literature review service design

Leveraging service design as a multidisciplinary approach to service innovation

Journal of Service Management

ISSN : 1757-5818

Article publication date: 26 September 2019

Issue publication date: 15 November 2019

Service design is a multidisciplinary approach that plays a key role in fostering service innovation. However, the lack of a comprehensive understanding of its multiple perspectives hampers this potential to be realized. Through an activity theory lens, the purpose of this paper is to examine core areas that inform service design, identifying shared concerns and complementary contributions.

Design/methodology/approach

The study involved a literature review in two stages, followed by a qualitative study based on selected focus groups. The first literature review identified core areas that contribute to service design. Based on this identification, the second literature review examined 135 references suggested by 13 world-leading researchers in this field. These references were qualitatively analyzed using the NVivo software. Results were validated and complemented by six multidisciplinary focus groups with service research centers in five countries.

Six core areas were identified and characterized as contributing to service design: service research, design, marketing, operations management, information systems and interaction design. Data analysis shows the various goals, objects, approaches and outcomes that multidisciplinary perspectives bring to service design, supporting them to enable service innovation.

Practical implications

This paper supports service design teams to better communicate and collaborate by providing an in-depth understanding of the multiple contributions they can integrate to create the conditions for new service.

Originality/value

This paper identifies and examines the core areas that inform service design, their shared concerns, complementarities and how they contribute to foster new forms of value co-creation, building a common ground to advance this approach and leverage its impact on service innovation.

• Service innovation
• Multidisciplinary
• Service design

Prestes Joly, M. , Teixeira, J.G. , Patrício, L. and Sangiorgi, D. (2019), "Leveraging service design as a multidisciplinary approach to service innovation", Journal of Service Management , Vol. 30 No. 6, pp. 681-715. https://doi.org/10.1108/JOSM-07-2017-0178

Emerald Publishing Limited

Copyright © 2019, Maíra Prestes Joly, Jorge Grenha Teixeira, Lia Patrício and Daniela Sangiorgi

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

Service design has grown as a human-centered, collaborative, holistic approach focused on improving existing services or creating new ones ( Blomkvist et al. , 2011 ; Mahr et al. , 2013 ; Ostrom et al. , 2015 ; Teixeira et al. , 2017 ; Yu and Sangiorgi, 2018 ). Service design can bring new service ideas to life by understanding customer experiences ( Mahr et al. , 2013 ), envisioning new value propositions ( Ostrom et al. , 2015 ), supporting the introduction of technology into service ( Teixeira et al. , 2017 ) and contributing to the entire new service development (NSD) process ( Yu and Sangiorgi, 2018 ). This approach integrates design thinking with a service perspective ( Wetter-Edman et al. , 2014 ) and brings together multidisciplinary contributions, such as the value proposition offered to the customer ( Edvardsson et al. , 2000 ), service interfaces that embody service offerings ( Secomandi and Snelders, 2011 ), service operations ( Hill et al. , 2002 ) and supportive technologies that fuel service innovation ( Kieliszewski et al. , 2012 ).

Multidisciplinarity means juxtaposing disciplinary contributions (e.g. concepts and approaches), in order to foster wider knowledge to tackle a common issue ( Gustafsson, Högström, Radnor, Friman, Heinonen et al. , 2016 ; Klein, 2010 ).While an intra-disciplinary approach to research theorizes within the boundaries of a discipline, within a multidisciplinary approach one borrows theory from one discipline to another, advancing knowledge in other fields. However, these disciplines are coordinated to remain separated, maintaining the original identity of their elements and not crossing their existing knowledge structures. A multidisciplinary approach, then, differs from interdisciplinary or transdisciplinary perspectives, where the focus is, respectively, to integrate knowledge from two or more disciplines and to build a comprehensive theory that arises from a common theoretical understanding of the preexisting disciplines ( Gustafsson, Högström, Radnor, Friman, Heinonen et al. , 2016 ).

While service design is considered a multidisciplinary field, its contributions often adapt a specific disciplinary stance, lacking a more complete and integrated approach that encompasses the entire range of multidisciplinary contributions to fully support the design of new value propositions. For instance, while some perspectives focus on the material and design process-oriented aspects of service design ( Kimbell, 2011 ; Secomandi and Snelders, 2011 ), others focus on the customer experience enabled by its approach ( Zomerdijk and Voss, 2010 ; Andreassen et al. , 2016 ) and, still others, on how it can create new operations and technology to support the service delivery ( Sampson, 2012 ; Glushko, 2010 ). These different views offer a valuable contribution for specific aspects of service design. However, considering its holistic approach, there is a lack of a comprehensive understanding about which are the main multidisciplinary perspectives that inform service design and which contributions they bring. The lack of this understanding hinders the dialog and shared ground among service designers coming from different backgrounds, risking for researchers and practitioners to build knowledge in silos ( Anderl et al. , 2009 ).

The lack of a shared understanding among service design perspectives has implications on service innovation, since service design has been championed as a service innovation approach ( Mahr et al. , 2013 ; Ostrom et al. , 2015 ; Teixeira et al. , 2017 ; Yu and Sangiorgi, 2018 ; Patrício, Gustafsson and Fisk, 2018 ). Service innovation has been defined as the creation of new service offerings, service delivery processes and service business models ( Ostrom et al. , 2010 ). From a service-dominant logic (S-D logic) perspective, this definition has been reframed to understand service innovation as a process of integrating resources in novel ways to enable new forms of value co-creation among actors ( Lusch and Nambisan, 2015 ). Due to the multidimensional character of service innovation ( Gustafsson, Kristensson, Schirr and Witell, 2016 ), supporting it from multidisciplinary lenses is a strategic imperative for service researchers and practitioners who aim to understand and generate new forms of value co-creation within service ecosystems ( Lusch and Nambisan, 2015 ).

Service design has a key role in service innovation as it brings new service ideas to life ( Ostrom et al. , 2010, 2015 ). However, it is not clear how different multidisciplinary perspectives contribute to service design and, consequently, how these perspectives support service design to enable service innovation. This challenge demands that service design evolves as a multidisciplinary activity, able to take into account complementary aspects related to service innovation ( Lusch and Nambisan, 2015 ).

This paper addresses the challenges of the lack of a comprehensive understanding about which are the main multidisciplinary perspectives and their contributions to service design, and which are cross-cutting areas and complementarities that work as bridges between these multiple perspectives, strengthening service design approach to service innovation. In this sense, this paper presents a study focused on understanding “How do multidisciplinary perspectives contribute to service design and support this approach to enable service innovation?” By addressing these challenges, this paper brings two fundamental contributions to advance service design as a multidisciplinary activity to service innovation: the identification, characterization and systematization of core multidisciplinary perspectives on service design; and an integrative examination of how these perspectives contribute to service design, supporting it as a service innovation approach.

This analysis of the multidisciplinary perspectives on service design was supported by activity theory ( Wertsch, 1979 ; Kaptelinin and Nardi, 2012 ). Through an activity theory lens, service design can be understood as an activity composed by goals, objects, approaches and outcomes ( Kaptelinin and Nardi, 2012 ; Wertsch, 1979 ). An activity is developed by a subject who can be a person or a group of people. The subject who acts over an object is part of a community of practice, which is a unit broader than the individual action ( Lave and Wenger, 1991 ; Engeström et al. , 1999 ). Activity theory offers a suitable framework to understand how multidisciplinary communities have different ways of developing the service design activity, which is reflected on their distinct goals, object, approaches and outcomes.

As such, this paper identifies core multidisciplinary perspectives and their contributions to service design, addressing the call to reinforce the foundations of service design as an interdisciplinary research field ( Patrício, Gustafsson and Fisk, 2018 ). Nonetheless, the paper brings a key contribution to service researchers and practitioners by supporting a better understanding of service design as an activity able to tackle complementary levels of complexity of service projects ( Chandler and Vargo, 2011 ).

2. Theoretical background

This section introduces multiple perspectives associated with service design and service innovation. This literature review presents service design as a multidisciplinary approach and service innovation as a multidimensional phenomenon.

2.1 Service design

The term “service design” was originally employed in the context of service blueprint design ( Shostack, 1982 ) and as a specific step within a NSD process ( Scheuing and Johnson, 1989 ), focused on generating ideas and formulating service concepts ( Johnson et al. , 2000 ). In the 1990s, service design began to be treated as a discipline within the design field, because of the interest among the design community in exploring and understanding the application of design capabilities to the service sector ( Erlhoff et al. , 1997 ; Pacenti, 1998 ). More recently, a renewed interest in service innovation has focused attention on “leveraging service design” as a key research priority in service research ( Ostrom et al. , 2015 ). Service design and innovation can increase the relevance of service research by addressing important real-world problems, whether in organizations or society ( Patrício, Gustafsson and Fisk, 2018 ).

Multidisciplinary perspectives have contributed to service design, focusing on different aspects. Shostack (1982, 1984) addresses service design by systematically planning the sequence of the various events and service evidences that are involved during service operations. Zomerdijk and Voss (2010) discuss service design in the context of experience-centric services, focused on crafting the customer experience to create distinctive service offerings. Glushko (2010) , on the other hand, describes person-to-person, person-to-machine and machine-to-machine interactions as different use cases that service design can be applied to. Kimbell (2011) describes service design as an exploratory process, where designers approach their work as an open-ended inquiry. Secomandi and Snelders (2011) discuss the service interface as the object of service design, which can include material artifacts, environments and embodied human interactions to intermediate service encounters. Andreassen et al. (2016) present a service research perspective on service design, by describing it as an approach that can aid providers in their efforts to become more customer centric. Likewise, Karpen et al. (2017) examine capabilities, practices and abilities which facilitate the use of service design within organizations.

These multiple research efforts provide heterogeneous views and do not reflect a full landscape of multidisciplinary perspectives on service design. Therefore, a fundamental step toward overcoming knowledge silos and leveraging the role of service design in service innovation is to identify, systematize and characterize multidisciplinary perspectives on service design.

2.2 Service innovation

Service innovation can be viewed from an assimilation, a demarcation and a synthesis perspective ( Witell et al. , 2016 ). From an assimilation point of view, early studies have identified new technology as the main driver of service innovation ( Toivonen and Tuominen, 2009 ), adapting theories and instruments developed from traditional product innovation research ( Miozzo and Soete, 2001 ). From a demarcation perspective, service innovation is understood as differing in nature and character from product innovation ( Coombs and Miles, 2000 ), involving new service-specific theories to understand and analyze service innovative solutions ( Tether, 2005 ). Finally, from a synthesis standpoint, research claims for an integrative view of assimilation and demarcation perspectives, arguing that theories on service innovation should encompass innovation in both service and manufacturing ( Gallouj and Savona, 2009 ). Witell et al. (2016) describe a synthesis perspective connected with theories and concepts from a service logic point of view ( Michel et al. , 2008 ). In this context, the focus is placed on the customer role within the value co-creation process, extending it “beyond a simple buyer–seller relationship into value constellations” ( Michel et al. , 2008 , p. 58). In this sense, service innovation can be enabled through the design of new practices and/or resources, which converge to original value propositions from the customers’ point of view ( Skålén et al. , 2015 ).

From a S-D logic perspective, service innovation can be understood as a multifaceted concept, related to multiple phenomena ( Gustafsson, Högström, Radnor, Friman, Heinonen et al. , 2016 ), such as business model innovation ( Hsieh et al. , 2013 ), social innovation ( Windrum et al. , 2016 ), public-sector innovation ( Alves, 2013 ) and institutional innovation ( Vargo et al. , 2015 ). While business innovation is usually supported at the organizational level ( Hsieh et al. , 2013 ), social innovation often involves multi-agent and multilateral networks focused on generating social value ( Windrum et al. , 2016 ), whereas institutional innovation is achieved when new rules and practices are created at an ecosystem level ( Vargo et al. , 2015 ).

Service innovation, therefore, can be enabled at the micro, meso and macro levels of service ecosystems ( Chandler and Vargo, 2011 ), where service design presents a key role in creating new resources and infrastructures that support new forms of value co-creation ( Wetter-Edman et al. , 2018 ; Kurtmollaiev et al. , 2018 ). The micro level is identified by interactions between dyads of actors, such as an organization and its customers ( Mahr et al. , 2013 ). The meso level refers to the value co-creation context inside service networks ( Akaka et al. , 2012 ). Finally, the macro level is characterized by the context of institutions, rules (often tacit and implicit) and common knowledge that connect actors in the micro and meso levels ( Lusch and Vargo, 2014 ; Vargo et al. , 2015 ).

