chapter 2 research review of related literature

Review of Related Literature

• First Online: 16 September 2017

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• Sayed Hadi Sadeghi 3  

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This chapter presents a review of the literature and consists of three parts. The first part traces, via various studies, the historical background and rapid development of e-learning and presents some current definitions of the concept.

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Sadeghi, S.H. (2018). Review of Related Literature. In: E-Learning Practice in Higher Education: A Mixed-Method Comparative Analysis. Studies in Systems, Decision and Control, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-65939-8_2

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Chapter 2: What is a Literature Review?

Learning objectives.

At the conclusion of this chapter, you will be able to:

• Recognize how information is created and how it evolves over time.
• Identify how the information cycle impacts the reliability of the information.
• Select information sources appropriate to information need.

2.1 Overview of information

Because a literature review is a summary and analysis of the relevant publications on a topic, we first have to understand what is meant by ‘the literature’.  In this case, ‘the literature’ is a collection of all of the relevant written sources on a topic.  It will include both theoretical and empirical works.  Both types provide scope and depth to a literature review.

2.1.1 Disciplines of knowledge

When drawing boundaries around an idea, topic, or subject area, it helps to think about how and where the information for the field is produced. For this, you need to identify the disciplines of knowledge production in a subject area.

Information does not exist in the environment like some kind of raw material. It is produced by individuals working within a particular field of knowledge who use specific methods for generating new information. Disciplines are knowledge-producing and -disseminating systems which consume, produce and disseminate knowledge. Looking through a  course catalog of a post-secondary educational institution gives clues to the structure of a discipline structure. Fields such as political science, biology, history and mathematics are unique disciplines, as are education and nursing, with their own logic for how and where new knowledge is introduced and made accessible.

You will need to become comfortable with identifying the disciplines that might contribute information to any search strategy. When you do this, you will also learn how to decode the way how people talk about a topic within a discipline. This will be useful to you when you begin a  review of the literature in your area of study.

For example, think about the disciplines that might contribute information to a the topic such as  the role of sports in society. Try to anticipate the type of perspective each discipline might have on the topic. Consider the following types of questions as you examine what different disciplines might contribute:

• What is important about the topic to the people in that discipline?
• What is most likely to be the focus of their study about the topic?
• What perspective would they be likely to have on the topic?

In this example, we identify two disciplines that have something to say about the role of sports in society: allied health and education. What would each of these disciplines raise as key questions or issues related to that topic?

2.1.1.1 Nursing

• how sports affect individuals’ health and well-being
• assessing and treating sports injuries
• physical conditioning for athletes

2.1.1.2 Education

• how schools privilege or punish student athletes
• how young people are socialized into the ideal of team cooperation
• differences between boys’ and girls’ participation in organized sports

We see that a single topic can be approached from many different perspectives depending on how the disciplinary boundaries are drawn and how the topic is framed. This step of the research process requires you to make some decisions early on to focus the topic on a manageable and appropriate scope for the rest of the strategy. ( Hansen & Paul, 2015 ).

‘The literature’ consists of the published works that document a scholarly conversation in a field of study. You will find, in ‘the literature,’ documents that explain the background of your topic so the reader knows where you found loose ends in the established research of the field and what led you to your own project.  Although your own literature review will focus on primary, peer-reviewed resources, it will begin by first grounding yourself in background subject information generally found in secondary and tertiary sources such as books and encyclopedias.  Once you have that essential overview, you delve into the seminal literature of the field. As a result, while your literature review may consist of research articles tightly focused on your topic with secondary and tertiary sources used more sparingly, all three types of information (primary, secondary, tertiary) are critical to your research.

2.1.2 Definitions

• Theoretical – discusses a theory, conceptual model or framework for understanding a problem.
• Empirical – applies theory to a behavior or event and reports derived data to findings.
• Seminal – “A classic work of research literature that is more than 5 years old and is marked by its uniqueness and contribution to professional knowledge.” ( Houser, 4th ed., 2018, p. 112 ).
• Practical – “…accounts of how things are done” ( Wallace & Wray, 3rd ed., 2016, p. 20 ). Action research, in Education, refers to a wide variety of methods used to develop practical solutions. ( Great Schools Partnership, 2017 ).
• Policy – generally produced by policy-makers, such as government agencies.
• Primary – published results of original research studies .
• Secondary – interpret, discuss, summarize original sources
• Tertiary – synthesize or distill primary and secondary sources.  Examples include: encyclopedias, directories, dictionaries, handbooks, guides, classification, chronology, and other fact books.
• Grey literature – research and information released by non-commercial publishers, such as government agencies, policy organizations, and think-tanks.

‘The literature’ is published in books, journal articles, conference proceedings, theses and dissertations.  It can also be found in newspapers, encyclopedias, textbooks, as well as websites and reports written by government agencies and professional organizations. While these formats may contain what we define as ‘the literature’, not all of it will be appropriate for inclusion in your own literature review.

These sources are found through different tools that we will discuss later in this section. Although a discovery tool, such as a database or catalog, may link you to the ‘the literature’ not every tool is appropriate to every literature review.  No single source will have all of the information resources you should consult.  A comprehensive literature review should include searches in the following:

• Multiple subject and article databases
• Library and other book catalogs
• Grey literature sources

2.2 Information Cycle

To get a better idea of how the literature in a discipline develops, it’s useful to see how the information publication lifecycle works.  These distinct stages show how information is created, reviewed, and distributed over time.

The following chart can be used to guide you in searching literature existing at various stages of the scholarly communication process (freely accessible sources are linked, subscription or subscribed sources are listed but not linked):

2.3 Information Types

To continue our discussion of information sources, there are two ways published information in the field can be categorized:

• Articles by the type of periodical in which an article it is published, for example, magazine, trade, or scholarly publications .
• Where the material is located in the information cycle, as in primary, secondary, or tertiary information sources .

2.3.1 Popular, Trade, or Scholarly publications

2.3.1.1 types of periodicals.

Journals, trade publications, and magazines are all periodicals, and articles from these publications they can all look similar article by article when you are searching in the databases. It is good to review the differences and think about when to use information from each type of periodical.

2.3.1.2 Magazines

A magazine is a collection of articles and images about diverse topics of popular interest and current events.

Features of magazines:

• articles are usually written by journalists
• articles are written for the average adult
• articles tend to be short
• articles rarely provides a list of reference sources at the end of the article
• lots of color images and advertisements
• the decision about what goes into the magazine is made by an editor or publisher
• magazines can have broad appeal, like Time and Newsweek , or a narrow focus, like Sports Illustrated and Mother Earth News .

Popular magazines like Psychology Today , Sports Illustrated , and Rolling Stone can be good sources for articles on recent events or pop-culture topics, while Harpers , Scientific American , and The New Republic will offer more in-depth articles on a wider range of subjects. These articles are geared towards readers who, although not experts, are knowledgeable about the issues presented.

2.3.1.3 Trade Publications

Trade publications or trade journals are periodicals directed to members of a specific profession. They often have information about industry trends and practical information for people working in the field.

Features of trade publications:

• Authors are specialists in their fields
• Focused on members of a specific industry or profession
• No peer review process
• Include photographs, illustrations, charts, and graphs, often in color
• Technical vocabulary

Trade publications are geared towards professionals in a discipline. They report news and trends in a field, but not original research. They may provide product or service reviews, job listings, and advertisements.

2.3.1.4 Scholarly, Academic, and Scientific Publications

Scholarly, academic, and scientific publications are a collections of articles written by scholars in an academic or professional field. Most journals are peer-reviewed or refereed, which means a panel of scholars reviews articles to decide if they should be accepted into a specific publication. Journal articles are the main source of information for researchers and for literature reviews.

Features of journals:

• written by scholars and subject experts
• author’ credentials and institution will be identified
• written for other scholars
• dedicated to a specific discipline that it covers in depth
• often report on original or innovative research
• long articles, often 5-15 pages or more
• articles almost always include a list of sources at the end (Works Cited, References, Sources, or Bibliography) that point back to where the information was derived
• no or very few advertisements
• published by organizations or associations to advance their specialized body of knowledge

Scholarly journals provider articles of interest to experts or researchers in a discipline. An editorial board of respected scholars (peers) reviews all articles submitted to a journal. They decide if the article provides a noteworthy contribution to the field and should be published. There are typically few  little or no advertisements. Articles published in scholarly journals will include a list of references.

2.3.1.5 A word about open access journals

Increasingly, scholars are publishing findings and original research in open access journals .   Open access journals are scholarly and peer-reviewed and open access publishers provide unrestricted access and unrestricted use.  Open access is a means of disseminating scholarly research that breaks from the traditional subscription model of academic publishing. It is free of charge to readers and because it is online, it is available at anytime, anywhere in the world, to anyone with access to the internet.  The Directory of Open Access Journals ( DOAJ ) indexes and provides access to high-quality, peer-reviewed scholarly articles.

In summary, newspapers and other popular press publications are useful for getting general topic ideas. Trade publications are useful for practical application in a profession and may also be a good source of keywords for future searching. Scholarly journals are the conversation of the scholars who are doing research in a specific discipline and publishing their research findings.

2.3.1.6 Primary, Secondary, and Tertiary Sources

Primary sources of information are those types of information that come first. Some examples of primary sources are:

• original research, like data from an experiment with plankton.
• diaries, journals, photographs
• data from the census bureau or a survey you have done
• original documents, like the constitution or a birth certificate
• newspapers are primary sources when they report current events or current opinion
• speeches, interviews, email, letters
• religious books
• personal memoirs and autobiographies
• pottery or weavings

There are different types of primary sources for different disciplines.  In the discipline of history, for example, a diary or transcript of a speech is a primary source.  In education and nursing, primary sources will generally be original research, including data sets.

Secondary sources are written about primary sources to interpret or analyze them. They are a step or more removed from the primary event or item. Some examples of secondary sources are:

• commentaries on speeches
• critiques of plays, journalism, or books
• a journal article that talks about a primary source such as an interpretation of Steinbeck’s The Grapes of Wrath, or the flower symbolism of Monet’s water garden paintings
• textbooks (can also be considered tertiary)
• biographies
• encyclopedias

Tertiary sources are further removed from the original material and are a distillation and collection of primary and secondary sources. Some examples are:

• bibliography of critical works about an author
• textbooks (also considered secondary)

A comparison of information sources across disciplines:

2.4 Information Sources

In this section, we discuss how to find not only information, but the sources of information in your discipline or topic area.  As we see in the graphic and chart above, the information you need for your literature review will be located in multiple places.  How and where research and publication occurs drives how and where the information is located, which in turn determines how you will discover and retrieve it.  When we talk about information sources for a literature review in education or nursing, we generally mean these five areas: the internet, reference material and other books, empirical or evidence-based articles in scholarly, peer-reviewed journals, conference proceedings and papers, dissertations and theses, and grey literature.

The World Wide Web can be an excellent place to satisfy some initial research needs.

• It is a good resource for background information and for finding keywords for searching in the library catalog and databases.
• It is a good tool for locating professional organizations and searching for information and the names of experts in a given discipline.
• Google Scholar is a useful discovery tool for citations, especially if you are trying to get the lay of the land surrounding your topic or if you are having a problem with keywords in the databases. You can find some information to refine your search terms. It is NOT acceptable to depend on Google Scholar for finding articles because of the spotty coverage and lack of adequate search features.

2.4.2 Books and Reference Sources

Reference materials and books are available in both print and electronic formats. They provide gateway knowledge to a subject area and are useful at the beginning of the research process to:

• Get an overview of the topic, learn the scope, key definitions, significant figures who are involved, and important timelines
• Discover the foundations of a topic
• Learn essential definitions, vocabulary terms, and keywords you can use in your literature searching strategy

2.4.3 Scholarly Articles in Journals

Another major category of information sources is scholarly information produced by subject experts working in academic institutions, research centers and scholarly organizations. Scholars and researchers generate information that advances our knowledge and understanding of the world. The research they do creates new opportunities for inventions, practical applications, and new approaches to solving problems or understanding issues.

Academics, researchers and students at universities make their contributions to scholarly knowledge available in many forms:

• masters’ theses
• doctoral dissertations
• conference papers
• journal articles and books
• individual scholars’ web pages
• web pages developed by the researcher’s’ home institution (Hansen & Paul, 2015).

Scholars and researchers introduce their discoveries to the world in a formal system of information dissemination that has developed over centuries. Because scholarly research undergoes a process of “peer review” before being published (meaning that other experts review the work and pass judgment about whether it is worthy of publication), the information you find from scholarly sources meets preset standards for accuracy, credibility and validity in that field.

