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What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on December 17, 2021 by Tegan George . Revised on June 22, 2023.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

Single-blind review
Double-blind review
Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, other interesting articles, frequently asked questions about peer reviews.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

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Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymized) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymized comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymized) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymized) review —where the identities of the author, reviewers, and editors are all anonymized—does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimizes potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymize everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimize back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

First, the author submits the manuscript to the editor.
Reject the manuscript and send it back to the author, or
Send it onward to the selected peer reviewer(s)
Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarize the argument in your own words

Summarizing the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organized. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

Tip: Try not to focus too much on the minor issues. If the manuscript has a lot of typos, consider making a note that the author should address spelling and grammar issues, rather than going through and fixing each one.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticized, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the “compliment sandwich,” where you “sandwich” your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

Easy to understand
Constructive

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Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

Group 1 was not allowed to use their phone before bedtime.
Group 2 used their phone for 1 hour before bedtime.
Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarized or duplicated research from being published.

Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

Helps you identify any weaknesses in your argument

Peer review acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published. There is also high risk of publication bias , where journals are more likely to publish studies with positive findings than studies with negative findings.

Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

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

Normal distribution
Measures of central tendency
Chi square tests
Confidence interval
Quartiles & Quantiles
Cluster sampling
Stratified sampling
Thematic analysis
Discourse analysis
Cohort study
Ethnography

Research bias

Implicit bias
Cognitive bias
Conformity bias
Hawthorne effect
Availability heuristic
Attrition bias
Social desirability bias

Peer review is a process of evaluating submissions to an academic journal. Utilizing rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication. For this reason, academic journals are often considered among the most credible sources you can use in a research project– provided that the journal itself is trustworthy and well-regarded.

In general, the peer review process follows the following steps:

Reject the manuscript and send it back to author, or
Send it onward to the selected peer reviewer(s)
Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

A credible source should pass the CRAAP test and follow these guidelines:

The information should be up to date and current.
The author and publication should be a trusted authority on the subject you are researching.
The sources the author cited should be easy to find, clear, and unbiased.
For a web source, the URL and layout should signify that it is trustworthy.

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Reumatologia
v.59(1); 2021

Peer review guidance: a primer for researchers

Olena zimba.

1 Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Armen Yuri Gasparyan

2 Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK

The peer review process is essential for quality checks and validation of journal submissions. Although it has some limitations, including manipulations and biased and unfair evaluations, there is no other alternative to the system. Several peer review models are now practised, with public review being the most appropriate in view of the open science movement. Constructive reviewer comments are increasingly recognised as scholarly contributions which should meet certain ethics and reporting standards. The Publons platform, which is now part of the Web of Science Group (Clarivate Analytics), credits validated reviewer accomplishments and serves as an instrument for selecting and promoting the best reviewers. All authors with relevant profiles may act as reviewers. Adherence to research reporting standards and access to bibliographic databases are recommended to help reviewers draft evidence-based and detailed comments.

Introduction

The peer review process is essential for evaluating the quality of scholarly works, suggesting corrections, and learning from other authors’ mistakes. The principles of peer review are largely based on professionalism, eloquence, and collegiate attitude. As such, reviewing journal submissions is a privilege and responsibility for ‘elite’ research fellows who contribute to their professional societies and add value by voluntarily sharing their knowledge and experience.

Since the launch of the first academic periodicals back in 1665, the peer review has been mandatory for validating scientific facts, selecting influential works, and minimizing chances of publishing erroneous research reports [ 1 ]. Over the past centuries, peer review models have evolved from single-handed editorial evaluations to collegial discussions, with numerous strengths and inevitable limitations of each practised model [ 2 , 3 ]. With multiplication of periodicals and editorial management platforms, the reviewer pool has expanded and internationalized. Various sets of rules have been proposed to select skilled reviewers and employ globally acceptable tools and language styles [ 4 , 5 ].

In the era of digitization, the ethical dimension of the peer review has emerged, necessitating involvement of peers with full understanding of research and publication ethics to exclude unethical articles from the pool of evidence-based research and reviews [ 6 ]. In the time of the COVID-19 pandemic, some, if not most, journals face the unavailability of skilled reviewers, resulting in an unprecedented increase of articles without a history of peer review or those with surprisingly short evaluation timelines [ 7 ].

Editorial recommendations and the best reviewers

Guidance on peer review and selection of reviewers is currently available in the recommendations of global editorial associations which can be consulted by journal editors for updating their ethics statements and by research managers for crediting the evaluators. The International Committee on Medical Journal Editors (ICMJE) qualifies peer review as a continuation of the scientific process that should involve experts who are able to timely respond to reviewer invitations, submitting unbiased and constructive comments, and keeping confidentiality [ 8 ].

The reviewer roles and responsibilities are listed in the updated recommendations of the Council of Science Editors (CSE) [ 9 ] where ethical conduct is viewed as a premise of the quality evaluations. The Committee on Publication Ethics (COPE) further emphasizes editorial strategies that ensure transparent and unbiased reviewer evaluations by trained professionals [ 10 ]. Finally, the World Association of Medical Editors (WAME) prioritizes selecting the best reviewers with validated profiles to avoid substandard or fraudulent reviewer comments [ 11 ]. Accordingly, the Sarajevo Declaration on Integrity and Visibility of Scholarly Publications encourages reviewers to register with the Open Researcher and Contributor ID (ORCID) platform to validate and publicize their scholarly activities [ 12 ].

Although the best reviewer criteria are not listed in the editorial recommendations, it is apparent that the manuscript evaluators should be active researchers with extensive experience in the subject matter and an impressive list of relevant and recent publications [ 13 ]. All authors embarking on an academic career and publishing articles with active contact details can be involved in the evaluation of others’ scholarly works [ 14 ]. Ideally, the reviewers should be peers of the manuscript authors with equal scholarly ranks and credentials.

However, journal editors may employ schemes that engage junior research fellows as co-reviewers along with their mentors and senior fellows [ 15 ]. Such a scheme is successfully practised within the framework of the Emerging EULAR (European League Against Rheumatism) Network (EMEUNET) where seasoned authors (mentors) train ongoing researchers (mentees) how to evaluate submissions to the top rheumatology journals and select the best evaluators for regular contributors to these journals [ 16 ].

The awareness of the EQUATOR Network reporting standards may help the reviewers to evaluate methodology and suggest related revisions. Statistical skills help the reviewers to detect basic mistakes and suggest additional analyses. For example, scanning data presentation and revealing mistakes in the presentation of means and standard deviations often prompt re-analyses of distributions and replacement of parametric tests with non-parametric ones [ 17 , 18 ].

Constructive reviewer comments

The main goal of the peer review is to support authors in their attempt to publish ethically sound and professionally validated works that may attract readers’ attention and positively influence healthcare research and practice. As such, an optimal reviewer comment has to comprehensively examine all parts of the research and review work ( Table I ). The best reviewers are viewed as contributors who guide authors on how to correct mistakes, discuss study limitations, and highlight its strengths [ 19 ].

Structure of a reviewer comment to be forwarded to authors

Section	Notes
Introductory line	Summarizes the overall impression about the manuscript validity and implications
Evaluation of the title, abstract and keywords	Evaluates the title correctness and completeness, inclusion of all relevant keywords, study design terms, information load, and relevance of the abstract
Major comments	Specifically analyses each manuscript part in line with available research reporting standards, supports all suggestions with solid evidence, weighs novelty of hypotheses and methodological rigour, highlights the choice of study design, points to missing/incomplete ethics approval statements, rights to re-use graphics, accuracy and completeness of statistical analyses, professionalism of bibliographic searches and inclusion of updated and relevant references
Minor comments	Identifies language mistakes, typos, inappropriate format of graphics and references, length of texts and tables, use of supplementary material, unusual sections and order, completeness of scholarly contribution, conflict of interest, and funding statements
Concluding remarks	Reflects on take-home messages and implications

Some of the currently practised review models are well positioned to help authors reveal and correct their mistakes at pre- or post-publication stages ( Table II ). The global move toward open science is particularly instrumental for increasing the quality and transparency of reviewer contributions.

Advantages and disadvantages of common manuscript evaluation models

Models	Advantages	Disadvantages
In-house (internal) editorial review	Allows detection of major flaws and errors that justify outright rejections; rarely, outstanding manuscripts are accepted without delays	Journal staff evaluations may be biased; manuscript acceptance without external review may raise concerns of soft quality checks
Single-blind peer review	Masking reviewer identity prevents personal conflicts in small (closed) professional communities	Reviewer access to author profiles may result in biased and subjective evaluations
Double-blind peer review	Concealing author and reviewer identities prevents biased evaluations, particularly in small communities	Masking all identifying information is technically burdensome and not always possible
Open (public) peer review	May increase quality, objectivity, and accountability of reviewer evaluations; it is now part of open science culture	Peers who do not wish to disclose their identity may decline reviewer invitations
Post-publication open peer review	May accelerate dissemination of influential reports in line with the concept “publish first, judge later”; this concept is practised by some open-access journals (e.g., F1000 Research)	Not all manuscripts benefit from open dissemination without peers’ input; post-publication review may delay detection of minor or major mistakes
Post-publication social media commenting	May reveal some mistakes and misconduct and improve public perception of article implications	Not all communities use social media for commenting and other academic purposes

Since there are no universally acceptable criteria for selecting reviewers and structuring their comments, instructions of all peer-reviewed journal should specify priorities, models, and expected review outcomes [ 20 ]. Monitoring and reporting average peer review timelines is also required to encourage timely evaluations and avoid delays. Depending on journal policies and article types, the first round of peer review may last from a few days to a few weeks. The fast-track review (up to 3 days) is practised by some top journals which process clinical trial reports and other priority items.

In exceptional cases, reviewer contributions may result in substantive changes, appreciated by authors in the official acknowledgments. In most cases, however, reviewers should avoid engaging in the authors’ research and writing. They should refrain from instructing the authors on additional tests and data collection as these may delay publication of original submissions with conclusive results.

Established publishers often employ advanced editorial management systems that support reviewers by providing instantaneous access to the review instructions, online structured forms, and some bibliographic databases. Such support enables drafting of evidence-based comments that examine the novelty, ethical soundness, and implications of the reviewed manuscripts [ 21 ].

Encouraging reviewers to submit their recommendations on manuscript acceptance/rejection and related editorial tasks is now a common practice. Skilled reviewers may prompt the editors to reject or transfer manuscripts which fall outside the journal scope, perform additional ethics checks, and minimize chances of publishing erroneous and unethical articles. They may also raise concerns over the editorial strategies in their comments to the editors.

Since reviewer and editor roles are distinct, reviewer recommendations are aimed at helping editors, but not at replacing their decision-making functions. The final decisions rest with handling editors. Handling editors weigh not only reviewer comments, but also priorities related to article types and geographic origins, space limitations in certain periods, and envisaged influence in terms of social media attention and citations. This is why rejections of even flawless manuscripts are likely at early rounds of internal and external evaluations across most peer-reviewed journals.

Reviewers are often requested to comment on language correctness and overall readability of the evaluated manuscripts. Given the wide availability of in-house and external editing services, reviewer comments on language mistakes and typos are categorized as minor. At the same time, non-Anglophone experts’ poor language skills often exclude them from contributing to the peer review in most influential journals [ 22 ]. Comments should be properly edited to convey messages in positive or neutral tones, express ideas of varying degrees of certainty, and present logical order of words, sentences, and paragraphs [ 23 , 24 ]. Consulting linguists on communication culture, passing advanced language courses, and honing commenting skills may increase the overall quality and appeal of the reviewer accomplishments [ 5 , 25 ].

Peer reviewer credits

Various crediting mechanisms have been proposed to motivate reviewers and maintain the integrity of science communication [ 26 ]. Annual reviewer acknowledgments are widely practised for naming manuscript evaluators and appreciating their scholarly contributions. Given the need to weigh reviewer contributions, some journal editors distinguish ‘elite’ reviewers with numerous evaluations and award those with timely and outstanding accomplishments [ 27 ]. Such targeted recognition ensures ethical soundness of the peer review and facilitates promotion of the best candidates for grant funding and academic job appointments [ 28 ].

Also, large publishers and learned societies issue certificates of excellence in reviewing which may include Continuing Professional Development (CPD) points [ 29 ]. Finally, an entirely new crediting mechanism is proposed to award bonus points to active reviewers who may collect, transfer, and use these points to discount gold open-access charges within the publisher consortia [ 30 ].

With the launch of Publons ( http://publons.com/ ) and its integration with Web of Science Group (Clarivate Analytics), reviewer recognition has become a matter of scientific prestige. Reviewers can now freely open their Publons accounts and record their contributions to online journals with Digital Object Identifiers (DOI). Journal editors, in turn, may generate official reviewer acknowledgments and encourage reviewers to forward them to Publons for building up individual reviewer and journal profiles. All published articles maintain e-links to their review records and post-publication promotion on social media, allowing the reviewers to continuously track expert evaluations and comments. A paid-up partnership is also available to journals and publishers for automatically transferring peer-review records to Publons upon mutually acceptable arrangements.

Listing reviewer accomplishments on an individual Publons profile showcases scholarly contributions of the account holder. The reviewer accomplishments placed next to the account holders’ own articles and editorial accomplishments point to the diversity of scholarly contributions. Researchers may establish links between their Publons and ORCID accounts to further benefit from complementary services of both platforms. Publons Academy ( https://publons.com/community/academy/ ) additionally offers an online training course to novice researchers who may improve their reviewing skills under the guidance of experienced mentors and journal editors. Finally, journal editors may conduct searches through the Publons platform to select the best reviewers across academic disciplines.

Peer review ethics

Prior to accepting reviewer invitations, scholars need to weigh a number of factors which may compromise their evaluations. First of all, they are required to accept the reviewer invitations if they are capable of timely submitting their comments. Peer review timelines depend on article type and vary widely across journals. The rules of transparent publishing necessitate recording manuscript submission and acceptance dates in article footnotes to inform readers of the evaluation speed and to help investigators in the event of multiple unethical submissions. Timely reviewer accomplishments often enable fast publication of valuable works with positive implications for healthcare. Unjustifiably long peer review, on the contrary, delays dissemination of influential reports and results in ethical misconduct, such as plagiarism of a manuscript under evaluation [ 31 ].

In the times of proliferation of open-access journals relying on article processing charges, unjustifiably short review may point to the absence of quality evaluation and apparently ‘predatory’ publishing practice [ 32 , 33 ]. Authors when choosing their target journals should take into account the peer review strategy and associated timelines to avoid substandard periodicals.

Reviewer primary interests (unbiased evaluation of manuscripts) may come into conflict with secondary interests (promotion of their own scholarly works), necessitating disclosures by filling in related parts in the online reviewer window or uploading the ICMJE conflict of interest forms. Biomedical reviewers, who are directly or indirectly supported by the pharmaceutical industry, may encounter conflicts while evaluating drug research. Such instances require explicit disclosures of conflicts and/or rejections of reviewer invitations.

Journal editors are obliged to employ mechanisms for disclosing reviewer financial and non-financial conflicts of interest to avoid processing of biased comments [ 34 ]. They should also cautiously process negative comments that oppose dissenting, but still valid, scientific ideas [ 35 ]. Reviewer conflicts that stem from academic activities in a competitive environment may introduce biases, resulting in unfair rejections of manuscripts with opposing concepts, results, and interpretations. The same academic conflicts may lead to coercive reviewer self-citations, forcing authors to incorporate suggested reviewer references or face negative feedback and an unjustified rejection [ 36 ]. Notably, several publisher investigations have demonstrated a global scale of such misconduct, involving some highly cited researchers and top scientific journals [ 37 ].

Fake peer review, an extreme example of conflict of interest, is another form of misconduct that has surfaced in the time of mass proliferation of gold open-access journals and publication of articles without quality checks [ 38 ]. Fake reviews are generated by manipulating authors and commercial editing agencies with full access to their own manuscripts and peer review evaluations in the journal editorial management systems. The sole aim of these reviews is to break the manuscript evaluation process and to pave the way for publication of pseudoscientific articles. Authors of these articles are often supported by funds intended for the growth of science in non-Anglophone countries [ 39 ]. Iranian and Chinese authors are often caught submitting fake reviews, resulting in mass retractions by large publishers [ 38 ]. Several suggestions have been made to overcome this issue, with assigning independent reviewers and requesting their ORCID IDs viewed as the most practical options [ 40 ].

Conclusions

The peer review process is regulated by publishers and editors, enforcing updated global editorial recommendations. Selecting the best reviewers and providing authors with constructive comments may improve the quality of published articles. Reviewers are selected in view of their professional backgrounds and skills in research reporting, statistics, ethics, and language. Quality reviewer comments attract superior submissions and add to the journal’s scientific prestige [ 41 ].

In the era of digitization and open science, various online tools and platforms are available to upgrade the peer review and credit experts for their scholarly contributions. With its links to the ORCID platform and social media channels, Publons now offers the optimal model for crediting and keeping track of the best and most active reviewers. Publons Academy additionally offers online training for novice researchers who may benefit from the experience of their mentoring editors. Overall, reviewer training in how to evaluate journal submissions and avoid related misconduct is an important process, which some indexed journals are experimenting with [ 42 ].

The timelines and rigour of the peer review may change during the current pandemic. However, journal editors should mobilize their resources to avoid publication of unchecked and misleading reports. Additional efforts are required to monitor published contents and encourage readers to post their comments on publishers’ online platforms (blogs) and other social media channels [ 43 , 44 ].

The authors declare no conflict of interest.

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Evaluation – Peer review is an effective form of research evaluation to help select the highest quality articles for publication.
Integrity – Peer review ensures the integrity of the publishing process and the scholarly record. Reviewers are independent of journal publications and the research being conducted.
Quality – The filtering process and revision advice improve the quality of the final research article as well as offering the author new insights into their research methods and the results that they have compiled. Peer review gives authors access to the opinions of experts in the field who can provide support and insight.

Types of peer review

Single-anonymized – the name of the reviewer is hidden from the author.
Double-anonymized – names are hidden from both reviewers and the authors.
Triple-anonymized – names are hidden from authors, reviewers, and the editor.
Open peer review comes in many forms . At Sage we offer a form of open peer review on some journals via our Transparent Peer Review program , whereby the reviews are published alongside the article. The names of the reviewers may also be published, depending on the reviewers’ preference.
Post publication peer review can offer useful interaction and a discussion forum for the research community. This form of peer review is not usual or appropriate in all fields.

To learn more about the different types of peer review, see page 14 of ‘ The Nuts and Bolts of Peer Review ’ from Sense about Science.

Please double check the manuscript submission guidelines of the journal you are reviewing in order to ensure that you understand the method of peer review being used.

Journal Author Gateway
Journal Editor Gateway
Transparent Peer Review
How to Review Articles
Using Sage Track
Peer Review Ethics
Resources for Reviewers
Reviewer Rewards
Ethics & Responsibility
Sage editorial policies
Publication Ethics Policies
Sage Chinese Author Gateway 中国作者资源

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What is peer review?

Reviewers play a pivotal role in scholarly publishing. The peer review system exists to validate academic work, helps to improve the quality of published research, and increases networking possibilities within research communities. Despite criticisms, peer review is still the only widely accepted method for research validation and has continued successfully with relatively minor changes for some 350 years.

Elsevier relies on the peer review process to uphold the quality and validity of individual articles and the journals that publish them.

Peer review has been a formal part of scientific communication since the first scientific journals appeared more than 300 years ago. The Philosophical Transactions opens in new tab/window of the Royal Society is thought to be the first journal to formalize the peer review process opens in new tab/window under the editorship of Henry Oldenburg (1618- 1677).

Despite many criticisms about the integrity of peer review, the majority of the research community still believes peer review is the best form of scientific evaluation. This opinion was endorsed by the outcome of a survey Elsevier and Sense About Science conducted in 2009 opens in new tab/window and has since been further confirmed by other publisher and scholarly organization surveys. Furthermore, a 2015 survey by the Publishing Research Consortium opens in new tab/window , saw 82% of researchers agreeing that “without peer review there is no control in scientific communication.”

To learn more about peer review, visit Elsevier’s free e-learning platform Researcher Academy opens in new tab/window and see our resources below.

The peer review process

Types of peer review.

Peer review comes in different flavours. Each model has its own advantages and disadvantages, and often one type of review will be preferred by a subject community. Before submitting or reviewing a paper, you must therefore check which type is employed by the journal so you are aware of the respective rules. In case of questions regarding the peer review model employed by the journal for which you have been invited to review, consult the journal’s homepage or contact the editorial office directly.

Single anonymized review

In this type of review, the names of the reviewers are hidden from the author. This is the traditional method of reviewing and is the most common type by far. Points to consider regarding single anonymized review include:

Reviewer anonymity allows for impartial decisions , as the reviewers will not be influenced by potential criticism from the authors.

Authors may be concerned that reviewers in their field could delay publication, giving the reviewers a chance to publish first.

Reviewers may use their anonymity as justification for being unnecessarily critical or harsh when commenting on the authors’ work.

Double anonymized review

Both the reviewer and the author are anonymous in this model. Some advantages of this model are listed below.

Author anonymity limits reviewer bias, such as on author's gender, country of origin, academic status, or previous publication history.

Articles written by prestigious or renowned authors are considered based on the content of their papers, rather than their reputation.

But bear in mind that despite the above, reviewers can often identify the author through their writing style, subject matter, or self-citation – it is exceedingly difficult to guarantee total author anonymity. More information for authors can be found in our double-anonymized peer review guidelines .

Triple anonymized review

With triple anonymized review, reviewers are anonymous to the author, and the author's identity is unknown to both the reviewers and the editor. Articles are anonymized at the submission stage and are handled in a way to minimize any potential bias towards the authors. However, it should be noted that:

The complexities involved with anonymizing articles/authors to this level are considerable.

As with double anonymized review, there is still a possibility for the editor and/or reviewers to correctly identify the author(s) from their writing style, subject matter, citation patterns, or other methodologies.