Research has shown connections between service design and service innovation across these service ecosystem levels ( Chandler and Vargo, 2011 ) by, for example, the design of new touchpoints and the use of technology to improve customer experience at the micro level ( Bolton et al. , 2018 ; Lo, 2011 ), the conceptualization of networks of service offerings at the meso level ( Caic et al. , 2018 ; Patrício, Pinho, Teixeira and Fisk, 2018 ), as well as through making, breaking and maintaining institutions at the macro level ( Koskela-Huotari et al. , 2016 ; Kurtmollaiev et al. , 2018 ) and shaping mental models ( Vink et al. , 2019 ) at the macro level. However, it is still not clear how multidisciplinary perspectives contribute to service design to foster service innovation across these multiple levels. As such, comprehending the core multidisciplinary perspectives and their contributions to service design can enhance the use of this approach to enable service innovation, improving the connections between service design and service innovation research ( Antons and Breidbach, 2018 ). This endeavor is key for service researchers and practitioners to better understand the potential of service design in enabling multiple forms of resource integration within service ecosystems ( Lusch and Nambisan, 2015 ).

3. Methodology

In order to tackle these challenges, the aims of this study were twofold: identify, characterize and systematize the core multidisciplinary perspectives on service design; and provide an integrative examination of how these perspectives contribute to service design, supporting it as a service innovation approach.

Due to the dispersed nature of multidisciplinary contributions to service design in terms of publication outlets (journal articles, conference proceedings, books, etc.), a systematic literature review ( Booth et al. , 2012 ) would not alone provide a comprehensive overview of the relevant scholarship. Furthermore, considering the wide variety of fields that offer contributions to service design, this study focused on the core disciplinary areas connected to service design. For this reason, the research involved two stages of expert-based literature review and a qualitative study with focus groups, developed in three stages, as presented in the Table I .

The phases of the research process are detailed in the following sub-sections.

3.1 Phase 1

The first phase involved a literature review on service design. The selection of publications for this preliminary literature review was based on references selected by the multidisciplinary research team. The sample criterion was the relevance of the publication for service design, in terms of concepts, processes and approaches (e.g. service system, design thinking and service prototyping). After this selection, the content of the references was analyzed in order to identify their associated disciplinary areas. The results of this analysis are presented in Appendix 1.

As the name implies, service design builds on multidisciplinary contributions from service research and design research ( Patrício, Gustafsson and Fisk, 2018 ). Therefore, literature review covered these two research areas, revealing they provide the foundations of service design. A more in-depth examination on the service research stream of literature revealed other areas also contributing to service design, namely, marketing, operations management and information systems. The analysis of literature coming from a design stream also revealed a significant body of publications connecting interaction design to service design. Based on this first round of literature review of multidisciplinary perspectives, six core areas were identified as contributors to service design: service research and design research, as the key research umbrellas to service design, and marketing, operations management, information systems and interaction design as specific research areas connected to these two main streams of literature. The description of each area’s perspective is presented in Section 4.1.

3.2 Phase 2

Building upon this identification of the six areas, the second stage involved a qualitative approach ( Gioia et al. , 2012 ) based on an expert-based literature review, focused on gaining an in-depth understanding of these contributions. This phase was based on the recommendations of 13 leading international researchers in service design from research centers in nine countries in Europe, North America, South America and Asia, as presented in Table AII . These experts were selected based on their leading research roles in the six identified areas, ensuring the selection of a minimum of two experts from each area. Each expert was invited by e-mail to participate in the study by suggesting 10–15 articles that, from his or her field’s perspective, represented the most relevant contributions to service design. In this context, some of these articles may not explicitly address service design as such, but from the experts’ perspectives they developed concepts and approaches that make valuable contributions to this field. The experts’ responses resulted in a set of 135 unique references covering a rich variety of multidisciplinary contributions to service design, including 90 journal articles, 13 conference papers, 30 book chapters and 2 publications from other sources. The total of references per area suggested by the experts are: service research (30), design (37), marketing (17), operations management (18), information systems (26) and interaction design (25).

These articles were analyzed with a qualitative approach that aimed to integrate the information that emerged from the data analysis and establish connections with theory to build robust results. This involved two types of coding – initial and focused coding – using NVivo software. Within this process, fragments of data like segments of text were first coded close to their analytical import (initial coding), and then finally condensed, integrated and synthesized into more meaningful categories (focused coding) ( Charmaz, 2014 ).

The results of data analysis were then structured into a conceptual model composed by four main categories (goals, objects, approaches and outcomes). This conceptual model was framed adopting the activity theory framework ( Kaptelinin and Nardi, 2012 ; Wertsch, 1979 ) and, therefore, examining service design as an activity (see Section 4.2.1).

3.3 Phase 3

Building upon the results of the previous phases, the third stage involved focus group ( Krueger and Casey, 2015 ) with six research centers with leading roles in the identified areas ( Table AIII ), in five different countries. The aims of the focus groups were to provide feedback on the results of the previous stages and to further explore how multidisciplinary perspectives contribute to advance service design as an approach to service innovation. Each local facilitator invited expert researchers from his/her network to the focus group, resulting in a total of 40 participants. Data were audio-recorded, transcribed and qualitatively analyzed, as described in the Results section.

This section presents the identification, systematization and characterization of the core multidisciplinary perspectives and their contributions to service design. It starts with the six core areas contributing to service design that were identified in the first stage of research, followed by an in-depth examination of these contributions that resulted from the expert-based literature review and the focus groups.

4.1 Phase 1: identification of core multidisciplinary perspectives on service design

The first stage of literature review enabled the identification of six core areas contributing to service design: service research, design, marketing, operations management, information systems and interaction design. The analysis of this first set of literature showed that service research perspective provides the focus and context to service design, bringing definitions such as the concept of service as the application of the competences of one entity for the benefit of another entity ( Vargo and Lusch, 2008 ), the service concept ( Edvardsson et al. , 2000 ) or value propositions ( Frow et al. , 2014 ) that enable value co-creation. Service research also highlights the central role of service systems, which involve a set of inter-related structures that support and enable value co-creation among actors ( Edvardsson et al. , 2012 ). A design perspective instead provides the mindset, processes and tools that offer a holistic, iterative approach to creating new services. The literature review in the design research sphere revealed the coexistence of an exploratory inquire perspective to creating new services and a more rational problem-solving approach that is closer to engineering design ( Kimbell, 2011 ). This design perspective contributes to understanding and visualizing user experiences ( Blomkvist and Segelström, 2014 ), and offers collaborative design practices and participatory design principles ( Holmlid, 2007 ).

A service marketing perspective addresses the design of service concepts and multi-interface service systems focused on the customer experience, with techniques and concepts such as service blueprinting ( Bitner et al. , 2008 ) and service clues ( Berry et al. , 2002 ). An operations management perspective focuses on designing service processes, making the connection between service in the front and back stages through models such as the process chain network ( Sampson, 2012 ). Some service literature connected to information systems also addresses the technological and back-office processes that support person-to-person, person-to-machine and machine-to-machine interactions ( Glushko, 2010 ). Finally, literature review identified an interaction design perspective as one of the pioneering influences on service design ( Pacenti and Sangiorgi, 2010 ), contributing to design service interfaces for the user experience with tools such as storyboarding ( Truong et al. , 2006 ) and experience prototyping ( Buchenau and Suri, 2000 ). These six areas contributing to service design served as the basis for the subsequent research stages.

4.2 Phases 2 and 3: multidisciplinary perspectives and their contributions to service design

The qualitative analysis of the 135 references recommended by the 13 experts in the second stage and the focus groups from the third stage enabled an understanding of service design as an activity ( Wertsch, 1979 ; Kaptelinin and Nardi, 2012 ) that can incorporate multidisciplinary contributions. The following sub-sections present the conceptual model that resulted from data analysis through an activity theory lens, with the description of the goals, objects, approaches and outcomes of core multidisciplinary perspectives and their contributions to service design.

4.2.1 Service design conceptual model

The iterative process of the research Phases 2 and 3 enabled the development of a conceptual model, which was used to characterize core multidisciplinary perspectives and their contributions to service design. This conceptual model examines service design as an activity ( Wertsch, 1979 ; Kaptelinin and Nardi, 2012 ). According to activity theory, an activity is composed of a sequence of steps, defined as actions that are guided by goals ( Wertsch, 1979 ). Kaptelinin and Nardi (2012 , p. 30) define a goal as “what directs the activity” being developed by a subject, who can be a person or a group of people. Objects, on the other hand, “motivate and direct activities, around them activities are coordinated, and in them activities are crystallized when the activities are complete” ( Kaptelinin and Nardi, 2012 , p. 29). Kaptelinin and Nardi (2012) also describe approaches as the mediational means that intermediate the subject-object interaction. Finally, the outcome of the activity system is described as “a transformation of the object produced by the activity in question into an intended result, which can be utilized by other activity systems” ( Kaptelinin and Nardi, 2012 , p. 34). The conceptual model that resulted from examining service design through activity theory is presented in Figure 1 , being composed by goals (designing for), objects (focus of design), approaches (designing through) and outcomes (intended or emergent changes that can be viewed as innovations).

This conceptual model was used for a more detailed data analysis of the multidisciplinary contributions to service design. This resulted in a structure of sub-categories within goals, objects, approaches and outcomes, which were used to characterize each perspective, as presented in Tables II–VI in the following sub-sections. These tables present indirect quotations (collected during Phase 2 of the Methodology) which illustrate distinctive aspects of how each multidisciplinary perspective contribute to service design, according to the results.

4.2.2 Goals

As presented in Table II , results indicate designing for enhancing customer experience, strategic value co-creation and supporting service as the main goals shared by all the areas. Likewise, designing for improving service quality is cited by service research, marketing, operations and information systems perspectives as a relevant goal for service design.

A service research perspective demonstrates a focus on enhancing customer experience by developing theory and conceptual frameworks that explore, for instance, “emotional responses as mediating factors between the physical and relational elements and loyalty behaviors” ( Pullman and Gross, 2004 , p. 551). Along with service research, marketing literature has a strong focus on designing for enhancing customer experience. The literature notes, for instance, the planning of dramatic structures for service events, coupling back-stage employees with front-stage processes, which provide customized service ( Zomerdijk and Voss, 2010 ). Literature analysis shows service research and marketing also devoting attention to designing for supporting service and improving service quality, through the design and rigorous analysis of service delivery systems to identify problems before they happen ( Bitner et al. , 2008 ; Shostack, 1982, 1984 ).

The operations management literature analyzed, instead, offers knowledge on how to apply design to support service delivery by planning, visualizing, implementing and managing the service delivery processes that enable value co-creation within organizations and with their partners ( Sampson, 2012 ; Lovelock and Wirtz, 2016 ). Service Research Center 2 confirms that: “from an operations” perspective, we look at design at the level of the processes, so the contribution design can bring to innovation naturally appears in our literature more focused on the design of service operations. The data indicate how this area contributes to managing service capacity and creating flexible processes to deal with customer variability so as to maintain or improve operational efficiency and efficacy ( Frei, 2006 ; Sampson and Froehle, 2006 ).

Furthermore, the focus of information systems literature resulted the one of designing for supporting service delivery, for instance, by creating service-oriented architectures and web services to support business-to-business collaborations ( Chesbrough and Spohrer, 2006 ). In addition, literature from this perspective reports the use of web-based technological solutions to enhance the customer experience during service delivery processes, by increasing the power of choice of customers through a self-service approach ( Davis et al. , 2011 ).

Designing for enabling service interactions appears as a common goal in both design and interaction design perspectives. They both contribute to enabling service interactions through the application of “design methods and skills to improve the user experience” ( Meroni and Sangiorgi, 2011 , p. 9), by dealing with one-to-one, many-to-many and open-ended service relations within and among organizations ( Sangiorgi, 2009 ). In addition, the results describe these areas as contributing to improving the service design process, by creating and exploring the use of tools and techniques to visualize and analyze the user experience ( Miettinen and Koivisto, 2009 ), as well as by researching and facilitating co-design activities, where the user plays “a large role in knowledge development, idea generation and concept development” ( Sanders and Stappers, 2008 , p. 8).

Finally, results also show that a design perspective is turning the focus of service design toward improving societal well-being. This is reported in the literature as the active participation of designers in local communities, contributing with “specific design knowledge [like] design skills, capabilities and sensitivities” able to support new service models and social innovation ( Jégou and Manzini, 2008 , p. 41). Social innovation is here described as the “changes in the way individuals or communities act to solve a problem or to generate new opportunities” ( Jégou and Manzini, 2008 , p. 29).