Likewise, scholarly journal articles are generally considered to be among the most reliable sources of information because they have gone through a peer-review process.

2.4.5 Conference Papers & Proceedings

Conferences are a major source of  emerging research where researchers present papers on their current research and obtain feedback from the audience.  The papers presented in the conference are then usually published in a volume called a conference proceeding.  Conference proceedings highlight current discussion in a discipline and can lead you to scholars who are interested in specific research areas.

A word about conference papers: several factors contribute to making these documents difficult to find.  It may be months before a paper is published as a journal article, or it may never be published.  Publishers and professional associations are inconsistent in how they publish proceedings.  For example, the papers from an annual conference may be published as individual, stand-alone titles, which may be indexed in a library catalog, or the conference proceedings may be treated more like a periodical or serial and, therefore, indexed in a journal database.

It is not unusual that papers delivered at professional conferences are not published in print or electronic form, although an abstract may be available.  In these cases, the full paper may only be available from the author or authors.

The most important thing to remember is that if you have any difficulty finding a conference proceeding or paper, ask a librarian for assistance.

2.4.6 Dissertations and Theses

Dissertations and theses can be rich sources of information and have extensive reference lists to scan for resources. They are considered gray literature, so are not “peer reviewed”. The accuracy and validity of the paper itself may depend on the school that awarded the doctoral or master’s  degree to the author.

2.5 Conclusion

In thinking about ‘the literature’ of your discipline, you are beginning the first step in writing your own literature review.  By understanding what the literature in your field is, as well as how and when it is generated, you begin to know what is available and where to look for it.

We briefly discussed seven types of (sometimes overlapping) information:

• information found on the web
• information found in reference books and monographs
• information found in scholarly journals
• information found in conference proceedings and papers
• information found in dissertations and theses
• information found in magazines and trade journals
• information that is primary, secondary, or tertiary.

By conceptualizing or scoping how and where the literature of your discipline or topic area is generated, you have started on your way to writing your own literature review.

Finally, remember:

“All information sources are not created equal. Sources can vary greatly in terms of how carefully they are researched, written, edited, and reviewed for accuracy. Common sense will help you identify obviously questionable sources, such as tabloids that feature tales of alien abductions, or personal websites with glaring typos. Sometimes, however, a source’s reliability—or lack of it—is not so obvious…You will consider criteria such as the type of source, its intended purpose and audience, the author’s (or authors’) qualifications, the publication’s reputation, any indications of bias or hidden agendas, how current the source is, and the overall quality of the writing, thinking, and design.”  ( Writing for Success, 2015, p. 448 ).

We will cover how to evaluate sources in more detail in Chapter 5.

For each of these information needs, indicate what resources would be the best fit to answer your question. There may be more than one source so don’t feel like you have to limit yourself to only one. See Answer Key for the correct response.

• You are to write a brief paper on a theory that you only vaguely understand. You need some basic information. Where would you look?
• If you heard something on the radio about a recent research involving an herbal intervention for weight loss where could you find the actual study?
• You are going to be doing an internship in a group home for young men. You have heard that one issue that comes up for them is anger. Where would you look for practical interventions to help you manage this problem if it came up?
• You have the opportunity to work on a research project through a grant proposal. You need to justify the research question and show that there is an interest and a need for this research. What resources would you cite in your application?
• You have been assigned a project to find primary sources about classroom discipline used in early 20th-century schools. What primary sources could you use and where would you find them?
• You have an idea for a great thesis but you are afraid that it has been done before. Since you would like to do something original, where could you find out if someone else has done the project?
• There was a post on Facebook that welfare recipients in Arizona were recently tested for drug use with only three in 140,000 having positive results. Where can I find out if this number is accurate?

Test Yourself

Question 1  match the type of periodical to its content.

Trade publication Scholarly journal Magazine

• Contains articles about a variety of topics of popular interest; also contains advertising.
• Has information about industry trends and practical information for professionals in a field.
• Contains articles written by scholars in an academic field and reviewed by experts in that field.

Question 2: Given what you know about information types and sources, put the following information sources in order from the least accurate and reliable  to the most accurate and reliable. (1 least accurate/4 most accurate)

• Books and encyclopedias
• News broadcasts and social media directly following an event.
• Analysis of an event in the news media or popular magazine weeks after an event.
• Articles written by scholars and published in a journal.

Question 3: What is information called that is either a diary, a speech, original research, data, artwork, or a religious book.

Question 4: to find the best information in the databases you need to use keywords that are used by the scholars. where do you find out what keywords to try.

• From websites
• In journal articles
• All of the above

Question 5: Which of the following is NOT true about scholarly journals?

• They contain the conversation of the scholars on a particular subject.
• They are of interest to the general public.
• The articles are followed by an extensive reference list.
• They contain reports of original research.

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Literature Reviews for Education and Nursing Graduate Students Copyright © by Linda Frederiksen is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Review of Related Literature (RRL)

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The Review of Related Literature (RRL) is a crucial section in research that examines existing studies and publications related to a specific topic. It summarizes and synthesizes previous findings, identifies gaps, and provides context for the current research. RRL ensures the research is grounded in established knowledge, guiding the direction and focus of new studies.

What Is Review of Related Literature (RRL)?

The Review of Related Literature (RRL) is a detailed analysis of existing research relevant to a specific topic. It evaluates, synthesizes, and summarizes previous studies to identify trends, gaps, and conflicts in the literature. RRL provides a foundation for new research, ensuring it builds on established knowledge and addresses existing gaps.

Format of Review of Related Literature (RRL)

The Review of Related Literature (RRL) is a critical part of any research paper or thesis . It provides an overview of existing research on your topic and helps to establish the context for your study. Here is a typical format for an RRL:

1. Introduction

• Purpose : Explain the purpose of the review and its importance to your research.
• Scope : Define the scope of the literature reviewed, including the time frame, types of sources, and key themes.

2. Theoretical Framework

• Concepts and Theories : Present the main theories and concepts that underpin your research.
• Relevance : Explain how these theories relate to your study.

3. Review of Empirical Studies

• Sub-theme 1 : Summarize key studies, including methodologies, findings, and conclusions.
• Sub-theme 2 : Continue summarizing studies, focusing on different aspects or variables.
• Sub-theme 3 : Include any additional relevant studies.

4. Methodological Review

• Approaches : Discuss the various methodologies used in the reviewed studies.
• Strengths and Weaknesses : Highlight the strengths and weaknesses of these methodologies.
• Gaps : Identify gaps in the existing research that your study aims to address.

5. Synthesis and Critique

• Integration : Integrate findings from the reviewed studies to show the current state of knowledge.
• Critique : Critically evaluate the literature, discussing inconsistencies, limitations, and areas for further research.

6. Conclusion

• Summary : Summarize the main findings from the literature review.
• Research Gap : Clearly state the research gap your study will address.
• Contribution : Explain how your study will contribute to the existing body of knowledge.

7. References

• Citation Style : List all the sources cited in your literature review in the appropriate citation style (e.g., APA, MLA, Chicago).

Review of Related Literature (RRL) 1. Introduction This review examines research on social media’s impact on mental health, focusing on anxiety and depression across various demographics over the past ten years. 2. Theoretical Framework Anchored in Social Comparison Theory and Uses and Gratifications Theory, this review explores how individuals’ social media interactions affect their mental health. 3. Review of Empirical Studies Adolescents’ Mental Health Instagram & Body Image : Smith & Johnson (2017) found Instagram use linked to body image issues and lower self-esteem among 500 high school students. Facebook & Anxiety : Brown & Green (2016) showed Facebook use correlated with higher anxiety and depressive symptoms in a longitudinal study of 300 students. Young Adults’ Mental Health Twitter & Stress : Davis & Lee (2018) reported higher stress levels among heavy Twitter users in a survey of 400 university students. LinkedIn & Self-Esteem : Miller & White (2019) found LinkedIn use positively influenced professional self-esteem in 200 young professionals. Adult Mental Health General Social Media Use : Thompson & Evans (2020) found moderate social media use associated with better mental health outcomes, while excessive use correlated with higher anxiety and depression in 1,000 adults. 4. Methodological Review Studies used cross-sectional surveys, longitudinal designs, and mixed methods. Cross-sectional surveys provided large data sets but couldn’t infer causation. Longitudinal studies offered insights into long-term effects but were resource-intensive. Mixed methods enriched data through qualitative insights but required careful integration. 5. Synthesis and Critique The literature shows a complex relationship between social media and mental health, with platform-specific and demographic-specific effects. However, reliance on self-reported data introduces bias, and many cross-sectional studies limit causal inference. More longitudinal and experimental research is needed. 6. Conclusion Current research offers insights into social media’s mental health impact but leaves gaps, particularly regarding long-term effects and causation. This study aims to address these gaps through comprehensive longitudinal analysis. 7. References Brown, A., & Green, K. (2016). Facebook Use and Anxiety Among High School Students . Psychology in the Schools, 53(3), 257-264. Davis, R., & Lee, S. (2018). Twitter and Psychological Stress: A Study of University Students . Journal of College Student Development, 59(2), 120-135. Miller, P., & White, H. (2019). LinkedIn and Its Effect on Professional Self-Esteem . Journal of Applied Psychology, 104(1), 78-90. Smith, J., & Johnson, L. (2017). The Impact of Instagram on Teen Body Image . Journal of Adolescent Health, 60(5), 555-560. Thompson, M., & Evans, D. (2020). The Relationship Between Social Media Use and Mental Health in Adults . Cyberpsychology, Behavior, and Social Networking, 23(4), 201-208.

Review of Related Literature (RRL) Examples

Review of related literature in research, review of related literature in research paper, review of related literature qualitative research.

Review of Related Literature Quantitative Research

More Review of Related Literature (RRL) Examples

• Impact of E-learning on Student Performance
• Effectiveness of Mindfulness in Workplace
• Green Building and Energy Efficiency
• Impact of Technology on Healthcare Delivery
• Effects of Nutrition on Cognitive Development in Children
• Impact of Employee Training Programs on Productivity
• Effects of Climate Change on Biodiversity
• Impact of Parental Involvement on Student Achievement
• Effects of Mobile Learning on Student Engagement
• Effects of Urban Green Spaces on Mental Health

Purpose of the Review of Related Literature (RRL)

The Review of Related Literature (RRL) serves several critical purposes in research:

• Establishing Context : It situates your research within the broader field, showing how your study relates to existing work.
• Identifying Gaps : It highlights gaps, inconsistencies, and areas needing further exploration in current knowledge, providing a clear rationale for your study.
• Avoiding Duplication : By reviewing what has already been done, it helps ensure your research is original and not a repetition of existing studies.
• Building on Existing Knowledge : It allows you to build on the findings of previous research, using established theories and methodologies to inform your work.
• Theoretical Foundation : It provides a theoretical basis for your research, grounding it in existing concepts and theories.
• Methodological Insights : It offers insights into the methods and approaches used in similar studies, helping you choose the most appropriate methods for your research.
• Establishing Credibility : It demonstrates your familiarity with the field, showing that you are well-informed and have a solid foundation for your research.
• Supporting Arguments : It provides evidence and support for your research questions, hypotheses, and objectives, strengthening the overall argument of your study.

How to Write Review of Related Literature (RRL)

Writing a Review of Related Literature (RRL) involves several key steps. Here’s a step-by-step guide:

1. Define the Scope and Objectives

• Determine the Scope : Decide on the breadth of the literature you will review, including specific themes, time frame, and types of sources.
• Set Objectives : Clearly define the purpose of the review. What do you aim to achieve? Identify gaps, establish context, or build on existing knowledge.

2. Search for Relevant Literature

• Identify Keywords : Use keywords and phrases related to your research topic.
• Use Databases : Search academic databases like Google Scholar, PubMed, JSTOR, etc., for relevant articles, books, and papers.
• Select Sources : Choose sources that are credible, recent, and relevant to your research.

3. Evaluate and Select the Literature

• Read Abstracts and Summaries : Quickly determine the relevance of each source.
• Assess Quality : Consider the methodology, credibility of the authors, and publication source.
• Select Key Studies : Choose studies that are most relevant to your research questions and objectives.

4. Organize the Literature

• Thematic Organization : Group studies by themes or topics.
• Chronological Organization : Arrange studies in the order they were published to show the development of ideas over time.
• Methodological Organization : Categorize studies by the methods they used.

5. Write the Review

• State the purpose and scope of the review.
• Explain the importance of the topic.
• Theoretical Framework : Present and discuss the main theories and concepts.
• Summarize key studies, including their methodologies, findings, and conclusions.
• Organize by themes or other chosen organizational methods.
• Methodological Review : Discuss the various methodologies used, highlighting their strengths and weaknesses.
• Synthesis and Critique : Integrate findings, critically evaluate the literature, and identify gaps or inconsistencies.
• Summarize the main findings from the literature review.
• Highlight the research gaps your study will address.
• State how your research will contribute to the existing knowledge.

