	V	V	V	V	V	Striped marlin
25.	[ ]	M	M	MH	V	V	V	V	V	V	Common snook

3.2. Sustainability-Related Information in Demersal Fish Stock Assessments for the Surimi Industry

3.3. methodology of length-based reproductive assessments (lb-sprs), 3.4. case studies on the application and benefits of the lb-spr, 3.5. multi-aspect implications of lb-spr: fisheries business, communities, and policies, 3.6. contribution to the field, gaps, and recommendations for future research, 4. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Sonu, S.C. Surimi ; NOAA Technical Memorandum NMFS; National Marine Fisheries Service: Sacramento, CA, USA, 1986; p. 135. [ Google Scholar ]

Click here to enlarge figure

No.	Framework	Criteria	Keywords	Database Applications
1	PICO	1.1 Populations	“Demersal fish”	Google Scholar, Scopus, and Publish and Perish (PoP)
		1.2 Intervention	“Spawning potential ratio” OR “SPR”	Google Scholar, Scopus, and Publish and Perish (PoP)
		1.3 Comparison	-
		1.4 Outcome	“Surimi Industry”	Google Scholar, Scopus, and Publish and Perish (PoP)
2	SPIDER	2.1 Sample	“Demersal fish” OR “spawning potential ratio”	Google Scholar, Scopus, and Publish and Perish (PoP)
		2.2 Phenomenon of Interest	“Spawning potential ratio” OR “demersal fish”	Google Scholar, Scopus, and Publish and Perish (PoP)
		2.3 Design	“Spawning potential ratio” OR “SPR” or “demersal fish”	Google Scholar, Scopus, and Publish and Perish (PoP)
		2.4 Evaluation	-	Google Scholar, Scopus, and Publish and Perish (PoP)
		2.5 Research type	“Qualitative” OR “quantitative”, “mixed methods”, “literature review”, OR “bibliometric”	Google Scholar, Scopus, and Publish and Perish (PoP)

No.	Production and Export	2019	2020	2021	2022	2023
1	Difference Weight Value of Demersal Fishing Activities for Surimi Material (in MT *):
	- Gulamah	1,031,852	−867,323	696,694
	- Swanggi	2725	12,533	231
	- Kurisi	8448	−4245	11,649	-	-
	- Lencam	1253	627	18,597	-	-
	- Biji Nangka	8615	2665	4795	-	-
	- Gerot-gerot	101	−3313	2032	-	-
	- Beloso	267	−3506	−302	-	-
	- Kerong-kerong	682	−1779	−800	-	-
	- Ekor Kuning	−2541	14,499	−247	-	-
2	Export Volume (in MT)	35,173	31,467	23,643	17,093	14,098
3	Export Frequency	-	1162	880	603	534
4	Export Value (in USD)	82,676,537	88,206,000	69,517,000	61,984,000	51,515,000

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Nugroho, K.C.; Zulbainarni, N.; Asikin, Z.; Budijanto, S.; Marimin, M. Toward a Sustainable Surimi Industry: Comprehensive Review and Future Research Directions of Demersal Fish Stock Assessment Techniques. Sustainability 2024 , 16 , 7759. https://doi.org/10.3390/su16177759

Nugroho KC, Zulbainarni N, Asikin Z, Budijanto S, Marimin M. Toward a Sustainable Surimi Industry: Comprehensive Review and Future Research Directions of Demersal Fish Stock Assessment Techniques. Sustainability . 2024; 16(17):7759. https://doi.org/10.3390/su16177759

Nugroho, Kuncoro Catur, Nimmi Zulbainarni, Zenal Asikin, Slamet Budijanto, and Marimin Marimin. 2024. "Toward a Sustainable Surimi Industry: Comprehensive Review and Future Research Directions of Demersal Fish Stock Assessment Techniques" Sustainability 16, no. 17: 7759. https://doi.org/10.3390/su16177759

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Needs Assessment Step-by-Step

Keep in mind!

2. Identify the individuals who play a significant role before, during, and after conducting the needs assessment.

3. Gather existing information to decide if a needs assessment is warranted.

4. Identify secondary data (what is known) and pinpoint what you still want to know.

5. Determine the data-collection technique to gather the needed data.

Keep in mind

6. Analyze the data you collected and prioritize needs.

7. Use the data to set program priorities, create an action plan to address the needs, and share the results.

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A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

Search strategy

Inclusion and exclusion criteria

Data extraction

Synthesis of results

General characteristics of the included studies

Definition of needs

Definition of community

Definition of assets

Definition of community health needs (and assets) assessment

Key steps to conduct CHNAA

Formulation of a leadership team

Identification of needs, assets and prioritisation

Quantitative studies

Qualitative studies

Mixed- methods studies

Data analysis and interpretation

Formulation of recommendations across various levels (individual, institution, community, policy levels)

Planning of programmes and interventions, implementation and evaluation

Dissemination of findings

Community participation

Facilitators and enablers

Availability of data and materials

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1. Choose a topic. Define your research question.

2. Decide on the scope of your review

3. Select the databases you will use to conduct your searches.

4. Conduct your searches to find the evidence. Keep track of your searches.

Review the literature