4.2.3 Objects

As shown in Table III , results indicate service system, service interface and service concept/value proposition as service design objects in all areas. Likewise, service delivery process is cited by service research, design, marketing, operations and information systems perspectives as relevant objects for service design.

Results show that a service research perspective focuses on understanding the service interface, especially in terms of service clues ( Berry and Bendapudi, 2003 ) and servicescape ( Bitner, 1992 ). In recent years, the interest in service systems is also reported, expanding its focus from an organizational level ( Ding et al. , 2009 ; Kaltcheva and Weitz, 2006 ) to also include the study of value networks ( Akaka et al. , 2012 ) and service ecosystems ( Edvardsson and Tronvoll, 2013 ).

Along with service research, the marketing analyzed literature reports an interest in orchestrating all the “clues” of the service interface during the buying process ( Berry et al. , 2002 ). Results also show a marketing focus on service systems, for instance, by assessing value creation within the service delivery system ( Kleijnen et al. , 2007 ).

Data analysis demonstrates a design and interaction design foci on the service interface, by highlighting, for instance, the importance of “service evidence and physical cues in the servicescapes to interpret both intended and unintended relational messages that communicate the service providers’ perceptions about customers” ( Lo, 2011 , p. 05). Likewise, literature analysis suggests how a design perspective contributes to creating service systems, service concepts and service delivery processes, proposing dedicated tools as the business model canvas that “easily describe and manipulate business models to create new strategic alternatives” ( Osterwalder and Pigneur, 2010 , p. 15).

An operations’ perspective focus on the service delivery process, by designing and managing all the activities and service evidences that support the service encounter ( Shostack, 1984 ; Lovelock and Wirtz, 2016 ). Data analysis shows, from an information systems’ perspective, a focus on service systems, service interface and service delivery process, such as by the application of service-oriented architecture methodologies to deploy web services that allow service system operations to be efficient and scalable ( Glushko, 2008 ).

Nevertheless, technology is a common object brought by information systems, operations and interaction design perspectives. For instance, an IT perspective describes the design of a CAD tool to evaluate and improve product–service systems ( Hara et al. , 2009 ), and an operations’ one contributes to understand how technology can change and enhance service delivery systems ( Zomerdijk and de Vries, 2007 ). Service Research Center 1, from an information systems’ background, points out that “new technology can end literally into innovation,” describing that “it is just a question of finding a new technology and a market gap and put them together to design something out of it.” In parallel, an interaction design perspective places its focus on understanding interactions between technological solutions (e.g. robots and cell phone app) and their users ( Lee et al. , 2010 ).

Finally, results also show that design and interaction design perspectives bring a focus on improving the service design process, such as by creating new service design approaches, methods and tools. Literature reports, for instance, these areas exploring the use of tools and techniques to make future service situations tangible (as through role play, desktop walkthrough, prototyping), in order to facilitate the involvement and analysis of user experience ( Steen et al. , 2011 ; Blomkvist, 2015 ). This literature on the service design process is quite different from the literature on the service delivery process. Although the first focuses on developing new approaches, models and tools to improve the process of service design, the latter focuses on using service design to improve the process of service delivery.

4.2.4 Approaches

Results indicate that service design approaches can be characterized by their customer-centered and systemic approach in all areas, as summarized in Tables IV and V .

Literature analysis in service research introduces both customer- and employee-centered foci to service design by describing, for instance, an integrated view of the organizational service delivery system, including the roles of service providers and customers ( Bitner et al. , 2008 ). Service researchers acknowledge both NSD ( Edvardsson and Olsson, 1996 ) and design thinking ( Dorst, 2011 ) as two approaches to designing for service.

Human, customer and user centeredness are associated with a design perspective, by employing Design Thinking and Participatory Design approaches that “use visual methods to explore and generate ideas” ( Kimbell, 2011 , p. 42). In this context, literature describes design for social innovation as an approach employed by designers to “recognize and support solutions developed autonomously by groups of people to solve their own problems in their local contexts” ( Cipolla and Bartholo, 2014 , p. 87).

A marketing perspective, on the other hand, brings a strong customer orientation to service design, defined as “the set of beliefs that puts the customer’s interest first” ( Deshpande et al. , 1993 , p. 27). Data analysis reflects also an interest in a systemic approach, for instance, by using service system as a theoretical construct to understand “configurations of people, technology, and value propositions” ( Mahr et al. , 2013 , p. 437). The analyzed marketing literature describes experience design as an approach to create emotional connections with customers through the careful planning of tangible and intangible service elements ( Berry et al. , 2002 ).

Literature analysis from an operations’ perspective refers to both customer and employee-centered foci to service design, by presenting studies that systematically manage the flow of resources along the service delivery system, in order to guarantee that operations in the back and front stages occur as planned ( Zomerdijk and de Vries, 2007 ). In this sense, results show that this perspective contributes with systemic and procedural approaches to service design, with tools such as blueprint, flowcharts and diagrams to visually represent the flow of resources along the service operation, facilitating decision making during service projects ( Shostack, 1984 ; Sampson, 2012 ).

An information systems’ perspective refers to customer, user and employee-centered views on service design. Service Research Center 1 also reported a technology-centered approach associated with this area, which is interested in the “design of the service where two machines are interacting to each other […] focusing primarily on the technology and how to design what works best for these two machines.” Results refer to a systemic process, using service system as an abstraction to understand value co-creation ( Spohrer and Kwan, 2009 ) and an experience design approach to improve the usability of service interfaces ( Constantine and Lockwood, 2001 ).

Interaction design literature characterizes a mostly user-centered approach, illustrated by the claim that “the main and distinctive focus of service design tools concerns the design, description and visualization of the user experience, including the potentials of different interaction modes, paths and choices” ( Maffei et al. , 2005 , p. 6). Participatory design and co-creation are also associated approaches with design and interaction design, while a systemic approach is highlighted by the interest in understanding and contextualizing interactions within user systems ( Sangiorgi, 2009 ).

4.2.5 Outcomes

Data analysis enabled the identification of service design outcomes which can be positioned at different levels of service ecosystems ( Chandler and Vargo, 2011 ). This positioning is not rigid as service design may simultaneously impact at distinct service ecosystem levels simultaneously, and value co-creation is a dynamic process, which changes according to the context ( Edvardsson and Tronvoll, 2013 ). Nevertheless, the organization of the service design outcomes across the micro, meso and macro levels of service ecosystems ( Chandler and Vargo, 2011 ) was useful to reflect the analyzed literature main foci and facilitate the interpretation of results. In this sense, if the literature under analysis focused more on service design outcomes based on dyadic interactions between users and service providers, as well as more specific organizational service processes, it was categorized at the micro level. On the other hand, if it described service design outcomes based on many-to-many interactions or value propositions in the value network, then it was considered as having a meso focus. Finally, if service design outcomes were identified as connected to institutional change, then this literature was characterized as having an impact on the macro level ( Lusch and Vargo, 2014 ). These service design outcomes are presented in Table VI .

As shown in Table VI , at a micro level of service ecosystems, all perspectives are reported to bring knowledge that support changing the service encounter, in terms of new service clues and servicescape ( Bitner, 1992 ), new service interfaces ( Secomandi and Snelders, 2011 ), new brand-related stimuli ( Brakus et al. , 2009 ), new service evidences ( Shostack, 1982 ), new user interfaces ( Glushko, 2010 ) and new configurations of people, products and information that support the user experience ( Sangiorgi, 2009 ). Operations management and information systems are the perspectives that mostly contribute to designing new service delivery processes, by reducing variability in service operations ( Frei, 2006 ) and using technology to increase service performance ( Schmenner, 2004 ). Moreover, both these areas and interaction design show a focus on supporting service design to designing new technology ( Hara et al. , 2009 ) to improve service operations ( Roth and Menor, 2003 ) and to innovate service interactions ( Zimmerman et al. , 2011 ). A marketing perspective also contributes to create new service clues that integrate the service encounter ( Berry et al. , 2002 ).

At a meso level of service ecosystems, operations management and information systems’ perspectives are reported to support service design to conceptualize new service delivery processes within supply chains ( Sampson, 2012 ) and leverage technology to enable new interactions that support service network change ( Davis et al. , 2011 ; Von Ahn and Dabbish, 2008 ). Moreover, a design perspective brings a social innovation orientation to service design ( Jégou and Manzini, 2008 ), through the creation of service platforms that support new value co-creation interactions between actors, strengthening novel social and economic networks ( Baek et al. , 2015 ). Service Research Center 6 highlights, for instance, that “in projects, such as Nutrire Milano, designers have created platforms to support new forms of interactions between actors enabling social innovation inside communities.”

At a macro level of service ecosystems, a design perspective contributes to enable institutional change, by envisioning new services ecosystems that support more sustainable lifestyles and consumption habits (e.g. distributed power generation systems, programs of urban and regional development) ( Manzini, 2009 ), as well as new service concepts that change citizens’ practices and routines ( Manzini and Staszowski, 2013 ; Cipolla et al. , 2015 ). On the other hand, a service research stream offers expertise that supports service design to understand and enable institutional change, through the questioning of existing socially constructed systems of norms, values and definitions, as well as by reconfiguring novel service ecosystems based on new practices and beliefs ( Vargo et al. , 2015 ; Koskela-Huotari et al. , 2016 ). Service Research Center 4, from a service research perspective, argues that “service design can be really part of questioning, breaking institutions, creating prerequisites for new ones, new behaviors, new practices and new norms.”

5. Discussion

After identifying, characterizing and systematizing the core multidisciplinary perspectives on service design in terms of goals, objects, approaches and outcomes ( Kaptelinin and Nardi, 2012 ), this section provides an integrative examination of the research and managerial implications that these multiple contributions bring to service design.

5.1 Research implications

This paper builds a multidisciplinary perspective to service design sustained by the systematization of multiple contributions that service research, design, marketing, operations, information systems and interaction design bring to this approach. By focusing on the relations between these multiple perspectives, it is possible to identify cross-cutting research areas and complementarities, which are discussed in the following sub-sections.

5.1.1 Building a shared ground with cross-cutting research areas

The cross-cutting research areas show that there is a common ground that can build the foundations to strengthen service design as a multidisciplinary activity to service innovation. These shared concerns are represented by the convergent foci that the multidisciplinary perspectives have on value co-creation, customer experience and service system, supported by a human-centered approach, which reflect on interconnected aspects of the service design activity in terms of goals, objects, approaches and outcomes.

In terms of goals, all areas contribute to design for value co-creation, enhance the customer experience and support service. Service design understanding about the customer experience, for instance, is enriched by a marketing’s expertise on designing experience-centric services ( Zomerdijk and Voss, 2010 ) and a design view on the application of approaches to conceptualize and improve the experience from a human-centered point of view ( Holmlid, 2007 ; Miettinen and Koivisto, 2009 ). This is also reflected on the employment of web-based solutions to enhance value co-creation with users, from an information systems standpoint ( Davis et al. , 2011 ).

Regarding the cross-cutting objects, all areas refer to service system as an integrative abstraction, focusing on its different components, namely the value proposition, the service interface and the service delivery process. Value propositions, for instance, are approached in different ways from a design, a service research, a marketing and an information systems perspective. As such, these perspectives address value propositions in the form of service offerings to social and economic problems ( Burns et al. , 2006 ), as new modes of value co-creation within service networks ( Akaka et al. , 2012 ) and as new service solutions supported by online systems to increase operations’ efficiency ( Chesbrough and Spohrer, 2006 ), respectively.

Regarding service design approaches, the cross-cutting area is the human-centricity, with each perspective focusing on designing solutions for the various roles people can assume within service systems. From a user-centered point of view, service design can integrate users’ needs and design for user experiences ( Segelström, 2009 ; Glushko, 2008 ), integrating design, information systems and interaction design perspectives. Through a customer-centered standpoint supported by all areas, service design turns the attention to understanding customers’ desires and cultures, as well as to stimulating new customers’ roles ( Zomerdijk and de Vries, 2007 ). Finally, service research, marketing, operations and information systems bring attention to an employee perspective, which contribute to understand and design employees’ roles in the service delivery system, as well as use employees’ knowledge as sources of customer experience innovation ( Bitner et al. , 2008 ; Shostack, 1984 ).

In terms of service design outcomes, the cross-cutting areas result from the objects’ transformations and, therefore, are similar to the service design objects. As such, cross-cutting outcomes are the service encounter, the service delivery process and the value proposition changes, which converge to innovate service networks. In this integration of multidisciplinary perspectives, service designers can profit, for instance, from a design view to create new service models based on social innovation initiatives ( Jégou and Manzini, 2008 ), from an information systems contribution to integrate networked peer-to-peer collaborations ( IfM and IBM, 2007 ), or even from an operations’ perspective to implement new service delivery systems ( Roth and Menor, 2003 ).