6. Cite the Sources

• Use Appropriate Citation Style : Follow the required citation style (e.g., APA, MLA, Chicago).
• List References : Provide a complete list of all sources cited in your review.

What is an RRL?

An RRL summarizes and synthesizes existing research on a specific topic to identify gaps and guide future studies.

Why is RRL important?

It provides context, highlights gaps, and ensures new research builds on existing knowledge.

How do you write an RRL?

Organize by themes, summarize studies, evaluate methodologies, identify gaps, and conclude with relevance to current research.

What sources are used in RRL?

Peer-reviewed journals, books, conference papers, and credible online resources.

How long should an RRL be?

Length varies; typically 10-20% of the total research paper.

What are common RRL mistakes?

Lack of organization, insufficient synthesis, over-reliance on outdated sources, and failure to identify gaps.

Can an RRL include non-scholarly sources?

Primarily scholarly, but reputable non-scholarly sources can be included for context.

What is the difference between RRL and bibliography?

RRL synthesizes and analyzes the literature, while a bibliography lists sources.

How often should an RRL be updated?

Regularly, especially when new relevant research is published.

Can an RRL influence research direction?

Yes, it identifies gaps and trends that shape the focus and methodology of new research.

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Peer-reviewed

Research Article

The effects of gases from food waste on human health: A systematic review

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, Department of Health Sciences, Western University, London, ON, Canada

Roles Investigation, Methodology, Writing – review & editing

Affiliation Department of Geography and Environment, Western University, London, ON, Canada

Roles Supervision, Validation, Writing – review & editing

• Paulina Rudziak, 
• Evans Batung, 
• Isaac Luginaah

• Published: March 27, 2024
• https://doi.org/10.1371/journal.pone.0300801
• Reader Comments

Food waste is a routine and increasingly growing global concern that has drawn significant attention from policymakers, climate change activists and health practitioners. Amid the plurality of discourses on food waste-health linkages, however, the health risks from food waste induced emissions have remained under explored. This lack of evidence is partly because of the lack of complete understanding of the effects of food waste emissions from household food waste on human health either directly through physiological mechanisms or indirectly through environmental exposure effects. Thus, this systematic review contributes to the literature by synthesizing available evidence to highlight gaps and offers a comprehensive baseline inventory of food waste emissions and their associated impacts on human health to support public health decision-making. Four database searches: Web of Science, OVID(Medline), EMBASE, and Scopus, were searched from inception to 3 May 2023. Pairs of reviewers screened 2189 potentially eligible studies that addressed food waste emissions from consumers and how the emissions related to human health. Following PRISMA guidelines, 26 articles were eligible for data extraction for the systematic review. Findings indicate that emissions from food waste, such as hydrogen sulphide, ammonia, and volatile organic carbons, can affect human endocrine, respiratory, nervous, and olfactory systems. The severity of the human health effects depends on the gaseous concentration, but range from mild lung irritation to cancer and death. This study recommends emission capture technologies, food diversion programs, and biogas technologies to reduce food waste emissions.

Citation: Rudziak P, Batung E, Luginaah I (2024) The effects of gases from food waste on human health: A systematic review. PLoS ONE 19(3): e0300801. https://doi.org/10.1371/journal.pone.0300801

Editor: Helen Onyeaka, University of Birmingham, UNITED KINGDOM

Received: August 21, 2023; Accepted: March 5, 2024; Published: March 27, 2024

Copyright: © 2024 Rudziak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: Funding for this study was provided by Western University’s Undergraduate Student Research Internship. The funder provided support in the form of a bursary for the author [PR], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: Funding for this study was provided by Western University’s Undergraduate Student Research Internship in the form of a bursary. The funding does not interfere with the full and objective presentation, peer review, editorial decision-making, or publication of research submitted to PLOS ONE.

Introduction

Food waste is a common global issue–the latest Food and Agricultural Organization (FAO) report on food waste approximates 1.3 billion tonnes of food in the world is lost or wasted each year [ 1 ]. Food waste emits harmful gases, such as CO 2 , H 2 S, CH 4 , N 2 O, and PM 2.5 , that are detrimental to human health [ 2 – 4 ]. Emissions from food waste can negatively impact human health directly and indirectly. These impacts may include an increasing number of respiratory issues, and mild and severe headaches [ 2 , 5 ]. The human health impacts have led to many global emission-related food waste policies and goals. For example, the FAO plans to halve the per capita global food waste at the retail and consumer levels in response to Sustainable Development Goal 12− Responsible Consumption and Production by 2030 [ 1 ]. In this study, composting, a form of food waste, is used to measure and characterize food waste emissions [ 2 , 6 ].

Level of analysis

For this systematic review, food is defined as edible products that contribute to human nourishment [ 7 ]. The definition of food waste will be “discarded food” from households, restaurants, and food catering services. Kitchen food waste mainly consists of fruit, vegetables, meat and bones, bread, fish bones, pasta, shellfish, rice, eggshells, coffee grounds, and dairy products [ 8 ]. Residential food waste can quickly decompose and produce odours because of its nature, high organic content, chemical mixtures, and sensitivity to room temperature [ 6 ].

Although food waste occurs in multiple stages of the food chain, focusing on the consumer level is important because of the relationship between consumption and food waste reinforced by the rapid industrialization, urbanization and economic development that have increased food waste levels [ 9 ]. Food waste estimates show that anthropogenic influence accounts for nearly one pound of wasted food per person per day [ 10 , 11 ]. Wasted food is equivalent to over 30 million acres of cropland each year, mainly accounting for grains, oilseeds, vegetables, fruit, and dairy [ 10 ]. Fruits and vegetables are among the most wasted products [ 11 ]. Restaurants are guilty of serving portions too large for people to gauge higher price and profit margins. As a result, lots of food is wasted if the consumer does not like the idea of eating leftovers the next day [ 12 ]. Moreover, hotels, convention centres, resorts, and banquet halls that host large gatherings throw away a lot of viable food [ 13 ].

Metaphorically, if food waste were a country, it would be the third-largest greenhouse gas emitting country [ 1 ]. Thus, research on food waste emissions from households and consumer outlets needs to be the prime area of focus for their direct and indirect impacts on human health. Furthermore, most studies addressing food waste emissions are in contexts that vary in climatic conditions; thus, differences between food waste emissions will be assessed to account for different climatic conditions of composting areas. Warmer months with low aeration provide optimal conditions for food waste to emit gases at high concentrations [ 9 ]. Hence, food waste gas concentrations will be discussed in relation to odour thresholds (maximum tolerable gaseous concentration without odour annoyance) and olfactometry thresholds (the ability to change olfactory cell physiology) [ 9 , 14 ].

The current solutions to food waste emissions

Alternatives to food waste emissions have been explored, such as generating biofuels to power vehicles, heat homes, and generate electricity [ 15 ]. In this manner, food waste emissions are reused rather than released into the atmosphere which can have deleterious effects due to imbalances. Biofilters for composting sites have been experimented with to understand which filtering method best limits food waste emissions [ 14 , 16 ]. In addition, food diversion systems have also been explored to ship untouched food from restaurants and catering events to local food banks and provide nourishment to people in need of food [ 13 ]. Despite these innovations, the net effect of the unprocessed food waste is negative as emissions continue to harm human health. It is therefore unsurprising that alternative methods to releasing food waste emissions into ambient air are being intensively explored [ 16 ].

Relevance of this study

Previous systemic reviews addressing food waste have focussed on production and agricultural food waste, and loss prevention and mitigation techniques, but less so on human health outcomes and consumer food waste emissions [ 17 – 20 ]. This systematic review is unique in that it combines the studies reporting on various foods that emit toxic emissions from a consumer level and studies focusing more on the human consequences of these gaseous emissions. Such a review illustrates a clear link of food waste emissions and the impact on human health.

Hypothesis and objectives

For this review, we hypothesize that food waste emissions will pose respiratory, nasal, and social health issues based on the current food waste evidence in the literature. Accordingly, the objective of this study is to review analyses of how gas emissions from food waste can impact human health both directly and indirectly. The objective will be accomplished by summarizing findings from literature and creating an inventory of food waste gases and their associated health effects. In this systematic review, direct human health impacts relate to physiological effects on the human body. Indirect human health effects relate to secondary outcomes, such as fresh-water acidification, which can lead to human health effects.

We began the design by searching the international database of Prospectively Registered Systematic Reviews (PROSPERO) in “Health” and “Social care” for similar or identical reviews prior to study commencement, and none were found [ 21 ]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were then employed to systematically identify and assess approaches to ensure consistent methods and analyses for this review [ 22 ]. To inform this systematic review, the databases Web of Science, OVID(Medline), EMBASE, and Scopus were searched from inception to 3 May 2023. These databases were selected based on their relevance to environmental and human health research. No restrictions on language or publication date were set in the databases. Three strings were searched in each database. The strings included keywords ‘food waste’ AND ‘human health’ AND ‘gases,’ and synonyms for gases were also searched, including ‘emissions’ and ‘vapours.’ An additional search strategy was later added to review compost emissions more broadly. The key words ‘compost emissions’ AND ‘human health’ were searched in Web of Science, OVID(Medline), EMBASE, and Scopus ( S1 Fig ).

For the first search strategy, a pair of reviewers screened 1020 potentially eligible titles and abstracts in the systematic review software Rayyan, after removing 483 duplicates ( Fig 1 ) [ 23 ]. This software allows for uploads of search strategies from databases into a project folder, detects duplicates among the added titles and abstracts, and allows for highlights of keywords to help each reviewer with the inclusion of articles.

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https://doi.org/10.1371/journal.pone.0300801.g001

For the second and third search strategy, a pair of reviewers screened 668 potentially eligible titles and abstracts for the systematic review in the systematic review software Covidence, after removing 348 duplicates [ 24 ]. Covidence was used for the second search strategy because of the upgrades that were made available to facilitate the screening process with relative ease. Following training, pairs of reviewers independently screened all titles and abstracts, followed by full-text articles that were identified as potentially eligible. When necessary, a consensus was reached through a discussion.

The inclusion criteria for titles and abstracts consisted of primary research related to food waste emissions from the human consumer level, such as household food waste, restaurant food waste, and purposeful viable food discards from food retailers. Articles that report a mix of municipal solid waste, everyday garbage consisting of everything and anything, for food waste emissions data were not considered for the review [ 25 ]. This is because emissions from unsorted municipal solid waste cannot be generalized to the food waste within. The articles of focus are studies that report emissions from consumer food waste/ scraps and organic compost. Food waste from production, manufacturing, and commercial farming was also not considered because of differences in definitions of food waste across studies and the vast complexities involved. Title and abstracts also had to mention human health in context to be included for full-text screening.

A total of 70 (6.8%) articles were marked as discrepancies between reviewers after title and abstract screening and were resolved after discussion. To facilitate full-text screening, articles were restricted to the English language [ 26 ]. After title and abstract screening, 80 articles were eligible for full-text screening, and two articles were excluded because they did not have the full-text published. In total, 78 full-text articles from the search strategy itself were screened by a pair of reviewers. An excel sheet was formulated for full-text screening with identical inclusion criteria ( S2 and S3 Figs). Criteria for inclusion consisted of primary research articles that addressed food waste, waste emissions, human health, and articles published in the English language. The link to human health could be direct or indirect (measured or mentioned in context). Editorials, commentaries, and reviews were excluded to focus on evidence-based primary research. After resolving 13 (32.5%) discrepancies, 19 out of 78 articles were included for data analyses after full-text screening, and 59 out of 78 articles were excluded ( Fig 1 ). The excluded articles lacked addressing human health directly or indirectly and consisted of varying definitions of food waste that were too challenging too extract. The bibliography of included articles was searched for relevance to minimize the risk of not including relevant studies. Seven articles were included from searching citations of included articles, expanding the included full-text articles for data analysis to 26 articles ( S4 Fig ).

To evaluate the quality of each publication selected for the systematic review, a modified version of the “McMaster University’s Critical Review Form” was used to thoroughly critique the studies ( S5 and S6 Figs) [ 27 ]. Reviewers individually used the modified form to critique articles in the following areas:

• purpose of the study,
• background information,
• study design,
• interventions,
• results, and
• conclusions of article.