Open review

Open peer review is an umbrella term for many different models aiming at greater transparency during and after the peer review process. The most common definition of open review is when both the reviewer and author are known to each other during the peer review process. Other types of open peer review consist of:

Publication of reviewers’ names on the article page

Publication of peer review reports alongside the article, either signed or anonymous

Publication of peer review reports (signed or anonymous) with authors’ and editors’ responses alongside the article

Publication of the paper after pre-checks and opening a discussion forum to the community who can then comment (named or anonymous) on the article

Many believe this is the best way to prevent malicious comments, stop plagiarism, prevent reviewers from following their own agenda, and encourage open, honest reviewing. Others see open review as a less honest process, in which politeness or fear of retribution may cause a reviewer to withhold or tone down criticism. For three years, five Elsevier journals experimented with publication of peer review reports (signed or anonymous) as articles alongside the accepted paper on ScienceDirect ( example opens in new tab/window ).

More transparent peer review

Transparency is the key to trust in peer review and as such there is an increasing call towards more  transparency around the peer review process . In an effort to promote transparency in the peer review process, many Elsevier journals therefore publish the name of the handling editor of the published paper on ScienceDirect. Some journals also provide details about the number of reviewers who reviewed the article before acceptance. Furthermore, in order to provide updates and feedback to reviewers, most Elsevier journals inform reviewers about the editor’s decision and their peers’ recommendations.

Article transfer service: sharing reviewer comments

Elsevier authors may be invited to  transfer  their article submission from one journal to another for free if their initial submission was not successful.

As a referee, your review report (including all comments to the author and editor) will be transferred to the destination journal, along with the manuscript. The main benefit is that reviewers are not asked to review the same manuscript several times for different journals.

Tools and resources

Interesting reads.

Chapter 2 of Academic and Professional Publishing, 2012, by Irene Hames in 2012 opens in new tab/window

"Is Peer Review in Crisis?" Perspectives in Publishing No 2, August 2004, by Adrian Mulligan opens in new tab/window

“The history of the peer-review process” Trends in Biotechnology, 2002, by Ray Spier opens in new tab/window

Reviewers’ Update articles

Peer review using today’s technology

Lifting the lid on publishing peer review reports: an interview with Bahar Mehmani and Flaminio Squazzoni

How face-to-face peer review can benefit authors and journals alike

Innovation in peer review: introducing “volunpeers”

Results masked review: peer review without publication bias

Elsevier Researcher Academy modules

The certified peer reviewer course opens in new tab/window

Transparency in peer review opens in new tab/window

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Understanding Peer Review in Science

Peer review is an essential element of the scientific publishing process that helps ensure that research articles are evaluated, critiqued, and improved before release into the academic community. Take a look at the significance of peer review in scientific publications, the typical steps of the process, and and how to approach peer review if you are asked to assess a manuscript.

What Is Peer Review?

Peer review is the evaluation of work by peers, who are people with comparable experience and competency. Peers assess each others’ work in educational settings, in professional settings, and in the publishing world. The goal of peer review is improving quality, defining and maintaining standards, and helping people learn from one another.

In the context of scientific publication, peer review helps editors determine which submissions merit publication and improves the quality of manuscripts prior to their final release.

Types of Peer Review for Manuscripts

There are three main types of peer review:

Single-blind review: The reviewers know the identities of the authors, but the authors do not know the identities of the reviewers.
Double-blind review: Both the authors and reviewers remain anonymous to each other.
Open peer review: The identities of both the authors and reviewers are disclosed, promoting transparency and collaboration.

There are advantages and disadvantages of each method. Anonymous reviews reduce bias but reduce collaboration, while open reviews are more transparent, but increase bias.

Key Elements of Peer Review

Proper selection of a peer group improves the outcome of the process:

Expertise : Reviewers should possess adequate knowledge and experience in the relevant field to provide constructive feedback.
Objectivity : Reviewers assess the manuscript impartially and without personal bias.
Confidentiality : The peer review process maintains confidentiality to protect intellectual property and encourage honest feedback.
Timeliness : Reviewers provide feedback within a reasonable timeframe to ensure timely publication.

Steps of the Peer Review Process

The typical peer review process for scientific publications involves the following steps:

Submission : Authors submit their manuscript to a journal that aligns with their research topic.
Editorial assessment : The journal editor examines the manuscript and determines whether or not it is suitable for publication. If it is not, the manuscript is rejected.
Peer review : If it is suitable, the editor sends the article to peer reviewers who are experts in the relevant field.
Reviewer feedback : Reviewers provide feedback, critique, and suggestions for improvement.
Revision and resubmission : Authors address the feedback and make necessary revisions before resubmitting the manuscript.
Final decision : The editor makes a final decision on whether to accept or reject the manuscript based on the revised version and reviewer comments.
Publication : If accepted, the manuscript undergoes copyediting and formatting before being published in the journal.

Pros and Cons

While the goal of peer review is improving the quality of published research, the process isn’t without its drawbacks.

Quality assurance : Peer review helps ensure the quality and reliability of published research.
Error detection : The process identifies errors and flaws that the authors may have overlooked.
Credibility : The scientific community generally considers peer-reviewed articles to be more credible.
Professional development : Reviewers can learn from the work of others and enhance their own knowledge and understanding.
Time-consuming : The peer review process can be lengthy, delaying the publication of potentially valuable research.
Bias : Personal biases of reviews impact their evaluation of the manuscript.
Inconsistency : Different reviewers may provide conflicting feedback, making it challenging for authors to address all concerns.
Limited effectiveness : Peer review does not always detect significant errors or misconduct.
Poaching : Some reviewers take an idea from a submission and gain publication before the authors of the original research.

Steps for Conducting Peer Review of an Article

Generally, an editor provides guidance when you are asked to provide peer review of a manuscript. Here are typical steps of the process.

Accept the right assignment: Accept invitations to review articles that align with your area of expertise to ensure you can provide well-informed feedback.
Manage your time: Allocate sufficient time to thoroughly read and evaluate the manuscript, while adhering to the journal’s deadline for providing feedback.
Read the manuscript multiple times: First, read the manuscript for an overall understanding of the research. Then, read it more closely to assess the details, methodology, results, and conclusions.
Evaluate the structure and organization: Check if the manuscript follows the journal’s guidelines and is structured logically, with clear headings, subheadings, and a coherent flow of information.
Assess the quality of the research: Evaluate the research question, study design, methodology, data collection, analysis, and interpretation. Consider whether the methods are appropriate, the results are valid, and the conclusions are supported by the data.
Examine the originality and relevance: Determine if the research offers new insights, builds on existing knowledge, and is relevant to the field.
Check for clarity and consistency: Review the manuscript for clarity of writing, consistent terminology, and proper formatting of figures, tables, and references.
Identify ethical issues: Look for potential ethical concerns, such as plagiarism, data fabrication, or conflicts of interest.
Provide constructive feedback: Offer specific, actionable, and objective suggestions for improvement, highlighting both the strengths and weaknesses of the manuscript. Don’t be mean.
Organize your review: Structure your review with an overview of your evaluation, followed by detailed comments and suggestions organized by section (e.g., introduction, methods, results, discussion, and conclusion).
Be professional and respectful: Maintain a respectful tone in your feedback, avoiding personal criticism or derogatory language.
Proofread your review: Before submitting your review, proofread it for typos, grammar, and clarity.
Couzin-Frankel J (September 2013). “Biomedical publishing. Secretive and subjective, peer review proves resistant to study”. Science . 341 (6152): 1331. doi: 10.1126/science.341.6152.1331
Lee, Carole J.; Sugimoto, Cassidy R.; Zhang, Guo; Cronin, Blaise (2013). “Bias in peer review”. Journal of the American Society for Information Science and Technology. 64 (1): 2–17. doi: 10.1002/asi.22784
Slavov, Nikolai (2015). “Making the most of peer review”. eLife . 4: e12708. doi: 10.7554/eLife.12708
Spier, Ray (2002). “The history of the peer-review process”. Trends in Biotechnology . 20 (8): 357–8. doi: 10.1016/S0167-7799(02)01985-6
Squazzoni, Flaminio; Brezis, Elise; Marušić, Ana (2017). “Scientometrics of peer review”. Scientometrics . 113 (1): 501–502. doi: 10.1007/s11192-017-2518-4

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What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on 6 May 2022 by Tegan George . Revised on 2 September 2022.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

Single-blind review
Double-blind review
Triple-blind review

Collaborative review

Open review.

Prevent plagiarism, run a free check.

Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymised) review . Here, the names of the reviewers are not known by the author.

Double-blind peer review

In double-blind (or double anonymised) review , both the author and the reviewers are anonymous.

Triple-blind peer review

While triple-blind (or triple anonymised) review – where the identities of the author, reviewers, and editors are all anonymised – does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimises potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymise everyone involved in the process.

In general, the peer review process includes the following steps:

First, the author submits the manuscript to the editor.
Reject the manuscript and send it back to the author, or
Send it onward to the selected peer reviewer(s)
Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarise the argument in your own words

Summarising the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organised. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticised, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the ‘compliment sandwich’, where you ‘sandwich’ your constructive criticism between two compliments.

As a rule of thumb, your feedback should be:

Easy to understand
Constructive

Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

The sample was then divided into 3 groups:

Group 1 was not allowed to use their phone before bedtime.
Group 2 used their phone for 1 hour before bedtime.
Group 3 used their phone for 3 hours before bedtime.

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Protects the quality of published research

Gives you access to feedback from experts in your field

Helps you identify any weaknesses in your argument

Peer review acts as a first defence, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

Reviewer bias

Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published.

Risk of human error

Peer review is a process of evaluating submissions to an academic journal. Utilising rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication.

For this reason, academic journals are often considered among the most credible sources you can use in a research project – provided that the journal itself is trustworthy and well regarded.

It acts as a first defence, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

In general, the peer review process follows the following steps:

Reject the manuscript and send it back to author, or
Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

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We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean? How does it work?

Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists’ work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.

Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators. The intention behind this system is to ensure evaluation is not biased.

The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

The process in details

The peer review process for journals involves at least three stages.

1. The desk evaluation stage

When a paper is submitted to a journal, it receives an initial evaluation by the chief editor, or an associate editor with relevant expertise.

At this stage, either can “desk reject” the paper: that is, reject the paper without sending it to blind referees. Generally, papers are desk rejected if the paper doesn’t fit the scope of the journal or there is a fundamental flaw which makes it unfit for publication.

In this case, the rejecting editors might write a letter summarising his or her concerns. Some journals, such as the British Medical Journal , desk reject up to two-thirds or more of the papers.

2. The blind review

If the editorial team judges there are no fundamental flaws, they send it for review to blind referees. The number of reviewers depends on the field: in finance there might be only one reviewer, while journals in other fields of social sciences might ask up to four reviewers. Those reviewers are selected by the editor on the basis of their expert knowledge and their absence of a link with the authors.

Reviewers will decide whether to reject the paper, to accept it as it is (which rarely happens) or to ask for the paper to be revised. This means the author needs to change the paper in line with the reviewers’ concerns.

Usually the reviews deal with the validity and rigour of the empirical method, and the importance and originality of the findings (what is called the “contribution” to the existing literature). The editor collects those comments, weights them, takes a decision, and writes a letter summarising the reviewers’ and his or her own concerns.

It can therefore happen that despite hostility on the part of the reviewers, the editor could offer the paper a subsequent round of revision. In the best journals in the social sciences, 10% to 20% of the papers are offered a “revise-and-resubmit” after the first round.

3. The revisions – if you are lucky enough

If the paper has not been rejected after this first round of review, it is sent back to the author(s) for a revision. The process is repeated as many times as necessary for the editor to reach a consensus point on whether to accept or reject the paper. In some cases this can last for several years.

Ultimately, less than 10% of the submitted papers are accepted in the best journals in the social sciences. The renowned journal Nature publishes around 7% of the submitted papers.

Strengths and weaknesses of the peer review process

The peer review process is seen as the gold standard in science because it ensures the rigour, novelty, and consistency of academic outputs. Typically, through rounds of review, flawed ideas are eliminated and good ideas are strengthened and improved. Peer reviewing also ensures that science is relatively independent.

Because scientific ideas are judged by other scientists, the crucial yardstick is scientific standards. If other people from outside of the field were involved in judging ideas, other criteria such as political or economic gain might be used to select ideas. Peer reviewing is also seen as a crucial way of removing personalities and bias from the process of judging knowledge.

Despite the undoubted strengths, the peer review process as we know it has been criticised . It involves a number of social interactions that might create biases – for example, authors might be identified by reviewers if they are in the same field, and desk rejections are not blind.

It might also favour incremental (adding to past research) rather than innovative (new) research. Finally, reviewers are human after all and can make mistakes, misunderstand elements, or miss errors.

Are there any alternatives?

Defenders of the peer review system say although there are flaws, we’re yet to find a better system to evaluate research. However, a number of innovations have been introduced in the academic review system to improve its objectivity and efficiency.

Some new open-access journals (such as PLOS ONE ) publish papers with very little evaluation (they check the work is not deeply flawed methodologically). The focus there is on the post-publication peer review system: all readers can comment and criticise the paper.

Some journals such as Nature, have made part of the review process public (“open” review), offering a hybrid system in which peer review plays a role of primary gate keepers, but the public community of scholars judge in parallel (or afterwards in some other journals) the value of the research.

Another idea is to have a set of reviewers rating the paper each time it is revised. In this case, authors will be able to choose whether they want to invest more time in a revision to obtain a better rating, and get their work publicly recognised.

Peer review

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Peer review process

Introduction to peer review, what is peer review.

Peer review is the system used to assess the quality of a manuscript before it is published. Independent researchers in the relevant research area assess submitted manuscripts for originality, validity and significance to help editors determine whether a manuscript should be published in their journal.

How does it work?

When a manuscript is submitted to a journal, it is assessed to see if it meets the criteria for submission. If it does, the editorial team will select potential peer reviewers within the field of research to peer-review the manuscript and make recommendations.

There are four main types of peer review used by BMC:

Single-blind: the reviewers know the names of the authors, but the authors do not know who reviewed their manuscript unless the reviewer chooses to sign their report.

Double-blind: the reviewers do not know the names of the authors, and the authors do not know who reviewed their manuscript.

Open peer: authors know who the reviewers are, and the reviewers know who the authors are. If the manuscript is accepted, the named reviewer reports are published alongside the article and the authors’ response to the reviewer.

Transparent peer: the reviewers know the names of the authors, but the authors do not know who reviewed their manuscript unless the reviewer chooses to sign their report. If the manuscript is accepted, the anonymous reviewer reports are published alongside the article and the authors’ response to the reviewer.

Different journals use different types of peer review. You can find out which peer-review system is used by a particular journal in the journal’s ‘About’ page.

Why do peer review?

Peer review is an integral part of scientific publishing that confirms the validity of the manuscript. Peer reviewers are experts who volunteer their time to help improve the manuscripts they review. By undergoing peer review, manuscripts should become:

More robust - peer reviewers may point out gaps in a paper that require more explanation or additional experiments.

Easier to read - if parts of your paper are difficult to understand, reviewers can suggest changes.

More useful - peer reviewers also consider the importance of your paper to others in your field.

For more information and advice on how to get published, please see our blog series here .

How peer review works

The peer review process can be single-blind, double-blind, open or transparent.

You can find out which peer review system is used by a particular journal in the journal's 'About' page.

N. B. This diagram is a representation of the peer review process, and should not be taken as the definitive approach used by every journal.

Peer review

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Peer review at APA Journals

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APA Journals Peer Review Process

Like other scientific journals, APA journals utilize a peer review process to guide manuscript selection and publication decisions.

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What is peer review?

From a publisher’s perspective, peer review functions as a filter for content, directing better quality articles to better quality journals and so creating journal brands.

Running articles through the process of peer review adds value to them. For this reason publishers need to make sure that peer review is robust.

Editor Feedback

"Pointing out the specifics about flaws in the paper’s structure is paramount. Are methods valid, is data clearly presented, and are conclusions supported by data?” (Editor feedback)

“If an editor can read your comments and understand clearly the basis for your recommendation, then you have written a helpful review.” (Editor feedback)

Peer Review at Its Best

What peer review does best is improve the quality of published papers by motivating authors to submit good quality work – and helping to improve that work through the peer review process.

In fact, 90% of researchers feel that peer review improves the quality of their published paper (University of Tennessee and CIBER Research Ltd, 2013).

What the Critics Say

The peer review system is not without criticism. Studies show that even after peer review, some articles still contain inaccuracies and demonstrate that most rejected papers will go on to be published somewhere else.

However, these criticisms should be understood within the context of peer review as a human activity. The occasional errors of peer review are not reasons for abandoning the process altogether – the mistakes would be worse without it.

Improving Effectiveness

Some of the ways in which Wiley is seeking to improve the efficiency of the process, include:

Reducing the amount of repeat reviewing by innovating around transferable peer review
Providing training and best practice guidance to peer reviewers
Improving recognition of the contribution made by reviewers

Visit our Peer Review Process and Types of Peer Review pages for additional detailed information on peer review.

Transparency in Peer Review

Wiley is committed to increasing transparency in peer review, increasing accountability for the peer review process and giving recognition to the work of peer reviewers and editors. We are also actively exploring other peer review models to give researchers the options that suit them and their communities.

Special Issues

Special Issues are subject to extensive review, during which journal Editors or Editorial Board input is solicited for each proposal. Our approval process includes an assessment of the rationale and scope of the proposed topic(s), and the expertise of Guest Editors, if any are involved. Special Issue articles must follow the same policies as described in the journal's Author Guidelines.

Editor/Editorial Board papers

Papers authored by Editors or Editorial Board members of the title are sent to Editors that are unaffiliated with the author or institution and monitored carefully to ensure there is no peer review bias.

Peer Reviewed Literature

What is peer review, terminology, peer review what does that mean, what types of articles are peer-reviewed, what information is not peer-reviewed, what about google scholar.

How do I find peer-reviewed articles?
Scholarly vs. Popular Sources

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For more help on this topic, please contact our Research Help Desk: [email protected] or 781-768-7303. Stay up-to-date on our current hours . Note: all hours are EST.

This Guide was created by Carolyn Swidrak (retired).

Research findings are communicated in many ways. One of the most important ways is through publication in scholarly, peer-reviewed journals.

Research published in scholarly journals is held to a high standard. It must make a credible and significant contribution to the discipline. To ensure a very high level of quality, articles that are submitted to scholarly journals undergo a process called peer-review.

Once an article has been submitted for publication, it is reviewed by other independent, academic experts (at least two) in the same field as the authors. These are the peers. The peers evaluate the research and decide if it is good enough and important enough to publish. Usually there is a back-and-forth exchange between the reviewers and the authors, including requests for revisions, before an article is published.

Peer review is a rigorous process but the intensity varies by journal. Some journals are very prestigious and receive many submissions for publication. They publish only the very best, most highly regarded research.

The terms scholarly, academic, peer-reviewed and refereed are sometimes used interchangeably, although there are slight differences.

Scholarly and academic may refer to peer-reviewed articles, but not all scholarly and academic journals are peer-reviewed (although most are.) For example, the Harvard Business Review is an academic journal but it is editorially reviewed, not peer-reviewed.

Peer-reviewed and refereed are identical terms.

From Peer Review in 3 Minutes [Video], by the North Carolina State University Library, 2014, YouTube (https://youtu.be/rOCQZ7QnoN0).

Peer reviewed articles can include:

Original research (empirical studies)
Review articles
Systematic reviews
Meta-analyses

There is much excellent, credible information in existence that is NOT peer-reviewed. Peer-review is simply ONE MEASURE of quality.

Much of this information is referred to as "gray literature."

Government Agencies

Government websites such as the Centers for Disease Control (CDC) publish high level, trustworthy information. However, most of it is not peer-reviewed. (Some of their publications are peer-reviewed, however. The journal Emerging Infectious Diseases, published by the CDC is one example.)

Conference Proceedings

Papers from conference proceedings are not usually peer-reviewed. They may go on to become published articles in a peer-reviewed journal.

Dissertations

Dissertations are written by doctoral candidates, and while they are academic they are not peer-reviewed.

Many students like Google Scholar because it is easy to use. While the results from Google Scholar are generally academic they are not necessarily peer-reviewed. Typically, you will find:

Peer reviewed journal articles (although they are not identified as peer-reviewed)
Unpublished scholarly articles (not peer-reviewed)
Masters theses, doctoral dissertations and other degree publications (not peer-reviewed)
Book citations and links to some books (not necessarily peer-reviewed)
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Last Updated: Feb 12, 2024 9:39 AM
URL: https://libguides.regiscollege.edu/peer_review

Understanding the peer review process

What is peer review a guide for authors.

The peer review process starts once you have submitted your paper to a journal.

After submission, your paper will be sent for assessment by independent experts in your field. The reviewers are asked to judge the validity, significance, and originality of your work.

Below we expand on what peer review is, and how it works.

What is peer review? And why is important?

Peer review is the independent assessment of your research paper by experts in your field. The purpose of peer review is to evaluate the paper’s quality and suitability for publication.

As well as peer review acting as a form of quality control for academic journals, it is a very useful source of feedback for you. The feedback can be used to improve your paper before it is published.

So at its best, peer review is a collaborative process, where authors engage in a dialogue with peers in their field, and receive constructive support to advance their work.

Use our free guide to discover how you can get the most out of the peer review process.

Why is peer review important?

Peer review is vitally important to uphold the high standards of scholarly communications, and maintain the quality of individual journals. It is also an important support for the researchers who author the papers.

Every journal depends on the hard work of reviewers who are the ones at the forefront of the peer review process. The reviewers are the ones who test and refine each article before publication. Even for very specialist journals, the editor can’t be an expert in the topic of every article submitted. So, the feedback and comments of carefully selected reviewers are an essential guide to inform the editor’s decision on a research paper.

There are also practical reasons why peer review is beneficial to you, the author. The peer review process can alert you to any errors in your work, or gaps in the literature you may have overlooked.

Researchers consistently tell us that their final published article is better than the version they submitted before peer review. 91% of respondents to a Sense about Science peer review survey said that their last paper was improved through peer review. A Taylor & Francis study supports this, finding that most researchers, across all subject areas, rated the contribution of peer review towards improving their article as 8 or above out of 10.

Read the infographic with information about peer review for journal articles.

Enlarge the infographic

Choose the right journal for your research: Think. Check. Submit

We support Think. Check. Submit. , an initiative launched by a coalition of scholarly communications organizations. It provides the tools to help you choose the right journal for your work.

Think. Check. Submit. was established because there are some journals which do not provide the quality assurance and services that should be delivered by a reputable journal. In particular, many of these journals do not make sure there is thorough peer review or editor feedback process in place.

