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Guidance for conducting systematic scoping reviews

Article  in  International Journal of Evidence-Based Healthcare · July 2015

DOI: 10.1097/XEB.0000000000000050 · Source: PubMed

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 M E T H O D O L O G Y PA P E R

Guidance for conducting systematic scoping reviews

Micah D.J. Peters BHSc, MA(Q), PhD, 1 Christina M. Godfrey RN PhD, 2 Hanan Khalil BPharm, MPharm, PhD, 3
Patricia McInerney PhD, 4 Deborah Parker 5 and Cassia Baldini Soares RN, MPH, PhD 6
1
The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia, 2Queen’s Joanna Briggs
Collaboration, Queen’s University Kingston, Ontario, Canada, 3Monash University, School of Rural Health, The Centre for Chronic Diseases
Management, Victoria, Australia, 4The Wits-JBI Centre for Evidence-Based Practice, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa, 5Australian Centre for Evidence Based Community Care, The University of Queensland, Toowong, Queensland,
Australia, and 6The Brazilian Centre for Evidence-based Healthcare, School of Nursing, University of São Paulo, São Paulo, Brazil

ABSTRACT

Reviews of primary research are becoming more common as evidence-based practice gains recognition as the
benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review
types is the ‘scoping review’. In general, scoping reviews are commonly used for ‘reconnaissance’ – to clarify working
definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a
body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not
amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to
determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and
of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommen-
dations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to
systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic
scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five
Joanna Briggs Collaborating Centres.
Key words: evidence synthesis, literature review, methodology, scoping review, systematic review
Int J Evid Based Healthc 2015; 13:141–146.

Introduction method.4–6 Scoping reviews have great utility for syn-

R eviews of primary research are becoming more

common as evidence-based practice gains recog-
nition as the benchmark for care, and the number of, and
thesizing research evidence and are often used to map
existing literature in a given field in terms of its nature,
features, and volume.3 As such, scoping reviews have
access to, primary research sources has grown. As more also been called ‘mapping’ reviews.3,4,7 In general, scop-
authors are conducting reviews to integrate research ing reviews are commonly used for ‘reconnaissance’ – to
findings, various review types have evolved with their clarify working definitions and conceptual boundaries of
respective methodologies developing in precision and a topic or field.5 Scoping reviews are therefore of particu-
clarity. In 2009, Grant and Booth identified 14 different lar use when a body of literature has not yet been
types of literature reviews.1 One of these review types comprehensively reviewed, or exhibits a large, complex,
was the ‘scoping review’. Although the first framework or heterogeneous nature not amenable to a more pre-
for scoping reviews was published in 2005,3 scoping cise systematic review. While scoping reviews may be
reviews are still a relatively new methodology that, as conducted to determine the value and probable scope
yet, do not possess a universal definition or definitive of a full systematic review, they may also be undertaken
as exercises in and of themselves to summarize and
disseminate research findings, to identify research gaps,
Correspondence: Micah D.J. Peters, BHSc, MA(Q), PhD, The Joanna
Briggs Institute, Faculty of Health Sciences, The University of Ade-
and to make recommendations for future research.3
laide, Adelaide, SA 5005, Australia. E-mail: micah.peters@adelaide. This article will first briefly introduce the reader to
edu.au scoping reviews, how they are different from systematic
DOI: 10.1097/XEB.0000000000000050 reviews, and why they might be conducted. We will then

International Journal of Evidence-Based Healthcare ß 2015 University of Adelaide, Joanna Briggs Institute 141

©2015 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
 MDJ Peters et al.