The Joanna Briggs Institute critical appraisal form for case reports was used for the one included case report [ 28 ]. To facilitate the appraisal process, excel files were created using the checklists of the critical appraisal reports. Critical appraisals were completed in duplicate, and opinions on the credibility of articles were discussed and decided amongst the reviewers. To facilitate the write-up process, annotations of included full-text articles were created. Included in the annotations were methodologies, results, limitations, and recommendations. The annotations helped to determine common themes among included articles to help articulate the systematic review and helped determine the set-up of the results summary table. The summarization of ideas in articles is subjective to a certain degree but allows researchers to compare views and extract shared meanings [ 29 ].

Results and discussion

Studies analyzed research in various countries with different food waste emission regulations. Olfactory and odour thresholds differed among countries, likely because of the change in climate and governmental stipulations [ 4 , 9 , 14 ]. The 26 included studies were conducted mainly in Asia (38%), Europe (35%), and the United States of America (23%) ( Fig 2 ). Most of the articles were also published within the last decade (65%) ( Fig 3 ). The number of articles reporting mild to severe direct human health impacts is summarized in Table 1 . Because of the variability in composition, temperature, climate, and moisture of food waste across countries, the summary of food waste emissions in Table 2 is not generalizable for the entire world, but the impact on human health from such gases is universal.

The python-generated map includes circles of various sizes representing the number of studies included from various countries. China, Europe, and the United States of America were the main origins of studies conducted. Most studies were conducted in Asia.

https://doi.org/10.1371/journal.pone.0300801.g002

The year 2017 had the most frequent publication date, and the last decade showed the most publications in general.

https://doi.org/10.1371/journal.pone.0300801.g003

https://doi.org/10.1371/journal.pone.0300801.t001

https://doi.org/10.1371/journal.pone.0300801.t002

Classification of food waste emissions

Typical for composting conditions, food waste was mixed with a percentage of wood chips, usually 30% in included studies [ 39 ]. A typical food waste composting process includes sorting/crushing food mechanically, hydrothermal hydrolysis, then conversion into a liquid for anaerobic digestion or conversion into a solid for aerobic fermentation [ 31 ]. During all stages of the composting process food waste emissions can be released in various levels of toxicity into the surrounding environment [ 31 ]. Composting conditions across included studies were not variable enough to emit higher amounts of toxic gases, but higher concentrations of food waste gases were typically collected in winter months [ 9 , 31 ]. Most studies used a gas chromatography-mass spectrometer to identify the emissions from food waste [ 4 , 9 , 14 , 31 ]. Emissions from food waste during various stages of composting were compared to odour thresholds recommended by environmental protection agencies of the countries represented in the studies [ 14 ].

The most common harmful gases captured from food waste include some volatile organic carbons (VOCs) (such as terpenes and sulphur compounds); 1,2,4-trimethylbenzne; aromatic compounds and hydrogen sulphide because of their associated human health effects [ 9 , 14 , 16 ]. Food waste composting is influenced by the concentration of emissions, which is dependent on aeration, temperature, moisture, and storage [ 34 ]. Food waste decomposes more at higher temperatures, and odour intensity increases linearly with increasing storage time and increasing temperatures [ 6 ]. The measure of total organic carbon can be used to quantify the amount of organic matter present within compost [ 6 ]. Quantification of organic matter is important to determine the homogeneity of the compost, and if different factors contribute to high emission concentrations or high odour intensity levels.

Odour intensity can be measured by two evaluators smelling buckets of food waste at 1, 4, 7, 10, and 14 days apart, and at 20°C and 8°C temperature differences [ 6 ]. Generally, the more extended storage periods at 7, 10, and 14 days at 20°C had a scaled odour intensity described as overpowering, intolerable for any length of time, and acute exposure could change olfactory physiology. The odours in common with all the buckets were ammonia and isovaleric acid. Both have low odour thresholds and strong scents, possibly causing the strong odours from all the buckets evaluated at 20°C. At 8°C, the emissions were considered very distinguishable, irritable, and objectionable [ 6 ]. The most common harmful gases captured from food waste include some volatile organic carbons (VOCs) (such as terpenes and sulphur compounds); 1,2,4-trimethylbenzne; aromatic compounds; and hydrogen sulphide that tested above their designated odour thresholds [ 9 , 14 , 16 ]. Hundreds of VOCs emitted from compost, and they pose a hazard to human health [ 34 ]. The VOCs shown on Table 2 mainly include terpenes, butane, halogenated compounds, aromatic compounds, isobutane, pentane, butane, dimethyl sulphide, and dimethyl disulphide [ 16 , 31 , 34 , 40 ]. VOCs emit odours during conditions of low aeration and high moisture levels, increasing the volatility of compounds by increasing their vapour pressure and availability of microorganisms to degrade the food waste [ 34 ]. Given the various health effects described in Table 2 , VOC emissions variably break down because of the uneven distribution of methanogenic bacteria used to break down composted food and varying molecular weights of compounds [ 34 , 40 ]. The VOCs with lower molecular weights can quickly enter the gaseous phase and become volatile [ 41 ]. In the aqueous compost phase, VOCs can solubilize easily under high temperatures and are emitted at high rates into the surrounding atmosphere [ 34 , 40 ]. Concentrations of VOCs are higher and more concerning for human health in indoor settings than in outdoor settings [ 16 ]. Human health is compromised from long-term VOC emissions from food waste because of the carcinogenicity of VOCs, their ability to irritate olfactory cells, change their physiology, and compromise endocrine, respiratory, and nervous systems [ 31 ].

Seasonal fluctuations in food waste emissions

Dietary changes in the summer months create food waste mainly consisting of fruits and vegetables, compared to high fat and protein foods consumed in the winter months [ 9 ]. Fruits and vegetables contain large amounts of sugars and carbohydrates that are easily converted into oxygenated organic compounds such as acetaldehyde. In January, people consume more eggs and meats that contain sulphur proteins, so sulphur malodors are common [ 9 ].

The difference between the measurements during the two seasons was higher water content and higher temperature during summer months, making decomposition easier [ 9 , 34 ]. This difference is specific to China’s summer and winter months and follows Chinese odour regulations [ 9 ]. During September emission measurement collections, thresholds were exceeded for toluene (0.65173 mg m -3 ), dimethyl sulphide (0.00776 mg m -3 ), and acetaldehyde (0.00282 mg m -3 ) across multiple compost sites [ 9 ]. Ammonia emissions exceeded the threshold (1.0629 mg m -3 ) at one compost plant during September emission collections. During both September and January emission collections, thresholds were exceeded for methanethiol (0.00014 mg m -3 ), dimethyl disulphide (0.00862 mg m -3 ), and hydrogen sulphide (0.000581 mg m -3 ) across multiple compost sites. Hydrogen sulphide was the only gas that exceeded its threshold at every compost location in both September and January collections, suggesting its emission of a powerful odour [ 9 ]. A study completed in Taiwan compared food waste emissions during typically high temperature and humidity conditions of the compost plant to olfactory thresholds [ 14 ]. The emissions p-Cymene and ethylbenzene exceeded their olfactory thresholds (12 ug m -3 ) and (13 ug m -3 ), respectively, compromising the health of workers. Concentrations below the emission thresholds stated are considered safe for workers in the compost area [ 9 , 14 ].

The emissions stated all had low odour thresholds, which means that even the slightest concentration above threshold levels can irritate workers and residents nearby, measured using an odour activity value (OAV). Hydrogen sulphide, dimethyl sulphide, dimethyl disulphide, methanethiol and acetaldehyde had large OAV values, causing great and sustained annoyance among workers and residents nearby. Large OAV values can detriment workers’ and residences’ health, well-being, and quality of life [ 9 , 14 ]. Hydrogen sulphide is arguably the most lethal food waste emission, having the capability to cause cardiovascular, respiratory, neurological, and vision complications that can lead to impaired functioning and death [ 3 ]. Toluene has a low OAV value and poses minimal annoyance for workers and residents nearby [ 9 ].

Connection to human health

The evidence provided here shows a positive linkage between food waste emissions and both direct and indirect human health impacts. Food waste can disrupt olfactory cell functioning, atmospherically spread to nearby residents, and cause occupational safety concerns [ 4 ]. One of the main concerns of food waste emissions is the possible impairment of olfactory cells [ 4 , 9 , 14 ]. Some studies used the odour thresholds of chemical compounds that varied among studies, to determine the hazard potential for workers at the compost site and residents living nearby [ 9 , 14 , 16 ]. Odours can irritate olfactory cells, which are vulnerable to impairment from strong odours. This can in turn, decrease the safety and quality of life for individuals affected [ 14 , 41 , 42 ]. For example, individuals may not be able to tell when food is spoiled by the smell and may ingest harmful products [ 4 , 14 ]. In another example, the odours from Taiwanese food waste plants forced residents nearby to protest, causing a shutdown and an investigation of the plants [ 4 ]. Proper aeration and controlling temperatures of food decomposition are essential to lower concentrations of food waste emissions [ 16 , 31 ].

Table 2 includes information about respiratory health issues related to food waste emissions. Respiratory health issues range from least severe, lung irritation, to most severe, carcinogenicity. The respiratory health reports came from complaints of compost plant workers and residents living nearby them [ 4 , 9 , 16 ]. The highly volatile gaseous compounds, such as VOCs, had the most detrimental respiratory human health effects [ 16 ].

Moreover, the emissions of food waste, such as ammonia gas, have social health costs in addition to environmental health and human physiological health. For example, ammonia is a precursor for the formation of Particulate Matter 2.5, which are ultra-fine particles known to cause severe respiration complications by lodging deep into alveoli, obstructing their function and shape [ 43 ]. Particulate matter can travel long distances, affecting populations not only in the nearby composting location [ 2 ]. Arguably, a possible solution to human exposure to food waste emissions is to locate composting sites in very sparsely populated areas [ 2 ]. However, an environmental inequity would arise because rural inhabitants would be exposed to polluted air from food they mostly did not throw away.

Key components in food waste

In addition to gaseous chemical emissions, biological aerosols and endotoxins are emitted from food waste compost and pose potentially serious human health respiratory repercussions [ 44 ]. Such toxicity is especially harmful to humans because of the biological aspect that can create more severe human health complications [ 45 ].

Bioaerosols

Bioaerosols are aerosols with any biological origin; bacteriological and fungal aerosols are mainly reported in this review [ 44 ]. The highest concentration of bioaerosols is found at the boundary areas for site collection, which may be due to accumulation from being carried upwind [ 45 ]. Peaks in bioaerosol emissions occur at the 100 and 150m boundary downwind of the composting sample, possibly because of the buoyancy effect, causing some bioaerosols to rise above sampling height until cooled to sink back to a sampling height [ 45 ]. Inhalation of bioaerosols pose respiratory challenges for humans, such as inducing allergies, sensitivity, and infectious disease [ 46 ]. A standard for microbes in the air is not universally settled, but not exceeding 1000cfu/m 3 is recommended [ 39 ]. Size of bioaerosol particles matter since smaller particles can penetrate deeper into the respiratory system, making it more difficult to for lungs to recover [ 46 ]. Bioaerosols of particles >7.1μm reach the nasal cavity, 4.7–7.1μm reach the pharynx, 3.3–4.7μm reach the trachea and primary bronchi, 2.1–3.3μm reach the secondary bronchi, 1.1–2.1μm reach the terminal bronchi, and 0.65–1.1μm reach the alveoli [ 47 ]. Such deep penetrations can pose respiratory challenges as mentioned previously [ 46 ]. Bacteria emitted from a United Kingdom compost site were <0.6μm in diameter, threatening deep tissues of human lungs. Some larger particles were actinobacteria and firmicutes, with a diameter >3.3μm.