That means, if you submit to one of these journals, you will not benefit from helpful article feedback from your peers. It may also lead to others being skeptical about the validity of your published results.

You should therefore make sure that you submit your work to a journal you can trust. By using the checklist provided on the Think. Check. Submit. website , you can make an informed choice.

Peer review integrity at Taylor & Francis

Vector illustration of a tick within a circle.

Every full research article published in a Taylor & Francis journal has been through peer review, as outlined in the journal’s aims & scope information. This means that the article’s quality, validity, and relevance has been assessed by independent peers within the research field.

We believe in the integrity of peer review with every journal we publish, ascribing to the following statement:

All published research articles in this journal have undergone rigorous peer review, based on initial editor screening, anonymous refereeing by independent expert referees, and consequent revision by article authors when required.

Different types of peer review

Peer review takes different forms and each type has pros and cons. The type of peer review model used will often vary between journals, even of the same publisher. So, check your chosen journal’s peer-review policy before you submit , to make sure you know what to expect and are comfortable with your paper being reviewed in that way.

Every Taylor & Francis journal publishes a statement describing the type of peer review used by the journal within the aims & scope section on Taylor & Francis Online.

Below we go through the most common types of peer review.

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Common types of peer review

Single-anonymous peer review.

This type of peer review is also called ‘single-blind review’. In this model, the reviewers know that you are the author of the article, but you don’t know the identities of the reviewers.

Single-anonymous review is most common for science and medicine journals.

Find out more about the pros and cons of single-anonymous peer review .

Double-anonymous peer review

In this model, which is also known as ‘double-blind review’, the reviewers don’t know that you are the author of the article. And you don’t know who the reviewers are either. Double-anonymous review is particularly common in humanities and some social sciences’ journals.

Discover more about the pros and cons of double-anonymous peer review .

If you are submitting your article for double-anonymous peer review, make sure you know how to make your article anonymous .

Open peer review

There is no one agreed definition of open peer review. In fact, a recent study identified 122 different definitions of the term. Typically, it will mean that the reviewers know you are the author and also that their identity will be revealed to you at some point during the review or publication process.

Find out more about open peer review .

Post-publication peer review

In post-publication peer review models, your paper may still go through one of the other types of peer review first. Alternatively, your paper may be published online almost immediately, after some basic checks. Either way, once it is published, there will then be an opportunity for invited reviewers (or even readers) to add their own comments or reviews.

You can learn about the pros and cons of post-publication peer review here.

Registered Reports

The Registered Reports process splits peer review into two parts.

The first round of peer review takes place after you’ve designed your study, but before you’ve collected or analyzed any data. This allows you to get feedback on both the question you’re looking to answer, and the experiment you’ve designed to test it.

If your manuscript passes peer review, the journal will give you an in-principle acceptance (IPA). This indicates that your article will be published as long as you successfully complete your study according to the pre-registered methods and submit an evidence-based interpretation of the results.

Explore Registered Reports at Taylor & Francis .

F1000 Research: Open and post-publication peer review

F1000Research is part of the Taylor & Francis Group. It operates an innovative peer review process which is fully transparent and takes place after an article has been published.

How it works

Before publication, authors are asked to suggest at least five potential reviewers who are experts in the field. The reviewers also need to be able to provide unbiased reports on the article.

Submitted articles are published rapidly, after passing a series of pre-publication checks that assess, originality, readability, author eligibility, and compliance with F1000Research’s policies and ethical guidelines.

Once the article is published, expert reviewers are formally invited to review.

The peer review process is entirely open and transparent. Each peer review report, plus the approval status selected by the reviewer, is published with the reviewer’s name and affiliation alongside the article.

Authors are encouraged to respond openly to the peer review reports and can publish revised versions of their article if they wish. New versions are clearly linked and easily navigable, so that readers and reviewers can quickly find the latest version of an article.

The article remains published regardless of the reviewers’ reports. Articles that pass peer review are indexed in Scopus, PubMed, Google Scholar and other bibliographic databases.

How our publishing process works for articles

1. Article submission

Submitting an article is easy with our single-page submission system.

The in-house editorial team carries out a basic check on each submission to ensure that all policies are adhered to.

2. Publication and data deposition

Once the authors have analysed the manuscript, the article (with its associated source data) is published within a week, enabling immediate viewing and caution.

3. Open peer review & user commenting

Expert reviewers are selected and invited. Their reports and names are published alongside the article, together with the authors’ responses and comments from registered users.

4. Article revision

Authors are encouraged to publish revised versions of their article. All versions of an article are linked and independently citable.

Articles that pass peer review are indexed in external databases such as PubMed, Scopus and Google Scholar.

Discover more about how the F1000Research model works .

Get to know the peer review process

Peer review follows a number of steps, beginning with submitting your article to a journal.

Step 1: Editor assessment

When your manuscript arrives at the journal’s editorial office it will receive an initial desk assessment by the journal’s editor or editorial office. They will check that it’s broadly suitable for the journal.

They will ask questions such as:

Is this the right journal for this article?

Does the paper cover a suitable topic according to the journal’s aims & scope ?

Has the author followed the journal’s guidelines in the instructions for authors ? They will check that your paper meets the basic requirements of the journal, such as word count, language clarity, and format.

Has the author included everything that’s needed for peer review? They will check that there is an abstract, author affiliation details, any figures, and research-funder information.

Does it make a significant contribution to the existing literature?

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If your article doesn’t pass these initial checks the editor might reject the article immediately. This is known as a ‘desk reject’ and it is a decision made at the editor’s discretion, based on their substantial experience and subject expertise. By having this initial screening in place, it can enable a quick decision if your manuscript isn’t suitable for the journal. This means you can submit your article to another journal quickly.

If your article does pass the initial assessment, it will move to the next stage, and into peer review.

“As an editor, when you first get a submission, at one level you’re simply filtering. A fairly small proportion do not get sent out by me for review. Sometimes they simply fall outside the scope of the journal.”

– Michael Reiss, Founding Editor of Sex Education

Step 2: First round of peer review

Next, the editor will find and contact other researchers who are experts in your field, and will ask them to review the paper. A minimum of two independent reviewers is normally required for every research article. The aims and scope of each journal will outline their peer review policy in detail.

The reviewers will be asked to read and comment on your article. They may also be invited to advise the editor whether your article is suitable for publication in that journal.

So, what are the reviewers looking for?

This depends on the subject area, but they will be checking that:

Your work is original or new.

The study design and methodology are appropriate and described so that others could replicate what you have done.

You’ve engaged with all the relevant current scholarship.

The results are appropriately and clearly presented.

Your conclusions are reliable, significant, and supported by the research.

The paper fits the scope of the journal.

The work is of a high enough standard to be published in the journal.

If you have not already shared your research data publicly , peer reviewers may request to see your datasets, to support validation of the results in your article.

Once the editor has received and considered the reviewer reports, as well as making their own assessment of your work, they will let you know their decision. The reviewer reports will be shared with you, along with any additional guidance from the editor.

If you get a straight acceptance, congratulations, your article is ready to move to publication. But, please note, that this isn’t common. Very often, you will need to revise your article and resubmit it. Or it may be that the editor decides your paper needs to be rejected by that journal.

Please note that the final editorial decision on a paper and the choice of who to invite to review is always the editor’s decision. For further details on this, please see our peer review appeals and complaints policy.

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Step 3: Revise and resubmit

It is very common for the editor and reviewers to have suggestions about how you can improve your paper before it is ready to be published. They might have only a few straightforward recommendations (‘minor amendments’) or require more substantial changes before your paper will be accepted for publication (‘major amendments’). Authors often tell us that the reviewers’ comments can be extremely helpful, to make sure that their article is of a high quality.

During this stage of the process you will have time to amend your article based on the reviewers’ comments, resubmitting it with any or all changes made. Make sure you know how to respond to reviewer comments, we cover this in the next section.

Once you resubmit your manuscript the editor will look through the revisions. They will often send it out for a second round of peer review, asking the reviewers to assess how you’ve responded to their comments.

After this, you may be asked to make further revisions, or the paper might be rejected if the editor thinks that the changes you’ve made are not adequate. However, if your revisions have now brought the paper up to the standard required by that journal, it then moves to the next stage.

Vector illustration of a pencil with the tip pointing down.

If you do not intend to make the revisions suggested by the journal and resubmit your paper for consideration, please make sure you formally withdraw your paper from consideration by the journal before you submit elsewhere.

Make sure you resubmit

If you have not already shared your research data publicly , peer reviewers may request to see your datasets to support the validation of the results in your article.

Step 4: Accepted

And that’s it, you’ve made it through peer review. The next step is production

How long does peer review take?

Editorial teams work very hard to progress papers through peer review as quickly as possible. But it is important to be aware that this part of the process can take time.

The first stage is for the editor to find suitably qualified expert reviewers who are available. Given the competing demands of research life, nobody can agree to every review request they receive. It’s therefore not uncommon for a paper to go through several cycles of requests before the editor finds reviewers who are both willing and able to accept.

Then, the reviewers who do accept the request, have to find time alongside their own research, teaching, and writing, to give your paper thorough consideration.

Please do keep this in mind if you don’t receive a decision on your paper as quickly as you would like. If you’ve submitted your paper via an online system, you can use it to track the progress of your paper through peer review. Otherwise, if you need an update on the status of your paper, please get in touch with the editor.

Many journals publish key dates alongside new articles, including when the paper was submitted, accepted, and published online. While you’re at the stage of choosing a journal to submit to, take a look at these dates for a range of recent articles published in the journals you’re considering. While each article will have a slightly different timeline, this may help you to get an idea of how long publication may take.

A 360⁰ view of peer review

Peer review is a process that involves various players – the author, the reviewer and the editor to name a few. And depending on which of these hats you have on, the process can look quite different.

To help you uncover the 360⁰ peer review view, read these interviews with an editor, author, and reviewer.

How to respond to reviewer comments

If the editor asks you to revise your article, you will be given time to make the required changes before resubmitting.

Vector illustration of a character wearing blue, holding a laptop in one hand, and other hand in their pocket.

When you receive the reviewers’ comments, try not to take personal offence to any criticism of your article (even though that can be hard).

Some researchers find it helpful to put the reviewer report to one side for a few days after they’ve read it for the first time. Once you have had chance to digest the idea that your article requires further work, you can more easily address the reviewer comments objectively.

When you come back to the reviewer report, take time to read through the editor and reviewers’ advice carefully, deciding what changes you will make to your article in response. Taking their points on board will make sure your final article is as robust and impactful as possible.

Please make sure that you address all the reviewer and editor comments in your revisions.

It may be helpful to resubmit your article along with a two-column grid outlining how you’ve revised your manuscript. On one side of the grid list each of the reviewers’ comments and opposite them detail the alterations you’ve made in response. This method can help you to order your thoughts, and clearly demonstrate to the editor and reviewers that you’ve considered all of their feedback.

If there are any review comments which you don’t understand or don’t know how to respond to, please get in touch with the journal’s editor and ask for their advice.

What if you don’t agree with the reviewers’ comments?

If there’s a review comment that you don’t agree with, it is important that you don’t ignore it. Instead, include an explanation of why you haven’t made that change with your resubmission. The editor can then make an assessment and include your explanation when the amended article is sent back to the reviewers.

You are entitled to defend your position but, when you do, make sure that the tone of your explanation is assertive and persuasive, rather than defensive or aggressive.

“Where possible, a little constructive advice on how to make use of the views of the referees can make all the difference, and the editor has the responsibility of deciding when and how to do this.”

– Gary McCulloch, Editor, British Journal of Educational Studies

What if my paper is rejected?

Nobody enjoys having their paper rejected by a journal, but it is a fact of academic life. It happens to almost all researchers at some point in their career. So, it is important not to let the experience knock you back. Instead, try to use it as a valuable learning opportunity.

Take time to understand why your paper has been rejected

If a journal rejects your manuscript, it may be for one of many reasons. Make sure that you understand why your paper has been rejected so that you can learn from the experience. This is especially important if you are intending to submit the same article to a different journal.

Are there fundamental changes that need to be made before the paper is ready to be published, or was this simply a case of submitting to the wrong journal? If you are unsure why your article has been rejected, then please contact the journal’s editor for advice.

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Some of the common reasons manuscripts are rejected

The author has submitted their paper to the wrong journal: it doesn’t fit the aims & scope or fails to engage with issues addressed by the journal.

The manuscript is not a true journal article, for instance it is too journalistic or clearly a thesis chapter.

The manuscript is too long or too short.

There is poor regard of the journal’s conventions, or for academic writing in general.

Poor style, grammar, punctuation or English throughout the manuscript. Get English language editing assistance.

The manuscript does not make any new contribution to the subject.

The research has not been properly contextualized.

There is a poor theoretical framework used. There are actio nable recommendations to improve your manuscript .

The manuscript is poorly presented.

The manuscript is libelous or unethical.

Carefully consider where to submit next

When you made your original submission, you will probably have had a shortlist of journals you were considering. Return to that list but, before you move to your second choice, you may wish to assess whether any feedback you’ve received during peer review has changed your opinion. Your article may also be quite different if it has been through any rounds of revision. It can be helpful at this stage to re-read the aims & scope statements of your original shortlisted journals.

Once you have selected which journal to submit to next, make sure that you read through its information for authors and reformat your article to fit its requirements. Again, it is important to use the feedback from the peer review process to your advantage as you rewrite and reformat the manuscript.

Is ‘transferring’ an option?

A growing number of publishers offer a transfer or cascade service to authors when their paper is rejected. This process is designed for papers which aren’t suitable for the journal they were originally submitted to.

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If your article falls into this category then one or more alternative journals from the same publisher will be suggested. You will have the option either to submit to one of those suggested journals for review or to withdraw your article.

If you choose to transfer your article this will usually save you time. You won’t need to enter all of the details into a new submission system. Once you’ve made any changes to your paper, bearing in mind previous editor or reviewer comments, the article will be submitted to the new journal on your behalf.

We have some more information about article transfers, and also some FAQs about the Taylor & Francis transfer process.

Why you should become a peer reviewer

When you’re not in the middle of submitting or revising your own article, you should consider becoming a reviewer yourself.

There are many demands on a researcher’s time, so it is a legitimate question to ask why some of that precious time should be spent reviewing someone else’s work. How does being a reviewer help you in your career? Here are some of the benefits.

Keep up with the latest thinking As a reviewer you get an early view of the exciting new research being done in your field. Not only that, peer review gives you a role in helping to evaluate and improve this new work.

Improve your own writing Carefully reviewing articles written by other researchers can give you an insight into how you can make your own work better. Unlike when you are reading articles as part of your research, the process of reviewing encourages you to think critically about what makes an article good (or not so good). This could be related to writing style, presentation, or the clarity of explanations.

Boost your career While a lot of reviewing is anonymous, there are schemes to recognize the important contribution of reviewers. You can also include reviewing work on your resume. Your work as a reviewer will be of interest to appointment or promotion committees who are looking for evidence of service to the profession.

Become part of a journal’s community Many journals act as the center of a network of researchers who are in conversation about key themes and developments in the field. Becoming a reviewer is a great way to get involved with that group. This can give you the opportunity to build new connections for future collaborations. Being a regular reviewer may also be the first step to becoming a member of the journal’s editorial board.

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Your research community needs you

Of course, being a reviewer is not just about the benefits it can bring you. The Taylor & Francis peer review survey found that these are the top 3 reasons why researchers choose to review:

Being an active member of the academic community Peer review is the bedrock of academic publishing. The work of reviewers is essential in helping every piece of research to become as good as it can be. By being a reviewer, you will play a vital part in advancing the research area that you care about.

Reciprocating the benefit Researchers regularly talk about the benefits to their own work from being reviewed by others. Gratitude to the reviewers who have improved your work is a great motivation to make one’s own contribution of service to the community.

Enjoying being able to help improve papers Reviewing is often anonymous, with only the editor knowing the important contribution you’ve made. However, many reviewers attest that it is work that makes them feel good, knowing that they have been able to support a fellow researcher.

How to be an effective peer reviewer

Our popular guide to becoming a peer reviewer covers everything you need to know to get started, including:

How to become a peer reviewer

Writing review reports: step-by-step

Ethical guidelines for peer reviewers

Reviewer recognition

Read the Taylor & Francis reviewer guidelines .

“Reviewers are the lifeblood of any journal”

– Mike J. Smith, Editor-in-Chief of Journal of Maps

Further resources

Cover of Article submission and peer review eBook

Peer Review: the nuts and bolts A guide to peer review written by early career researchers, for early career researchers and published by Sense about Science.

A guide to becoming a peer reviewer An overview of what’s involved in becoming a reviewer for a Taylor & Francis journal.

Ethical guidelines for peer reviewer Produced by COPE, the Committee on Publication Ethics, setting out the standards all peer reviewers should follow.

Using peer review effectively: quick tips Advice available to staff and students at institutions with a Vitae membership.

Publishing tips, direct to your inbox

Expert tips and guidance on getting published and maximizing the impact of your research. Register now for weekly insights direct to your inbox.

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Insights topic: Peer review

Tips on how to become a peer reviewer

Behind the scenes of peer review: meet the taylor & francis editorial office team.

Peer Review

What is peer review.

Additional support This link opens in a new window

Peer-reviewed journal articles (also called scholarly or refereed articles) are written by expert researchers and reviewed by other experts in the field. Peer review refers to a process in which information sources are examined and approved by a number of experts in that subject area before being published. Scholarly articles or books will usually be read by two or three academic reviewers who will suggest to reject or accept the article/chapters (with no, minor or major revisions) for publication. Peer-reviewed journal articles are often used as the main component of academic research. Using peer-reviewed material is a good way to make sure that the information you are receiving is creditable and correct.

Watch this video below for an introduction to the peer review process:

Where do peer-reviewed articles fit into the information timeline?

The timeline below demonstrates the creation of scholarly information, including where peer-reviewed fits in. It is very important to consider when a peer-reviewed article was published in order to understand where it fits into the scholarly conversation you are studying.

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Last Updated: Jun 30, 2023 4:32 PM
URL: https://libguides.adelaide.edu.au/c.php?g=913180

Peer-Reviewed Literature: Peer-Reviewed Research: Primary vs. Secondary

Peer-Reviewed Research: Primary vs. Secondary
Types of Peer Review
Identifying Peer-Reviewed Research

Peer Reviewed Research

Published literature can be either peer-reviewed or non-peer-reviewed. Official research reports are almost always peer reviewed while a journal's other content is usually not. In the health sciences, official research can be primary, secondary, or even tertiary. It can be an original experiment or investigation (primary), an analysis or evaluation of primary research (secondary), or findings that compile secondary research (tertiary). If you are doing research yourself, then primary or secondary sources can reveal more in-depth information.

Primary Research

Primary research is information presented in its original form without interpretation by other researchers. While it may acknowledge previous studies or sources, it always presents original thinking, reports on discoveries, or new information about a topic.

Health sciences research that is primary includes both experimental trials and observational studies where subjects may be tested for outcomes or investigated to gain relevant insight. Randomized Controlled Trials are the most prominent experimental design because randomized subjects offer the most compelling evidence for the effectiveness of an intervention. See the below graphic and below powerpoint for further information on primary research studies.

Research Design

Secondary Research

Secondary research is an account of original events or facts. It is secondary to and retrospective of the actual findings from an experiment or trial. These studies may be appraised summaries, reviews, or interpretations of primary sources and often exclude the original researcher(s). In the health sciences, meta-analysis and systematic reviews are the most frequent types of secondary research.

A meta-analysis is a quantitative method of combining the results of primary research. In analyzing the relevant data and statistical findings from experimental trials or observational studies, it can more accurately calculate effective resolutions regarding certain health topics.
A systematic review is a summary of research that addresses a focused clinical question in a systematic, reproducible manner. In order to provide the single best estimate of effect in clinical decision making, primary research studies are pooled together and then filtered through an inclusion/exclusion process. The relevant data and findings are then compiled and synthesized to arrive at a more accurate conclusion about a specific health topic. Only peer-reviewed publications are used and analyzed in a methodology which may or may not include a meta-analysis.

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Last Updated: Sep 29, 2023 10:05 AM
URL: https://ttuhsc.libguides.com/PeerReview

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How to - Devon's videos

Video Tutorial - Peer Review

What is peer review? a tutorial video by Devon Olson

What is "peer review", and is it the same as "scholarly"?

People often use "peer review" and "scholarly" interchangeably, but they aren't the same.

Peer Review

An article has been "peer reviewed" if it has been reviewed by a group of the article author's peers prior to that article being published. "Peers" of an author are anyone in a similar scholarly discipline who have the necessary expertise to judge that particular research study. Articles need to pass this peer review process before they are published, and sometimes articles have to undergo multiple rounds of review, with the author being required to edit anything from their grammar, to tables portraying data, to the structure of the article.

How do you know if an article has been peer reviewed?

There is one way to check for sure:

Look up the website of the journal that published your article
Look for a section of the website where the journal will describe their peer review process. This will sometimes be called "Information for Authors" or "Submit to the Journal" or maybe even "About". Usually it will be a drop-down from a toolbar somewhere near the center top of the webpage.
Every journal website should have a section discussing its peer-review process, and should also list the members of its editorial board (those "peers" who do the reviewing).
It's a bad sign if your journal doesn't provide this info on their website, and it may mean that your journal is not peer reviewed, though it is possible that they just have a poor website. Either way, it doesn't signal high quality.

In practice, most people assume that research articles published on a journal and listed in a database provided by a university library will be peer-reviewed, simply because non-peer reviewed articles and journals wouldn't be accepted into library databases. This isn't necessarily always true, and some databases, like CINAHL and PsycINFO, carry magazine and newspaper articles in addition to scholarly journal peer-reviewed articles.

"What is peer review?" video explanation by Devon

Peer review terminology

single blind peer review: The author does not know who the reviewers are, but the reviewers do know who the author is when they decide whether to accept or reject their article

double blind peer review : neither the author nor the reviewer know the other's identity and those details cannot influence the article's acceptance or rejection

open peer review: both the author and peer reviewer know each other's identities. This system also often means that the reviewer's comments are public, possibly meaning that they are held more accountable for their comments than if they were anonymized.

collaborative peer review: occurs on a platform provided by the journal where the author and reviewers can discuss edits and revisions to the article. Reviewers' identities may be kept anonymous or revealed at the time of publication.

third party review: authors have their articles reviewed by an independent peer review service before they submit to a journal. Then, based on the reviews, they make revisions before submitting their article to a journal.

cascading peer review: an article may be reviewed at one journal and rejected because of a misalignment with scope, and the peer reviews done at that first journal may accompany the article and be submitted alongside it when the author resubmits the article to a new journal.