5.1.2 Complementarities that support a service design holistic approach

The study results show the richness of contributions that multiple perspectives can bring to service design, making service design a multidisciplinary field able to get a broad and holistic understanding of service related challenges. These multiple areas also provide complementary perspectives, which taken together support the foundations for an actual holistic service design approach that could not be achieved by each perspective by itself. The systematization of these multiple perspectives enhances the dialog and shared ground among service designers coming from different backgrounds, elucidating the connections between the various approaches and concepts of their communities of practice.

A service research perspective informs service designers with the conceptual frameworks to understand, analyze and design new forms of value co-creation within service systems ( Edvardsson and Tronvoll, 2013 ). Complementary to this perspective, a design view brings tools and methods ( Miettinen and Koivisto, 2009 ) to understand, envision and create new forms of value co-creation within socio-material configurations ( Kimbell, 2011 ). For that, designers contribute to creating service interfaces ( Secomandi and Snelders, 2011 ) and to facilitating co-design processes ( Steen et al. , 2011 ) that concretize and sustain the interactions between actors in service systems ( Wetter-Edman et al. , 2014 ).

A marketing perspective, on the other hand, brings an extensive knowledge on understanding and designing the customer experience ( Zomerdijk and Voss, 2010 ). This area’s perspective supports service designers to conceptualize customer-centric service systems ( Mahr et al. , 2013 ), for instance, by planning the tangible and intangible service elements that increase service quality ( Bitner et al. , 2008 ). An operations’ view to service design supports to build the customer experience, by creating operational strategies ( Roth and Menor, 2003 ), planning and controlling service operations ( Shostack, 1984 ) and designing the entire service delivery system, which sustain the quality of the service encounter ( Sampson, 2012 ). In parallel, an information systems view contributes to designing the technology that supports these service delivery systems to run ( Glushko and Nomorosa, 2013 ). By bringing a technology-perspective, this area increases the service delivery performance ( Schmenner, 2004 ), as well as creates new user interfaces ( Glushko, 2010 ) and designs service monitoring systems to evaluate the customer satisfaction ( Glushko and Nomorosa, 2013 ).

Nonetheless, an interaction design perspective contributes to understand and design service interactions that support the user experience ( Zimmerman et al. , 2011 ). This area’s contributions range from creating approaches that facilitate co-design activities ( Sanders and Stappers, 2008 ), to the visualization and interpretation of user journeys within service systems ( Sangiorgi, 2009 ).

5.2 Managerial implications

The identification and characterization of the goals, objects and approaches that service design multidisciplinary perspectives can deal with during service design projects demonstrate the diversity of complementary contributions this approach can bring to service innovation. Understanding these perspectives can help to articulate which kind of contribution is useful along the service innovation process ( Gustafsson, Kristensson, Schirr and Witell, 2016 ), in order to coordinate resources to create new service. For instance, if the goal is designing for supporting service with improved service operations, it may be interesting to integrate knowledge from capacity and customer variability ( Frei, 2006 ), with an understanding of how to articulate resources along the customer journey to enhance customer experience ( Truong et al. , 2006 ), from operations and interaction design areas, respectively. These perspectives can also be complemented by designing the technology that will support the service delivery system ( Glushko, 2010 ), with an information systems point of view.

This paper brings a valuable contribution to organizations which are interested in enabling diverse forms of innovation, by describing how a service design multidisciplinary approach can have a wide impact on service innovation, reflected in: new service interfaces ( Secomandi and Snelders, 2011 ), technological innovation ( Zimmerman et al. , 2011 ), new value propositions, new service networks ( Patrício, Pinho, Teixeira and Fisk, 2018 ), social innovation ( Baek et al. , 2015 ), public-sector innovation ( Manzini and Staszowski, 2013 ) and institutional innovation ( Koskela-Huotari et al. , 2016 ). Likewise, the paper identifies approaches, such as systemic and participatory design ( Kimbell, 2011 ), experience design ( Berry et al. , 2002 ) and design thinking ( Dorst, 2011 ), which can be used by teams to coordinate the integration of resources during service design projects.

This characterization and systematization supports a better understanding of service design as an innovation practice, which can incorporate multidisciplinary perspectives to enable new forms of value co-creation ( Lusch and Nambisan, 2015 ) at different levels of service ecosystems ( Chandler and Vargo, 2011 ). In this sense, this paper clarifies which multiple contributions service management researchers and practitioners can integrate to tackle complementary levels of complexity of service projects.

Finally, the paper supports creating a common ground that enables service designers from different backgrounds to better communicate and understand each other when collaborating, which boosts the involvement of multidisciplinary teams during service design and innovation projects ( Ostrom et al. , 2015 ). Therefore, this comprehensive discussion contributes to pave the way to advance service design as an interdisciplinary field better connected to service innovation ( Gustafsson, Högström, Radnor, Friman, Heinonen et al. , 2016 ; Ostrom et al. , 2015 ; Patrício, Gustafsson and Fisk, 2018 ).

6. Limitations and future research

This paper supports the understanding of service design as a multidisciplinary activity able to foster service innovation, by bringing together complementary contributions. However, in spite of the effort to systematize multidisciplinary contributions to service design, this study has limitations. First, the research process was expert based, which means that a sample of service design experts was selected, influencing the selection of suggested literature and, consequently, the results. This limitation was partially overcome by strengthening the analysis of the literature review through focus groups involving 40 researchers from 6 service research areas in 5 countries. As the service design community grows, future research could accompany its multidisciplinary evolution and its new efforts toward supporting service innovation.

Second, the research process concentrated on collecting multidisciplinary contributions from the point of view of service design scholars. Therefore, further research could focus on understanding how multidisciplinarity is dealt in the practice of service design, as well as how service designers actually enable service innovation at different levels of service ecosystems through their projects. This could be complemented by studies that investigate other areas connected to service design which were not considered in this study.

Finally, the results also indicate emerging research areas that are not yet shared by all perspectives. One of these emerging research topics that seem especially important is the connection between service design and service ecosystem. Currently, this research area is mainly supported by design ( Burns et al. , 2006 ; Sangiorgi, 2011 ) and service research ( Vargo et al. , 2015 ; Koskela-Huotari et al. , 2016 ). From a design perspective, service design brings a transformational approach ( Burns et al. , 2006 ; Sangiorgi, 2011 ), focused on enabling society-driven innovation, by addressing social challenges and creating solutions that support more sustainable service ecosystems ( Baek et al. , 2015 ). In this sense, service design can be used not just as an approach to innovate dyadic relations between customers and service providers, but a process for radical change through the envisioning and design of new service systems ( Burns et al. , 2006 ; Manzini, 2009 ). More recently, a design perspective has also been developed to support the connection between service design and institutions, claiming that changes at the micro level are critical to catalyze institutional change at the macro level of service ecosystems ( Wetter-Edman et al. , 2018 ). Therefore, in terms of social innovation outcomes it is possible to notice that the distinction between meso and macro levels of service ecosystems is getting increasingly blurred, since the efforts on fostering socially innovative service networks ( Baek et al. , 2015 ) and stimulating institutional change ( Cipolla et al. , 2015 ) are inter-related.

From a service research perspective, the emerging concern about service ecosystems focuses on social structures ( Edvardsson and Tronvoll, 2013 ) and on breaking down existing institutional arrangements, reconfiguring new service ecosystems based on novel practices and beliefs ( Koskela-Huotari et al. , 2016 ). Public policies can also consolidate institutional change and shape the macro level of service ecosystem, as highlighted by Trischler and Charles (2019) , since they coordinate the collective, multi-actor and systemic phenomenon of value co-creation between actors. Therefore, understanding users and their value co-creation processes are key to public policy design, in order to identify the most suitable configuration of resources to integrate and support emergent solutions within service ecosystems ( Trischler and Charles, 2019 ). Building on this emerging area, further research is needed to explore the connections between service design and service ecosystems, by bringing supportive knowledge from other research perspectives beyond service research and design.

Service design activity conceptual model

Research process and summary of findings

Service design multidisciplinary goals

Service design multidisciplinary objects

Service design multidisciplinary approaches – centeredness

Service design multidisciplinary approaches – process

Service design multidisciplinary outcomes

Results of Phase 1

Phase 1 – experts in service design from multidisciplinary areas

Phase 3 – research centers participating in the focus groups

The selected references from Phase 1 are presented in the table below. The identification of the main associated areas was made based on the analysis of the publications’ content. Table AI

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Further reading

Blomberg , J. and Darrah , C. ( 2015 ), “ Towards an anthropology of services ”, The Design Journal , Vol. 18 No. 2 , pp. 171 - 192 .

Corbin , J. and Strauss , A. ( 2008 ), Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory , Sage Publications , New York, NY .

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Patrício , L. , Fisk , R.P. and e Cunha , J. ( 2008 ), “ Designing multi-interface service experiences: the service experience blueprint ”, Journal of Service Research , Vol. 10 No. 4 , pp. 318 - 334 .

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• Wang X Dong J (2023) Research on the strategy of travel service system for visually impaired people based on service design thinking Proceedings of the Eleventh International Symposium of Chinese CHI 10.1145/3629606.3629610 (25-36) Online publication date: 13-Nov-2023 https://dl.acm.org/doi/10.1145/3629606.3629610
• Schön E Silva da Silva T Hinderks A Sharp H Thomaschewski J (2023) Introduction to special issue on Agile UX Information and Software Technology 10.1016/j.infsof.2023.107193 158 :C Online publication date: 1-Jun-2023 https://dl.acm.org/doi/10.1016/j.infsof.2023.107193
• Chen L Huang M Liu Z Jiang Y Wu T (2023) Applying Service Design Thinking to UX Research: A Case of Smart Campus Dance Experience Design Design, User Experience, and Usability 10.1007/978-3-031-35696-4_5 (57-74) Online publication date: 23-Jul-2023 https://dl.acm.org/doi/10.1007/978-3-031-35696-4_5

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Service design for children and young people with common mental health problems: literature review, service mapping and collective case study

Affiliations.

• 1 School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK.
• 2 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
• 3 School of Healthcare Studies, Cardiff University, Cardiff, UK.
• 4 Common Room North, Leeds, UK.
• 5 Lancashire and South Cumbria NHS Foundation Trust, Preston, UK.
• PMID: 38767587
• DOI: 10.3310/DKRT6293

Background: The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm.

Aim: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services.

Design: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services.

Setting: Global (systematic reviews); England and Wales (service map; case study).

Data sources: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites.

Methods: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'.

Results: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems.

Limitations: Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn.

Conclusions: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research.

Future work: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility.

Study registration: This study is registered as PROSPERO CRD42018106219.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

Keywords: ADOLESCENT; ADOLESCENT HEALTH SERVICES; CAMHS; CASE STUDY RESEARCH; CHILD; CHILD HEALTH SERVICES; DELIVERY OF HEALTH CARE; HEALTH SERVICES; INTEGRATIVE REVIEW; LITERATURE REVIEW; MENTAL DISORDERS; MENTAL HEALTH; MENTAL HEALTH SERVICES; ORGANISATIONAL CASE STUDIES; SCHOOL MENTAL HEALTH SERVICES; SCOPING REVIEW; SERVICE MAP; SERVICE MODEL; SYSTEMATIC REVIEW; TYPOLOGY.

Plain language summary

In this research study, we explored services for children and young people with ‘common’ mental health problems like depression, anxiety and self-harm. We aimed to find out what services exist, how children/young people and families find out about and access these services, what the services actually do, whether they are helpful and whether they offer value for money. We looked at the international literature (reports and research papers) to identify different approaches to providing support, and to find out whether certain approaches worked better than others and whether children/young people and families preferred some approaches over others. The literature provided very little information about the value for money of services. We also carried out a survey and used the internet to identify 154 relevant services in England and Wales. To explore services in more detail, and hear directly from those using them, we planned to visit 9 of the 154 services to interview children/young people, parents and staff. Unfortunately, coronavirus disease 2019 stopped us directly visiting the nine services and so we conducted phone and video interviews instead. We still managed to speak to, and hear the experiences of, more than 100 people (including children/young people and parents). We combined information from the literature with information from the interviews to create an evidence-based ‘model’ of what services should look like. This model considers some basic things like how quickly children/young people could access a service, what information was available, the importance of confidentiality and whether staff make the service fit with the child/young person’s needs and interests. It also considers whether the service helps children/young people learn skills to manage their mental health and whether staff at a service work well together. We hope our model will help existing and new services improve what they offer to children/young people and families.