Fungal aerosols are also considered bioaerosols and they range in size. Common fungal aerosols found around the world in compost are Penicillium , Aspergillus , Emericella , and Paecilomyes [ 39 , 48 ]. In some samples, such as a UK composting site, Capnodiales were found to have a diameter >3.3μm, and made up more than 25% of the fungal community in the compost. Eurotiales have a diameter between 4.7–1.1μm and made up more than 50% of the fungal community in the compost. Ascomycota have a diameter between 3.3–4.7um and make up a little more than 6% of the fungal community in the compost. Glomeromycota have a diameter between 1.1–0.65μm and make up 6% of the fungal community in the compost [ 47 ]. Table 3 classifies bioaerosols and gases by odour thresholds or diameter.

https://doi.org/10.1371/journal.pone.0300801.t003

Endotoxin emissions released from compost are potent and proinflammatory for human respiration; associated with ailments such as airway obstruction, pneumonitis, bronchitis and decreased lung function [ 50 ]. Endotoxins do not disperse into communities near compost sites as dispersal is maxed at 280m past the compost site. Thus, endotoxins mainly threaten the health of plant workers [ 51 ]. Endotoxin emission >50EU/m3 can impose damage to human respiration systems, very low emissions of endotoxins (~2.3EU/m3) were reported in the study, which cannot justify the respiratory complaints of the occupational workers [ 51 ]. Table 4 summarizes the range of colony forming units (CFUs) for fungal emissions and general endotoxin emissions from compost.

https://doi.org/10.1371/journal.pone.0300801.t004

Potential solutions to food waste emissions

Based on the findings, we propose potential solutions. Considering the health threats that food waste can pose to human health, we suggest several pathways in which this effect can be avoided. First, an eco-friendlier solution to uncompromised, ready-to-eat food is to partner with a food bank to provide ready meals and ingredients that would have otherwise been thrown away [ 13 ]. In about a year, a pilot study donated 24,703kg of recovered food, providing about 45,383 meals, which prevented the release of 82.8 MT CO 2 eE of CO 2 , 15.5 MT CO 2 E of CH 4 , and 8.5 MT CO 2 E of N 2 O [ 13 ]. Not only does redirecting food decrease landfill area use, but it also provides food to starving populations which can play a critical role in increasing the health and well-being of food insecure and malnourished groups.

Second, we also propose the use of organic food waste to create biofuel to power vehicles and provide electricity and heating [ 15 ]. Biofuel creation can still emit typical food waste gases, so a gas capture technology is necessary [ 2 ]. Biofuel for vehicle use could avoid climate change impacts caused by petrol fuel by capturing most food waste emissions and converting it into energy [ 15 ]. A study conducted in China measured the impact on human health from diverting food waste to create biofuel in Disability Adjusted Life Years (DALYs) [ 15 ]. The impact on human health from climate change and particulate matter was measured as 3.51x10 -6 DALYs and 2.6 x 10 −4 DALYs, respectively. Biogas used for electricity and heating had a human health damage of 10.65 x 10 −5 DALYs/ tonne food waste. Biogas for city gas had a human health damage of 26.46 x10 -5 DALYs/ tonne food waste. Biogas for vehicle use was calculated to have negative DALY values, considering the avoidance of petrol fuel [ 15 ].

A potential solution for food waste emissions from compost is to install a biofilter or bio-tricking filter to reduce gaseous food waste emissions, such as toxic hydrogen sulphide. A biofilter is a tower made from gravel, wood chips, food waste compost and coal bottom ash, whereas as a bio-trickling filter consists of a tower with polypropylene balls to filter material [ 2 , 14 , 16 ]. For example, a biofilter can capture 90% of ammonia emissions from composted food piles [ 14 ]. In general, less strong odorous gases, such as ammonia and VOCs, can be emitted at composting plants that use either biofilters or bio-trickling filters, because of deodorization [ 14 ].

Public policies

Reduction of compost gas emissions would be advantageous to the physical and social health of workers and close neighborhoods [ 52 ]. Policies for diverting food waste can include a food redistribution program to redistribute edible food to food banks, and education. Educating the public and commercial food retail can include topics on food waste, portion size, food purchasing, planning and preparation, and enacting more served plated food rather than buffet style [ 13 ]. A redistribution program can target restaurants, banquet halls, convention centres, and catering services to collect viable food to donate to local food banks. Educating the public on planning meals before grocery shopping can limit food waste. In addition, educating the public on how to properly store certain foods can help decrease wastefulness. Educating commercial food retailers on how to preserve prepared food, waste less food during preparation, and serve smaller portion sizes. Transitioning from buffet-style food businesses to plated foods can significantly decrease food waste and decrease food preparation costs for the businesses. In this manner, public sectors and individuals can be educated on limiting food waste.

Encouraging cities to enact “green bin initiatives” with capture technologies can help decrease malodor complaints and associated human health consequences for compost plant workers and people residing near the plant [ 2 ]. In addition, capturing emissions could also create biofuels to generate electricity for nearby residents [ 15 ]. In this manner, people would be recycling food waste into a clean, usable energy source.

Limitations and strengths

Notwithstanding our thorough search, only a few articles focused on consumer food waste, despite this sector growing in food waste gas emissions over the years as gross domestic product increases [ 13 ]. Furthermore, most of the articles in the search strategy that were excluded from this study focused on emissions during food production processes, rather than food waste processes. In addition, very few articles measured direct human health effects of food waste emissions, most focused on identification of gases and indirect human health links. This systematic review makes a crucial addition to the food waste literature because of the limited primary research and systematic reviews on consumer food waste and human health impacts, and calls upon researchers to explore more human impacts from food waste emissions.

A strength of this study is the duplication of abstract screening, full-text screening, and critical appraisals for all the search strategies that generated 1688 unique articles. PRISMA guidelines have also been thoroughly followed, increasing this article’s validity as a systematic review [ 22 ]. The critical appraisals of the included articles deemed each study to be conducted well, increasing the strength of the compiled data. Lastly, the compilation of data into Table 3 was a major accomplishment that strengthened the systematic review as a thorough synthesis of food waste emission impacts on human health.

Areas for future research

Future primary research needs to address human health outcomes directly through clinical trials, like how a study [ 6 ] used two individuals to rate odours from buckets of food waste. Direct observations of human health outcomes can strengthen the current literature and provide clear evidence for relevant stakeholders to enact policies. In addition, a more holistic approach to human health effects needs to be studied to address the interconnectedness of environmental health and human health. Moreover, a study understanding the difference in food waste thresholds across countries could help address the worldwide human health risk of varying waste emission concentrations to workers and the public. Understanding the differences in odour thresholds by means of guidelines or standardization on documenting gas emissions and limits could warrant a meta-analysis in the food waste literature. Lastly, studies on global distillation could help address the worldwide effect of food waste emissions from individual countries and help implement international regulations.

Conclusions

This study presents a compilation and categorization of evidence of food waste emissions and their impacts on human health. After analyzing 26 articles, this study found that food waste from consumers can emit gases, such as VOCs, ammonia, carbon dioxide, methane, and hydrogen sulphide, which can be a detriment to human health directly through physiological effects and indirectly through secondary environmental health effects. Hydrogen sulphide, aromatic compounds, and halogenated compounds posed the greatest risk to human health. These emissions complicated multiple organ systems and increased the chance of death and cancer. This study has the potential to inform decision-makers to enact food waste policies that can prevent the adverse human health effects of food waste emissions. Solutions to reduce food waste emissions have also been explored, such as food diversion programs, emission capture and filter technologies for compost, and creating biofuel. However, few policies have been implemented to reduce food waste emissions, including food redistribution and food waste education programs. Funding more primary research in the entire food waste sector is needed to raise awareness of associated health risks and help decision-makers formulate plans of action.

Supporting information

S1 fig. search strategy strings..

https://doi.org/10.1371/journal.pone.0300801.s001

S2 Fig. Full-text screening of identified articles 2021.

https://doi.org/10.1371/journal.pone.0300801.s002

S3 Fig. Full-text screening of identified articles 2022 and 2023.

https://doi.org/10.1371/journal.pone.0300801.s003

S4 Fig. Articles from references.

Articles included for data analysis from references of articles included from the search strategy (n = 4).

https://doi.org/10.1371/journal.pone.0300801.s004

S5 Fig. Critical appraisals of search strategy 2021.

https://doi.org/10.1371/journal.pone.0300801.s005

S6 Fig. Critical appraisals of search strategy 2022.

https://doi.org/10.1371/journal.pone.0300801.s006

S1 Graphical abstract. The effects of gases from food waste on human health: A systematic review.

https://doi.org/10.1371/journal.pone.0300801.s007

Acknowledgments

We are grateful for the editorial comments and guidance provided by Paulina Kowalewska, Dr. Beth Hundey, and Dr. Katrina Moser (Western University). Kevin McIntrye is acknowledged for providing biostatistical guidance on the study design.

• View Article
• PubMed/NCBI
• Google Scholar
• 5. Soni V, Singh P, Shree V, & Goel V. Effects of VOCs on Human Health. In: Sharma N, Agarwal A, Eastwood P, Gupta T, & Singh A, editors. Air Pollution and Control. Energy, Environment, and Sustainability. 2018. Springer, Singapore. P. 119–142.
• 24. Covidence systematic review software [Internet]. Veritas Health Innovation: Melbourne, Australia; n.d. Available from: www.covidence.org .
• 25. United States Environmental Protection Agency. Municipal solid waste. United States Environmental Protection Agency; n.d [cited March 23, 2022]. Available from: https://archive.epa.gov/epawaste/nonhaz/municipal/web/html/ .
• 28. Joanna Briggs Institute. Critical appraisal tools [Internet]. Joanna Briggs Institute; n.d [cited April 1, 2022]. Available from: https://jbi.global/critical-appraisal-tools .

This paper is in the following e-collection/theme issue:

Published on 23.5.2024 in Vol 26 (2024)

Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review

Authors of this article:

• Marjorie M Kelley 1 , MS, RN, PhD   ; 
• Tia Powell 2 , MD   ; 
• Djibril Camara 3 , MPH, MD   ; 
• Neha Shah 4 , MSPH   ; 
• Jenna M Norton 4 , MPH, PhD   ; 
• Chelsea Deitelzweig 5 , BA   ; 
• Nivedha Vaidy 4   ; 
• Chun-Ju Hsiao 6 , PhD   ; 
• Jing Wang 7 , MPH, RN, PhD   ; 
• Arlene S Bierman 5 , MS, MD  

1 The Ohio State University College of Nursing, Columbus, OH, United States

2 Montefiore Einstein Center for Bioethics, Albert Einstein College of Medicine, Bronx, NY, United States

3 Credence Management Solution, USAID Global Health Technical Professionals, Washington, DC, United States

4 National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States

5 Agency for Health Care Research and Quality, Rockville, MD, United States

6 Center for Evidence and Practice Improvement, Agency for Health Care Research and Quality, Rockville, MD, United States

7 Florida State University College of Nursing, Tallahassee, FL, United States

Corresponding Author:

Arlene S Bierman, MS, MD

Agency for Health Care Research and Quality

5600 Fishers Lane

Rockville, MD, 20857

United States

Phone: 1 (301) 427 1104

Email: [email protected]

Background: People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians.

Objective: We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities.

Methods: Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus.

Results: We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record.

Conclusions: Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination.

Introduction

In 2020, between 17.7 and 40 million Americans were family caregivers of adults aged 65 years or older [ 1 ], defined as unpaid relatives, partners, or friends who assist persons in daily activities due to disease, disability, or other conditions. The need for family caregivers is projected to increase by 2030 with the older adult population and complexity of care increasing [ 2 ]. Many care recipients have multiple chronic conditions (MCCs) defined as the presence of 2 or more chronic physical or mental health conditions [ 3 ]. Over a quarter of the US adult population (27.2%) struggles with MCCs, with the highest prevalence (76.9%) among adults with both Medicare and Medicaid [ 3 ]. People living with MCCs are high users of care, including outpatient, emergency, inpatient, postacute, home, and long-term care, as well as prescription drugs [ 4 ]. People with MCCs account for 64% of all clinician visits, 70% of all in-patient stays, 83% of all prescriptions, 71% of all health care spending, and 93% of Medicare spending [ 5 ].

Complex care routines are common among patients with MCCs and often difficult for people living with MCCs and their caregivers to maintain, leading to avoidable adverse events, poor health outcomes, increased health spending, duplication of services, and polypharmacy [ 6 ]. The many challenges associated with care complexity and care planning add to the physical, psychological, and financial burdens associated with caregiving [ 7 ]. In fact, 14.5% of American caregivers have reported that they experienced mental health decline for at least half the days in a month [ 2 ].

Poor caregiver health and unmet needs have been widely documented and include mental and physical health concerns [ 8 ], unmet need for information on medication and care management to support the care recipient [ 7 ], limited access to supportive services [ 7 ], issues with communication across the care continuum [ 9 ], and burdens associated with work, social isolation [ 7 ], and finances [ 10 ]. Importantly, assistance with care coordination and planning has been consistently noted as an unmet need for caregivers [ 11 ].

Care Planning and Care Coordination

Developing care plans and organizing care involves the marshaling of personnel and other resources needed to carry out essential patient care activities and requires the exchange of information among participants responsible for different aspects of care [ 12 ]. Care planning is a collaborative process focused on discussing patient and clinical goals of care, conducting shared decision-making to identify strategies for clinical and self-management to achieve these goals based on evidence and patient preference, clarifying roles for different members of the care team, and empowering patients and caregivers [ 13 ]. These processes link health professionals, caregivers, and patients in the tasks of designing and implementing care.