Scholarly-ness and levels of evidence

Sometimes, in the health sciences and biomedical disciplines, "scholarly" means a certain level of evidence. Different types of research are considered to be higher or lower levels of evidence, and are sometimes arranged in a pyramid, called "the Pyramid of Evidence":

image: By CFCF -Licensed under Creative Commons CC BY-SA 4.0

In the above pyramid, Meta-Analyses are considered the highest level of evidence, with Case Reports being the lowest. Some other pyramids place animal research on a level below that.

Sometimes when instructors say "Find a scholarly article", what they mean is "Find primary or secondary research carried out by a qualified researcher".

Primary Research

Primary research (also known as original research) is a direct or first-hand account of research or an experience. In primary research, the author is usually the one who carried out and is reporting about their research. Randomized control trials, cohort studies, and case control studies, etc., are all primary research.

Secondary Research

Secondary research is a second-hand account. Usually, in secondary research, someone other than the original researcher is writing about the research. Meta-analyses and Systematic Reviews are secondary research because the authors collect existing research, summarize the findings, and report about that. It is a good idea to include both primary and secondary research in your study, and beginning with secondary research can give you a quick birds-eye view of the current state of a field.

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Last Updated: Jun 21, 2024 3:36 PM
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by Denise-Marie Ordway, The Journalist's Resource May 8, 2021

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As scholars and other experts rush to release new research aimed at better understanding the coronavirus pandemic, newsrooms must be more careful than ever in vetting the biomedical studies they choose to cover. One of the first steps journalists should take to gauge the quality of all types of research is answering this important question: Has the paper undergone peer review?

Peer review is a formal process through which researchers evaluate and provide feedback on one another’s work, ideally filtering out flawed and low-quality studies while strengthening others. Academic journals generally do not publish papers that have not survived the process. Researchers often share studies that have not been peer reviewed — usually referred to as working papers or preprints — by posting them to online servers and repositories.

It’s worth noting the world’s largest preprint servers for life sciences — bioRxiv — and health sciences — medRxiv — screen papers for plagiarism and content that is offensive, non-scientific or might pose a health or biosecurity risk. But there are preprint servers in other fields that do not apply the same level of scrutiny.

While peer review is intended for quality control, it is imperfect. For example, reviewers, who often are college faculty with expertise in the same field as the work they are examining, sometimes fail to detect fraud, data discrepancies and other problems. Even some of the most prestigious journals with the most rigorous peer-review processes have had to retract articles. Retractions are rare, however.

“Only about four of every 10,000 papers are now retracted. And although the rate roughly doubled from 2003 to 2009, it has remained level since 2012,” Science magazine reported in 2018 .

As of early May 2021, a total of 108 papers about COVID-19 , the bulk of which appeared in journals, had been withdrawn, according to Retraction Watch , which maintains an online database of research retractions going back decades.

Despite its flaws, researchers, overall, seem confident in peer review. During a 2019 survey of more than 3,000 researchers across disciplines in multiple countries, 85% agreed or strongly agreed that without peer review, there is no control in scientific communication. The survey — conducted by Elsevier , one of the world’s largest journal publishers, and Sense about Science , a London-based nonprofit promoting public interest in science and evidence — also finds 90% of participating researchers agreed or strongly agreed that peer review improves the quality of research.

Several published studies present similar findings. A 2017 paper in Learned Publishing indicates early career researchers are “generally supportive of peer review” but complain the process is time-consuming and that reviewers, who typically work on a volunteer basis, should be rewarded with some sort of professional acknowledgement or payment.

Regardless of the type of research journalists cover, they should have at least a basic understanding of the peer-review process and its benefits and shortcomings.

Below, we explain some of the most important aspects with help from several experts, including Diane Sullenberger , executive editor of Proceedings of the National Academy of Sciences ; Miriam Lewis Sabin , a senior editor at The Lancet ; and John Inglis , executive director of Cold Spring Harbor Laboratory Press and co-founder of bioRxiv and medRxiv.

1. Peer reviewers are not fraud detectors. They also do not verify the accuracy of a research study.

The peer-review process is meant to validate research, not verify it. Reviewers typically do not authenticate the study’s data or make sure its authors actually followed the procedures they say they followed to reach their conclusions. Reviewers, sometimes called referees, also do not determine whether findings are correct, given the data and other evidence used to reach them.

Reviewers do examine academic papers to answer a range of relevant questions. They look at whether the research questions are clear, for example, and whether the study’s design, sampling methods and analysis are appropriate for answering those questions. They also assess whether the paper answers such questions as:

Is the study explained clearly enough and in enough detail that another researcher could replicate it?
How does the study challenge or add to the body of knowledge on this topic?
Does it fit the standards and scope of the journal to which it was submitted?
If the study involves humans or animals, did the authors acquire the required approvals and meet ethical standards?
Does it give proper attribution to earlier research?

When German theologian Henry Oldenburg created the first journal dedicated to science in 1665, he considered the key functions of a research journal to be registration, certification, dissemination and archiving, writes Robert Campbell , a senior publisher at Wiley-Blackwell Publishing, in the book Academic and Professional Publishing .

Peer review is considered the gold standard for assessing research content, Sullenberger explained in an email interview. But journalists must understand it is not infallible, she added.

“Science is self-correcting through replication and reproducibility, and research fraud can be difficult to detect in peer review,” she wrote.

2. Journalists can help the public recognize the value of peer review by noting whether the studies they cover have been peer reviewed.

Scholars, research organizations and others regularly criticize news outlets for failing to explain whether new research they report on or the older studies they incorporate into their stories have undergone peer review. It’s important that journalists differentiate between peer-reviewed research and preprint papers, which often present preliminary findings.

Sullenberger told JR : “Greater clarity when journalists cover unreviewed preprints is needed; they should not be reported as having the same validity and authority as peer-reviewed research papers. “

A recent study in the journal Health Communication finds that many of the news articles written about COVID-related preprints during the first four months of 2020 did not indicate the scientific uncertainty of that research. About 43% of the stories analyzed did not mention the research was a preprint, unreviewed, preliminary or in need of verification.

At the time of that study, however, many of the journalists drawn into reporting the frenzy of stories about the pandemic were unfamiliar with preprints, Inglis says. Today, he adds, journalists covering the coronavirus are much more likely to include phrases such as “not yet peer reviewed” to describe preprints.

Sense About Science urges the public to pay attention to whether a study being discussed in a government meeting or in the media has been peer reviewed. “The more we ask, ‘is it peer reviewed?’ the more obliged reporters will be to include this information,” the organization asserts in a leaflet it created to help the public scrutinize the scientific information featured in news stories.

Knowing whether research has been peer reviewed helps a person judge how much weight to give the claims being made by its authors, Tracey Brown , the managing director of Sense About Science, explained during an interview with The Scholarly Kitchen blog.

“We have to establish an understanding that the status of research findings is as important as the findings themselves,” Brown says in a prepared statement . “This understanding has the capacity to improve the decisions we make across all of society.”

3. Peer reviewers help decide a study’s fate.

Journal editors typically assign two or more reviewers to each research paper. Some also employ a statistical specialist.

While the selection process differs, journals choose reviewers based on factors such as expertise, reputation and the journal’s prior experience with the reviewer. While it can be difficult to recruit scientists willing to examine manuscripts because of the time required for proper scrutiny, many do it because of “a sense of duty to help advance their disciplines, as well as the need for reciprocity, knowing other researchers volunteer to peer review their manuscript submissions,” Science magazine reported earlier this year .

Reviewers can make recommendations about whether a journal should accept, reject or send a paper back for minor or major revisions. Reviewers usually submit reports offering their overall impressions of a paper and suggestions for improvements. Most often, though, the final decision lies with one or more of the journal’s editors or its editorial board.

Inglis, a former assistant editor of The Lancet who is now a publisher of five peer-reviewed journals, says a common criticism of the peer-review process is its lengthy timeline, which can span from weeks to a year or more. Another complaint: Sometimes, journals send a study back and notify the authors that they would be willing to accept or reconsider the paper for publication if the authors do more research.

“Sometimes, the demands made are completely unrealistic,” Inglis adds. “The criticism from the authors is that editors don’t know that when they say ‘Do this additional experiment,’ that’s another year [added to the timeline]. Meanwhile, the work is perfectly valid.”

Inglis says bioRxiv (pronounced “bio-archive”) and medRxiv (pronounced “med-archive”) were created so researchers could disseminate preliminary versions of their papers, allowing the scientific community to immediately use and start building on those findings and data.

4. The peer-review process varies significantly among academic journals.

There are several kinds of peer review, and journals often state on their websites which one they use. The most common are single-blinded peer review, which allows reviewers to know the authors’ identities while reviewers’ identities remain anonymous, and double-blinded peer review, in which authors and reviewers are unaware of each other’s identities.

Both have advantages. Advocates argue anonymity protects reviewers from retribution. It also helps shield authors from biases based on factors such as gender, nationality, language and affiliations with less prestigious institutions, Tony Ross-Hellauer , a postdoctoral researcher at the Know-Center in Austria, writes in “ What is Open Peer Review? A Systematic Review ,” published on the European open access platform F1000Research in 2017.

Keeping identities secret can create problems, however.

“At the editorial level, lack of transparency means that editors can unilaterally reject submissions or shape review outcomes by selecting reviewers based on their known preference for or aversion to certain theories and methods,” Ross-Hellauer writes. He adds that reviewers, “shielded by anonymity, may act unethically in their own interests by concealing conflicts of interest.”

A newer type of peer review, called open peer review , is not as prevalent. But the scientific community has ongoing discussions about whether its greater transparency might help improve research quality.

While there is no universally accepted definition of open peer review, also known as open identity peer review, the identities of both authors and reviewers typically are made known to each other. Ross-Hellauer notes that disclosing reviewers’ names may force them “to think more carefully about the scientific issues and to write more thoughtful reviews.”

A growing number of journals are posting not just the papers they accept but also the feedback peer reviewers gave the papers’ authors.

5. Peer review continues to evolve.

Some journals have started initiating peer review after a paper is published instead of beforehand, although this still is not common. MedEdPublish , an online scholarly journal, is one of those that employ post-publication peer review . Its papers undergo peer review on the website by members of the medical education community, which could include the journal’s editor, members of its editorial board or a panel of reviewers.

Under the MedEdPublish model, a paper has undergone formal peer review after at least two members of the journal’s review panel evaluate it. The paper can be critiqued and improved over time as a living document on the journal website.

“Post-publication peer review follows an open and transparent process, which aims to avoid editorial bias while increasing the speed of publication,” according to the website. “We use an ‘open identities’ principle, whereby all reviewers submit their feedback publicly, under their own name, and everyone visiting an article page can see all peer review reports, referee names, and comments, and can join the discussion if they wish.”

Another noteworthy shift: Some journals are working to diversify their pools of reviewers by ensuring women, racial and ethnic minorities, and scientists from other countries help appraise and select studies for publication.

Research indicates the overwhelming majority of experts chosen as reviewers are men. A study published earlier this year in Science Advances examines internal data for 145 scholarly journals across fields and finds that women comprised 21% of their reviewers between 2010 and 2016. At journals dedicated to biomedical and health research, 24.6% of reviewers were women.

The Lancet medical journal has set targets for increasing the number of women and scientists from low- and middle-income countries, Sabin, one of its senior editors, wrote in an email interview with JR . In 2019, The Lancet family of journals announced its Diversity Pledge .

“We track, monitor, and report representation of authors, reviewers, and editorial advisors by gender and across geography,” Sabin told JR in an e-mail.

She added that the journal formed a task force late last year to, among other things, examine its policies and processes to find ways to increase the representation of experts who are racial and ethnic minorities.

The Coalition for Diversity and Inclusion in Scholarly Communications has focused on the issue globally. More than 90 organizations have adopted the coalition’s Joint Statement of Principles , which aims to “promote involvement, innovation, and expanded access to leadership opportunities that maximize engagement across identity groups and professional levels.”

Identity groups include racial and sexual minorities, military veterans, pregnant women, parents and people from lower social classes and socioeconomic backgrounds.

The Journalist’s Resource would like to thank Rick Weiss, the director of SciLine, and Meredith Drosback, SciLine’s associate director of science, for their help in creating this tip sheet.

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For analysis articles The BMJ has fully open peer review. This means that accepted analysis papers submitted from February 2016 onwards usually have their prepublication history posted alongside them on bmj.com.

This prepublication history comprises previous versions of the manuscript, reports from the manuscript committee meeting(s), reviewers’ comments, and the authors’ responses to comments from reviewers and editors.

In rare instances we may determine after careful consideration that we should not make certain portions of the prepublication record publicly available. For example, in cases of stigmatised illnesses we seek to protect the confidentiality of reviewers who have these illnesses. In other instances there may be legal or regulatory considerations that make it inadvisable or impermissible to make available certain parts of the prepublication record.

In all instances in which we have determined that elements of the prepublication record should not be made publicly available, we expect that authors will respect these decisions and also will not share this information.

For commissioned series of articles, the prepublication history captures the formal submissions, paper-based peer review, and revisions uploaded and registered in our online submission system. The prepublication history does not capture the proceedings of the numerous author meetings, correspondence outside the online system, and in-person editorial and peer review that often accompany the appraisal and development of commissioned series. It also does not include prepublication histories of papers commissioned but ultimately rejected from the series of articles.

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A systematic review of peer-reviewed gender literature in sustainability science

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Published: 15 June 2024

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Elisabeth Frank 1 ,
Rike Mühlhaus 2 ,
Katinka Malena Mustelin 3 ,
Esther Lara Trilken 4 ,
Noemi Katalin Kreuz 5 ,
Linda Catharine Bowes 6 ,
Lina Marie Backer 7 &
Henrik von Wehrden 8

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We conducted a systematic review of the available peer-reviewed literature that specifically focuses on the combination of sustainability and gender. We analyzed the existing peer-reviewed research regarding the extent to which gender plays a role in the empirical literature, how this is methodologically collected and what understanding of gender is applied in those articles. Our aim is to provide an overview of the current most common fields of research and thus show in which areas gender is already being included in the sustainability sciences and to what extent and in which areas this inclusion has not yet taken place or has only taken place to a limited extent. We identified 1054 papers that matched our criteria and conducted research on at least one sustainable development goal and gender research. Within these papers (i), the overall number of countries where lead authors were located was very high (91 countries). While the majority of lead authors were located in the Global North, less than a third of the articles were led by authors located in the Global South. Furthermore, gender is often just used as a category of empirical analysis rather than a research focus. We were able to identify (ii) a lack in coherent framing of relevant terms. Often no definition of sustainability was given, and only the sustainability goals (SDGs or MDGs) were used as a framework to refer to sustainability. Both gender and sustainability were often used as key words without being specifically addressed. Concerning the knowledge types of sustainability, our expectation that system knowledge dominates the literature was confirmed. While a problem orientation dominates much of the discourse, only a few papers focus on normative or transformative knowledge. (iii) Furthermore, the investigated literature was mainly contributing to few SDGs, with SDG 5 ‘Gender Equality’ accounting for 83% of all contributions, followed by SDG 8 ‘Decent Work and Economic Growth’ (21%), SDG 3 ‘Good Health and Well-being’ (15%) and SDG 4 ‘Quality Education’ (12%). We were additionally able to identify seven research clusters in the landscape of gender in sustainability science. (iv) A broad range of diverse methods was utilized that allow us to approximate different forms of knowledge. Yet within different research clusters, the spectrum of methodologies is rather homogeneous. (v) Overall, in most papers gender is conceptualized in binary terms. In most cases, the research is explicitly about women, running the risk that gender research in sustainability sciences grows into a synonym for women's studies.

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Introduction

The progression of climate change and further environmental degradation have direct ecological and social consequences that affect and will affect people differently according to different structures of social inequality (Kaijser and Kronsell 2014 ; Johnson et al. 2022 ; Thompson-Hall et al. 2016 ). This insight is important insofar as it sheds light on the fact that environmental problems and climate change will not have the same effects globally, but are context specific and related to power and domination structures (see contextualized vulnerability O’Brien et al. 2007 ) and must therefore be analyzed accordingly (Hackfort 2015 ; Johnson et al. 2022 ). However, sustainability science is not only dedicated to analyzing the problems that we will face as a result of ecological exploitation in ecological, social and economic terms, but also attempts to develop solution-oriented strategies and provide policy advice (von Wehrden et al. 2017 ). Therefore, it is equally important to reflect this power and domination-critical perspective in the search for solution options and to include different stakeholders (Malin and Ryder 2018 ). One specific issue that should be analyzed in connection with sustainability science problems and solution development is gender. As many studies have already shown, the effects of climate change and other problems resulting from the exploitation of natural resources have a gender-specific (Dankelman 2010 ; Denton 2002 ; MacGregor 2010 ) or intersectional impact (Kaijser and Kronsell 2014 ; Johnson et al. 2022 ; Thompson-Hall et al. 2016 ). Even though the unequal impacts of, e.g., climate change in terms of gender have been researched empirically in many areas such as agriculture (Agarwal 1998 ; Alston and Whittenbury 2013 ; Glazebrook et al. 2020 ), migration (Chindarkar 2012 ; Lama et al. 2021 ) and natural disasters (Enarson and Chakrabarty 2009 ; Neumayer and Plümper 2007 ), to date there has been no systematic recording of the research field of gender in the sustainability sciences. Our focus in this review is to give a broad overview of the current state of art regarding the topic of gender in sustainability science. We analyze the existing research regarding the extent to which gender plays a role in the empirical literature, how this is methodologically collected and what understanding of gender is applied in those articles. Our aim is to provide an overview of the currently most common fields of research and thus show in which areas gender is already being included in the sustainability sciences and to what extent and in which areas this inclusion has not yet taken place or has only taken place to a limited extent. Before describing our research focus in more detail, we first define our two main concepts, namely sustainability and gender.

We refer to sustainability based on the widely quoted definition by the Brundtland report from 1987 as meeting present needs without compromising the ability to compromise the needs of future generations (Brundtland 1987 ). Furthermore, our sustainability understanding includes an integrational perspective, also referred to as nested circles model, meaning that sustainability builds on economic, social and ecological dimensions that are interdependent and interconnected (Lozano 2008 ; Odrowaz-Coates 2021 ). In this framework in opposition to others, the economic and social pillars are not independent from the environmental dimension, but instead depend on it (Mebratu 1998 ).

Sustainability science addresses the challenges that threaten the long-term security of societal development conditions by distinguishing three levels that need to be researched: the systemic level to create system knowledge, the normative level to map out target knowledge and the operative level that aims to develop transformative knowledge (Brandt et al. 2013 ; Grunwald 2007 ; Michelsen and Adomßent 2014 ). System knowledge aims at describing and understanding a given social and/or ecological system via descriptive analysis. This often is disciplinary empirical research to analyze the dynamics, root causes and underlying mechanisms of the identified problem or system. System knowledge tries to reflect the current state of a system and its ability to change (Brandt et al. 2013 ; Grunwald 2007 ; von Wehrden et al. 2017 ; Wiek and Lang 2016 ). After identifying a problem and being able to describe it, target or normative knowledge is important to indicate the perception and direction of change. By asking what a desirable future situation could look like, target knowledge provides an orientation and an aim toward the development of solution options. This knowledge is normative since it asks which values are important when developing solutions to the identified problem (Grunwald 2007 ; von Wehrden et al. 2017 ). To then be able to address real-world place-based problems, transformative or action-oriented knowledge is necessary. By developing evidence-supported solutions, transformative knowledge offers possible transition paths from the current to the desirable situation (Grunwald 2007 ; von Wehrden et al. 2017 ; Wiek and Lang 2016 ). This action-oriented knowledge which aims at solving and mitigating the identified context-specific problem represents the main gap to this day (von Wehrden et al. 2017 ). While there are diverse and multi-faceted approaches in sustainability science (Clark and Harley 2019 ), we use the sustainable development goals as a lens of analysis. We agree that the conceptual foundation of sustainability is very diverse, and have mentioned the root literature above. However, the sustainable development goals can be seen as a main policy basis that currently attempts to shift the world toward a more sustainable development. While we agree that many conceptual foundations exist to this end, we focus on the SDGs since these contain a diversity of topical focuses, including gender.

Within the domain of sustainability, this review focuses on the diverse scientific literature published under the term of ‘gender’. We refer to gender as a historical construct consisting of attributes, norms, roles, opportunities, responsibilities and expectations that are socially, culturally and institutionally embedded and produce certain gender identities and social constructs (Arevalo 2020 ; Lieu et al. 2020 ; Mechlenborg and Gram-Hanssen 2020 ). Consequently, gender is not ‘given’ but learned and therefore dynamic and changing across a diverse and fluid spectrum (Curth and Evans 2011 ; Moyo and Dhliwayo 2019 ). Furthermore, we acknowledge the ‘intersectional’ nature of gender, i.e., the idea that one’s gendered experience of life overlaps and interacts with other axes of identity and systems of oppression (Richardson 2015 ).