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• National Institute for Health Research Health Services and Delivery Research. Commissioning Brief 17/09 – Services to Support Early Intervention and Self-care for Children and Young People Referred to Children and Young People’s Mental Health Services/CAMHS with Common Emotional and Behavioural Problems. Southampton: NIHR; 2017.
• National Institute for Health and Care Research (NIHR). Research Award: Identifying and Evaluating Mental Health Early Intervention Services and Self-care Support for Lesbian, Gay, Bisexual and Transgender Young People: A Mixed Methods Study, 17/09/04. Funding and Awards. 2017. URL: https://fundingawards.nihr.ac.uk/award/17/09/04 (accessed 13 April 2022).
• Murphy M, Fonagy P. Mental health problems in children and young people. In Lemer C, editor. Our Children Deserve Better: Prevention Pays, Annual Report of the Chief Medical Officer 2012. London: Department of Health; 2013.
• National Assembly for Wales Children, Young People and Education Committee. Inquiry into Specialist Child and Adolescent Mental Health Services. Cardiff: National Assembly for Wales; 2014.
• NHS England. Future in Mind: Promoting, Protecting and Improving Our Children and Young People’s Mental Health and Wellbeing. London: NHS England; 2015.

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A review of service design pedagogy to identify potential added value to product innovation in higher education.

1. Introduction

2. literature review, 2.1. definition of service design and service design pedagogy, 2.2. product design and product innovation, 4. findings, 4.1. core author analysis, 4.2. research institution analysis, 4.3. keyword co-occurrence analysis.

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4.3.1. Service Design and Value Co-Creation

4.3.2. product design and methodology, 4.3.3. service innovation and participatory design, 4.3.4. service learning and higher education, 5. discussion, 5.1. key factors motivating product innovation teaching in higher education, 5.2. service design pedagogy/service learning in higher education toward sustainable multidisciplinary communication, 5.3. sustainability in pss in design and sustainability in pss in design education, 5.4. how does service design better facilitate sustainability considerations by product designers during their education, 6. conclusions, 6.1. research conclusions, 6.2. future research, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Suoheimo, M.; Vasques, R.; Rytilahti, P. Deep diving into service design problems: Visualizing the iceberg model of design problems through a literature review on the relation and role of service design with wicked problems. Des. J. 2020 , 24 , 231–251. [ Google Scholar ] [ CrossRef ]
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Share and Cite

Ding, S.; de Bont, C.J.P.M.; Cockbill, S.; Zhou, Q. A Review of Service Design Pedagogy to Identify Potential Added Value to Product Innovation in Higher Education. Sustainability 2023 , 15 , 15530. https://doi.org/10.3390/su152115530

Ding S, de Bont CJPM, Cockbill S, Zhou Q. A Review of Service Design Pedagogy to Identify Potential Added Value to Product Innovation in Higher Education. Sustainability . 2023; 15(21):15530. https://doi.org/10.3390/su152115530

Ding, Shiyao, Cees J. P. M. de Bont, Stuart Cockbill, and Qiaozhuang Zhou. 2023. "A Review of Service Design Pedagogy to Identify Potential Added Value to Product Innovation in Higher Education" Sustainability 15, no. 21: 15530. https://doi.org/10.3390/su152115530

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Service Design

What is service design.

Service design is a process where designers create sustainable solutions and optimal experiences for both customers in unique contexts and any service providers involved. Designers break services into sections and adapt fine-tuned solutions to suit all users’ needs in context—based on actors, location and other factors.

“When you have two coffee shops right next to each other, and each sells the exact same coffee at the exact same price, service design is what makes you walk into one and not the other.” — 31Volts Service Design Studio

See how effective service design can result in more delightful experiences.

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Service Design is about Designing for the Biggest Picture

Users don’t access brands in a vacuum, but within complex chains of interactions. For example, a car is a product, but in service design terms it’s a tool when an elderly customer wants to book an Uber ride to visit a friend in hospital. There’s much to consider in such contexts. This user might be accessing Uber on a smartphone, which she’s still learning to use. Perhaps she’s infirm, too, lives in an assisted living facility and must inform the driver about her specific needs. Also, she’s not the only user involved here. Other users are any service providers attached to her user experience. For example, the driver that customer books also uses Uber—but experiences a different aspect of it. To cater to various users’ and customers’ contexts as a designer, you must understand these sorts of relations between service receivers and service providers and the far-reaching aspects of their contexts from start to finish. Only then can you ideate towards solutions for these users’/customers’ specific ecosystems while you ensure brands can deliver on expectations optimally and sustainably .

In service design, you work within a broad scope including user experience (UX) design and customer experience (CX) design . To design for everyone concerned, you must appreciate the macro- and micro-level factors that affect their realities.

A service design experience often involves multiple channels, contexts and products.

Marc Stickdorn and Jakob Schneider, authors of This is Service Design Thinking , identify five key principles—for service design to be:

User-centered – Use qualitative research to design focusing on all users.

Co-creative – Include all relevant stakeholders in the design process.

Sequencing – Break a complex service into separate processes and user journey sections.

Evidencing – Envision service experiences to make them tangible for users to understand and trust brands.

Holistic – Design for all touchpoints throughout experiences, across networks of users and interactions.

Designers increasingly work more around services than around physical products—e.g., SaaS (software as a service). Meanwhile, with advances in digital technology continually redefining what users can expect whenever they proceed towards goals, brands focus on maximizing convenience and removing barriers for their users . A digital example is Square, which unbundles point-of-sale systems from cash registers and rebundles smartphones as potential point-of-sale systems.

How to Do Service Design Best

First, identify these vital parts of any service encounter:

Actors (e.g., employees delivering the service)

Location (e.g., a virtual environment where customers receive the service)

Props (e.g., objects used during service delivery)

Associates (other organizations involved in providing the service – e.g., logistics)

Processes (e.g., workflows used to deliver the service)

You’ll need to define problems, iterate and address all dimensions of the customers’, users’ and business needs best in a holistic design . To begin, you must empathize with all relevant users/customers. These are some of the most common tools:

Customer journey maps (to find the customers’ touchpoints, barriers and critical moments)

Personas (to help envision target users)

Service blueprints (elevated forms of customer journey maps that help reveal the full spectrum of situations where users/customers can interact with brands)

You should use these to help leverage insights to account for such vital areas as accessibility and customer reengagement.

Service blueprints are an important tool in the service design process.

Do Service Design for the Complete Experience

Remember to design for the complete experience. That means you should accommodate your users’/customers’ environment/s and the various barriers, motivations and feelings they’ll have. Here are some core considerations:

Understand your brand’s purpose, the demand for it and the ability of all associated service providers to deliver on promises.

The customers’ needs come ahead of the brand’s internal ones .

Focus on delivering unified and efficient services holistically —as opposed to taking a component-by-component approach.

Include input from users .

Streamline work processes to maximize efficiency .

Co-creation sessions are vital to prototyping .

Eliminate anything (e.g., features, work processes) that fails to add value for customers.

Use agile development to adapt to ever-changing customer needs.

Service design applies both to not-so-tangible areas (e.g., riders buying a single Uber trip) and tangible ones (e.g., iPhone owners visiting Apple Store for assistance/repairs). Overall, service design is a conversation where you should leave your users and customers satisfied at all touchpoints, delighted to have encountered your brand.

Learn More about Service Design

Learn all about service design by taking our course: Service Design: How to Design Integrated Service Experiences .

Read this insightful piece, Service Design: What Is It, What Does It Involve, And Should You Care?

Discover more about service blueprinting in Service Design 101

Read this eye-opening piece exploring Service Design Thinking

Examine Uber’s service design in Uber Service Design Teardown

Questions related to Service Design

A service design diagram is a visual representation of the overall structure and components of a service, including the interactions between different elements. It provides an overview of the service and helps stakeholders understand how different parts of the service fit together. It may include information such as user interfaces, system components, data flows, and more.

Actors/Roles: Entities bringing the experience to the customer.

Information Flow: Details of data shared, required, or used.

Interactions: Between people, systems, and services.

Devices & Channels: Tools and mediums of communication.

The diagram is essential for understanding the current state of a service, emphasizing the intricacies and interdependencies, guiding service blueprint creation, and identifying potential breakpoints or areas for enhancement.

In the context of service design, frontstage refers to the actions performed by employees that are visible to the customer. It includes interactions such as customer service, product demonstrations, and any other activities that customers can directly observe.

On the other hand, backstage actions are performed by employees that are not visible to the customer. These actions support the service delivery and may include tasks such as inventory management, quality control, and other behind-the-scenes operations.

Good service design is a holistic approach that prioritizes every user interaction, both in digital and real-life contexts. Jonas Piet, Director and Service Design Lead at Inwithforward shares the example of Kudoz, a learning platform to demonstrate backstage service design.

While the digital platform is a crucial component, the user's journey begins long before they interact with the app. It might start with discovering the service at a community event or through a promotional video. Service designers ensure that every touchpoint, from community events to the digital interface, provides a coherent and positive experience. They focus on the intricate details, be it designing the role of an 'Experience Curator', crafting a compelling story, or ensuring safety checks. In essence, good service design intertwines various interactions, ensuring they align perfectly.

Discover the principles of human-centered design through Interaction Design Foundation's in-depth courses: Design for the 21st Century with Don Norman offers a contemporary perspective on design thinking, while Design for a Better World with Don Norman emphasizes designing for positive global impact. To deepen your understanding, Don Norman's seminal book, " Design for a Better World: Meaningful, Sustainable, Humanity Centered ," from MIT Press, is an invaluable resource.

Developing service design begins with 

In-depth user research, often ethnographic field studies, forming personas and journey maps. 

Engage stakeholders early and consistently. 

Utilize tools like the business model and value proposition canvases for a strategic foundation. 

Transition from journey maps to service blueprints, mapping out the entire service ecosystem. 

Embrace prototyping, iteratively refining with stakeholder input. 

Thoroughly test prototypes, launch the finalized service, and continuously measure its impact. 

Learn more from the video below:

Service design starts by understanding all pieces of an activity, centered on a user's need. 

It involves figuring out systems from the ground up to support the experience, considering digital, physical, and social contexts. In-depth user research, stakeholder engagement, and aligning organizational resources, user needs, and outcomes are vital. 

Service design, as discussed in our video, encompasses both the visible interactions a customer experiences and the underlying processes staff engage with. It deals with a complex web of interconnectivity, from front-end interactions to back-end systems and distribution. However, the challenge isn't just about designing services. The organizational culture must be receptive. Even if service designers identify areas of improvement, if the organization isn't prepared or faces legislative and technological barriers, change becomes arduous. Despite having dedicated individuals wanting change, they can often be constrained by larger, intricate issues. Service design requires a holistic approach, and while it can pinpoint problems, actual implementation might be held back by factors beyond the design realm.

UX (User Experience) design centers on the digital experience of users, focusing on specific touchpoints (which are often screen-based interactions). CX (Customer Experience) is broader, encompassing every touchpoint a customer has with a brand, from digital to in-store. 

Service design has the highest scope of the three concepts, factoring in business processes, systems, and other back-end elements that the customer does not interact with. While UX zooms in on digital interactions, service design steps back, integrating everything for a seamless journey. All three disciplines aim to enhance the user's or customer's experience but operate at different scales and depths.

Absolutely! As businesses increasingly recognize the value of delivering exceptional customer experiences, service design has become a pivotal discipline. It ensures seamless and holistic services that cater to both customer needs and business goals.

• Copyright holder: Matthew Yohe. Appearance time: 0:06 - 0:08 Copyright license and terms: CC-BY-SA-3.0 . Modified: No. Link: https://commons.wikimedia.org/wiki/File:Steve Jobs Headshot 2010-CROP (cropped_2).jpg

The demand for professionals with expertise in service design is growing across various industries, from tech to hospitality. In order to stay competitive and satisfy the current demand, many individuals are looking to improve their skills. For those keen on mastering this domain, Interaction Design Foundation's course on Service Design provides an in-depth understanding and hands-on learning. It's a great way to get started or deepen your expertise!

Answer a Short Quiz to Earn a Gift

What is the primary goal of service design?

• To create visually appealing service interfaces
• To ensure financial growth for service providers
• To optimize experiences for both customers and service providers

Which principle of service design involves breaking complex services into manageable parts?

• Co-creative

Which tool is an elevated form of a customer journey map to reveal a full spectrum of user interactions with a brand?

• Service blueprints
• User scenarios

What should designers focus on for a complete service experience?

• They should concentrate solely on the technological aspects.
• They should prioritize brand needs over customer needs.
• They should understand and accommodate user environments and barriers.