explain in greater detail our guidance for the develop- research available regarding a topic but also the way
ment of systematic scoping reviews using a method- the research has been conducted.12 For example, a
ology developed by members of the Joanna Briggs recent scoping review of scoping reviews aimed to
Institute (JBI) and members of five Joanna Briggs provide an overview of how scoping reviews have been
Collaborating Centres. conducted.13
To support the greater breadth of scoping reviews, a
What are scoping reviews and why conduct variety of study designs are usually included. This is not
one? prescriptive, however, and reviewers may decide that
The JBI views the systematic review and the synthesis of certain study designs are not appropriate for consider-
evidence to be at the core of evidence-based practice. ation for their particular scoping review. For example, in
Traditionally, systematic reviews have brought together a scoping review on homecare safety and medication
quantitative literature on a particular condition or inter- management for older adults, the review authors
vention to answer questions of effectiveness. In addition considered both qualitative and quantitative study
to effectiveness, the JBI is also concerned with the designs.14 It is, however, important to highlight the
appropriateness, meaningfulness, and feasibility of distinction between scoping reviews and ‘comprehen-
healthcare practices and delivery. Such questions are sive systematic reviews’, which draw upon evidence from
more commonly answered through the consideration of multiple study designs to answer a series of related
other forms of research evidence, for example, qualita- and specific questions. In a comprehensive systematic
tive and economic evidence. The JBI regards the results review, the goal is to synthesize the evidence from
of well designed research studies of any methodology as multiple study designs, and often the knowledge (and
potential sources of credible evidence. To correspond richness) gained from the qualitative evidence is used to
with the JBI’s broader and more inclusive view of enhance the knowledge gained from the quantitative
evidence, the Institute has developed a number of evidence. In these reviews, the activity of synthesis is
theories, methodologies, and processes for the syn- actively undertaken. Whereas in a scoping review, the
thesis of diverse forms of evidence to aid decision- goal is to determine what range of evidence (quantitat-
making in healthcare.8 All JBI systematic reviews begin ive and/or qualitative) is available on a topic and to
with the development of a protocol, followed by a represent this evidence visually as a mapping or charting
rigorous, replicable, and extensive search of the inter- of the located data. The act of synthesis is not under-
national literature. Whereas a typical systematic review taken, but rather the range of located evidence is
aims to answer a specific question or series of ques- graphically represented.
tions according to a rigid set of a priori delimiting Another distinction between scoping reviews and
factors detailed in the protocol, a scoping review will systematic reviews is that unlike a systematic review,
have a broader approach, generally with the aim of scoping reviews are designed to provide an over-
mapping literature and addressing a broader research view of the existing evidence base regardless of quality.
question. Hence, a formal assessment of methodological
Unlike systematic reviews, the aim of the scoping quality of the included studies is generally not per-
reviews is a way of mapping the key concepts that formed.
underpin a research area.3 Scoping reviews can be
particularly useful for bringing together literature in Developing a systematic scoping review
disciplines with emerging evidence, as they are suited A scoping review requires at least two reviewers and, as
to addressing questions beyond those related to the with all systematic reviews, an a priori scoping review
effectiveness or experience of an intervention. Scoping protocol must be developed prior to undertaking the
reviews can be conducted to map a body of literature review itself. Following the same process, as the conduct
with relevance to time, location (e.g. country or context), of a systematic review, the scoping review protocol pre-
source (e.g. peer-reviewed or grey literature), and origin defines the objectives and methods of the scoping
(e.g. healthcare discipline or academic field).4 The value review and details the proposed plans. Whereas devi-
of scoping reviews to evidence-based practice is the ations from a review protocol for a traditional systematic
examination of a broader area to identify gaps in the review are rare, due to the more iterative nature of a
research knowledge base,9 clarify key concepts,10 and scoping review, some changes may be necessary. Any
report on the types of evidence that address and inform discrepancies should still be clearly detailed and justi-
practice in the field.11 Scoping reviews also may be fied in the ‘Methods’ section of the scoping review
carried out to determine not only the extent of the report, if and when they occur.

142 International Journal of Evidence-Based Healthcare ß 2015 University of Adelaide, Joanna Briggs Institute

©2015 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
 METHODOLOGY PAPER

Title Types of participants

The title must be concise enough to reflect the ‘Popu- The relevant characteristics of participants should be
lation’, ‘Concept’, and ‘Context’ of the review, which are detailed, including age and other qualifying criteria,
the elements of a scoping review used to establish a which match the review question and identify them
priori inclusion and exclusion criteria which will be as appropriate for the objectives of the scoping review.
explained in more depth shortly. The scoping review In our exemplar scoping review, studies were included
by Godfrey et al.,14 published in 2013, serves as an that focused on older individuals (mean age 65 years or
exemplar for the following discussion on the require- older) who were receiving homecare services. Studies
ments of a scoping review. The title of this review is: that focused on providers (licensed or unlicensed) and
‘Homecare safety and medication management with caregivers [family/friends (paid or unpaid)] who were
older adults: a scoping review of the quantitative and involved in the medication management process were
qualitative evidence’. also included.

Background Concept
The background of a scoping review should be compre- The principal focus or concept examined by the scoping
hensive and should cover the main elements of the review should be clearly detailed to guide the review’s
topic, important definitions, and the existing knowledge scope and breadth. Explanation of the concept may
in the field. include details that pertain to the ‘interventions’
and/or ‘phenomena of interest’ that would be specified
Review question/objective in greater detail in a systematic review. The concept
The review objective(s) and specific review question(s) examined in a scoping review may not be related to
must be clearly stated. The objective may be broad and interventions or phenomena of interest, and may
will guide the scope of the enquiry. The review ques- be instead related to research designs, frameworks,
tion(s) should be consistent with the title and direct the theories, or classifications. The standard ‘outcomes’ of
development of the specific inclusion criteria. In our a systematic review may be a component of the concept
exemplar scoping review, the objectives of the review of a scoping review and should be linked closely to the
were focused on the pertinent issues specifically related objective and the purpose of the scoping review. In our
to medication management for individuals living at exemplar scoping review, the key concept was the
home and receiving homecare services, and were guided process of medication management, and studies were
by the following research questions: considered that evaluated the process of medication
management involving either providers (licensed and
1. What are the issues encountered by individuals, unlicensed) or caregivers (family/friends paid or unpaid).
families, caregivers, and healthcare providers
related to the medication management of individ- Context
uals living in the community and receiving The context of a scoping review will vary depending on
homecare services? the objective(s)/question(s). The context should be
2. What are the documented errors or adverse events clearly defined and may include consideration of geo-
that occur in this population that relate to the graphical or locational factors, cultural factors, and/or
management of their medications? specific racial or sex-based interests. The context may
3. What strategies have been implemented and eval- also encompass details about the specific setting (such
uated in the home setting that address the issues as acute care, primary health care, or community) or
related to medication management encountered by discipline (e.g. education, pharmacy, or nursing) under
this population? examination. In our exemplar scoping review, the con-
text was the provision of care in the individual’s home
Inclusion criteria or residence.
As with systematic reviews, inclusion criteria provide a
guide to understanding what is proposed by the Searching
reviewers and, more importantly, a guide for the The approach to searching for studies for a scoping
reviewers themselves to base decisions on the sources review follows the same three-step method recom-
to be included in the scoping review. The rationale or mended as in standard JBI systematic reviews.15 The
justification for each of the inclusion criteria should be search strategy should be comprehensive in order to
explained clearly and thoroughly in the background. identify both published and unpublished (grey literature)