Gender and environment

Now that we have defined the two core concepts of this article, sustainability and gender, we proceed to briefly summarize the state of research on gender in environmental and sustainability sciences. Before sustainability was declared a central part of international development in the 1990s and gender issues were incorporated in those development frameworks from the early 2000s, activists and researchers drew attention to the links between environmental degradation and gender inequality as early as the 1970s, with a particular focus on the disadvantages faced by women (Levy 1992 ; Mehta 2016 ). This early field of research called ecofeminism postulated an intrinsic relationship between women and nature based on their shared reproductive capacity (Majumdar 2019 ). Ecofeminism unites many currents and movements. Some of these take up an essentialist and biologistic understanding of gender, e.g., Shiva ( 1988 ), Mies and Shiva ( 1995 ), Agarwal ( 1992 ), Hackfort ( 2015 ). Women are understood as caring and nurturing by nature and at the same time suppressed by patriarchy as always being inferior and dominated by men (Agarwal 1992 ). Ecofeminists identified that the exploitation of women as well as of nature occurs in similar patterns, which is why it was assumed that "all women would have the same kind of sympathies and understandings of environmental change as a consequence of their close connection to nature [as well as their shared experience in exploitation]" (Majumdar 2019 , p. 72). Politically, these arguments and claims were taken up by the Women in Development (WID) approach which was adopted by many development agencies and NGOs in the 1970s. They argued that because of women's unique relationship with the environment as well as their particular affection by the effects of environmental degradation, women should receive special attention in global economic development (Levy 1992 ; Mehta 2016 ; Sasser 2018 ). Over the years, the arguments and theories of the essentialist view of ecofeminism outlined above have been widely criticized (e.g., Agarwal 1992 ). Many feminist researchers have pointed out that concepts of nature and gender are socially and historically constructed and not biologically determined (Agarwal 1992 ; Gottschlich et al. 2022 ; Levy 1992 ). Furthermore, the depiction of women as a unitary was declared insufficient, as gender must be considered and analyzed in combination with other forms of oppression such as race, class, caste and so on (Agarwal 1992 ; Häusler 1997 ; Levy 1992 ).

What is disputed, however, is not that the oppressive relationship between gender and nature exists, but how it is justified and how it should be responded to Gottschlich et al. ( 2022 ). One of the most recited critiques stems from the Indian economist Bina Agarwal ( 1992 ), who, instead of an essentialist derived connection between nature and gender, adopts a materialist perspective to describe the link between Indian women and the environment (Agarwal 1992 ; Gottschlich et al. 2022 ). Agarwal points out that a gendered and class-based organization of production, reproduction and distribution results in differential access to natural resources and ecological processes (Agarwal 1992 ). For example, women’s responsibility for certain natural resources is based on the gendered division of labor as well as class-specific ownership and property relations. This ascription can also be seen as dependence of women on these natural resources to make a living, which often entails a greater sensitivity to the respective ecological processes (Agarwal 1992 ; Gottschlich et al. 2022 ; Sasser 2018 ). Agarwal terms this research perspective ‘feminist environmentalism’ (Agarwal 1992 ). As a further development of feminist environmentalism, feminist political ecology (FPE) emerged in the 1990s, which takes a more holistic, intersectional perspective regarding gender on the connections between gender and nature (see for example Rocheleau et al. 1996 ; Gottschlich et al. 2022 ; Sasser 2018 ). FPE focuses explicitly on gender-specific power relations, which are considered in their historical, political and economic contexts, as well as across a range of scales (Gottschlich et al. 2022 ; Mehta 2016 ). Possible research foci include, for example, gender-specific access to natural resources and an intersectional and decolonial approach to environmental degradation and ecological change, as well as ecological conservation and sustainable development (Gottschlich et al. 2022 ; Mehta 2016 ; Sasser 2018 ). FPE questions the so far dominating victimizing narratives and stereotypes of women often from the Global South and emphasize instead their agency in, for example, highlighting their resistance practices and activism (MacGregor 2020 ). As research from feminist environmentalism and feminist political ecology has broadened the perspective on the connections between gender and the environment, new approaches have also been sought at the international political level. The focus and programs now shifted toward gender and development (GAD) which addresses all genders. GAD approaches also acknowledge socially constructed gender roles as the cause for gender inequality and aim at creating different forms of empowerment from a grassroots, bottom-up perspective that includes, for example, women as active participants in development from the beginning (Sasser 2018 ). The last concept which we want to highlight is queer ecology that was developed from the 2010s onward, e.g., Mortimer-Sandilands and Erickson ( 2010 ). Queer ecology analyzes and critically reflects the dominant human–environment relationships in terms of the underlying heteronormative order of the gender binary. The queer perspective expands feminist political ecology by deconstructing the 'naturalness' of heterosexual desire and the associated heteronormative relations of reproduction and production. The queer theoretical perspective questions the heterosexual nuclear family as the basic economic unit of the household and instead expands the view of social re-production by focusing on queer care relationships (Bauhardt 2022 ; Hofmeister et al. 2012 ).

Gender and sustainability

Research integrating gender as well as insights and theories from gender studies into sustainability science is relatively new and as we will see is not yet an established cornerstone in this research field. Nevertheless, scholars so far have already presented some important aspects as to why and how gendered perspectives should be integrated into sustainability science. Both gender studies and sustainability science are inherently normative sciences. They aim both at system knowledge about existing inequalities and unsustainable structures and their causes, but at the same time also gaining transformational knowledge about how inequalities can be reduced and resolved to create a more just world (Hofmeister et al. 2012 ). Both research fields position themselves as inter- and transdisciplinary and furthermore conduct their research across different scales, spatial as well as temporal (Bürkner 2012 ; Jerneck et al. 2011 ; Martens 2006 ; Rodenberg 2009 ). Feminist analyses and the integration of gender into sustainability science can however help integrate social and historical contexts more comprehensively in the analysis of socio-ecological systems as well as contribute to the development of suitable policy instruments for reducing gender inequalities and expanding adaptive capacities by contributing a social science perspective (Hackfort 2015 ; Hofmeister et al. 2012 ; Littig 2002 ). Feminist scholarship especially enhances sustainability science research by including analysis of power relations. Research interests within sustainability science should uncover the prevalent power relations in nature–society relationships and deconstruct them at various levels (Hackfort 2015 ; Hofmeister et al. 2012 ). Furthermore, feminist analysis critiques the claims of objective, universal and (gender) neutral scientific research and instead emphasizes the generation of situated knowledge that adopts partial perspectives which cannot be understood in isolation from its context (Hofmeister et al. 2012 ).

While the concept of gender is already explored within some research areas of sustainability science literature (Eger et al. 2022 ; Khalikova et al. 2021 ; Meinzen-Dick et al. 2014 ), the current state of the art remains widely unclear (Gottschlich et al. 2022 ; Hackfort 2015 ).

Research interests

Thus, in this paper, we explore the heterogeneous research area of gender in sustainability science by means of a systematic literature review of the peer-reviewed literature to identify prevalent research foci, trends and gaps. We focus on five research interests outlined in the following.

Bibliometric indicators

Firstly, we create a bibliometric overview of the scientific literature on gender in sustainability, thereby giving an account of the geographic origins, contexts and affiliations of authors as well as geographic tendencies concerning both authorships and study locations. Moreover, we closely examine definitions and perceptions of gender within the given research. Here, we differentiate between two applications: (1) gender as a specific empirical category and (2) gender as the general research topic. We focus on analyzing whether articles use gender as one of several variables in their empirical research or focus on gender as a central research topic. Our aim here is to examine whether research to date has addressed gender in a rather superficial way or whether and in which cases deeper analyses of gender and sustainability are taking place.

Sustainability definitions

Our second research interest centers around specific definitions of sustainability, which we acknowledge to be diverse and often incoherent within the available literature. We examine which sustainability concepts are predominantly used in the reviewed articles as well as if and how sustainability is defined. By identifying the diverse understandings of sustainability within gender research, we explore the different ways that specific concepts of sustainability and gender are intertwined. In addition, we link these notions to the three knowledge types we described above, system, target and transformative knowledge. These different types of knowledge are all important when conducting transdisciplinary research as is done in sustainability science (Wiek and Lang 2016 ). They all fulfill important steps when approaching wicked problems such as climate change or gender equality and build the basis for a comprehensive understanding which is needed when dealing with multifaceted and complex problems (von Wehrden et al. 2017 ). Our research interest is to analyze what kind of knowledge there is already in regard to gender in sustainability science and to present a state of the art which knowledge types are prevalent and which need more attention in the future. To this end, we assume that systemic, descriptive knowledge (Brandt et al. 2013 ; CASS et al. 1997 ) is decreasing over time, yet still expect to find overall less papers creating target or transformative knowledge.

Sustainable development goals and gender equality

Thirdly, we focus our scope of research on articles linked to at least one of the sustainable development goals (SDGs) (United Nations 2015 ). Building on and extending the Millennium Development Goals, the SDGs provide an umbrella of sectors which the examined research articles can be attributed to and/or associate themselves with. The SDGs were agreed on by the United Nations as “a comprehensive, far-reaching and people-centered set of universal and transformative Goals and targets” (United Nations 2015 ). Applying the lens of the SDGs allows us to narrow down the range of articles related to sustainability, while acknowledging they do not provide an ultimate, but a prominent framework. In view of the SDGs as forming an entity of interlinked targets which are aimed at fostering simultaneous, overarching developments (Toth et al. 2022 ), we want to find out whether the papers are equally distributed to the SDGs or whether a few SDGs are dominating the discourse. This approach makes it possible to compare the number of research articles on gender associated with individual goals as well as to highlight clusters of SDGs which are prevalently mentioned together. By deriving research areas which are represented in a smaller share, we identify possible future areas to focus on.

In the fourth research interest, we concentrate on the methods used in the reviewed articles. Research within gender studies and feminist research are dominated by qualitative methods. Many scholars investigate their research interests regarding gender and gender equality by applying qualitative methods which document the subjects’ experiences and perspectives in their own terms (Gaybor 2022 ; Harcourt and Argüello Calle 2022 ). We determine clusters of methods used and how these connect to the knowledge types of sustainability and also to the respective SDGs that each article targets. Based on that, we are able to specify certain research clusters which can be grouped according to their generated knowledge and applied methods as well as thematic focus. This gives us information about which methods dominate in which research fields, to what extent they differ and which methods have not been used much to date.

Definition and understanding of gender

Finally, we aim to draw conclusions on definitions and understandings of gender in sustainability science and how these have changed over time. There cannot be a general historical account of the understanding of gender as it must always be specific to societies, cultures and regions of the world. For instance, the Western academic understanding of gender has undergone certain fundamental changes in the past century (Haig 2004 ; Muehlenhard and Peterson 2011 ). In this paper, we focus on two changes, namely (i) the constructivist turn which conceptualizes gender as not biologically determined in a binary of man and woman, but instead socially constructed (Fenstermaker 2013 ; West and Zimmerman 1987 ) and (ii) the acknowledgment of the ‘intersectional’ nature of gender (Bürkner 2012 ), i.e., the idea that one’s gendered experience of life overlaps and interacts with other axes of identity and systems of oppression (Crenshaw 1989 ; Richardson 2015 ). We explore if these important developments in the understanding of gender are reflected in the temporal distribution of the reviewed literature. Moreover, we detect correlations between (non-)binary, (non-)intersectional understandings of gender and research clusters/fields of sustainability.

In this review, we attempt to systematize a complex and heterogeneous field of research, which is why we are aware that this aim entails the risk of uncovering inconsistencies, renewing them or even creating them. We do not claim that our research interests and choice of methods are the ‘correct’ ones to systematically assess the topic of gender in sustainability science, but rather to provide an overview of which topics and methods have dominated the field of research to date, how these can be located in light of sustainability science concepts such as knowledge types or the SDGs as well as how individual international contributions can be used constructively for the further development of the subject area.

The paper is organized as follows. In section two, we describe the methods used, followed by the presentation of our results in section three. In section four, we discuss these results and give an account of their methodological limitations. Finally, we conclude by reflecting upon the results of this review and postulate future research implications.

Our systematic literature review was based on a quantitative bibliometric content analysis of the available literature. We thus created a broad overview of the state of the literature, with a particular focus on the key interests named in the introduction.

We identified articles via the Scopus database (Elsevier B.V 2020 ). Scopus was chosen as it contains natural science as well as social science articles. Additionally, Scopus allows for the search and preview of abstracts, which was helpful for conducting the systematic review.

We applied a search string containing the two words ‘gender AND sustainab*’. The initial search resulted in 5993 papers for the period of 1991–2021. We restricted our search to this time period because hardly any literature was available before, and most journals have no online record before. We excluded books, conference papers and book chapters and limited the review to articles that were published in English.

Inductively we created the following criteria: the included articles must

be able to be assigned to at least one SDG and

have gender as a research focus, and not only as a category of analysis.

Since the review focuses on gender in sustainability science, we needed at least two criteria for the inclusion of the articles. For one, the paper should make a clear link to sustainability, since this term is often used as a buzzword and we tried to exclude any literature that mentioned the concept only vaguely or in passing, such as in the first part of the introduction of the latter parts of the discussion. Regarding the first exclusion criteria, we decided to use the SDGs as one possible framework that reflects our understanding of sustainability science topics, and that can be seen as the current policy baseline. For our analysis, this meant in practical terms that we checked whether the topic of an article could be assigned to at least one SDG and, if so, which one. The extent to which the article addresses the SDGs themselves did not play a role here.

The second criterion to include a paper in the full-text analysis refers to the realization of gender. When conducting a pre-test with a random sample of articles, we realized that many articles just used gender as one of many variables in their empirical research and that the focus of the research question lay upon something completely different, where gender was a mere building block or one of many variables. To be able to narrow down our sample, we decided to only include articles that focus on gender as a central research interest. Therefore, we always read the respective abstracts to be able to determine whether a thorough research focus on gender was given or not.

Based on these criteria, we excluded 4959 articles. The remaining 1054 papers were coded according to the following five questions:

Does the article create system knowledge, target knowledge and/or transformative knowledge? The definitions for the three individual types of knowledge were extracted and applied from various articles, as already detailed in the introduction (see: Brandt et al. 2013 ; Grunwald 2007 ; Michelsen and Adomßent 2014 ).

Which SDGs can be assigned to the article? Which sustainability concepts and definitions were named?

Which methods were used in the article? We inductively grouped the respective methods into categories.

Does the article conceptualize gender as binary, as non-binary and/or as social constructs?

Does the article consider gender as the only category of analysis? Were further social categories addressed as well or is there an intersectional approach? Other social categories were specified in such cases.

A team of seven coders worked on the literature review in an iterative process. We coded the papers separately as well as together and clarified possible pitfalls in the criteria to minimize ambiguities. The respective categories were then summarized in a table which was the basis of all statistical analysis of the content.

Furthermore, we are interested in investigating whether there are specific research clusters within the domain of gender in sustainability science. Our aim is to identify the dominant fields of research that deal with gender and sustainability and to characterize these in more detail on the basis of the above-mentioned research interests. To derive groups out of the reviewed papers, we used a linguistic approach that classifies all papers into groups based on their word abundance. Within this analysis, we compiled all words in a document containing all papers, and the respective x–y table was clustered into groups according to Ward ( 1963 ). To visualize the respective groups, we used a detrended correspondence analysis (Abson et al. 2014 ), which allows for a descriptive analysis of the linguistic patterns of the literature. The groups were illustrated by significant indicator words that we identified by an indicator species analysis. Based on this multivariate linguistic approach, we derived seven unbiased groups of the reviewed literature, which are solemnly based on the word abundance of the papers. All statistical analyses were conducted with the R Statistical Software (v4.2.2; R Core Team 2022 ).

We identified a total of 1054 papers, out of which almost half were published after 2017 (48%) (Fig. 1 ).

Total numbers of papers published per year

While some journals contain a relatively high proportion of papers (e.g., Sustainability 65 articles, Gender and Development 31 articles, World Development 21 articles, Gender, Place and Culture 14 articles, Corporate Social Responsibility and Environmental Management 14 articles), there is no dominating journal, and articles are published in a total of 566 journals. Lead authors originate mainly from the USA (19.9%), UK (11.5%), Australia (5.8%), Canada (4.6%), India (4.5%), South Africa (4.4%), Spain (4.3%) and Germany (4.2%). Lead authors from Sweden, Netherlands, Nigeria, Italy, China, Austria, Indonesia, South Korea, Denmark, Turkey, Norway and Switzerland published more than 1%, but less than 4% of the papers. All other countries have less than 1% of the lead authors in proportion (see online appendix 1). These numbers must be interpreted particularly in the aspect that only English articles were included in the analysis.

The vast majority of the papers (844) are empirical, and 113 papers utilize gender as a category within the empirical analysis. Roughly, a third of all the articles analyze gender in combination with other social categories. The most researched intersection is between gender and class (also specified as income differences), followed by the intersection between gender and race. Concerning the utilization of the SDGs, 83% of all papers research on Gender Equality (SDG 5). Decent Work and Economic Growth (SDG 8) is included in 20% of all papers. Good Health and Well-being (SDG 3) and Quality Education (SDG 4) are mentioned by about 15% of all papers. All other SDGs are mentioned by less than 10% of the papers (Table 1 ).

The majority of concrete definitions regarding sustainability built on the SDGs (137); the Millennium Goals are mentioned by some 40 papers, the Brundtland report by 23, Agenda 21 by 16, while all other frameworks such as the Kyoto protocol (2), national strategies (2), Rio declaration (2), IPCC (1), the Three Pillar Framework (1), Corporate Sustainability (1) and Club of Rome (1) are mentioned less often. Concerning the knowledge types, system knowledge clearly dominates, with stronger ties to normative knowledge and slightly weaker ties to transformative knowledge. All three types of knowledge are only achieved by few (31) papers (Fig. 2 ).

Distribution of knowledge types

Concerning the use of scientific methods, the most abundantly applied methods are literature reviews (22.5%), closely followed by interviews (22%). Statistical approaches are used by 12,7% of the papers, closely followed by methods of participatory research (10.4%), case study approaches (10.6%) and surveys (9.8%). Other methods are less abundantly used, including ethnographic approaches (3.6%), discourse or content analysis (2.7%) or systematic literature review (2.7%) (Fig. 3 ).

Percentage of papers using certain scientific methods

The majority of papers consider a binary gender understanding. While there was an increase in the absolute total number of papers that considered a socially constructed gender understanding overall, the proportion of papers falling into this category did decrease.

In the following section, we introduce the different groups derived from multivariate analysis, and present key characteristics of the individual groups (Fig. 4 ).

Research clusters with number of relevant contributions and the five most significant words that statistically indicate the research clusters

Cluster 1: gender equality and institutions

The first cluster, which contains 207 papers, emerged first in 1991 and is thus the oldest cluster. The proportion of articles displays a diverse activity, having peaked in 2020. The research focuses on the institutional commitment toward gender equality (Hennebry et al. 2019 ; Kalpazidou Schmidt et al. 2020 ; Larasatie et al. 2020 ). The topical focus encompasses entrepreneurship (Kamberidou 2020 ; Kravets et al. 2020 ; Vershinina et al. 2020 ), especially concerning the empowerment of women in social enterprises (Allen et al. 2019 ; Benítez et al. 2020 ; Green 2019 ), yet also research regarding peace building (Adjei 2019 ; Kim 2020 ; Turner 2020 ), foreign policy (Agius and Mundkur 2020 ; Cohn and Duncanson 2020 ) and security (Curth and Evans 2011 ; Mahadevia and Lathia 2019 ; Rothermel 2020 ) is conducted. These focal points are reflected in the usage of the most mentioned SDGs, 8 (decent work), 10 (reduced inequalities), and 16 (peace, justice and strong institutions). About one-quarter of the articles channel sustainability through SDGs and MDGs or the Brundtland report as well as the Agenda 21. The research questions of nearly all articles aim at generating system knowledge, yet more than half of them also create normative knowledge. Besides gender, half of the papers include other social categories in their analysis, mostly focusing on class, race, sexuality and ethnicity. A binary gender framing is mainly used, yet one-quarter of the articles acknowledge gender to be a social construct. Most of the papers are qualitative case studies utilizing interviews or ethnographic approaches.

Cluster 2: gender in health and well-being

The second cluster, consisting of 165 papers, emerged in 2003 and is closely related to the first and the 6th cluster. The topical focus of this cluster is on health equity and the impacts of gender on health services (Manandhar et al. 2018 ; Scheer et al. 2016 ; Thresia 2018 ), for instance concerning the evaluation or assessment of health programs (Friedson-Ridenour et al. 2019 ; Williams et al. 2009 ). Next to barrier identification (Kennedy et al. 2020 ; Sawade 2014 ; Sciortino 2020 ) and empowerment strategy assessment (Maluka et al. 2020 ; Plouffe et al. 2020 ; Yount et al. 2020 ), system knowledge is created through qualitative assessment strategies such as methods of participatory research and interviews. A considerable number of papers discussed health equity also in terms of motherhood, especially maternal health and maternal mortality rates were covered often (Klugman et al. 2019 ; Morgan et al. 2017 ). One-quarter of the articles reference sustainability through SDGs and MDGs. About one-third of the articles also apply other social categories in their analysis, mostly adding the concept of class but also ethnicity, race and religion. While the papers in this cluster widely build on a binary gender framework, many concern gender inequalities, especially aiming at low- and middle-income countries and communities.

Cluster 3: gendered access to resources

Cluster number three, which contains 244 papers, started to emerge in 1995, with the majority of papers being published between 2017 and 2020. According to the word abundance analysis, this cluster partly overlaps with cluster number two and six. On the one hand, the papers in this cluster focus on the assessment of inequalities and gender-specific barriers. Specifically, they examine the structural discrimination as well as underrepresentation of women in certain areas (Crockett and Cooper 2016 ; Ennaji 2016 ; Lama et al. 2017 ; Woodroffe 2015 ). Two areas that are analyzed most often are the limited access to specific natural resources respective institutions such as water (Andajani-Sutjahjo et al. 2015 ; Pandya and Shukla 2018 ; Singh and Singh 2015 ), energy (Burney et al. 2017 ), education (Ansong et al. 2018 ) and healthcare (Rivillas et al. 2018 ; Theobald et al. 2017 ). Secondly, the limited and ineffective opportunities to participate in decision-making processes, for example, in politics (Dyer 2018 ; Lama et al. 2017 ; Sindhuja and Murugan 2018 ), agriculture (Azanaw and Tassew 2017 ) and at the workplace (Limuwa and Synnevåg 2018 ; Rohe et al. 2018 ). The identification of different challenges which women face in regard to participation and representation clash with the fact that the women in these cases often bear the responsibility for survival and sustainability of the respective community (Belahsen et al. 2017 ; Garutsa and Nekhwevha 2016 ; Limuwa and Synnevåg 2018 ; Rohe et al. 2018 ). Apart from this problem-oriented focus creating system knowledge, quite many articles in this cluster offer evidence-based recommendations and solution strategies on how to improve those inequalities by suggesting possible areas of intervention such as enforcing legislation, mentorship, quotas, financial inclusion, etc. (Ansong et al. 2018 ; Appiah 2015 ; Burney et al. 2017 ; Mello and Schmink 2017 ; Saviano et al. 2017 ). The authors emphasize that adaptation strategies and policy-making must be gender sensitive and critically reflect gender-specific circumstances, vulnerabilities and experiences (Garai 2016 ; Rakib et al. 2017 ; Rivillas et al. 2018 ; Shanthi et al. 2017 ; Theobald et al. 2017 ). Some papers channel sustainability through SDGs and MDGs or the Brundtland report as well as the Agenda 21. About 50 papers focus on class or caste, race, ethnicity and religion as categories apart from gender. A binary gender framing is mostly used, and studies are predominantly qualitative case studies utilizing interviews, surveys or methods of participatory research.