Developing a comprehensive care plan both requires and supports care coordination by aggregating and streamlining data on health and social concerns, goals, care management strategies, and health status. Effective care coordination entails the organization of patient care activities to facilitate the appropriate and timely delivery of health care services by multiple clinicians in multiple care settings [ 12 ]. Care coordination involves the patient, clinicians, health care teams including nurses, pharmacists, physical therapists, and social workers, and caregivers. Such care coordination has been shown to benefit multiple domains, including decreased symptoms and mortality, and increased quality of life [ 14 ].

Digital Solutions

Digital solutions offer an opportunity to alleviate some of the care planning and coordination burdens currently shouldered by caregivers and patients. Digital health solutions encompass a variety of information or communication technologies applied to health needs. Digital health is mobile health (mHealth) when implemented on mobile devices. Digital health apps—or programs designed to accomplish specific tasks—fall into the category of mHealth when they are designed to operate on a mobile device.

mHealth apps have the inherent capability of increasing the reach of interventions, and transcending geography and time. They are also often more broadly accessible in the United States, as the uptake of mobile devices is greater than desktop computers [ 11 ]. Furthermore, they can be explicitly tailored to individual needs. Recent advances in technology and software now allow apps to be linked to other digital devices and the electronic health record (EHR).

Several systematic reviews outlined challenges associated with existing apps for caregivers, especially insufficient scientific evidence to support the efficacy of these apps [ 15 - 20 ]. However, no review has focused either on care planning and coordination apps overall or on caregivers of people with MCCs. Moreover, no review focused on the importance of care planning and coordination between the caregiver, care recipient, and professional health care providers. We conducted a scoping review to examine the evidence on the development and use of caregiver apps designed to support care planning and coordination, identify key factors related to their use (ie, needs, barriers, and facilitators), and characterize desired functionality. This review was undertaken to inform the development of a comprehensive, interoperable electronic care plan with clinician-, patient-, and caregiver-facing components to enhance care planning and coordination, address fragmentation of health care, and enhance the collection and sharing of critical patient-centered data across community, clinical, and research settings for people living with MCCs. The Agency for Healthcare Research and Quality (AHRQ) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), with support from the Assistant Secretary for Planning and Evaluation’s Patient-Centered Outcomes Research Trust Fund, are working in partnership to develop an interoperable e-care plan.

We conducted a scoping literature review using JBI (Joanna Briggs Institute) Scoping Review guidelines [ 21 ] and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [ 22 ] to guide our methods and reporting. Papers published in English between January 2011 and June 2021 were included. Hence, our initial search activity specific to care planning and coordination revealed a dearth of papers, we broadened our search to include papers intersecting 2 major domains: mHealth apps and caregivers ( Figure 1 ). We hoped to capture available information relevant to care planning and coordination from the perspective of the caregiver. We included mobile health apps like native apps (ie, residing on smartphones) as well as web-based apps designed for smartphone formats. We included all diseases and conditions and care settings (eg, ambulatory, hospital, home, hospice, and long-term care). Study types included pilot and feasibility and experimental and quasi-experimental study designs. Source documents included academic peer-reviewed journals, dissertations and theses, government policy documents, and white papers published by caregiver advocacy organizations (eg, AARP [American Association of Retired Persons] and National Alliance for Caregiving). Studies including paid caregivers or caregivers of patients aged younger than 18 years were excluded. Interventions delivered via social media, phone calls (including interactive voice response), video, telehealth, or text messaging alone were excluded. We also excluded interventions delivered in low- and middle-income countries given significant differences in information technology infrastructure and patterns of use [ 23 ]. As such, comparisons would be difficult. Research interventions involving assistive technologies (ie, motion sensors), non–health related, and health literacy alone were excluded. Source documents such as opinion or editorial papers, conference posters or abstracts, study protocols, blogs, and websites were excluded. Key search terms ( Textbox 1 ) alone or in combination, were used to create our search protocols in 6 databases: PubMed, Cochrane, CINAHL, SCOPUS, Web of Science, and Embase. We conducted ancestry searches of caregiver app reviews and caregiver literature reviews and searched several domain-specific journal databases including the Journal of the American Medical Informatics Association , Journal of Medical Internet Research , International Journal of Medical Informatics , Journal of the American Medical Association , and New England Journal of Medicine .

• Caregiver; caretaker; care provider; carer; care

mHealth app

• mHealth; “mobile health” app; applications; “digital application”; eHealth; and smartphone
• Medical Subject Headings terms: telemedicine [encompasses mHealth]; mobile applications

We exported search results into EndNote, a reference management software platform to eliminate duplications, then uploaded them into Covidence, a web-based systematic review platform, to streamline evidence synthesis and author collaboration. Covidence allowed the research team to work collaboratively when screening papers at the title, abstract, and full-text level. In total, 2 authors independently screened titles and abstracts for eligibility with full-text screening conducted in the same manner. Screening disagreements were resolved through discussion or review by a third author. In keeping with scoping review methodological practices, critical appraisal, and risk of bias were not assessed.

Working in pairs, authors independently extracted data after adapting the JBI data extraction template and a previously used and pilot-tested data extraction table [ 24 ]. Then, each author compared results with the other for consensus about the extracted element. Data extraction elements included first author, publication date, health care domain of the care recipient, country, title, participant demographics, study purpose, study design, intervention description, app name and hyperlink if available, primary app users (ie, patient, caregiver, health care provider, and other), key or primary findings, app features and functionality—including desired functionality, how app supported care coordination, and how app supported caregivers ( Multimedia Appendix 1 [ 25 - 45 ]). For qualitative studies, we extracted data elements associated with caregiver needs and desires. We used conventional content analysis methods, previously described by Hsieh and Shannon [ 46 ], to code and group categories as the phenomena of interest was new with little of the theoretical or literature available to guide the analysis. In keeping with conventional content analysis methods [ 47 ], we relied on inductive category development as categories and subcategories emerged from the literature, followed by deductive category and subcategory assignment.

Of the 3019 nonduplicative records screened, 34 papers [ 25 - 45 , 48 - 60 ] representing 25 individual studies were included in this scoping literature review ( Figure 1 ; Multimedia Appendix 1 ). Publication dates ranged from 2015 to 2021, with 29 (76%) papers published between January 2018 and August 2021. In total, 18 (53%) papers were feasibility, usability, or pilot studies [ 25 - 27 , 29 - 37 , 39 - 43 , 45 ] with qualitative or needs assessment papers representing 38% (n=13) [ 48 - 60 ]. Only 3 papers [ 28 , 38 , 44 ] reported using quantitative research methods to assess intervention efficacy ( Textbox 2 ). Research was predominantly conducted in the United States (22 of 34). Further, 5 papers were from Australia, 3 from Spain, and one each from Canada, the United Kingdom, South Korea, and Turkey. In total, 14 papers focused on cancer caregiving, 7 on dementia caregiving, 6 on general caregiving, 2 each for stem cell transplant and mental health, and one each on heart failure, liver, mental health, and hospice. See Textbox 2 for details of the health care domain and paper type.

Cancer (n=14)

• Experimental and quasi-experimental (n=1)
• Pilot, feasibility, or usability (n=9)
• Qualitative (n=4)

Dementia (n=7)

• Pilot, feasibility, or usability (n=2)

General caregiving (n=6)

• Pilot, feasibility, or usability (n=4)
• Qualitative (n=1)

Mental health (n=2)

• Qualitative (n=2)

Stem cell transplant (n=2)

• Pilot, feasibility, or usability (n=1)

Heart failure (n=1)

Liver (n=1)

Hospice pain management (n=1)

Experimental and Quasi-Experimental Studies

Of the 3 quasi-experimental or experimental studies [ 28 , 38 , 44 ], Park and colleagues [ 38 ] developed an app for caregivers focused on knowledge of dementia, communication, and coping. Ferré-Grau and colleagues [ 28 ] conducted a randomized controlled trial of an app intervention designed to promote caregiver mental health. Finally, research conducted by Uysal et al [ 44 ], used an app for caregivers of patients with cancer focused on caregiver self-care and education. Overall, these studies, like many mHealth interventions for caregivers, addressed important caregiver needs including quality of life. However, none of these apps linked to information in the EHRs or leveraged data standards to support interoperability of data across the care team, nor did the apps provide enhanced communication among caregivers and the health care team. None of the studies investigated or measured care planning or coordination.

Pilot and Feasibility Studies

In total, 18 pilot and feasibility papers [ 25 - 27 , 29 - 37 , 39 - 43 , 45 ], representing 12 studies, were included in this review. The majority (n=14, 78%) of these studies used small convenience samples. Furthermore, 11 of the papers focused exclusively on caregiver mental health or included a component of caregiver mental health in the interventions [ 25 - 27 , 32 - 34 , 36 , 37 , 39 , 40 , 43 ]. In total, 5 reported on apps that included disease education or caregiving education [ 25 , 26 , 31 , 37 , 41 ]. Further, 3 focused on caregiver communications with family and friends [ 41 , 42 , 45 ] but did not assess care coordination or communication with health care providers. One included education on the skills necessary to communicate with health care professionals but did not assess care planning, coordination, or communication as an outcome as it was a feasibility study [ 45 ].

Most of the pilot and feasibility studies focused on the important goal of supporting caregivers’ wellness but did not address care planning or coordination. For example, in one study—with results described in 3 papers [ 27 , 39 , 40 ]—the researchers conducted a 12-week feasibility study using a psycho-educational intervention delivered via video sessions with a goal of caregiver stress reduction. In another study [ 25 , 37 ], investigators used a mindfulness app and assessed cultural sensitivity and barriers to use as feasibility criteria. Kubo and colleagues [ 32 - 34 ] evaluated a commercially available mindfulness app to assess the feasibility of use to improve caregivers’ mental health. Similarly, Sikder and colleagues [ 43 ] pilot-tested an app focused on improving depression symptoms among caregivers.

In total, 7 papers included caregivers only as participants [ 27 , 31 , 36 , 39 , 40 , 42 , 43 ], while 9 papers included caregivers and care recipients as participants [ 25 , 29 , 30 , 32 - 35 , 37 , 41 ]. Only 2 feasibility studies, one conducted by Brown et al [ 26 ] and the other conducted by Wittenberg and colleagues [ 45 ], also included health professionals as participants. Brown and colleagues [ 26 ] examined the feasibility of an app for dementia caregivers, and included caregivers, homecare case managers, and primary health care providers as participants. The platform, CareHeros, was designed with the goal of bidirectional sharing of care recipients’ information between caregivers and health care professionals. The platform did not communicate with EHRs, and bidirectional communication was only reported between case managers and primary care providers, exclusive of caregivers and care recipients. There was limited uptake of the app, with participants logging into CareHeros an average of only 2.18 times over the 11-week period of this study. Wittenberg and colleagues [ 45 ] demonstrated the feasibility of an mHealth app to support caregiver communication skills related to caregiving. The overall objectives of the app development included: (1) to improve caregiver communication skills related to caregiving, (2) to facilitate information sharing among family members, (3) to provide self-care resources for caregivers, and (4) to increase caregiver knowledge. The app was not designed to connect to the EHR, nor was it designed to increase or support communication between caregivers and health care professionals. Caregivers and health care professionals participated in the design and the development of the app as well as usability and acceptability testing. Both groups found the app to be usable and acceptable for helping caregivers with educational needs and communication skills related to caregiving.

While none of the 18 pilot and feasibility studies directly evaluated care planning or coordination as an aim or outcome, 2 [ 30 , 35 ] investigated apps that could assist in care delivery—with caregivers assessing care recipients’ pain [ 35 ] and caregivers assessing care recipients’ hepatic encephalopathy [ 30 ]. Ganapathy and colleagues [ 30 ] used the PatientBuddy app, which sent alerts with critical values regarding hepatic encephalopathy to dyads of patients and caregivers as well as clinicians to support care management, obtaining a positive impact reducing 30-day readmissions in a small cohort. Mayahara et al [ 35 ] conducted a pilot study using e-Pain Reporter, which assisted caregivers in assessing and managing the pain of family members in home hospice. The e-Pain Reporter was designed to provide information on patient pain and pain management to nurses in real time. However, this pilot study did not assess the communication aspect of the app.

In summary, among these pilot and feasibility studies, heterogeneity in study design, interventions, and outcomes preclude meta-analysis, generalization, and direct comparisons. Additionally, most failed to provide support for care planning or coordination and none linked with the EHR or leveraged interoperable data standards. As with most pilot and feasibility studies, these results were preliminary, not powered to identify statistically significant differences in outcomes, and were specific to the app under investigation. Still, a small number of promising studies [ 26 , 30 , 35 , 45 ] attempted to enhance communication or information sharing, a component of care planning and coordination.