What is an intended outcome of employing service design in business practices?

• To decrease the overall user base to manage expectations better
• To increase service complexity to enhance user engagement
• To leave users satisfied at all touchpoints with the brand

Better luck next time!

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Literature on Service Design

Here’s the entire UX literature on Service Design by the Interaction Design Foundation, collated in one place:

Learn more about Service Design

Take a deep dive into Service Design with our course Service Design: How to Design Integrated Service Experiences .

Services are everywhere! When you get a new passport, order a pizza or make a reservation on AirBnB, you're engaging with services. How those services are designed is crucial to whether they provide a pleasant experience or an exasperating one. The experience of a service is essential to its success or failure no matter if your goal is to gain and retain customers for your app or to design an efficient waiting system for a doctor’s office.

In a service design process, you use an in-depth understanding of the business and its customers to ensure that all the touchpoints of your service are perfect and, just as importantly, that your organization can deliver a great service experience every time . It’s not just about designing the customer interactions; you also need to design the entire ecosystem surrounding those interactions.

In this course, you’ll learn how to go through a robust service design process and which methods to use at each step along the way. You’ll also learn how to create a service design culture in your organization and set up a service design team . We’ll provide you with lots of case studies to learn from as well as interviews with top designers in the field. For each practical method, you’ll get downloadable templates that guide you on how to use the methods in your own work.

This course contains a series of practical exercises that build on one another to create a complete service design project . The exercises are optional, but you’ll get invaluable hands-on experience with the methods you encounter in this course if you complete them, because they will teach you to take your first steps as a service designer. What’s equally important is that you can use your work as a case study for your portfolio to showcase your abilities to future employers! A portfolio is essential if you want to step into or move ahead in a career in service design.

Your primary instructor in the course is Frank Spillers . Frank is CXO of award-winning design agency Experience Dynamics and a service design expert who has consulted with companies all over the world. Much of the written learning material also comes from John Zimmerman and Jodi Forlizzi , both Professors in Human-Computer Interaction at Carnegie Mellon University and highly influential in establishing design research as we know it today.

You’ll earn a verifiable and industry-trusted Course Certificate once you complete the course. You can highlight it on your resume, CV, LinkedIn profile or on your website.

All open-source articles on Service Design

The principles of service design thinking - building better services.

• 1.3k shares
• 11 mths ago

Service Design - Design is Not Just for Products

The Moment of Truth: Build Desirable Relationships with Users and Customers

Product-Service Hybrids – When Products and Services Become One

• 3 years ago

10 Ideas to Help You Sell UX Work

Making sense of new UX words: A first dictionary for UX Ecosystem Design

• 8 years ago

Understand the Service Design Process

• 2 years ago

Keep These Goals in Mind to Create Successful Service Designs

Learn the Language of Service Design

Top Service Blueprint Templates

Start Your UX Journey: Essential Insights for Success

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• Knowledge Base

Methodology

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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A Systematic Review of Personal Information Sharing in Smart Cities: Risks, Impacts, and Controls

• Open access
• Published: 24 June 2024

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You have full access to this open access article

• Maha Ibrahim Alabsi   ORCID: orcid.org/0000-0003-1791-6907 1 , 2 &
• Asif Qumar Gill   ORCID: orcid.org/0000-0001-6239-6280 1  

Smart cities aim to deliver smart services that rely on emerging technologies to their users. In order for users to get the provided services, they need to share their personal information with different parties. However, sharing personal information in smart cities may impact the privacy of that information. Thus, there is a need to address privacy risks relevant to sharing personal information in smart cities. This study aims to address this issue by conducting a systematic literature review (SLR) to identify and extract privacy risks, impacts, and existing controls associated with sharing personal information, considering elements involved and interacting during the sharing activity in smart cities. A set of 83 selected studies in both academic and industry fields were reviewed, and the results were categorised into three main groups: privacy risks, impacts, and controls. Moreover, the implications and future research directions were also reported. The proposed privacy risk taxonomy will provide a much-needed foundation for the industry and research community, intending to research and evaluate privacy risk frameworks and design solutions for sharing personal information in smart cities.

Avoid common mistakes on your manuscript.

Introduction

More recently, the concept of smart cities has been getting significant attention from research and practice perspectives (Ahmad Mohamad et al., 2019 ). Several countries across the globe (e.g. Asia, Africa, America, and Europe) aim to consider their cities “smart” by developing and delivering smart services to their citizens and residents by using emerging ICT (information and communication technologies) (Ahmad Mohamad et al., 2019 ; Albino et al., 2015 ; Hsiao et al., 2021 ). The definitions of smart cities focus on the quality of citizens’ performance and activities, along with enhancing economic competitiveness by managing city resources and improving information and communications technology (ICT) infrastructure (Giffinger et al., 2007 , Caragliu et al. 2009 , Vu & Hartley, 2018 ). Also, smart city is defined as a 4th industrial model where emerging technologies, such as the Internet of Things, cloud computing, and big data, are used to optimise the cities (Safiullin et al., 2019 ). Accordingly, smart cities are proposed in particular areas or sectors such as governments, health, energy, buildings, airports, and businesses/organisations (Khatoun & Zeadally, 2017 ).

Due to the strong relationship between ICT and smart services within the overarching concept of smart cities, a vast amount of personal information is collected from users, devices, and applications (Martinez-Balleste et al., 2013 ). Furthermore, sharing and exchanging information among parties, including individuals and organisations, is possible using different sharing platforms that play a vital role in smart cities (Kong et al., 2018 , Kusumastuti et al., 2022 ). Internet of Things (IoT), Cloud, fog computing, and blockchain technology are examples of such platforms (Qian et al., 2018 , Imine et al., 2020 ; Gill, 2021 ). However, the flow of personal information in smart cities may result in individuals suffering from serious privacy risks that may impact their information (Martinez-Balleste et al., 2013 , Sharma et al., 2020 ).

According to NIST (Stoneburner et al., 2002 ), the risk is the possibility of a threat source exploiting a specific information system vulnerability and the resultant consequence. Assessing information privacy risks in smart cities is challenging due to information complexity and uncertain impact levels (Bogoda et al., 2019 ). In addition, privacy risks need to be assessed to minimise the risk impact by using appropriate controls (Hong et al., 2004 ). Thus, there is a need to assess privacy risks when sharing personal information in smart cities. This includes identifying and addressing privacy threats and vulnerabilities, their impacts, and appropriate privacy risk mitigation controls.

To the best of our knowledge, there is a lack of consolidated literature on this important topic of privacy assessments that cover privacy risks, impacts, and current controls for sharing personal information, considering the interaction among elements involved in sharing activity in smart cities. A consolidated view of the current work is needed to provide a foundation for further development in this important area of research.

Thus, this paper addresses this need by conducting a SLR and synthesising published research with a view to identify and extract privacy risks, impacts, existing controls, and elements involved and interacting to share personal information in smart cities, along with relevant regulation, to influence this activity. Thus, this paper focuses on the following key research questions:

RQ1: What are the privacy risks associated with sharing personal information in the context of smart cities considering the elements involved and interacting while sharing personal information?

RQ2: What are the impacts of those personal information privacy risks?

RQ3: What current privacy controls are in place to mitigate the identified risks?

This work builds on the earlier research on identifying privacy risks in smart airports (Alabsi & Gill, 2021 ). This paper extended this work to provide broader coverage of smart cities. This will help extract and define more comprehensive views of privacy risks, which will be used to design a holistic solution for assessing the privacy risks that may impact passengers’ personal information in their interaction journey in smart airports within the border context of smart cities. This will ensure that important privacy concerns are not overlooked when dealing with information privacy in smart airports. The main motivation behind this paper is the future development of the privacy framework in a smart airport context. The development of the proposed framework is beyond this paper’s scope and is subject to further research.

Contribution

The key contributions of this research are outlined below:

This paper provides an updated knowledge base covering various articles published in academic and industrial databases between 2017 and 2021, including smart cities, sharing information, privacy risk, impact, and existing control.

This paper provides both a theoretical and practical view of the review results by using the Adaptive EA and Concerns for Information Privacy framework (CFIP) as a theoretical lens and the NIST 800–30 framework as a practical lens. These lenses help identify the risk assessment components: privacy risk, the resulting impact, and current privacy control.

This paper contributes to enhancing the understanding of the review results by proposing a privacy risk taxonomy using the Concerns for Information Privacy framework (CFIP) as a theoretical lens. Based on CFIP, the proposed taxonomy categorises threats and vulnerabilities into the following: collection, error, unauthorised use, and improper access types.

This paper provides novel knowledge by mapping the privacy risks associated with sharing personal information with elements involved and interacting during the sharing activity by adopting the Adaptive EA framework as a theoretical lens. The mapping links the privacy risks dimensions under CFIP with the layers of Adaptive EA, including human, technology, facility, and environmental.

This paper provides a set of actionable knowledge by providing a clear understanding and mapping of the identified privacy threats to the requirements and available existing controls.

This paper provides future research directions regarding the privacy risks of sharing personal information in smart cities.

In a nutshell, this research provides a knowledge foundation, which can be casted into developing theoretical and practical frameworks and solutions for studying and enhancing personal information privacy in the contemporary context of smart cities.

This paper is organised as follows: the “Background and Related Work” section provides the research background and related works. The “Research Method” section explains the research method. Then, data extraction and synthesis are discussed in the “Data Extraction and Synthesis” section, followed by the SLR results in the “ Results ” section. The discussion of implications, study validity and limitations, and work directions is elaborated in the "Discussion" section. The last section encompasses the conclusion.

Background and Related Work

The meaning of privacy varies from one researcher to another. However, core components are common to most definitions of privacy. The most historical definition of privacy was “the right to be let alone” (Warren & Brandeis, 1890 ). Information privacy is defined as the relationship between an individual’s right to privacy and the ability to access and control the information held by organisations (Cranor, 2012 ; Hoffman, 1977 ; Hough, 2009 ; Martinez-Balleste et al., 2013 ). At present, many definitions of privacy have been proposed, and through the years, these definitions have evolved based on societal changes and technological development (Hiller & Russell, 2017 ; Li & Palanisamy, 2018 ; Peppet, 2014 ).

The smart city context has recently risen, and technology has gradually developed. A smart city is identified as an urban area that uses information and communication technology (ICT) to improve its services and enhance its residents’ quality of life (Giffinger et al., 2007 ; Kusumastuti et al., 2022 ). As a result, the individual shares their personal information with service providers, who share it with other organisations either explicitly—implying that the user is involved—or implicitly without the user’s knowledge (Spiekermann & Cranor, 2008 ). Personal information can be used to identify an individual, either directly or indirectly, such as name, email, or biometric information email (Wolford, 2020 ).

Accordingly, information privacy and security concerns have been significantly increased because cities are digitally connected, and individuals’ personal information has become more accessible and available (Hiller & Russell, 2017 ; Solove, 2011 ). This sometimes obstructs society’s adoption of smart cities (Pal et al., 2021 ). For that, personal information privacy risks that arise when sharing personal information in smart cities should be considered carefully to seize new threats and find reasonable solutions. This section briefs privacy risks, regulations, and privacy-enhancing technologies.

Privacy Risks

Privacy risk is defined as the expected losses related to personal information disclosure (Xu et al., 2011 ). Pervasive literature attempts to identify the privacy risks of personal information. For example, Nissenbaum ( 2004 ) proposed a privacy taxonomy based on the contextual integrity (CI) theory, which considers human factors, including their norms and attitudes, as part of privacy risk arising in public surveillance. Henriksen-Bulmer et al. ( 2019 )proposed a taxonomy using the same theoretical lens, IC, to address privacy risks in open data publishing. The privacy taxonomy developed by Solove ( 2006 ) aimed to improve the understanding of information privacy in the legal system. This taxonomy classified privacy risk into four elements: collection, processing, dissemination, and invasion (Solove, 2006 ). Avancha et al. ( 2012 ) developed a privacy taxonomy that classified privacy threats into identity threats, access threats, and disclosure threats in the health system. The framework designed by Deng et al. ( 2011 ) provides a comprehensive analysis of privacy threats to help analysts cover key issues in designing software. In the smart airport, unauthorised access, information leakage, and second use were discussed as privacy threats that affect passenger information (Choudhury & Rabbani, 2019 ; Khi, 2020 ; Tedeschi & Sciancalepore, 2019 ; Zhang, 2019 ). The review conducted by Ismagilova et al. ( 2020 ) focused on security, privacy, and risk in smart cities and how they impact the operational process of smart cities. In addition, a systematic literature review is conducted to identify privacy risks and current solutions relevant to passengers’ information (Alabsi & Gill, 2021 ). In this work, the privacy risks were classified based on the CFIP theory into four types: collection, error, unauthorised use, and improper access.