Cluster 4: gender inequality in public infrastructure

Cluster four contains 191 papers with first publications in 1997 and the majority of the papers being published between 2017 and 2020. The thematic focus of this cluster lies upon gender inequality in public infrastructure. The articles mainly apply a problem-oriented lens while addressing different areas of gender discrimination in which safe, affordable and sustainable access to certain institutions of public infrastructure is not given. Three areas are analyzed most often: gendered mobility investigates gender differences in travel patterns and modal split (Abasahl et al. 2018 ; Winslott Hiselius et al. 2019 ; Kawgan-Kagan 2020 ; Le et al. 2019 ; Mitra and Nash 2019 ; Polk 2003 ), gendered barriers in public transportation (Al-Rashid et al. 2020 ; Malik et al. 2020 ; Montoya-Robledo and Escovar-Álvarez 2020 ) as well as gender discrimination within transport planning and policy-making (Kronsell et al. 2016 , 2020 ; Wallhagen et al. 2018 ). The second area discusses gendered access to healthcare, mostly referring to services providing counseling and treatment for victims of gender-based violence (Betron et al. 2020 ; Minckas et al. 2020 ; Prego-Meleiro et al. 2020 ), sexual and reproductive health rights (Bosmans et al. 2008 ; Lince-Deroche et al. 2019 ; Loganathan et al. 2020 ) and HIV prevention as well as treatment (Gómez 2011 ; Ssewamala et al. 2019 ). The third area analyzes gendered access to education (Burridge et al. 2016 ; Islam and Siddiqui 2020 ). The majority of the papers create systemic knowledge. Notably, many papers are published in the journal ‘Sustainability’ and several articles contain ‘women’ in the papers’ title. A few articles reference sustainability by mentioning the SDGs and the Brundtland report. About 40 papers mention interlinkages with other types of social categories and do not solely focus on gender in their analysis. The gender framing is mostly binary. The methodology in this cluster utilizes most often literature reviews or case studies conducting interviews or surveys.

Cluster 5: gender inequalities in agricultural systems

This cluster consists of 102 papers, and dates back to 1995. Since 2017, its contribution is slowly increasing. The research within this cluster can be grouped into four aspects and widely generates system knowledge. The majority of the research focuses on gender roles and how these influence interactions with(in) local systems such as forestry (Benjamin et al. 2018 ; Nhem and Lee 2019 ; Stiem and Krause 2016 ), agriculture (Drafor et al. 2005 ; Ergas 2014 ; Fischer et al. 2017 ), fisheries (Tejeda and Townsend 2006 ; Szymkowiak and Rhodes-Reese 2020 ; Torell et al. 2019 ), water (Imburgia 2019 ; Singh 2006 , 2008 ) and the energy sector (Buechler et al. 2020 ; Stock 2021 ; Wiese 2020 ). One topical focus is about participation of women in decision-making and planning processes (Ihalainen et al. 2020 ; Mulema et al. 2019 ; Pena et al. 2020 ). Another focus aims at gender differences in climate adaptation and conservation strategies (Abdelali-Martini et al. 2008 ; Rao et al. 2020 ; Wekesah et al. 2019 ). Furthermore, many papers investigate challenges women face in (agricultural) resource control and management (Badstue et al. 2020 ; Pehou et al. 2020 ) as well as in the access to markets and the distribution of land (Holden and Tilahun 2020 ; Meinzen-Dick et al. 1997 ). Lastly, a considerable number of papers discuss gendered climate vulnerabilities and risk management (Friedman et al. 2019 ; Yadav and Lal 2018 ; Ylipaa et al. 2019 ). These research interests are also reflected in the mentioned SDGs, which are 15 (life on land), 8 (decent work), 2 (zero hunger) and 1 (no poverty). Only very few papers channel sustainability through SDGs and MDGs. About one-third of the articles also include other social categories in their research, mostly adding the concept of class but also religion, age, race and ethnicity. Regarding the understanding of gender about 10% perceive gender to be a social and cultural construct and only one mentions a non-binary understanding of gender. The majority of the papers conduct qualitative case studies, often combined with interviews, surveys or methods of participatory research. Papers within this cluster mostly report about local projects conducted in low- and middle-income countries of the Global South.

Cluster 6: inclusion of gender equality in sustainable development

Cluster six contains 45 articles and emerged in 1992. The number of published papers within this cluster fluctuated widely over the years, yet since 2019 the proportional contribution is slowly increasing. In contrast to the other clusters, the papers in this group are not centered around a certain topic, but rather focus on a general discussion regarding the inclusion of gender issues in research on sustainable development, yet here scholars mainly apply problem-oriented empirical research on gender inequalities, discrimination and biases often on a national scale. Those gender inequalities are often referred to as gender gap and focus mostly on political representation (Azmi 2020 ; Kreile 2005 ; Purwanti et al. 2018 ; von Dach 2002 ), access to education (Assoumou-ella 2019 ; Cortina 2010 ; Cheng and Ghajarieh 2011 ; Suvarna et al. 2019 ) and participation in natural resource management (Sasaki and Chopin 2002 ; Valdivia and Gilles 2001 ; Yadav and Sharma 2017 ). These topical areas also overlap with the mentioned SDGs, 4 (quality education), 8 (decent work), 3 (good health and well-being) and 16 (peace, justice and strong institutions). Gender equality is thus highlighted as one of the most important tasks in sustainable development. A few articles reference sustainability by mentioning the SDGs and the Brundtland report. About 20% of the articles also add further social categories apart from gender when analyzing inequalities in sustainable development. Besides gender, most of these focus on race and class. While a mere half of the papers in this cluster are conceptual, the rest conduct mainly qualitative case studies utilizing interviews, surveys and methods of participatory research. Studies range across the global and the country or local level.

Cluster 7: gender diversity and corporate performance

The last cluster is a recently emerging research area with contributions starting from the year 2016 onward. The 44 contributions in this cluster focus on human resource characteristics, primarily the gender diversity of boards (Orazalin and Baydauletov 2020 ; Romano et al. 2020 ; Xie et al. 2020 ) and the sustainable performance of firms or other organizations (Burkhardt et al. 2020 ; Mungai et al. 2020 ; Ozordi et al. 2020 ). The cluster as such is very homogenous with many contributions sharing similarly phrased research questions and a local approach that is reflected in either the focus on organizations in a certain geographic region or of a specific economic sector. This is also reflected in the most often mentioned SDG 8 (decent work and economic growth). Nevertheless, two research angles can be differentiated within this cluster which both contribute to create system knowledge: one angle investigates the relationship between gender representation and indicators of corporate social responsibility (CSR) (Tapver et al. 2020 ; Valls et al. 2020 ; Yarram and Adapa 2021 ), corporate environmental performance or specific sustainable policies (Birindelli et al. 2019 ; Elmagrhi et al. 2018 ; García Martín and Herrero 2020 ), while another more economic angle investigates the relationship between gender representation and the limitation of risks for ‘sustainable’ i.e., continuous growth (Gudjonsson et al. 2020 ; Loukil et al. 2019 ; Suciu et al. 2020 ). In their findings, most papers tend to highlight gender-(binary-)based differences in morality or ethics. There is no intersectional approach or other social categories in the articles, as well as nearly no sustainability references. The majority of the papers conducted quantitative research utilizing statistics.

In the introduction, we set out five research interests for this systematic literature review. Based on the research clusters, we revisit these focal points and embed our findings into the current debate.

(i) Regarding bibliometric data, while the overall number of countries with lead authors is very high with 91 countries, there is a tendency that the majority of lead authors are from the Global North, and less than a third of the articles are led by authors located in the Global South. This depicts an overall determined imbalance of publication origins as shown by Blicharska et al. ( 2017 ), Collyer ( 2018 ), Jeffery ( 2014 ), Karlsson et al. ( 2007 ) and Rokaya et al. ( 2017 ). Previous accounts found a domination of SDG-related publications from European regions (Sweileh 2020 ). Within our analysis, all of the countries from which most lead authors come are listed OECD countries and can thus be described as belonging widely to the Global North (Blicharska et al. 2017 ), underlining the data gap between the Global North and the Global South (Karlsson et al. 2007 ). A comparable imbalance was found regarding the countries most affected by climate change which are equally underrepresented in environmental science (Blicharska et al. 2017 ). This is even more pronounced since researchers from the Global North tend to hold higher posts within research teams, compared to those from the Global South (Jeffery 2014 ). Such power imbalances can, however, be tackled by a higher contextual transparency in the research conduct (Maina-Okori et al. 2018 ), and other SDG-aimed research reviews show a similar bias toward the European regions (Sweileh 2020 ), while for instance SDG 5 was least researched in the Western Pacific regions. Deeper contextual information is often omitted in research papers due to the demand in brevity; there are counterexamples that incorporate the author's background into the research context (Maina-Okori et al. 2018 ).

The proportion of papers that utilizes gender as a research focus was less than 10% and thus relatively low. Based on the word-driven analysis, we identify clear groups differentiated based on the topical focus, methodological approaches and theoretical foundation. The literature ranges from rather qualitative and discourse-oriented approaches to more survey and interview-driven literature. A second gradient in the literature ranges across different systems, for instance from agricultural systems to different organizations and their development.

(ii) Concerning our second research interest, we identify a lack in coherent framing of relevant terms. Often no definition of sustainability is given, and only the sustainability goals (SDGs or MDGs) are used as a framework to refer to sustainability. With other diverse sources such as the Brundtland report and the WCED 1987 as well as the Agenda 21 and the Rio Conference 1992 being cited to define the sustainability understanding of the respective paper, it is clear that a coherent and uniting framing of sustainability science is still lacking in this specific scientific literature. After all, these sources are quite old, and much has been published since (e.g., Clark 2007 , etc.). One article we want to highlight that situates itself both within sustainability science and includes a gendered perspective is by Ong et al. ( 2020 ). They classified their research on queer identities within tourism and leisure research as social sustainability, arguing that social sustainability advocates equal opportunities and human rights for both individual and social well-being (Ong et al. 2020 ). Another paper which we want to mention is that by Maina-Okori et al. ( 2018 ) because it argues from a perspective that was taken up very little by the analyzed articles. They call for the inclusion of Black feminist thought and Indigenous knowledge in sustainability science research as well as the reflection on colonial history, which is not given enough attention in research on climate protection, education for sustainable development or land use rights. Concerning the knowledge types of sustainability (systemic, normative and transformative), our expectation that system knowledge widely dominates the literature was confirmed, with a combination of systemic and normative as well as systemic and transformative knowledge being also abundantly published. We cautiously interpret this as a reflection of the research we investigated on partial knowledge, while an overarching integration of knowledge types is needed for many of the sustainability challenges we face, including the ones associated with gender. While a problem orientation dominates much of the discourse, only few papers focus on normative or transformative knowledge. In their paper on environmental justice in urban mobility decision-making, for instance, Chavez-Rodriguez et al. ( 2020 ) combined all three knowledge types. First, they dismantled how discourses and narratives on urban mobility are often socially exclusionary and reproduce patterns of marginalization (systemic knowledge). They then argued that environmental justice as an intersectional system must include mobility justice (normative knowledge). In the end, they proposed a framework definition of ‘queering the city’ which shall help to create a more emancipatory narrative on urban mobility (transformative knowledge) (Chavez-Rodriguez et al. 2020 ). However, the small proportion of papers doing this indicates a lack of an overarching perspective when it comes to the diverse knowledge types, which can be considered relevant to overcome the problems we face globally.

(iii) Concerning the third research interest, the investigated literature mainly contributed to few SDGs, with SDG 5 ‘Gender Equality’, SDG 8 ‘Decent Work and Economic Growth’, SDG 3 ‘Good Health and Well-being’ and SDG 4 ‘Quality Education’ being in the main focus. All other SDGs were mentioned by less than 10% of the papers. This underlines that most scientific papers are rather focused than holistic when viewed through an SDG perspective. While no research can meaningfully engage with all SDGs, we would propose that a wider coverage of other SDGs to be engaging more in gender research would be beneficial.

Furthermore, SDGs are often mentioned as a boundary framework while missing the chance to deeply engage with the conceptual foundation or purpose of the SDG framework. Within the vast majority of papers, the SDGs are referred to as a means to the end of positioning the research within a current discourse. In other words, many papers do not work with the SDGs to contribute toward its strategies and solutions, but instead to simply be affiliated to the broad movement of sustainable development. This reference often takes place in the introduction or conclusion of the paper and is of no importance in the actual research. This gives the impression that the popularity of the SDGs, which goes beyond the discourse of sustainability science, is used to categorize or identify one's own research within the light of sustainability.

However, there are many constructive contributions toward a critical perspective on the integration of the Sustainable Development Goals. Ong et al. ( 2020 ) highlight that queer identities are not included within the SDGs, yet they relate their research to several SDGs such as SDG 5, 10, 11 and 16. They argued that “these goals demonstrate the centrality of inclusivity to the development of sustainable communities'' (Ong et al. 2020 , p. 1477). Poku et al. ( 2017 ) went one step further and postulated the need to queer the SDGs by linking opportunities for addressing social exclusion for LGBTI in Africa to the SDGs.

(iv) Based on the set of the literature we analyzed, all in all, gender and sustainability research utilize a broad range of methods that allow for different forms of knowledge (Spangenberg 2011 ). However, we find strong links between specific methods and certain areas of sustainability within the emerging groups within the identified literature. For example, nearly all research in cluster seven, which focuses on corporations and economy, uses a quantitative statistical approach, while other clusters are defined by qualitative methods and lack quantitative ones. This methodological homogeneity within certain research clusters highlights already established preferences for certain methods in specific fields of research, disciplines and focal topics where some methods are more adequate than others. Due to the interdisciplinary nature of gender and sustainability, however, we critically regard these links as they often emerge from previously existing research traditions and thus lack methodological plurality.

(v) Within the examined literature, the two investigated understandings of gender, namely non-binarity and intersectionality, are differently acknowledged and incorporated in the reviewed literature. Very few authors challenge the gender binary approaches within the considered scientific articles, where less than a fifth of the papers considered gender to be socially constructed (14%) or non-binary (5%). While the vast majority of papers do not explicitly state that they build on a binary understanding of gender, they nevertheless replicate or suggest a binarity in their focus and/or empirical categorization that clearly indicates a binary division. Moreover, some papers put forward ethical or moral differences in men and women when it comes to sustainability. For example, some researchers are led by gender assumptions which often originate from the field of eco-feminism such as women being more caring of the environment, since they have a natural disposition to care and to being a mother (Brough et al. 2016 ; Lau et al. 2021 ). When such proposals do not pay attention to gender norms and power imbalances, they run the risk of further naturalizing the gender binarity as ‘immutable biological differences’ (Lau et al. 2021 ). Lastly, we find that gender differences are nearly always illustrated on behalf of women. While an explicit focus on women’s lives in research can be useful and necessary, it should not be limited to it. A narrow focus on women excludes many other genders from research and can furthermore evoke the assumption that gender equality and sustainability are ‘women’s issues’ (Lau et al. 2021 ).

No pattern regarding the temporal increase or decrease of non-binary or socially constructed gender understanding can be found in the body of literature examined by us, in absolute numbers or in proportions.

In summary, theories and findings from gender studies like the constructivist turn and queer theory as well as intersectionality are yet to permeate the field of sustainability research.

Within the examined research, there is clearly a limited acknowledgment of intersectionality, with less than a third of all articles using other social categories apart from gender in their analysis or applying even an intersectional approach. Intersectionality was thus applied in diverse research cluster groups underlining the importance for a diverse methodological approach to investigate intersectionality (Rice et al 2019 ). Intersectionality is most frequently addressed in the research cluster focusing on gender and institutions, meaning that this literature named and utilized the concept. We refrained from making a deeper analysis of whether more than one social category was analyzed, which would demand a deeper text analysis. We refrained from such interpretation, because due to the short form of peer-reviewed papers such information is often omitted or not coherently reported. However, intersectionality often is hardly mentioned in the analyzed papers, neither as a word nor as a concept. Instead, different identity categories than gender are merely used to further characterize the research subject(s). For instance, Theobald et al. ( 2017 ) referred to intersectionality in their research regarding gender mainstreaming within health and neglected tropical diseases, highlighting the impact of gender on health issues while acknowledging the intersection of gender with other axes of inequality. They illustrated how dimensions of gender interact with poverty, (dis)ability, occupation, power, geography and other individual positionalities in shaping impacts on health and care programs (Theobald et al. 2017 ).

The concept of intersectionality is applied on a diversity of topics. As Rice et al. ( 2019 ) point out, there is also “no single method for undertaking intersectional research. It can be used with many methods and approaches, quantitative and qualitative” (Rice et al. 2019 , p. 418). In addition to previously mentioned example papers from our analysis focusing on tourism as well as sustainability education, there are suggestions to match the SDGs with an intersectional conceptualization (Stephens et al. 2018 ; Zamora et al. 2018 ). Similarly, attempts to integrate intersectionality to other long standing policy communities such as global health exist (Theobald et al. 2017 ). Hardy et al. ( 2020 ) integrate the concept into research on indigenous youth. Such papers showcase the strong connectivity of the concept to many different branches of research. By integrating diverse voices, showcasing how injustices are intertwined and that different reasons for injustices amplify each other, intersectionality can serve as a strong foundational concept within sustainability science (Maina-Okori et al. 2018 ). Our review showcases that the majority of papers focusing on gender do not utilize the concept. Within the analyzed literature, overall citation rates are comparably low and the most highly cited papers do not utilize the concept. In summary, intersectionality has not fully reached the sustainability science community as of yet.

Before we come to our final conclusions, we would like to again reflect upon our positionality as scholars researching this topic. We recognize that we as scholars have a highly privileged position in academia as well as the world, both regarding resources and the institutions at which we are working in that make our voices heard. We would like to use this position to address the existing power dynamics within sustainability science to other equally privileged scholars. We hope to reflect upon and challenge the deeply embedded power structures within Western academic knowledge production as well as considering the role gender inclusive and intersectional approaches can play in addressing sustainability problems. This paper is a mere attempt to grasp the research that has so far been conducted upon gender in sustainability science, and from our end a definitive work in progress. Yet, this is then also the ultimate goal in writing this paper, to progress, even if it is only one step at a time.

Finally, we would like to give an outlook on what findings have been published in the period following our research period. For this purpose, we again entered our search string in the Scopus database and searched for articles on gender in sustainability science for the period January 2021 to October 2022. This search yielded a further 2.304 articles after applying our exclusion criteria. To narrow the analysis, we sorted these results by citation and looked at the articles with the highest citations. This cursory scan reveals that many papers consider gender only as an empirical category of analysis, and that these are thematically related to the field of economics and health, for example, with regard to the COVID-19 pandemic. Only a few focus on gender as a central research interest. These results also largely coincide with the results of this review. As a perspective, we would like to highlight the COVID-19 pandemic once again, because the analyses and studies that have been conducted in connection with gender can shed new light on the role of gender during global crises and are therefore an important contribution to sustainability science.

We have systematically examined the development and state of research focusing on gender in sustainability science by means of a quantitative analysis of 1054 peer-reviewed papers published between 1991 and 2021. Our analysis clearly illustrates that while a diverse body of literature on gender exists within sustainability science, several research clusters with different focal points are emerging. As all these branches of the literature utilize diverse methodological approaches and different conceptual foundations; there is a lack of a more holistic integration of the topic within the broader literature. While the word “holistic” is a clearly big claim, we can underline based on our review that conceptual foundations, definitions and agreement on the most simple terms and procedures are lacking to this day, while at the same time the problems of gender issues are mounting.

It is highly likely that the recent surge in literature will increase. Thus, we put forward five tangible suggestions on how the research community could further evolve below.

Although a research focus on gender will not solve the prevalent problem of postcolonial research structures, an increasing diversity of voices with different backgrounds would bring forth new and diverse knowledge. At this point, we would like to draw particular attention to the theories and bodies of knowledge of Black feminists, as well as Indigenous knowledge and decolonial approaches.

We advise the research community to build on distinct definitions of sustainability as well as to put a strong focus on the contribution toward solutions for sustainability challenges. The creation of descriptive-analytical system knowledge which outlines the current status quo of gender equality with regards to sustainability and points out many current problems is a necessary and helpful first step. Yet, knowing the mechanics and causes of a problem does not translate into knowing how to approach and move toward a state of more equality. We therefore urge scholars to also apply a solution-oriented perspective in their research regarding gender in sustainability science.

Moreover, although there is seemingly much research that discusses gender issues, only a low proportion of those papers actively engage with gender on an empirical level. To achieve the goal of a world with less inequalities, more research should enable deep normative understandings of diverse and inclusive recognitions of gender identities and associated social, economic and cultural consequences as well as investigate pathways of transformation and sustainable change. While such normative claims may facilitate ethical evaluations, more work is needed to enable an inclusive understanding of the context of such evaluations.

All in all, the emerging research clusters showcase that there are engaged researchers that focus on gender within sustainability science. However, there are gaps between the clusters where for example a recognition of intersectionality would hold benefits for more researchers, and a higher methodological plurality may benefit knowledge production, to name two examples. What is clear is that within sustainability science, gender issues are widely ignored to this day, and based on the systematic review we conducted, we can encourage more research on gender issues and diversity.

When gender is integrated as an analytical foundation or a concept associated with gender is being utilized within sustainability science, the critical perspective that the academic field of gender studies has developed over the past decades is seldom integrated, e.g., theories on the social construction of gender, queer theory and Black feminist theory. The concept of intersectionality should especially be further acknowledged, as it may shed a stronger light on perceived and endured injustices and give hope for a greater involvement of researchers not only to investigate these issues, but also to help to overcome them.