Qualitative Studies

In total, 13 (38%) papers [ 48 - 60 ] included in this review were qualitative studies assessing caregiver needs associated with mHealth apps. These caregiver needs were synthesized into 3 broad categories: (1) needs associated with providing care, (2) needs associated with self-care, and (3) desired app features and functionality. In terms of providing care (category 1), caregivers needed information, support, and help with care coordination. For self-care (category 2), caregivers reported a need for information and support. A detailed list of desired mHealth app features and functionality (category 3) is provided in Textbox 3 .

Needs associated with providing care

• Adjusting to a new role
• Information on disease or condition of care recipient
• Information on disease or condition common comorbidities
• Symptom, behavior, or safety
• When to seek help
• Changing nature of caregiving
• Financial and legal services (financial assistance, job help, and health care payment)
• On-demand education and training
• Community support links (transportation or community reintegration)
• Content tailored to care recipients’ needs
• Simple—easy to understand
• Up-to-date scientific evidence and mechanism for updating the information
• Multimodal delivery of information: video, audio, text, or animations
• Always accessible
• Support for care recipients’ physical and emotional needs
• Support with rehabilitation and activities of daily living (oral, bathing, dressing, grooming, toileting, feeding and nutrition, transferring, and ambulation)
• Decision-making support
• Medication management
• Tracking and monitoring of care recipient—mental, physical, emotional, and social (including symptoms, vital signs)
• Content tailored to care recipient’s needs
• Family or personal relationships (asking for help, safety, and communication)
• Integrated app with health care system—care coordination
• Ability to complete questionnaires at home, unrushed
• Finding care equipment
• List of important contacts and contact information for quick reference
• Information and connection to support services (specialty care, first responders, advocacy organizations, and respite services)
• Relationships with health care providers (personal contact)
• Feedback from health care providers—instant
• Automated data entry and reminders or prompts
• “One-stop-shopping”—all information in 1 place

Needs associated with self-care

• Information to help improve caregivers’ health (stress management, peer support, and support groups)
• Activities, programs, and therapy to improve mental, physical, and social support of caregivers
• Content tailored to caregivers’ needs
• Family or personal relationship help (safety or asking others for help or support)
• Preventing social isolation
• Tracking and monitoring of caregiver—mental, physical, emotional, or social (including symptoms, mental health, vital signs)
• Content tailored to caregiver needs
• Social media—“people like me” with expert moderator
• Peer mentor, support, or coaching

Desired mHealth app features and functionality

• Easy to use
• Easy to learn
• Integrated with phone contacts and other apps (exercise and weight management)
• Ability to report care recipient status or symptoms to health care providers and get a response, feedback, or follow-up quickly
• Task reminders (appointments, medication management, etc)
• Integrate with other platforms or devices (electronic health records, smart watches, or pharmacy)
• Share information with family members
• Integrate music or other entertainment
• Track patient symptoms or issues over time
• Track caregiver issues over time
• Customizable
• App from a trusted source and evidence-based content
• Data secure
• Integrated across health care systems
• Not too much information—just in time with the right information
• Font or screen size readable—Americans with Disabilities Act Standards for Accessible Design compliant
• Sustainable
• Help for digital naïve
• Does not reduce time with physician
• Clear perceived benefit
• Ability to personalize features and functions
• Automated data entry

Principal Findings

This scoping review synthesized the evidence on the development and use of caregiver apps designed to enable or support caregiver participation in care planning or care coordination. We identified key factors (ie, needs, barriers, and facilitators) related to care planning and coordination. We described important functionalities and features enabling caregiver apps to meet care planning and coordination needs and facilitate caregiving activities. This comprehensive summary of caregiver needs related to health apps and care coordination may be useful to developers and researchers as it relates to caregivers of those living with MCCs. A better understanding of usability and overall needs will enhance ongoing research efforts to improve e-care planning and care coordination among these populations.

Of the 34 papers, representing 25 individual studies included in this review, only 3 were experimental or quasi-experimental intervention studies [ 28 , 38 , 44 ]. None of the studies included in this review focused on care planning, care coordination, or care recipients with MCCs. This paucity of research precluded generalizations about caregivers’ apps, much less in care planning and coordination. Although most of the studies included in this review addressed important caregiver factors including caregiver education, coping, and self-care, these standalone interventions lacked components to reduce caregiver burdens associated with planning and coordinating complex care. An app designed to specifically improve care planning and coordination, thus reducing this burden, is needed—particularly for the increasing number of care recipients with MCCs.

Most studies within this review were qualitative studies or pilot and feasibility studies. Yet, a few of these studies [ 26 , 30 , 35 , 45 ] identified elements important for care planning and coordination in mHealth apps. By definition, these studies are preliminary in nature thus precluding generalizations; they do not represent proven efficacy or settled science. However, they provide a foundation for future exploration of the role of mHealth interventions in promoting care planning and coordination.

Comparison to Prior Work

Our findings parallel and extend the results identified in a recent review focused on native apps for informal caregiving [ 61 ]. Native apps are apps residing on smartphones as opposed to web-based apps. The principal findings specific to native apps [ 61 ] align with our more comprehensive review (including both native and web-based apps) in that the nascent technology has not matured enough to make meaningful recommendations beyond that of caregiver needs and wants. More rigorous research is needed, specifically among caregivers of patients with MCCs.

In terms of caregiver needs associated with care planning and coordination, caregivers and care recipients in included studies identified several important areas of needs and wants including apps that delivered “one-stop-shopping” or all the information in 1 place. These needs and wants were similar to those identified by Margarido and colleagues [ 61 ] in their 2022 scoping review. The results from both indicated caregivers wanted apps that integrated with the health care system (including the EHR) and could allow them to complete questionnaires at home in an unrushed fashion. They wanted apps that could help them find care equipment and information about support services and support contacts. Relationships with health care providers and feedback from the providers were of key importance, as were timely reminders and prompts (eg, upcoming appointments and medication changes).

Future Directions

More research is needed as this scoping review did not identify any of the following: an app designed to provide access and enhance communication among caregivers, patients, and health care workers, with access for all 3 groups to the EHR; use of data standards in apps to promote interoperability of data across the care team, including caregivers and care recipients; a focus on care planning and coordination; a free and publicly available digital platform; or demonstration of successful usability, efficacy, and sustainability.

The potential exists for emerging mHealth apps to contribute to care coordination by linking caregivers, patients, and clinicians to information and resources that improve the ability of the entire care team to actively engage. Ongoing research focused on developing and evaluating [ 62 - 65 ] interventions to support caregiver engagement in health care through direct EHR access and other digital means could provide important insights. Today, mHealth app-facilitated care planning and coordination remains a possibility, not a reality. This scoping review provides further evidence that existing caregiver-facing mHealth apps are not sufficiently supported by research, with many studies focused on well-educated, tech-savvy female caregivers [ 30 , 37 , 50 ]. There is a need for app development to meet caregiver needs in diverse populations. Most such apps address the burdens of caregiving through interventions aimed at education, self-care, and stress reduction. Though these are helpful, they do not address the fundamental challenges related to care planning and coordination.

Current government federal policies encourage care planning and coordination. There is a federal mandate through the Office of the National Coordinator for Health Information Technology for third-party mHealth apps to integrate with the EHR. These technologies need to be implemented into current health care workflows, but data blocking and the inability to write back to the EHR present challenges. Current workforce shortages, especially for nurses, are well documented and may increase the difficulty of introducing new technologies and tasks, requiring both additional training and time from an already overburdened workforce. On the other hand, a well-designed app that facilitates information sharing, care planning, and communication could potentially reduce the burden.

Strengths and Limitations

We acknowledge several limitations of this study. First, papers included in the scoping review do not include work published after June 2021. It is possible our search terms failed to identify relevant papers in this rapidly developing field. Second, the review included only studies published in English. Though digital health literature is predominantly published in English, there is the possibility of missing important work in other languages. In keeping with guidelines for scoping reviews, we neither assessed the risk of bias nor methodologies in the included studies. Finally, the heterogeneity of included research precluded a meta-analysis of findings across all studies.

This scoping review synthesizes the current evidence on developing mHealth apps to support caregivers in care planning and coordination, providing insights to inform future mHealth app development to engage caregivers as members of the health care team, share critical information across the entire health care team, reduce the burdens caregivers experience in trying to coordinate care, as well as identifying the functionality caregivers desired. Few experimental studies involving apps with needed functionality were identified in the scoping review, even though use of digital technology for caregiver support is a growing interest. We found no studies focused on care planning or coordination, and a very small number of pilot and other preliminary studies addressing specific aspects of care coordination, such as communication. Given the limited number of studies and the preliminary nature of many, there is insufficient evidence on mHealth apps to support caregivers in care planning and coordination. However, the need and potential for further work to achieve these aims is substantial.

Conclusions

In sum, research and evidence on the effective use of mHealth apps to support caregivers involved in care planning and coordination for people living with MCCs is limited. Apps to support caregivers have yet to be integrated into the EHRs. Multidirectional communication between caregivers, care recipients, and health care providers through the EHR holds great promise for relieving the burden on clinicians, patients, and their caregivers alike. The development and implementation of an mHealth app linking the 3 key stakeholder groups to work together to [ 65 ] enhance care planning and coordination, remains an unmet need. Prior work on the functionality desired by caregivers can inform this work.

Acknowledgments

No generative artificial intelligence was used. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), or the National Institutes of Health. No statement in this report should be construed as an official position of the AHRQ, NIDDK, National Institutes of Health, or the US Department of Health and Human Services. This project was conducted with support from the Assistant Secretary for Planning and Evaluation's Patient Centered Outcomes Research Trust Fund.

Conflicts of Interest

None declared.

Quantitative and pilot, feasibility, or acceptability study information.

PRISMA-ScR checklist.