This review of the literature shows that despite attempts to analyse privacy risks, they only focused on addressing threats without considering vulnerabilities as an essential factor in privacy risk analysis. Furthermore, there is a lack of addressing privacy risks relevant to personal information in other smart city themes, such as smart airport.

Privacy Regulations

The General Data Protection Regulation (GDPR) is a significant regulation that regulates information privacy. The EU adopted the GDPR in 2018 and incorporated principles for personal information processing (Wolford, 2020 ). The GDPR explains principles that help in protecting individual privacy (EUGDPR, 2018 ). Consent, breach announcement, and privacy by design are examples of GDPR principles (EUGDPR, 2018 ).

In the USA, the Fair Information Practices (FIPs) regulation was developed in 1973 to discuss the importance of protecting individual privacy, and it was adopted by the U.S. Privacy Act (Gellman, 2017 ; Li & Palanisamy, 2018 ). Following that time, different sectors in the USA, such as the health and business sectors, developed their privacy regulations called the Health Insurance Portability and Accountability Act (HIPAA) (Silva et al., 2021 ).

In Australia, the Privacy Act 1988 (Act) developed the Australian Privacy Principles (APPs) to protect and guide the use of personal information (Office of the Australian Information Commissioner n.d. ). The APPs consist of principles governing the collection, handling, accessing of personal information, and ensuring the accuracy and integrity of personal information (Office of the Australian Information Commissioner n.d. ).

Based on the above review, it is clear that countries share a common objective in protecting the privacy of personal information and governing how to use it despite their differing regulations.

Privacy-Enhancing Technologies

The interest in privacy protection has been increasing since the 1990s. Thus, there has been a continuous flux of efforts to develop and use Privacy-Enhancing Technologies (PETs) (Hiller & Blanke, 2016 ). PETs are well-designed (ICT) systems for securing and protecting the privacy of information through the reduction, deletion, or avoidance of improper and unnecessary processing of personal data without decreasing the value of the individual information (Chun, 2015 ). The goal of using PET in smart cities is to enable the personal and sensitive information embedded in the collected data to be hidden and not be discovered by any third party or service provider (Curzon et al., 2019 ). Recently, many PETs have been proposed to protect the privacy of information. For example, Van Blarkom et al. ( 2003 ) described PETs techniques such as encryption, anonymisation, pseud-identity, biometric, identification, authorisation, and authentication. Heurix et al. ( 2015 ) provided PETs taxonomy that covered privacy aspects such as user privacy and data privacy across domains not covered in security classifications. Curzon et al. ( 2019 ) provided a detailed review of privacy-enhancing technologies, commonly classified as anonymisation (such as masking and disruption of sensitive data) and security techniques (such as hashing and cryptographic techniques), as the broad types of techniques used mostly for personal information privacy protection. The PETs classification proposed by Kang et al. ( 2007 ) includes three types based on the privacy information life-cycle, including operation technology, common-based technology, and administrative technologies.

It is clear from previous and related research that the study of privacy-enhancing technology has been actively addressed, reflecting its importance in protecting the privacy of personal information.

In summary, protecting the privacy of personal information in smart cities is critical for its effective adoption by citizens or users. Studies have attempted to cover this topic by investigating many solutions and approaches. However, lack of systematic reviews effectively address and assess privacy risks, including threats, vulnerabilities, impacts, and exciting controls relevant to sharing personal information in smart cities, considering who and what is involved and interacted during the sharing activity. This study aims to address this critical need by employing the well-known SLR approach detailed in the following section.

Research Method

This section presents the SLR method applied to conduct this systematic literature review (Kitchenham & Charters, 2007 ). This section includes the following SLR stages: (A) study inclusion and exclusion criteria, (B) data sources and search strategies, (C) study selection process, and (D) quality assessment.

Study Inclusion and Exclusion Criteria

In this study, a set of inclusion and exclusion criteria based on the research questions was used to select the relevant studies from well-known academic and industrial sources. It is important to note here that industry sources have been used to complement the academic sources. Academic studies must be peer-reviewed, including journal articles, conference papers, and book chapters. The studies must satisfy the following criteria: written in the English language, published between 2017 and 2021, include the specified search terms (see Table  1 ), and provide information to address the research questions listed in “ Introduction ” section. Studies that did not meet the inclusion criteria were excluded. This ensures that recent literature relevant to the scope of this study has been adequately covered.

Data Source and Search Strategy

The following well-known electronic databases were used to answer the identified research questions: IEEE Xplore ( www.ieexplore.ieee.org/Xplore/ ), ScienceDirect ( www.sciencedirect.com ), ProQuest( www.proquest.com ), Willy (onlinelibrary.wiley.com/), Gartner ( www.gartner.com/ ).

The selected databases collectively cover a wide range of disciplines relevant to the topic at hand. Furthermore, this SLR includes academic and industrial studies, which distinguishes it from traditional SLR. However, the industrial sources were analysed separately to avoid mixing the non-peer-reviewed studies with academic sources. In the initial research stage, we used the selected search categories and terms presented in Table  1 to find the relevant studies that address the identified research questions. Each search term in the “privacy-preserving” category was combined with each term under the “information sharing” and “smart cities” categories with the operator “AND”. Furthermore, the operator “OR” is used to combine similar terms in each category to ensure maximum coverage.

Study Selection Process

The study selection process assesses the inclusion and exclusion criteria through the following stages. In stage 1, all identified search terms and keywords (see Table  1 ) were searched in the selected databases (as explained earlier), and studies not relevant to inclusion and exclusion criteria were excluded. This stage resulted in 1089 industrial and academic studies. In stage 2, a set of 372 industrial and academic studies were selected after the titles and keywords assessment. In stage 3, further assessments were conducted for the abstract and conclusion, and 127 from both academic and industrial sources were included. A full-text assessment was applied in the final stage to obtain the final set of 83 studies. Further, the quality assessment has been performed on the final selected studies based on pre-identified assessment criteria (Table 3 ) (Kitchenham & Charters, 2007 ). The relevant studies from each stage were stored and managed using EndNote and then exported to Excel sheets to recode inclusion/exclusion decisions. A flowchart of the study selection process, including stages and the number of included studies in each stage, is shown in Fig.  1 . Table 2 also presents the number of selected studies from each selected database in each stage.

Selection process stages and number of included studies

Quality Assessment

The quality assessment was performed based on the checklist made by Kitchenham and Charters ( 2007 ) to ensure the quality of this SLR. The quality assessment criteria items are presented in Table  3 .

The questions of quality criteria were applied to identify the study’s context, aim, and credibility. The selected studies were scored between 1 and 5 based on criteria items. The total score of the study reflects its quality. Each criterion got a score of “1” or “0”. The selected studies from academic sources scored 1 in the research column. Four selected studies scored “0” in the aim column due to a lack of clarity about the study’s aim, while a set of 3 selected studies scored “0” in the column of context because they did not include clear research context details. The majority of studies scored “1” in the finding column. A set of 12 selected studies scored “0” in the future column because of the lack of clarity about the future research directions. To sum up, as indicated in the last column of Table  4 , the quality of selected studies is considered acceptable if the score is 3 or more out of 5 (60% or above).

Data Extraction and Synthesis

We systematically analysed and synthesised the selected studies using the Adaptive Enterprise Architecture (AEA) and Concerns for Information Privacy framework (CFIP) as a theoretical lens, besides the NIST 800–30 framework as a practical lens. We used the CFIP because it helps extract the privacy risk elements (threats and vulnerability) of sharing personal information, which was configured into a proposed privacy risk taxonomy (Fig.  2 ). Our proposed taxonomy consists of four categories based on CFIP: collection, error, unauthorised use, and improper access. CFIP seems to be an appropriate lens (Smith et al., 1996 ) to assess and analyse individual concerns regarding the privacy of organisational information practices. It is a multidimensional framework used as one of the most reliable tools for addressing individual information privacy concerns in many areas, such as e-commerce (Van Slyke et al., 2006 ). The extracted privacy risks under CFIP dimensions are mapped with the AEA framework’s human, technology, facility, and environmental layers (Fig.  3 ). We also used Adaptive EA because it provides systematic layers to extract and map elements involved and interact while sharing personal information, besides relevant regulation as a governmental element that influences this activity. It is important to note here that sharing activity is considered the main element under the interaction layer. Adaptive EA (Gill, 2015 ) is a framework that guides the interaction in the digital ecosystems among five main layers: human, technology, facility, environment, and security. Further, we used NIST SP 800–30, the well-known standard, as a practical lens to identify and extract essential elements to assess privacy risks (Stoneburner et al. 2002 ). NIST was used to complement the theoretical lenses used in this study.

Proposed privacy risk taxonomy based on CFIP framework

Mapping CFIP with Adaptive EA

This was done to ensure that important points from practice were not overlooked. Thus, this study provides rich information incorporating both theoretical and practical perspectives. These elements include privacy threats, vulnerabilities, requirements, and privacy controls (see Fig. 4 ). The identified privacy controls include technical and non-technical controls (Fig. 4 ). The NIST 800–30 is used to carry out risk assessments according to the NIST guidelines (Peacock, 2021 ). The dimensions of CIFP cover different types of privacy risk components (threats and vulnerabilities) related to sharing personal information. Further, NIST 800–30 also offers a structured process that is used to assess privacy risks. Thus, we use CFIP and NIST 800–30 to report the results of this study, which are presented in the following section.

Assessing information privacy risk based on NIST 800–30

To answer the indicated research questions, we analysed the final selected papers in Table 14 in the Appendix. We reviewed and analysed the selected studies using CFIP and NIST 800–30 frameworks to address the research questions to identify privacy risks (privacy threats, vulnerability), privacy risk impacts, and existing privacy controls. It is worth mentioning that the majority of the papers (86%) were taken from academic sources, whereas only 14% of selected studies were found relevant from the well-known industry Gartner data.

It is widely accepted that information risk is composed of threats and relevant vulnerabilities that may impact information assets (Norta et al., 2019 ). In this context, privacy controls are placed to mitigate the risk.

To answer RQ1, we use the CFIP and Adaptive EA as theoretical lenses. Firstly, we identify and categorise the privacy risk components, including privacy threats and vulnerabilities, related to the privacy risk of sharing personal information in smart cities by adopting the CFIP framework dimensions: collection, error, unauthorised use, and improper access (Smith et al., 1996 ). Then, we mapped the identified risks with the layers of Adaptive EA to present the elements involved and interacted in sharing personal information associated with the identified risks and relevant regulation as a governmental element that influences this sharing activity. Adaptive EA consists of the following layers: human, technology, facility, and environmental (Gill, 2015 ).

Privacy Threats

NIST defines threats as undesired and potential harm to the organisational assets such as information, operation and service, or individuals (National Institute of Standards and Technology 2013 ). We reviewed the selected studies to identify privacy threats that affect the sharing of personal information in smart cities in general and several smart city sectors such as smart healthcare, smart grid, smart governments, smart business/organisation, and smart transportation. Based on the CFIP framework, we identified seven types of privacy threats: collection, unauthorised use, improper access, and error from 41% of selected studies. Table 5 presents the identified threats, categories, and selected studies.

As shown in Table  5 , the majority of selected studies (31%) discussed privacy threats under the unauthorised use category. This category includes the following threats: secondary use (T2), information modification (T3), information leakage (T4), and identity theft (T5). Seventeen percent of the reviewed studies highlighted unauthorised access (T1) as a privacy threat under the improper access category. The remaining studies discussed policy and regulation non-compliance privacy threat (T7) under the collection category (6%), with a few studies (2%) focused on information misuse (T6) privacy threats under the error category (3).

As shown in Table  5 , the privacy threats related to patient information sharing in smart health have been widely discussed in the reviewed studies (N3, S4, S5, S6, S7, S8, S12, S17, S3, S27). For example, unauthorised access (T1), information misuse (T6), and modification (T3) threats have been identified as the most common threats that affect the privacy of patient information (Iwaya et al., 2019 ). Patient biometric data are collected and shared with many parties in the smart health sector, which leads to secondary use (T2) and ID theft (T5) threats (Romanou, 2018 ). Regulators and ethics committees are relevant to the health sector classified information leakage (T4) as a privacy threat that affects the collection, use, and sharing of personal information in smart health (Thapa & Camtepe, 2020 ).