While our review only focuses on peer-reviewed literature and thus can only offer a specific perspective, we hope yet to offer a contribution to the bigger picture, thereby creating a link between gender and sustainability.

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Textbox definitions

Intersectionality.

The concept of intersectionality describes the ways in which systems of inequality intersect, or interlock, to create unique dynamics and effects. Popularized by Crenshaw ( 1989 ), this idea was expressed one of the first times by the Combahee River Collective in 1977. The collective pinned down how their identity as queer, middle-class, Black women led to a specific and distinct experience of oppression and exclusion, resulting in the need to develop an “integrated analysis and practice based upon the fact that the major systems of oppression are interlocking” (Combahee River Collective 1977/ 2018 ). Even though the historical focus of intersectionality was on gender, race and class, the concept is not limited to these axes of social difference, but can and should include many more items such as, for example, disability or sexuality (Bührmann 2009 ; Butler 1990 ; Lutz 2002 ; Nash 2008 ).

We refer to gender as a historical construct consisting of attributes, norms, roles, opportunities, responsibilities and expectations that are socially, culturally and institutionally embedded and produce certain gender identities and social constructs (Arevalo 2020 ; Lieu et al. 2020 ; Mechlenborg and Gram-Hanssen 2020 ). Consequently, gender is not ‘given’ but learned and therefore dynamic and changing across a diverse and fluid spectrum (Curth and Evans 2011 ; Moyo and Dhliwayo 2019 ). In this paper, we focus on two important aspects, namely (i) the idea that gender is not biologically determined in a binary of man and woman but instead socially constructed and (ii) the acknowledgment of the ‘intersectional’ nature of gender, i.e., the idea that one’s gendered experience of life overlaps and interacts with other axes of identity and systems of oppression (Richardson 2015 ).

Sustainability

We refer to sustainability based on the widely quoted definition by the Brundtland report from 1987 as meeting present needs without compromising the ability to compromise the needs of future generations (Brundtland 1987 ). Furthermore, our sustainability understanding includes an integrational perspective, also referred to as nested circles model, meaning that sustainability builds on economic, social and ecological dimensions that are interdependent and interconnected (Lozano 2008 ; Odrowaz-Coates 2021 ). In this framework, in opposition to others, the economic and social pillars are not independent from the environmental dimension, but instead depend on it (Mebratu 1998 ).

Global North/Global South

Since there is no agreed definition of these terms, we use the definition by Martins ( 2020 ) as well as Odeh ( 2010 ). The distinction between Global North and Global South is not a mere geographical one, but has its roots in colonialism and imperialism. It is important to mention that neither the North nor the South are homogeneous. The global South refers broadly to a grouping of countries that are agrarian based and experience economic and political marginalization within the global system. Global South countries often have a shared history of colonization and exploitation. The global North refers to regions traditionally referred to as ‘the West’ such as Europe, North America and Australia, among others. These countries are wealthy, technologically advanced, politically stable and aging as well as dominate the Global South in international trade (Martins 2020 ; Odeh 2010 ).

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Frank, E., Mühlhaus, R., Mustelin, K.M. et al. A systematic review of peer-reviewed gender literature in sustainability science. Sustain Sci (2024). https://doi.org/10.1007/s11625-024-01514-5

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Published on 20.6.2024 in Vol 26 (2024)

Effects of Peer- or Professional-Led Support in Enhancing Adherence to Wearable Monitoring Devices Among Community-Dwelling Older Adults: Systematic Review of Randomized Controlled Trials

Authors of this article:

Colette Sze Wing Chan, BSc ;
Mandy Ming Pui Kan, MSc ;
Arkers Kwan Ching Wong, PhD

School of Nursing, The Hong Kong Polytechnic University, Hung Hom, China (Hong Kong)

Corresponding Author:

Arkers Kwan Ching Wong, PhD

School of Nursing

The Hong Kong Polytechnic University

GH 502, The Hong Kong Polytechnic University

Hung Hom, 00000

China (Hong Kong)

Phone: 852 34003805

Email: [email protected]

Background: Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing guidance on the purpose and benefits of using WMDs, facilitating goal-setting aligned with the device’s features, promoting comprehension of the health data captured by the device, and assisting in overcoming technological challenges, peers and health care professionals can potentially enhance older adults’ adherence to WMDs. However, the effectiveness of such support mechanisms in promoting adherence to WMDs among older adults remains poorly understood.

Objective: The aims of this systematic review were to examine the effects of peer- or professional-led intervention programs designed to improve adherence to WMDs among community-dwelling older adults and to identify the intervention components that may positively influence the effects of the intervention.

Methods: We conducted a comprehensive search across 7 electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, EMBASE, PsycINFO, British Nursing Index, Web of Science, and CINAHL) to identify articles published between January 1, 2010, and June 26, 2023. We specifically targeted randomized controlled trials that examined the impact of peer- or professional-led interventions on enhancing adherence to WMDs among individuals aged 60 years and older residing in the community. Two independent reviewers extracted data from the included studies and assessed the potential risk of bias in accordance with the Cochrane Risk of Bias tool for randomized trials, version 2.

Results: A total of 10,511 studies were identified through the database search. Eventually, we included 3 randomized controlled trials involving 154 community-dwelling older adults. The participants had a mean age of 65 years. Our review revealed that increasing awareness of being monitored and implementing the SystemCHANGE approach, a habit change tool focusing on personal goals and feedback, were effective strategies for enhancing adherence to WMDs among older adults. All of the included studies exhibited a low risk of bias.

Conclusions: By collaboratively designing specific goals related to WMDs with health care professionals, including nurses and physicians, older adults exhibited a higher likelihood of adhering to the prescribed use of WMDs. These goal-setting tools provided a framework for structure and motivation, facilitating the seamless integration of WMDs into their daily routines. Researchers should prioritize interventions that target awareness and goal-setting as effective approaches to enhance adherence to WMDs among older adults, thereby maximizing the realization of associated health benefits.

Introduction

The global population is ageing at an unprecedented speed, with the number of people older than 65 years expected to double from 1 billion in 2020 to 2.1 billion in 2050 [ 1 ]. The World Health Organization has transformed this challenge into an opportunity by putting forward the concept of “healthy ageing,” which is about creating an environment that enables older adults to age with good health and well-being [ 2 ]. However, to put this concept into practice, older adults, who are usually living with multiple chronic health conditions, have to be competent in carrying out self-management activities, such as medication management, health monitoring, and fall prevention. This is more easily said than done, although it is not impossible with the help of emerging digital self-management technologies.

Wearable monitoring devices (WMDs) are a common digital technology specifically designed to help people take charge of their own health and develop an individualized care or treatment plan. WMDs, which include but are not limited to activity trackers, pedometers, and smartwatches, are useful for collecting a wide range of personal health data in real time, such as blood pressure and heart rate, and revealing an individual’s physical movements, GPS location, and calorie expenditure [ 3 ]. Not only can WMDs ensure the safety of users by the early screening of symptoms, but they can also empower users to continuously measure their health and well-being independently without the help of family members or health care professionals. Previous studies have demonstrated that WMDs are particularly effective for older adults with chronic diseases. A systematic review of the effectiveness of WMDs reported that WMDs could bring about a noticeable increase in daily step count and moderate-to-vigorous physical activities, although its impact on reducing sedentary behavior was found to be insignificant [ 4 ].

Despite the benefits provided by WMDs, studies suggested that the rate of adherence to WMDs among older adults is low. A study showed that 1 in 3 adults abandoned the use of WMDs within 6 months after purchasing one, while those aged 70 years and older discontinued its use after only 2 weeks [ 5 ]. Nonadherence to WMDs affects the completeness of health data and impairs early detection of the aggravation of a disease, which will eventually have a negative impact on the health of users [ 6 ]. Previous studies indicated that the characteristics of a WMD, such as its ease of use, size, security and privacy setting, and maintenance cost, as well as the characteristics of older adults, such as their technological competence and perception of the usefulness of the WMD, are some factors that may influence the intention of users to keep using the WMD [ 5 , 7 - 9 ].

Peers or health care professionals are crucial in promoting the long-term use of WMDs among older adults [ 10 - 12 ]. The literature suggests that these people can help older adults gain insights into the purpose of using the WMD, facilitate the planning and setting of goals with regard to the features of the WMD, understand the health data captured in the WMD, and overcome technological difficulties [ 11 , 13 , 14 ]. However, to the best of our knowledge, there has been no systematic review evaluating the effects of these peer- or professional-led intervention programs on improving long-term adherence to WMDs among older adults or identifying the specific components in these programs that can lead to positive effects. Conducting such reviews could help researchers and policy makers design targeted strategies to promote the use of WMDs, ultimately leading to better health monitoring and improved health care outcomes.

This review aims to explore the effects of peer- or professional-led intervention programs on enhancing adherence to WMDs among community-dwelling older adults and to disentangle the following research questions:

What existing interventions have been designed to improve adherence to WMDs among community-dwelling older adults?
What are the effects of these interventions on adherence to WMDs among community-dwelling older adults?
What intervention components may positively influence the effects of interventions aimed at enhancing adherence to WMDs?

Database Selection and Search Strategy

This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [ 15 ] guidelines, and the protocol was registered on PROSPERO (CRD42023395459).

A total of 7 electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, EMBASE, PsycINFO, British Nursing Index, Web of Science, and CINAHL) were searched to identify articles published between January 1, 2010, and June 26, 2023. A combination of search strings related to “wearable monitoring devices,” “older adults,” “intervention program,” and “adherence” were used. A complete search strategy for each database is shown in Multimedia Appendix 1 . A manual search of the reference lists of the included articles was performed to identify additional relevant articles.

Study Selection

This review intended to summarize evidence regarding the effectiveness of peer- or professional-led interventions on improving adherence to WMDs among community-dwelling older adults by comparing those who did and did not receive the intervention. For this review, our definition of peer-led and professional-led interventions referred to how peers and health care professionals contributed to promoting adherence to WMDs. The eligibility criteria were developed using the PICO (population, intervention, comparison, and outcomes) process.

Inclusion and Exclusion Criteria

Articles on studies that adopted a parallel randomized controlled trial (RCT), cluster RCT, or crossover RCT were eligible for inclusion in the current review if the study participants were community-dwelling older adults (with or without chronic diseases) aged ≥60 years using a WMD (population); a peer-led or professional-led intervention that sought to improve WMD adherence was tested (intervention); a comparison was made with participants not exposed to the interventions (comparison); and their adherence to the WMD was measured (outcomes). Meanwhile, articles were excluded if they were in a language other than English or Chinese; involved institutionalized or hospitalized patients; involved patients who were cognitively impaired or physically limited, making them incapable of adhering to the WMD; and focused mainly on the clinical outcomes of using WMD.

Screening Process

Articles identified from databases were imported to EndNote 20 to remove duplicates. All titles and abstracts were first independently screened by 2 reviewers (MMPK and CSWC) based on the eligibility criteria to identify potential articles. The 2 reviewers then independently reviewed the full text of these articles to determine whether the articles satisfied the selection criteria. Disagreements were resolved by consensus with a third reviewer (AKCW).

Data Extraction and Appraisal of the Methodological Quality

The 2 independent reviewers extracted data from the included studies to a Microsoft Excel template sheet and assessed the potential risk of bias in the studies, in accordance with the Cochrane Risk of Bias tool version 2 (RoB 2) for randomized trials [ 16 ]. The corresponding authors of the included articles were contacted for missing data or clarification, if necessary.

The data extracted from each eligible article included the following study characteristics:

Methods: country and periods during which the study was conducted, study design, and dropout rate
Participants: characteristics of all the participants by groups (eg, the number of participants, their mean age, gender, ethnicity, educational level, and socioeconomic status)
Features of the WMDs
Interventions: description of the intervention type, provider, content, frequency, and duration
Outcomes: adherence, sustained usage, and time points

The RoB 2 tool addressed the biases that potentially affect the results of an RCT in five domains: (1) bias arising from the randomization process; (2) bias due to deviations from intended interventions; (3) bias due to missing outcome data; (4) bias in measuring the outcome; and (5) bias in selecting the reported result. The level of bias in each domain and the overall risk of a study were judged to be either a “low risk of bias,” “some concerns,” or a “high risk of bias” [ 16 ].

Data Synthesis

We have included qualitative studies in our research and presented a summary of the findings in a narrative format. We conducted both a thematic synthesis, following the narrative synthesis guidelines established by Popay et al [ 17 ], and a more theory-driven analysis to interpret the results.

A total of 10,511 studies were identified from searching the databases. After removing 1624 duplicated studies, 8887 articles were screened based on their titles and abstracts. The full texts of 33 articles that were deemed eligible were then assessed. Finally, 3 articles were selected for the current review. No further articles were identified from the reference list of the included articles. The complete study selection process is illustrated in Figure 1 .

Study Characteristics

Of the 3 selected studies, 2 were conducted in the United States [ 18 , 19 ], and 1 was conducted in the Netherlands [ 20 ]. The study with the highest dropout rate (75.4%) was that by Lutjeboer et al [ 20 ]. All 3 articles used a 2-arm parallel-group RCT design [ 18 - 20 ].

Table 1 summarizes the 3 articles that were included in this study, which involved a total of 154 participants. The mean age of the participants was 65 years. The percentage of female participants ranged from 41.7% to 61.8%. Two studies focused on older adults who had undergone a kidney transplant [ 18 , 19 ], while the remaining study involved older adults with no major health problems [ 20 ]. The older adults in the included studies had a relatively high level of education, with more than half possessing an associate degree or higher [ 18 , 19 ]. The majority of participants in the two studies had an annual household income of more than US $20,000 [ 18 , 19 ]. This suggests that, in general, the participants had a fair to high socioeconomic status.

Author; year; country	Design	Sample size, n	Dropout rate (%)	Mean age (year); female participants (%)	Study population; ethnicity	Education level	Information about the WMD	Randomized ratio	Intervention arm 1	Comparison arm (intervention arm 2)	Outcomes measure and time points	Results	Intervention component
Lutjeboer et al (2020) [ ]; Netherlands	Parallel RCT	55	75.4	65.9; 1.8	Adults who received their first pair of orthopedic footwear for a health condition; NS	NS	Custom-made orthopedic footwear with a temperature sensor to measure use and nonuse of orthopedic footwear	1:1	Aware of the temperature on the sensor that measures use and nonuse (n=25)	Only knew the shoe temperature was being measured (n=30)	Adherence to orthopedic footwear reflected by wearing time in weeks 6 to 12	Intervention group: 7.32 hours/day; control group: 6.11 hours/day	Conscious awareness of WMD adherence being monitored enhances adherence to WMD
O’Brien et al (2020) [ ]; United States	Parallel RCT	53	11.7	65.4; 41.7	Older kidney transplant recipients; 98% non-Hispanic	58% of participants had an associate degree or higher; over 90% had an income of > US $20,000	Fitbit Charge 2 activity tracker measuring daily steps	1:1	Multicomponent physical activity intervention SystemCHANGE (ie, personal system-based solutions support with visual feedback from the activity tracker; n=27)	Standard educational information about posttransplant (n=26)	Adherence to wearing the activity tracker at 6 months	Intervention group: 100%; control group: 92.3%	Tailored individual activity goals with visual feedback from WMD promotes adherence to WMD
O’Brien et al (2021) [ ]; United States	Parallel RCT	46	23.3	65.4; 41.7	Older kidney transplant recipients; 87% non-Hispanic	52% of participants had an associate degree or higher; 77% had an income of >US $20,000	Fitbit Charge 2 activity tracker measuring daily steps	1:1	Multicomponent physical activity intervention SystemCHANGE (ie, personal system-based solutions support with visual feedback from the activity tracker; n=23)	Standard educational information about posttransplant healthy lifestyle choices (n=23)	Adherence to wearing the activity tracker at 12 months	Intervention group: 96.5%; control group: 80.8%; odds ratio 6.6 (95% CI 2.1-21.2)	Tailored individual activity goals with visual feedback from WMD promotes adherence to WMD

a WMD: wearable monitoring device.

b RCT: randomized controlled trial.

c NS: not specified.

WMD Information and Adherence Outcomes

The two studies that involved Fitbit smartwatches stated the rate of adherence to WMDs as their outcome but did not specify how it was measured [ 18 , 19 ]. In the third study, which involved orthopedic footwear for people with a foot condition, adherence (both use and nonuse) was measured using a built-in temperature sensor [ 20 ].

Objective 1: Existing Interventions to Improve WMD Adherence

In the 3 studies, we identified 2 interventions aimed at enhancing adherence to WMDs. In the study conducted by Lutjeboer et al [ 20 ], the intervention used was awareness of being monitored for wearing time [ 20 ]. Specifically, the “no awareness” group only knew that their footwear contained WMDs, which in this case were temperature sensors, but did not know the purpose of the study. On the other hand, the “awareness” group received a letter explaining the purpose of the study, thus ensuring they were well informed of being monitored on the time they spent wearing the WMDs.

Another intervention was the SystemCHANGE approach, in which the focus was on changing habits by targeting personal goals and providing feedback through 4 steps [ 18 , 19 ]. The first step involved identifying individuals who had an impact on the participants’ level of physical activity. These individuals, recognized by the participants as significant figures, could include peers, family members, and health care professionals. Then, the participants were asked to recognize their routine and the impact of that routine. Subsequently, the identified routine was graphically represented to help the participants understand how it affected their physical activity patterns. The final step entailed developing a customized solution for the participants, with the assistance of WMDs.

Objective 2: Effects of Interventions on WMD Adherence

Although the interventions in all 3 studies were not specifically designed to promote adherence or evaluate the components contributing to adherence, they did report adherence rates at single time points. The duration of the adherence that was measured varied across the studies, ranging from 12 weeks [ 20 ] to 12 months [ 18 ]. The results demonstrated that the participants’ awareness of being monitored while using WMDs was effective in enhancing adherence. This was evident from the longer mean wearing time in the intervention group (7.32 hours/day) compared to the comparison group (6.11 hours/day) [ 20 ]. Similarly, the studies found that participants were more likely to adhere to the WMDs when using the SystemCHANGE approach, a habit change tool that targets personal goals and provides feedback [ 18 , 19 ]. Adherence among the intervention participants in these 2 studies was 100% at 6 months and 96.5% at 12 months, in contrast to 92.3% and 80.8%, respectively, for the control participants.

Objective 3: Components That Positively Influence the Intervention Effect

In Lutjeboer et al’s study [ 20 ], physicians played a crucial role in promoting adherence to WMDs. The effectiveness of the intervention relied on physicians providing information about the purpose of the study to the participants. In the studies conducted by O’Brien et al [ 18 , 19 ], both nurses and participants worked together to achieve the intervention effect. The nurses were responsible for guiding the participants to reflect on their lifestyle during the monthly sessions, using the SystemCHANGE approach. Meanwhile, the participants actively engaged in formulating and implementing the action plan, taking an active role in the intervention process.

Risk of Bias Assessment

Figure 2 [ 21 ] indicates that in the RoB 2 bias assessment, there were “some concerns” about the 3 articles [ 18 - 20 ]. All of the included studies [ 18 - 20 ] demonstrated a low risk of bias in the domains of “randomization process” and “outcome measurements.” In 2 studies [ 18 , 20 ], there was some concern regarding deviation from intended interventions, as the research staff may have been aware of the intervention during the trial. The remaining study was rated as being of “low risk” for this issue [ 19 ]. In terms of the measurement of the outcome, there were some concerns with all 3 articles [ 18 - 20 ], as knowledge of the intervention could have affected the study outcomes. Regarding the selection of the reported result, there were “some concerns” in 1 article [ 19 ], while the other 2 were considered as being of “low risk” [ 18 , 19 ].

Principal Findings

In summary, this systematic review identified 3 RCTs, published between 2020 and 2021, that reported adherence to WMDs. Our findings revealed that low-cost interventions aimed at increasing adherence to WMDs were effective. Specifically, the review highlighted 2 types of interventions that showed promise in enhancing adherence to WMDs among older adults. The first intervention involved raising awareness among older adults about the wearing time of the devices. This approach aimed to ensure that individuals were consistently wearing the devices for the recommended duration. The second intervention strategy involved the use of goal-setting tools. By setting specific goals related to wearing the WMDs, older adults were more likely to adhere to the prescribed use. These goal-setting tools could provide individuals with the structure and motivation to incorporate the use of WMDs into their daily routines.

It is surprising that none of the interventions in the included articles were primarily aimed at promoting adherence to WMDs but rather at examining the effectiveness of the WMDs in enhancing health outcomes. For instance, there was a study about the effectiveness of WMDs on increasing step count, but no data were presented on the wearing time of the WMDs [ 22 ]. Another study examined adherence to an intervention program [ 23 ]. This study focused on assessing how well participants adhered to a specific intervention or treatment program rather than on specifically evaluating adherence to WMDs. Furthermore, most of the cross-sectional studies identified in the systematic review concentrated on investigating the reasons and factors influencing the use or nonuse of WMDs by older adults [ 5 , 7 , 9 , 24 - 26 ]. These studies aimed to understand the barriers and facilitators associated with older adults’ adoption and acceptance of WMDs but did not explore how older adults can sustain the use of WMDs over an extended period.

It is also noteworthy that the pilot study on organ transplant recipients [ 19 ] was related to another parent article [ 18 ], which theoretically followed up on the same population and intervention at two different time points. The decrease in the WMD adherence rate from 6 months (intervention: 100%; control: 92.3%) to 12 months (intervention: 96.5%; control: 80.8%) implies that interventions targeting adherence should be implemented to enhance the sustained use of WMDs for health monitoring. Previous studies found that the barriers contributing to the nonuse of WMDs included technological concerns and user experiences [ 25 - 27 ]. For instance, a lack of skills to use the WMDs, a feeling of uncomfortableness, and inaccuracies in the physiological data collected by WMDs reduced their use [ 27 ]. Additionally, inadequate support from health care providers to encourage the use of WMDs may reduce the patients’ trust in the accuracy of the data, hence discouraging WMD use [ 24 ]. Both eliminating such barriers and identifying facilitators are necessary to enhance adherence to WMDs.