International Journal of Evidence-Based Healthcare ß 2015 University of Adelaide, Joanna Briggs Institute 143

©2015 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
 MDJ Peters et al.

evidence. Each step must be clearly stated in this section should be a narrative description of the search decision
of the protocol. The first step is an initial limited search of process accompanied by the search decision flowchart
a selection of relevant databases, followed by an analysis (see Fig. 1).16 The flow chart should clearly detail the
of text words contained in the title and abstract, and of review decision process, indicate the results from the
the index terms used to describe the article. A second search, removal of duplicate citations, study selection,
search using all identified keywords and index terms is full retrieval, and additions from reference list searching
then undertaken across all included databases. Thirdly, and final summary presentation.
the reference list of all identified reports and articles The extraction of data for a scoping review is referred
should be searched for additional studies. Reviewers to as ‘charting the results’ and should be a logical and
should include the languages that will be considered descriptive summary of the results that align to the
for inclusion in the review, as well as the publication date objective/s and question/s of the review. A draft charting
limitations with an appropriate and clear justification table or form should be developed as part of the pro-
for choices. tocol to record characteristics of the included studies
and the key information relevant to the review question.
Extracting and charting the results Refinement of the charting forms may be required
The number of studies identified and selected for during the conduct of the full review, and reviewers
inclusion in the scoping review must be reported. There may need to trial the extraction form on two or three

Records identified through database Additional records identified through

Identification

searching other sources

(n = ) (n = )

Records after duplicates removed

(n = )
Screening

Records screened Records excluded

(n = ) (n = )

Full-text articles assessed for Full-text articles excluded,

eligibility with reasons
Eligibility

(n = ) (n = )
Included

Studies included
(n = )

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the scoping
review process.15

144 International Journal of Evidence-Based Healthcare ß 2015 University of Adelaide, Joanna Briggs Institute

©2015 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
 METHODOLOGY PAPER

Box 1. Example extraction fields educational, etc.), and research methods. It is up to the
reviewers to decide which would most rationally and
(1) Author(s)
(2) Year of publication clearly illustrate the nature of the results in terms of the
(3) Source origin/country of origin objective/s and question/s of the review. A summary of
(4) Aims/purpose
(5) Study population and sample size (if applicable) the results should logically describe the aims or purposes
(6) Methodology of the included articles, the concepts or approaches
(7) Intervention type and comparator (if applicable)
(8) Concept adopted in each, and the results that relate to the review
(9) Duration of the intervention (if applicable) question/s. For each category, a clear explanation should
(10) How outcomes are measured
(11) Key findings that relate to the review question be provided.
The extracted results may be classified under main
conceptual categories depending upon the objective
studies to ensure all relevant results are extracted (see or focus of the review, such as: ‘intervention type’;
Box 1 for the types of information that may be extracted). ‘study population’; ‘duration of intervention’; ‘aims’;
In a scoping review, the results may be presented as a ‘methodology adopted’; ‘key findings’; and ‘gaps in
‘map’ of the data in a logical, diagrammatic, or tabular the research’.
form, and/or in a descriptive format that aligns to the At the time of protocol development, the reviewers
objective/s and scope of the review. The tables and should detail a proposed plan for presenting the results.
charts may show results as: distribution of studies by This may then be further refined toward the end of the
year or period of publication (depends on each case), review when the reviewers have the greatest awareness
country of origin, area of intervention (clinical, policy, of the contents of their included studies. In our exemplar

Potentailly inappropriate
medications & drug
interaction
13

Provider
interventions
7

Provider Individual
perspective on knowledge
medication
4
management
4
Adverse
events/errors
3 Provider
knowledge
Adherence
2
2

Medication
order/delivery
administration Homecare agency Mortality
process characteristics healthcare
utilization
1 1
2

Figure 2. Map of outcomes measured by number of studies in the exemplar scoping review.

International Journal of Evidence-Based Healthcare ß 2015 University of Adelaide, Joanna Briggs Institute 145

©2015 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
 MDJ Peters et al.

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