• Committee on Family Caregiving for Older Adults, Board on Health Care Services, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. In: Schulz R, Eden J, editors. Families Caring for an Aging America. Washington, DC. The National Academies Press; 2016.
• Caregiving for family and friends—a public health issue. Center for Disease Control and Prevention. 2018. URL: https://www.cdc.gov/aging/caregiving/pdf/caregiver-brief-508.pdf [accessed 2024-03-14]
• Boersma P, Black LI, Ward BW. Prevalence of multiple chronic conditions among US adults, 2018. Prev Chronic Dis. 2020;17:E106. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States. Santa Monica, CA. RAND Corporation; 2017.
• Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, et al. Multiple chronic conditions chartbook. In: Agency for Healthcare Research and Quality. Capitol Hill, NC. HHS; 2010.
• Xu X, Mishra GD, Jones M. Evidence on multimorbidity from definition to intervention: an overview of systematic reviews. Ageing Res Rev. 2017;37:53-68. [ CrossRef ] [ Medline ]
• Price ML, Surr CA, Gough B, Ashley L. Experiences and support needs of informal caregivers of people with multimorbidity: a scoping literature review. Psychol Health. 2020;35(1):36-69. [ CrossRef ] [ Medline ]
• Queluz FNFR, Kervin E, Wozney L, Fancey P, McGrath PJ, Keefe J. Understanding the needs of caregivers of persons with dementia: a scoping review. Int Psychogeriatr. 2020;32(1):35-52. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Li J, Luo X, Cao Q, Lin Y, Xu Y, Li Q. Communication needs of cancer patients and/or caregivers: a critical literature review. J Oncol. 2020;2020:7432849. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Aung SHH, White K, Bloomfield J. The experiences and the needs of caregivers of patients with head and neck cancer: an integrative review. Cancer Nurs. 2021;44(6):E361-E373. [ CrossRef ] [ Medline ]
• McGilton KS, Vellani S, Yeung L, Chishtie J, Commisso E, Ploeg J, et al. Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review. BMC Geriatr. 2018;18(1):231. [ FREE Full text ] [ CrossRef ] [ Medline ]
• McDonald KM, Sundaram V, Bravata DM, Lewis R, Lin N, Kraft SA, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville, MD. Agency for Healthcare Research and Quality; 2007.
• Baker A, Cronin K, Conway PH, DeSalvo KB, Rajkumar R, Press MJ. Making the comprehensive shared care plan a reality. NEJM catalyst. 2016. URL: https://catalyst.nejm.org/doi/full/10.1056/CAT.16.0838 [accessed 2024-02-23]
• Kastner M, Cardoso R, Lai Y, Treister V, Hamid JS, Hayden L, et al. Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis. CMAJ. 2018;190(34):E1004-E1012. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chelberg GR, Neuhaus M, Mothershaw A, Mahoney R, Caffery LJ. Mobile apps for dementia awareness, support, and prevention—review and evaluation. Disabil Rehabil. 2022;44(17):4909-4920. [ CrossRef ] [ Medline ]
• Désormeaux-Moreau M, Michel CM, Vallières M, Racine M, Poulin-Paquet M, Lacasse D, et al. Mobile apps to support family caregivers of people with Alzheimer disease and related dementias in managing disruptive behaviors: qualitative study with users embedded in a scoping review. JMIR Aging. 2021;4(2):e21808. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lorca-Cabrera J, Martí-Arques R, Albacar-Riobóo N, Raigal-Aran L, Roldan-Merino J, Ferré-Grau C. Mobile applications for caregivers of individuals with chronic conditions and/or diseases: quantitative content analysis. Int J Med Inform. 2021;145:104310. [ CrossRef ] [ Medline ]
• Petrovic M, Gaggioli A. Digital mental health tools for caregivers of older adults-a scoping review. Front Public Health. 2020;8:128. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sala-González M, Pérez-Jover V, Guilabert M, Mira JJ. Mobile apps for helping informal caregivers: a systematic review. Int J Environ Res Public Health. 2021;18(4):1702. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Vandersman P, Perimal-Lewis L, Tieman J. Is there an app for that? A scoping review of apps for care workers in the aged care sector. In: Telehealth Innovations in Remote Healthcare Services Delivery. Amsterdam, Netherlands. IOS Press eBooks; 2021:124-134.
• Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-2126. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. [ FREE Full text ] [ CrossRef ] [ Medline ]
• McCool J, Dobson R, Whittaker R, Paton C. Mobile health (mHealth) in low- and middle-income countries. Annu Rev Public Health. 2022;43:525-539. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kelley MM, Kue J, Brophy L, Peabody AL, Foraker RE, Yen PY, et al. Mobile health applications, cancer survivors, and lifestyle modification: an integrative review. Comput Inform Nurs. 2021;39(11):755-763. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Beer JM, Smith KN, Kennedy T, Mois G, Acena D, Gallerani DG, et al. A focus group evaluation of breathe easier: a mindfulness-based mHealth app for survivors of lung cancer and their family members. Am J Health Promot. 2020;34(7):770-778. [ CrossRef ] [ Medline ]
• Brown EL, Ruggiano N, Page TF, Roberts L, Hristidis V, Whiteman KL, et al. CareHeroes Web and Android™ apps for dementia caregivers: a feasibility study. Res Gerontol Nurs. 2016;9(4):193-203. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Carr AL, Jones J, Gilbertson SM, Laudenslager ML, Kutner JS, Kilbourn K, et al. Impact of a Mobilized Stress Management Program (Pep-Pal) for caregivers of oncology patients: mixed-methods study. JMIR Cancer. 2019;5(1):e11406. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ferré-Grau C, Raigal-Aran L, Lorca-Cabrera J, Lluch-Canut T, Ferré-Bergadà M, Lleixá-Fortuño M, et al. A mobile app-based intervention program for nonprofessional caregivers to promote positive mental health: randomized controlled trial. JMIR mHealth uHealth. 2021;9(1):e21708. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Frisbee KL. Variations in the use of mHealth tools: the VA mobile health study. JMIR mHealth uHealth. 2016;4(3):e89. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ganapathy D, Acharya C, Lachar J, Patidar K, Sterling RK, White MB, et al. The patient buddy app can potentially prevent hepatic encephalopathy-related readmissions. Liver Int. 2017;37(12):1843-1851. [ CrossRef ] [ Medline ]
• Heynsbergh N, Heckel L, Botti M, Livingston PM. A smartphone app to support carers of people living with cancer: a feasibility and usability study. JMIR Cancer. 2019;5(1):e11779. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kubo A, Altschuler A, Kurtovich E, Hendlish S, Laurent CA, Kolevska T, et al. A pilot mobile-based mindfulness intervention for cancer patients and their informal caregivers. Mindfulness (N Y). 2018;9(6):1885-1894. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kubo A, Kurtovich E, McGinnis M, Aghaee S, Altschuler A, Quesenberry C, et al. A randomized controlled trial of mHealth mindfulness intervention for cancer patients and informal cancer caregivers: a feasibility study within an integrated health care delivery system. Integr Cancer Ther. 2019;18:1534735419850634. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kubo A, Kurtovich E, McGinnis M, Aghaee S, Altschuler A, Quesenberry C, et al. Pilot pragmatic randomized trial of mHealth mindfulness-based intervention for advanced cancer patients and their informal caregivers. Psycho-Oncology. 2024;33(2):e5557. [ CrossRef ] [ Medline ]
• Mayahara M, Wilbur J, Fogg L, Breitenstein SM, Miller AM. Feasibility of e-Pain reporter: a digital pain management tool for informal caregivers in home hospice. J Hosp Palliat Nurs. 2019;21(3):193-199. [ CrossRef ] [ Medline ]
• Otero P, Hita I, Torres, Vázquez FL. Brief psychological intervention through mobile app and conference calls for the prevention of depression in non-professional caregivers: a pilot study. Int J Environ Res Public Health. 2020;17(12):4578. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Owens OL, Smith KN, Beer JM, Gallerani DG, McDonnell KK. A qualitative cultural sensitivity assessment of the breathe easier mobile application for lung cancer survivors and their families. Oncol Nurs Forum. 2020;47(3):331-341. [ CrossRef ] [ Medline ]
• Park E, Park H, Kim EK. The effect of a Comprehensive Mobile Application Program (CMAP) for family caregivers of home-dwelling patients with dementia: a preliminary research. Jpn J Nurs Sci. 2020;17(4):e12343. [ CrossRef ] [ Medline ]
• Pensak NA, Carr AL, Jones J, Mikulich-Gilbertson SK, Kutner JS, Kilbourn K, et al. A pilot study of mobilized intervention to help caregivers of oncology patients manage distress. Psycho-Oncology. 2021;30(4):520-528. [ CrossRef ] [ Medline ]
• Pensak NA, Joshi T, Simoneau T, Kilbourn K, Carr A, Kutner J, et al. Development of a web-based intervention for addressing distress in caregivers of patients receiving stem cell transplants: formative evaluation with qualitative interviews and focus groups. JMIR Res Protoc. 2017;6(6):e120. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Quinn CC, Staub S, Barr E, Gruber-Baldini A. Mobile support for older adults and their caregivers: dyad usability study. JMIR Aging. 2019;2(1):e12276. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Quintana Y, Fahy D, Crotty B, Gorenberg M, Jain R, Kaldany E, et al. A usability evaluation of the InfoSAGE app for family-based medication management. Stud Health Technol Inform. 2019;257:352-357. ITCH. [ Medline ]
• Sikder AT, Yang FC, Schafer R, Dowling GA, Traeger L, Jain FA. Mentalizing imagery therapy mobile app to enhance the mood of family dementia caregivers: feasibility and limited efficacy testing. JMIR Aging. 2019;2(1):e12850. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Uysal N, Bağçivan G, Özkaraman A, Eşer AK, Çetin F, Çalışkan BB, et al. Empowering caregivers in the radiotherapy process: the results of a randomized controlled trial. Support Care Cancer. 2021;29(5):2395-2404. [ CrossRef ] [ Medline ]
• Wittenberg E, Xu J, Goldsmith J, Mendoza Y. Caregiver communication about cancer: development of a mHealth resource to support family caregiver communication burden. Psycho-Oncology. 2019;28(2):365-371. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. [ CrossRef ] [ Medline ]
• Mayring P. Qualitative content analysis: theoretical background and procedures. In: Bikner-Ahsbahs A, Knipping C, Presmeg N, editors. Approaches to Qualitative Research in Mathematics Education. Advances in Mathematics Education. Dordrecht, Germany. Springer; 2015.
• Bamgboje-Ayodele A, Levesque JV, Gerges M, Girgis A. What male caregivers of women with breast cancer want in an online intervention: a qualitative study. J Patient Exp. 2020;7(6):1771-1777. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Boele FW, van Uden-Kraan CF, Hilverda K, Weimer J, Donovan HS, Drappatz J, et al. Neuro-oncology family caregivers' view on keeping track of care issues using eHealth systems: it's a question of time. J Neurooncol. 2017;134(1):157-167. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chaar D, Shin JY, Mazzoli A, Vue R, Kedroske J, Chappell G, et al. A mobile health app (Roadmap 2.0) for patients undergoing hematopoietic stem cell transplant: qualitative study on family caregivers' perspectives and design considerations. JMIR mHealth uHealth. 2019;7(10):e15775. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Frisbee KL. The impact of mobile health (mHealth) technology on family caregiver's burden levels and an assessment of variations in mhealth tool use. The George Washington University. 2015. URL: https://scholarspace.library.gwu.edu/concern/gw_etds/1544bp27m?locale=de [accessed 2024-03-14]
• Heynsbergh N, Botti M, Heckel L, Livingston PM. Caring for the person with cancer: information and support needs and the role of technology. Psychooncology. 2018;27(6):1650-1655. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Heynsbergh N, Heckel L, Botti M, Livingston PM, Seung CO. Development of a smartphone app for informal carers of people with cancer: processes and learnings. JMIR Form Res. 2019;3(2):e10990. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Huerta-Ramos E, Escobar-Villegas MS, Rubinstein K, Unoka ZS, Grasa E, Hospedales M, et al. Measuring users' receptivity toward an integral intervention model based on mHealth solutions for patients with treatment-resistant schizophrenia (m-RESIST): a qualitative study. JMIR mHealth uHealth. 2016;4(3):e112. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kales HC, Gitlin LN, Stanislawski B, Marx K, Turnwald M, Watkins DC, et al. WeCareAdvisor™: the development of a caregiver-focused, web-based program to assess and manage behavioral and psychological symptoms of dementia. Alzheimer Dis Assoc Disord. 2017;31(3):263-270. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Owen JE, Jaworski BK, Kuhn E, Hoffman JE, Schievelbein L, Chang A, et al. Development of a mobile app for family members of veterans with PTSD: identifying needs and modifiable factors associated with burden, depression, and anxiety. J Fam Stud. 2017;26(2):286-307. [ CrossRef ]
• Rathnayake S, Moyle W, Jones C, Calleja P. Co-design of an mHealth application for family caregivers of people with dementia to address functional disability care needs. Inform Health Soc Care. 2021;46(1):1-17. [ CrossRef ] [ Medline ]
• Ruggiano N, Brown EL, Shaw S, Geldmacher D, Clarke P, Hristidis V, et al. The potential of information technology to navigate caregiving systems: perspectives from dementia caregivers. J Gerontol Soc Work. 2019;62(4):432-450. [ CrossRef ] [ Medline ]
• Shreve J, Baier RR, Epstein-Lubow G, Gardner RL. Dementia caregivers' technology preferences: design insights from qualitative interviews. Gerontechnology. 2016;14(2):89-96. [ FREE Full text ] [ CrossRef ]
• Wali S, Keshavjee K, Nguyen L, Mbuagbaw L, Demers C. Using an electronic app to promote home-based self-care in older patients with heart failure: qualitative study on patient and informal caregiver challenges. JMIR Cardio. 2020;4(1):e15885. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Margarido MG, Shah A, Seto E. Smartphone applications for informal caregivers of chronically ill patients: a scoping review. NPJ Digit Med. 2022;5(1):33. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Piette JD, Striplin D, Marinec N, Chen J, Trivedi RB, Aron DC, et al. A mobile health intervention supporting heart failure patients and their informal caregivers: a randomized comparative effectiveness trial. J Med Internet Res. 2015;17(6):e142. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Aikens JE, Trivedi R, Heapy A, Pfeiffer PN, Piette JD. Potential impact of incorporating a patient-selected support person into mHealth for depression. J Gen Intern Med. 2015;30(6):797-803. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Wolff JL, Darer JD, Berger A, Clarke D, Green JA, Stametz RA, et al. Inviting patients and care partners to read doctors' notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc. 2017;24(e1):e166-e172. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Piette JD, Marinec N, Janda K, Morgan E, Schantz K, Yujra ACA, et al. Structured caregiver feedback enhances engagement and impact of mobile health support: a randomized trial in a lower-middle-income country. Telemed J E Health. 2016;22(4):261-268. [ FREE Full text ] [ CrossRef ] [ Medline ]

Abbreviations

Edited by T Leung; submitted 30.01.23; peer-reviewed by J Wolff, Y Chu; comments to author 27.05.23; revised version received 28.09.23; accepted 01.03.24; published 23.05.24.

©Marjorie M Kelley, Tia Powell, Djibril Camara, Neha Shah, Jenna M Norton, Chelsea Deitelzweig, Nivedha Vaidy, Chun-Ju Hsiao, Jing Wang, Arlene S Bierman. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.05.2024.

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