Our results from 2 studies [ 18 , 19 ] were consistent with the findings from other studies. For instance, previous research has shown that having health care professionals assist older adults in setting health-related goals and providing them with feedback is a crucial factor influencing adherence to WMDs [ 11 , 26 ]. This is because personalized goals and individualized interventions can motivate older adults to achieve desired health outcomes [ 11 ] and empower them to make choices related to their health [ 28 ]. For example, the SystemCHANGE approach, as illustrated in the 2 studies [ 18 , 19 ], involved guiding participants to collaboratively establish goals with health care professionals by modifying their current routines, thereby making the goals more attainable.

In addition, O’Brien et al [ 19 ] emphasized the importance of consistently following up and providing physical incentives, such as gift cards, to enhance motivation among older adults to sustain the use of WMDs. On the other hand, Lutjeboer et al [ 20 ] found that older adults who were aware of being tracked in their footwear use demonstrated improved adherence. This finding can be explained by the Hawthorne effect in psychology, whereby participants may alter their behavior when they are aware of being observed [ 29 ]. In the case of orthopedic footwear being prescribed by physicians, older adults may seek to establish a therapeutic relationship by meeting the expectations of their physician. Furthermore, older adults may exhibit a greater willingness to wear the footwear when they are pursuing health-related goals [ 25 ].

Concerning whether professional-led or peer-led intervention programs are more effective in enhancing WMD adherence, more information is needed before coming to a conclusion. Combining the results from the included studies, health care professionals were found to have played an important role in assisting the participants in improving WMD adherence. A probable explanation for this is that health care professionals, such as physicians and nurses, could monitor the progress of older adults and answer any questions they might have [ 30 ]. However, it is unclear whether the effect of peers is comparable to that of professionals. For example, in O’Brien et al’s studies [ 18 , 19 ], monthly sessions were carried out in groups. This could imply that aside from health care professionals, peer sharing and support may help to enhance the WMD adherence of older adults. However, the report lacks detailed information on the group sessions, making it difficult to compare the effects of professional-led and peer-led intervention programs.

Our study has some limitations. Even though we planned to search for articles published during the past 13 years, the articles that matched our criteria for inclusion were only published in recent years. In addition, a meta-analysis on the topic could not be performed due to the small number of articles and their heterogeneity. This could be because WMDs have only become popular in recent years. Another limitation is linked to population bias. This report involved a small sample size of 154 older adults in total, and the population is assumed to be the same in 2 of the included studies. Meanwhile, all of the included studies targeted Western populations, so the results may not be generalizable to people in other countries because factors such as technological know-how could influence WMD use behavior.

Conclusions

Our findings revealed that low-cost interventions were effective in increasing adherence to WMDs. Several interventions have been identified as effective in promoting adherence to WMDs. However, it is important to note that further studies are needed to validate the results and assess the effectiveness of these interventions. Researchers should also explore other potential behavior change interventions that could be beneficial in improving adherence to WMDs, with a particular focus on community-dwelling older adults. By expanding the range of interventions and conducting more comprehensive studies, we can enhance our understanding of the most effective strategies for improving adherence to WMDs in this specific population.

Acknowledgments

This work was supported by the Departmental General Research Fund, The Hong Kong Polytechnic University (G-UAQ2).

Authors' Contributions

AKCW contributed to the conception and design of the study. CSWC and MMPK conducted the search strategy. All authors prepared the draft and reviewed the final manuscript.

Conflicts of Interest

None declared.

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Abbreviations

Cochrane Central Register of Controlled Trials

population, intervention, comparison, and outcomes

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

randomized controlled trial

Cochrane Risk of Bias tool version 2

wearable monitoring device

Edited by S Ma; submitted 12.10.23; peer-reviewed by SQ Yoong, E Fisher; comments to author 19.03.24; revised version received 25.03.24; accepted 23.04.24; published 20.06.24.

©Colette Sze Wing Chan, Mandy Ming Pui Kan, Arkers Kwan Ching Wong. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.06.2024.

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

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Open access
Published: 18 June 2024

New insights into physician burnout and turnover intent: a validated measure of physician fortitude

Laurence Weinzimmer 1 &
Stephen Hippler 2

BMC Health Services Research volume 24 , Article number: 748 ( 2024 ) Cite this article

53 Accesses

Metrics details

Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues.

A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity.

The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion ( r = -.62, p < .01), depersonalization ( r = -.70, p < .01) and personal accomplishment ( r = .65, p < .01), and turnover intent ( r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience ( p < .01).

Conclusions

Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.

Peer Review reports

For nearly thirty years, researchers have sought to understand the antecedents and consequences of physician burnout, yet the problem continues. Notably, Shanafelt et al., found that 62.8% of physicians had at least one manifestation of burnout in 2021, compared with 45.5% in 2011 [ 1 ]. Consequently, patients have a higher likelihood of being treated by a burned-out physician today than one who is not [ 1 , 2 ]. This is associated with decreased quality of care, medical errors, poor patient satisfaction, and limited patient access [ 3 , 4 ]. Moreover, beyond the human cost of burnout on individuals, the financial cost of burnout related turnover on the healthcare system is estimated to be $2.6 to $6.3 billion (USD) a year, or $7,600 (USD) per employed physician [ 5 ]. Clearly more research needs to be conducted to understand the antecedents of physician burnout and turnover so that more effective strategies can be developed to address this growing problem.

Overview of physician burnout

Existing research on physician burnout has primarily examined two sets of drivers, intrinsic personality traits and extrinsic work environments. Intrinsic personality traits such as high neuroticism, low agreeableness and low conscientiousness as measured by the Big 5 Inventory have been associated with an increased risk of burnout [ 6 ]. Likewise, extrinsic work environmental factors such as excessive workload, poor work-life balance, low autonomy and systemic barriers all contribute to burnout and intent to leave. [ 7 , 8 ].

Much recent research focused on the importance of the work environment has led to interventions to improve physician wellbeing [ 9 , 10 , 11 , 12 ]. However, in a recent meta-analysis of 38 randomized trials using different interventions focused on improving physician burnout, results suggested these efforts did not result in meaningful impacts on clinical burnout [ 13 ]. Furthermore, the authors suggest that a more nuanced understanding of the causes of burnout is needed to develop more effective interventions. Similarly, Cataputo et al., looked at interventions focused on mitigating work-related stress in healthcare using cognitive behavioral therapy, relaxation therapy; and interventions focused on the organization. They concluded that individual-level interventions were beneficial over the short term, but organizational-level intervention failed to show any benefit in reducing burnout [ 14 ]. Although these studies have provided important insights into physician burnout, there are still significant opportunities to extend these findings.

Consequently, a critical question to consider is while it is estimated that up to 50% of physicians are suffering from burnout at any one time, why do 50% of physicians in presumably similar circumstances not burnout? One possible explanation may be that individuals can perceive their work environment very differently. In a study of UK house officers, differences in self-reported trainee stress levels were shown to be related to individual differences within the doctors themselves and not organizational factors present or the administrative structure of hospitals [ 15 ]. Furthermore, in a separate study, researchers determined how doctors perceived their workplace climate and workload can be partially predicted by trait measures of personality taken five years earlier [ 16 ]. That is not to say that factors such as work environment and systemic factors are unimportant but suggests that there is a need to build upon this past empirical research to increase our collective understanding of how an individual’s perspective and attitude may contribute to their unique responses to environmental stressors in healthcare.

Extant literature has yielded a significant amount of research assessing the relationship between intra-personal attributes with burnout and/or turnover across multiple professions. Specifically, there is a growing body of research that has demonstrated how grit [ 17 , 18 , 19 ], self-efficacy [ 20 ], hardiness [ 21 , 22 , 23 ], resilience [ 24 , 25 ], mental toughness [ 26 , 27 ] and hope [ 28 , 29 ] individually mitigate the relationship between environmental stressors and burnout-related phenomena in healthcare and many other professions. While these unique individual attributes have proven to be beneficial, we believe there is a significant opportunity to integrate these constructs to develop a more holistic understanding of how individuals use all of these attributes to respond to their unique work-related stressors.

Integration of concepts

There have been previous attempts to integrate the abovementioned attributes. The limited literature on fortitude shows promise as a unifying construct [ 30 , 31 , 32 ]. However, this body of research has been studied using different definitions, antecedents and outcome measures. For example, Pretorius et al. defined fortitude as an attitude to manage stress and stay well. He postulated that this strength derives from an appraisal of the self, the family and support from others. Their 20 item Fortitude Questionnaire (FORQ) was tested and validated in undergraduate psychology students [ 31 ]. Henttonen et al. attempted to measure fortitude by developing a scale based on the Finnish cultural attribute of sisu , defined as determination and resoluteness in the face of adversity. They combined multiple intrapersonal attributes with personality traits to develop a 18-item scale in a general working population [ 30 ]. Similarly, VanTongeren et al. developed a validated measure for spiritual fortitude. Their measure includes items for spiritual enterprise, spiritual endurance and redemptive purpose and was validated in a volunteer population [ 32 ].

While there has been significant value from the fortitude research, its applicability and generalizability to physician burnout and turnover is limited. To advance the literature and extend our understanding of physician burnout, there is a need to arrive at a more precise definition relevant to healthcare. Subsequently, we suggest fortitude to be an interpersonal attitudinal attribute that enables one to succeed under repeated pressure and stress. Therefore, the purpose of this study is to gain new insights into burnout and turnover by investigating fortitude in healthcare and developing a statistically valid and reliable scale.

To assess the potential impact of physician fortitude on burnout and turnover intent, we drew on previous research that has focused on explaining how individuals overcome adversity. We employed a two-sample design to establish content validity, internal consistency, empirical reliability, unidimensionality, convergent validity and ultimately criterion-related validity. Surveys were approved by the University of Illinois College of Medicine Institutional Review Board. Informed consent was attained by all survey participants prior to completion of the survey.

Item generation

To ensure we met the psychometric assumptions proposed by our latent construct we define as fortitude, we used a deductive approach [ 33 ]. Grounded in extant literatures that have shown empirical promise regarding how individuals experience and ultimately overcome adversity, seven specific areas of research were identified. Specifically, we drew on grit, hardiness, mental toughness, resilience, hope, optimism and self-efficacy to generate a potential list of items for our integrative fortitude construct. Based on commonalities across these dimensions, 64 potential items were identified. We then engaged 73 physicians and non-physician healthcare leaders in 13 focus groups to provide feedback on the suitability of the potential items in a healthcare context. Based on relevancy, these focus groups reduced the potential list of survey items to 45.

Next, we ensured sufficient interrater reliability to evaluate internal consistency of potential items for the fortitude scale [ 34 ]. A panel of five academic researchers actively engaged in burnout and turnover research were queried and asked to match potential survey items with the fortitude construct. Crocker and Algina define a minimum value greater than 0.70 to be acceptable for consistency estimates of interrater reliability [ 35 ]. Consequently, if an item had an interrater reliability value that did not meet the 0.70 threshold, it was deleted as a possible item for the fortitude scale. This resulted in an interrater reliability 0.88. Results from the interrater reliability assessment yielded 34 potential items.

Data reduction, reliability and unidimensionality

To further reduce potential items, in our first study (study 1) we collected data from a sample of 909 practicing physicians, APPs and healthcare leaders from a large U.S. healthcare system. Respondents were asked to rate the degree to which each statement accurately described their own individual attributes on the 34 items using a seven-point Likert Scale, where 1 = strongly disagree and 7 = strongly agree. A seven-point Likert Scale was used, as this is most consistent with the literatures we used to develop our potential list of items.

Results from study 1 provided initial evidence of reliability, construct validity and unidimensionality. Exploratory factor analysis (EFA) was used to assess potential items. Given the data were normally distributed, a maximum likelihood extraction method and Varimax rotation were used [ 36 ]. We were able to identify potential items that had individual factor loadings greater than 0.70. This yielded a 12-item scale measuring fortitude in healthcare (HCF-12). Example items include “I am excited about working on achieving my goals,” “I am determined to succeed in achieving my goals,” “I am passionate about the work I do.”

The EFA provided initial support for the unidimensionality of a single factor for the HCF-12 scale, as well as initial construct validity. Specifically, scree plots indicated unidimensionality for our HCF-12 measure. The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was 0.88, well above the suggested threshold of 0.5 [ 37 ], and Bartlett’s test of sphericity was significant ( p < 0.05). Initial reliability was encouraging, yielding a Cronbach alpha of 0.89.

Convergent and criterion-related validity

After finding encouraging evidence of reliability and unidimensionality, we collected data from a second sample (study 2) to measure convergent validity and criterion-related validity. The survey in study 2 was sent to practicing physicians and healthcare leaders ( n = 212). Similar to Study 1, we found encouraging reliability with a Cronbach’s alpha = 0.93. Measures for internal consistency and factor loadings of the 12 items in the HCF-12 for Study 2 can be seen in Table 1 .

To test for convergent validity, Study 2 included the HCF-12 scale and scales grit [ 17 ], hardiness [ 21 ], resilience [ 24 ], mental toughness [ 27 ]. To establish criterion-related validity, the survey also included scales for all three subdimensions of burnout (emotional exhaustion, depersonalization, and personal achievement [ 38 ], and turnover intent [ 39 ], as previous literature has shown that chronic burnout leads to turnover [ 40 , 41 , 42 ]. Additionally, based on focus-group insights, control variables were added including age, gender, race, hours worked and call burden. Note that reliabilities for all scales used in Study 2 are included in Table 2 .

Given the HCF-12 draws on attitudinal measures specifically related to stressors, including grit, hardiness, resilience and mental toughness, we would expect strong relationships among these variables. To assess convergent validity, we used correlational analyses. We found significant correlations between fortitude and hardiness ( r = 0.28, p < 0.01) and resilience ( r = 0.71, p < 0.01). However, there were not significant relationships between our fortitude measure with grit or mental toughness . To assess criterion-related validity, we would expect that the HCF-12 measure to be negatively related to burnout and turnover intent. Fortitude was significantly related all three subdimensions of burnout, specifically emotional exhaustion ( r = -0.62, p < 0.01), depersonalization ( r = -0.70, p < 0.01) and personal accomplishment ( r = 0.65, p < 0.01), and turnover intent ( r = -0.55, p < 0.01). Given that fortitude was significantly related to all of these constructs in the predicted directions, this provides strong initial evidence for criterion-related validity.

Findings and results

Based on encouraging results regarding reliability and validities of the HCF-12, this creates a platform that allows us to compare fortitude with the scales currently recognized as antecedents in the extant burnout and turnover-intent literatures. Subsequently, we used ordinary least-squared (OLS) regression modeling to test significance levels and explained variance to compared the HCF-12 to grit, hardiness, mental toughness and resilience based on data from the 212 respondents in study 2,

Sample characteristics

Of the 212 respondents who completed the survey, 76% were female, 21% were male and 3% preferred not to answer. For race, 91% of respondents were White, 5% were Asian, 2% were Hispanic and 2% were Black. The average age of respondents was 47.4 years old; they worked an average of 51.3 h per week and worked for an average of 8.8 years in the current hospital system. Finally, in terms of their role, respondents were asked if they were a physician leader (26%), a non-physician leader (49%) or a practicing clinician (29%).

Descriptive statistics

Means, standard deviations, reliability scores, and bivariate correlations can be seen in Table 2 . Note that reliabilities for all scales met the minimum threshold of 0.70 (with the exceptions of hardiness) and the HCF-12 had the highest reliability score of 0.93. Also note that the fortitude measure was significantly related to all three subdimensions of burnout and turnover intent, providing encouraging support for the consideration of the new scale.

Ordinary least squares regression results

In order to compare the HCF-12 with existing measures, regression analyses were performed. Specifically, in Tables 3 – 6 , fortitude, grit, hardiness, mental toughness and resilience were all regressed on turnover intent and the three subdimensions of burnout, namely emotional exhaustion, depersonalization and personal accomplishment.

In Table 3 , all five scales were negatively related with turnover intent. Specifically, fortitude (β = -0.55), grit (β = -0.23) hardiness (β = -0.31), mental toughness (β = -0.27) and resilience (β = -0.28) were all statistically significant ( p < 0.01). Note that there was a statistically significant difference in explained variance between fortitude and all of the other measures ( p < 0.01). The adjusted R 2 for fortitude was 0.30 compared to grit (0.04), hardiness (0.09), mental toughness (0.06) and resilience (0.07).

In Table 4 , all five scales were negatively related with the burnout subdimension of emotional exhaustion. Specifically, fortitude (β = -0.62), grit (β = -0.35) hardiness (β = -0.56), mental toughness (β = -0.45) and resilience (β = -0.38) were all statistically significant ( p < 0.01). Note that there was a statistically significant difference in explained variance between fortitude and all of the other measures ( p < 0.01). The adjusted R 2 for fortitude was 0.39 compared to grit (0.12), hardiness (0.32), mental toughness (0.29) and resilience (0.15).

In Table 5 , all five scales were negatively related with the burnout subdimension of depersonalization. Specifically, fortitude (β = -0.69), grit (β = -0.36) hardiness (β = -0.50), mental toughness (β = -0.47) and resilience (β = -0.40) were all statistically significant ( p < 0.01). Note that there was a statistically significant difference in explained variance between fortitude and all of the other measures ( p < 0.01). The adjusted R 2 for fortitude was 0.48 compared to grit (0.13), hardiness (0.25), mental toughness (0.22) and resilience (0.16).

In Table 6 , all five scales were positively related with the burnout subdimension of personal accomplishment. Specifically, fortitude (β = 0.65), grit (β = 0.41) hardiness (β = 0.49), mental toughness (β = 0.49) and resilience (β = 0.59) were all statistically significant ( p < 0.01). Note that there was a statistically significant difference in explained variance between fortitude and all of the other measures ( p < 0.01). The adjusted R 2 for fortitude was 0.42 compared to grit (0.16), hardiness (0.23), mental toughness (0.23) and resilience (0.34).

In summary, fortitude explained significantly more variance in turnover intent, emotional exhaustion, depersonalization and personal accomplishment than any of the existing measures.

The primary focus of this research was to investigate the potential use of a new fortitude scale to increase our understanding of antecedents to physician burnout and turnover intent. Results from this study provide encouraging evidence that the integration of grit, hardiness, mental toughness and resilience, in a latent the construct defined as fortitude, provides new insights into understanding how the combination of these intrapersonal attributes contribute to physician burnout and turnover intent. Our proposed HCF-12 scale exhibited encouraging findings to support the psychometric properties of a physician fortitude scale. Specifically, based on a two-study design, we were able to establish content validity, unidimensionality, empirical reliability, convergent validity and criterion-related validity. Moreover, we were able to show that the HCF-12 resulted in significantly higher levels of explained variances for all three subdimensions of burnout and turnover intent when compared to all existing scales found in the extant literature. Consequently, findings from our study provide additional insights into understanding physician burnout and turnover intent. Specifically, our findings make several contributions.

First, our findings extend previous fortitude research that showed the combination of different psychological antecedents of well-being provide additional insights beyond single constructs alone. Specifically, Pretorius et al. derived their measure from the constructs of hardiness, sense of cohesion and potency and found that fortitude, defined as the strength to manage stress and to stay well, was significantly related to students’ well-being and distress [ 31 ]. Similarly, Henttonen et al. combined attributes of mental toughness, grit, hardiness, resilience, hope and self-efficacy with personality traits and studied the effects of beneficial and harmful sisu on the happiness and wellbeing of survey participants [ 30 ]. Likewise, VanTongeren et. al. developed a unique scale for spiritual fortitude which predicted variance in meaning in life, spiritual well-being, religious coping and adversity-related anxiety [ 32 ]. Our study and the Healthcare Fortitude Scale (HF-12) extends these studies conceptually and relies on well-established constructs and validated instruments. Furthermore, we validate this scale so that it is applicable to healthcare workers.

Second, our findings support and extend research examining the impact of resilience on burnout [ 24 , 25 ]. In a study by Roslen et. al. the authors contend the concept of resilience has unfortunately been used interchangeably with mental toughness, hardiness, and grit, adding to confusion in the literature [ 43 ]. Stoffel and Cain likewise state that it is often difficult to tell whether the constructs of resilience, grit, hardiness and mental toughness are distinct from each other as some authors use these terms interchangeably [ 44 ]. Consequently, by combining these concepts using the HCF-12, our findings support and extend this research by empirically demonstrating that an elevated concept of fortitude is a better and more precise construct than an expanded definition of resilience. Furthermore, our fortitude measure explains more variance than any of the individual concepts, including resilience alone, proving that the combination of constructs is better than any single one alone.

Third, the findings from this study may help to change the conversation regarding physician burnout and turnover intent. Our work suggests that the interpersonal attribute of fortitude leads to decreased burnout and turnover intent. Moreover, fortitude can be viewed as attitudinal and therefore malleable when compared to personality traits. Subsequently, it may help explain the interaction between each individual and their work environment. As such, interventions that are mindful of empowering individuals to develop fortitude in addition to changes in the work environment may lead to faster progress in mitigating this important issue in healthcare.

Limitations and future research

We recognize potential limitations of the current study. First, we used a cross-sectional sample, collected at one point in time. Second, we recognize the possibility of common-methods bias, even though cross-sectional sampling is considered an acceptable method of collecting perceptual data [ 45 ].

Future research should strive to obtain longitudinal data and sources of secondary data to improve criterion-related validity. Likewise, future research on fortitude may want to consider the impact of fortitude on organizational context measures, such as perceived supervisor support (PSS) and organizational culture. It may not be the environment or the person alone, but the interaction between the adequacy of the multiple skills and attributes of the individual with ever evolving demands of the environment that contributes to wellbeing. Given the encouraging measures of validity and reliability of the HCF-12, future research can also test the moderating and mediating roles of fortitude on the relationship between work stress and burnout, work stress and turnover intent and burnout and turnover intent. Finally, this research was performed on a U.S.-based sample. Future research can assess fortitude among physicians in other countries to increase generalizability.

This study represents the first attempt to define and measure fortitude using a U.S.-based sample in a healthcare environment. Moreover, this study develops a valid, reliable and generalizable scale that extends our understanding of antecedents that lead to physician burnout and turnover intent. As a malleable attribute, fortitude also provides new opportunities for targeted intervention strategies to improve physician wellbeing.

Availability of data and materials

No datasets were generated or analysed during the current study.

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Laurence Weinzimmer

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Weinzimmer, L., Hippler, S. New insights into physician burnout and turnover intent: a validated measure of physician fortitude. BMC Health Serv Res 24 , 748 (2024). https://doi.org/10.1186/s12913-024-11186-7

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