As for smart grid, reviewed studies (S9, S16, S18, S19) highlighted that threats included information modification (T3), information leaking (T4), and unauthorised access (T1) are the most common threats that impact consumers’ privacy information shared with different parties. On the other hand, unauthorised access (T1), secondary use (T2), and information leakage (T4) are discussed in the reviewed studies (S11, S20, S21, S13, S10, S22, N2, N5) as privacy threats that affect personal information sharing in smart cities.

As shown in Table  5 , 6 % of reviewed studies identified non-compliance with privacy policies and regulations (T7) as a privacy threat. Several countries and organisations have taken considerable steps toward data privacy policies and regulations in order to protect personal information. According to Wall et al. ( 2015 ), privacy compliance refers to an organisation’s adherence to regulatory privacy requirements to protect personal information. Studies have discussed the increasing information privacy issues in organisations due to non-compliance with privacy policies and regulations in different sectors, including smart cities. For example, healthcare industries handle patients’ information in the USA without explicit patient consent, which is at odds with granular consent under the Health Insurance Portability and Accountability Act (HIPAA) (Runyon, 2020 ).

Vulnerability

According to NIST (National Institute of Standards and Technology 2013 ), vulnerability is the weakness of an asset (e.g. information and system) plausibly exploited by threats. This section reviewed the selected studies based on this definition to extract the perceived vulnerabilities that identified threats might exploit.

As shown in Table  6 , we identified three types of vulnerabilities relevant to the identified threats. Based on our review, 5% of selected studies mentioned that lack and un-transparent policies lead to several privacy threats (Chua et al., 2017 ; Hou et al., 2018 ; Taplin, 2021 ). Examples of these policies include consent, ethics, and privacy policies. Furthermore, the lack of privacy regulation related to handling and sharing personal information, including biometric data, could make this information vulnerable to several privacy threats (S30) (Khi, 2020 ). Insecure/unprotected storage systems and insecure/unprotected sharing mechanisms were identified as vulnerabilities in 3% of selected studies. Insecure storage refers to storing sensitive data without appropriately controlling access. Sharing information in unsecured or unprotected environments leads to privacy risks in smart cities (Agrawal et al., 2021 ; Romanou, 2018 ).

Mapping CFIP Dimensions with Adaptive EA Layers

Our review focused on the threats that affect personal information shared in smart cities in general and different smart city sectors such as smart health, smart grid, smart government, and smart business/organisation. Furthermore, we considered who and what are involved and interacted in the sharing activity, besides relevant regulation as a governmental element that influences this activity (based on Adaptive EA). Tables 7 , 8 , 9 , 10 , and 11 present the elements relevant to Adaptive EA layers: human, technology, facility, and environment, in smart cities. Figures  5 , 6 , 7 , and 8 represent the map of CFIP dimensions with Adaptive EA layers.

As illustrated in Fig.  5 , in the smart health context, elements under human layers are identified from 11% of selected studies that discussed the unauthorised use privacy risk associated with sharing patients’ information in smart health. In contrast, with improper access and error risks, the studies’ percentages dropped to 7% and 1%. On the other hand, elements under technology layers are discussed in 6% of selected studies that investigated improper access and unauthorised use privacy risks, with 0% of studies in error and collection risks. However, the environmental layer is considered in selected studies (4%) when addressing privacy risks categorised under unauthorised use more than in improper access (1%) and collection dimensions (2%). We identified patients, service providers, and doctors as the main actors under human layers from 13% of selected studies. At the same time, infrastructure such as IoT and data storage, such as centralised databases, are identified under technology layers in 11% of selected studies. Facility layers are discussed in 6% of selected studies. The facility layer presents different smart health buildings, such as hospitals, medical centres, laboratories, and clinics. Privacy regulations are mainly discussed under the environmental layer in 6% of selected studies, which can be used to define or inform a separate layer of privacy. This seems to suggest the extension of the Adaptive EA framework through the introduction of the privacy layer. Table 7 presents elements under each layer of Adaptive AE in smart health context.

Mapping CFIP dimensions with AEA layers in smart health

In the smart grid, Fig.  6 shows that more selected studies mentioned human, technology, and facility layers when addressing improper access and unauthorised use privacy risks associated with sharing users’ information, while no studies discussed theses layers with error and collection privacy risks.

Mapping CFIP dimensions with AEA layers in the smart grid

In Table 8 , 4% of selected studies identified different actors under the human layer in the smart grid context, including users and customer service providers. Based on our review, 6% of selected studies discuss the usage of the cloud as the main data storage in the smart grid, while IoT applications and smart metres are the main infrastructures discussed in the smart grid system. Elements under facilities layers are found in 6% of selected studies that discuss privacy risks associated with sharing personal information in the smart grid. Examples of facility layer elements are control centres, power sources, and home gateways.

As presented in Fig.  7 , almost a few percent of studies only mentioned human and technology layers with improper access risk compared with studies that addressed unauthorised use privacy risks associated with sharing users’ information in the smart city context.

Mapping CFIP dimensions with AEA layers in smart city

Based on Table  9 , from 5% of selected studies, we identified two main actors under human layers who are involved in sharing personal information in smart cities. The main actors include individuals, such as citizens and users, and organisations, including service providers and data holders. Moreover, IoT devices, Cloud systems, and smart city applications are identified in 6% of selected studies as elements under technology layers used in sharing personal information in smart cities.

As illustrated in Fig.  8 , most selected studies in the smart business/organisation context explain elements in human, technology, and facilities layers when addressing unauthorised privacy risks associated with sharing personal information, whereas this percentage decreased with improper access privacy risk. On the other hand, the environmental layer is mentioned in 2% of studies that addressed privacy risks under improper access and unauthorised risks, with 1% with collection privacy risks.

Mapping CFIP dimensions with AEA layers in smart business/organisation

Based on Table  10 , we identified several actors, such as employees, customers, and experts, under the human layer from 4% of selected studies. The facility layer includes buildings, such as organisations, public workplaces, and industry, discussed in 7%. On the other hand, technical layer elements, such as infrastructure and data storage, and environmental elements, such as privacy regulation, are discussed in 5% of selected studies.

As shown in Table  11 , human, technology, and facility layers have been mentioned in 2% of selected studies that discussed improper access and unauthorised use privacy risks in smart government, with 1% of studies addressing unauthorised use in the smart transportation context.

Privacy Risks Impacts

To answer RQ2, we reviewed the selected studies to identify and extract privacy requirements impacted by the identified privacy risks. The proper privacy requirements should be considered when personal information is shared in smart cities. Thus, we reviewed the selected studies to extract the privacy requirements that the identified threats might impact (Table  12 maps the requirements with relevant threats). As shown in Table  12 , we identified eight classified requirements. The classifications include the CIA triad (confidentiality, integrity, availability) and IAAA (identification, authentication, authorization, accounting). In addition, we extracted the privacy requirements based on the classification proposed by Pfitzmann and Hansen ( 2010 ), which is very common in the privacy domain. The classification consists of anonymity and pseudonymity, unlinkability, undetectability, and unobservability. Table 12 includes a list of privacy requirements that need to be satisfied when sharing personal information in smart cities.

Concerning the CIA classification, 20% of selected studies discussed confidentiality and integrity as essential requirements to achieve privacy (Table  12 ). In contrast, availability is discussed in 10% of selected studies to achieve security besides privacy. In smart health, Health Information Exchange (HIE) has been adopted to enable the electronic sharing of patient information between several parties (Mutanu et al., 2022 ). Thus, confidentiality, integrity, and availability are essential to preserve patient information privacy and security (Yi et al., 2013 ). In addition, the CIA triad should be satisfied with a smart grid and smart transportation to protect privacy as the information is shared between relevant parties to provide various services to the users (Yang et al. 2014 ).

As for the IAAA classification, 13% of selected studies discussed authentication as a requirement for privacy (Table  12 ). However, authorization was discussed in 5% of selected studies, whereas identification was discussed in 2% of selected studies. In the smart grid, identification and authentication requirements need to be satisfied to secure access to the information or system component (Ferrag et al., 2018 ; Sadhukhan et al., 2021 ). In smart health, authentication, authorization, and identification requirements should be satisfied when sharing patient information to ensure that privacy is not compromised (Shamshad et al., 2020 ; Wang et al., 2019 ).

We reviewed the selected studies to extract the requirements classified based on the terminology proposed by Pfitzmann and Hansen ( 2010 ). As shown in Table 12 , 12% of selected studies discussed anonymity as an essential requirement to ensure the privacy of information, whereas only 1% mentioned unlinkability requirements. These requirements are addressed in both smart health and smart transportation to achieve the privacy of personal information (Yang et al., 2018 , Chenthara et al., 2019 ).

Existing Privacy Control

To answer the RQ3, we reviewed the privacy-preserving schemes for sharing personal information in smart cities. We also extracted the existing privacy controls proposed to mitigate the identified risks from the selected studies (Table  13 maps the privacy controls with identified threats). Further, we classified the identified control under technical and non-technical, as shown in Table  13 . Figure  9 represents the percentage of the identified privacy controls from the selected studies. Technical control methods include security-based solutions, such as encryption, access control, etc., whereas non-technical methods refer to policies, procedures and standards (National Institute of Standards and Technology, 2013 ).

Existing privacy control

Considering the technical solution, we identified ten technical controls categorised into four groups: anonymisation, cryptographic techniques, access control techniques, blockchain, and machine learning (Table  13 ). In this study, the classification of technical solutions is based on the classification of PETs proposed by Van Blarkom et al. ( 2003 ) and Curzon et al. ( 2019 ). In addition, we reviewed technical controls developed on blockchain and machine learning.

Data Anonymization

As sown in Table  13 , 7% of reviewed studies discussed anonymization techniques as technical privacy controls. This includes K-anonymity, differential privacy, and pseudonym. Data anonymization is the method used to protect personal information by preventing linking their identities (Curzon et al., 2019 ; Iyengar, 2002 ; Silva et al., 2021 ). K-anonymity and differential privacy are the most common methods of anonymization technique (Iyengar, 2002 ). As for smart health, the reviewed study (S12) discussed the popularity of using anonymity to preserve the privacy of transmitted personal information between parties. On the other hand, the pseudonym is discussed in (S49) as an anonymous technique that is proposed to preserve the privacy of sharing information in smart transportation.

Cryptographic Technique

Table 13 includes cryptographic techniques used in privacy-preserving schemes for sharing personal information in smart cities. The techniques were extracted from 8% of selected studies. Cryptographic technology entails ways of totally hiding data equivalent to the intensity of the cryptographic key and algorithm employed. Encrypting transmitted or stored personal information in smart cities is a broadly used technology that protects from leakage and achieves privacy requirements (Curzon et al., 2019 ; Gaire et al., 2019 ). For example, attribute-based encryption (ABE) is proposed to preserve patient information sharing in smart health (S7, S57). Cryptographic technique for processing biometric data is presented in (S12); in this method, the digital key is securely linked by a biometric sample that is used to encrypt and decrypt the key. Elliptic curve cryptography to secure and authenticate the communication between the consumer and the service provider in the smart grid is discussed in (S36, S28).

Access Control Mechanism

Access control is defined as security methods to control the access and use of information by applying access policies (Sandhu & Samarati, 1994 ). In Table  13 , 6% of reviewed studies discussed privacy-preserving schemes developed based on the access control mechanism. For example, schemes presented in selected studies proposed several access control mechanisms, such as fine-grained access control and multi-layer access control (MLAC), to preserve the privacy of patient information shared between different parties in a cloud-based environment.

Machine Learning

Table 13 shows that privacy-preserving schemes for sharing information in smart cities using machine learning techniques are discussed in 2% of selected studies. A self-organising map (SOM) is a machine learning technique used to share information about electricity usage between parties in the smart grid (S65). The machine learning technique, federated learning, is used to share and analyse medical cases in smart health without compromising patient privacy (S58).

As shown in Table  13 , 42% of selected studies proposed privacy-preserving schemes for sharing information using Blockchain technology. Blockchain is a decentralized cryptographic scheme employed to privatise and safeguard transactions in the confines of a network (Curzon et al., 2019 ). It has been noticed that the privacy-preserving schemes in selected studies integrated blockchain with other PETs to share personal information without compromising their privacy. For example, access control mechanisms and blockchain are proposed in studies (S4, S6, S20, S41, S48, S50, S6, S8, S26, S27, S33, S34) mainly for two purposes. The first one is to allow individuals to monitor and regulate their information sharing between parties in smart cities. The second purpose is to authenticate the identity while sharing and accessing the information in smart cities. The selected studies (S9, S39, S14, S63, S21, S45, S31) proposed privacy-preserving schemes that use several cryptographic techniques, including signature, identity-based proxy, proxy re-encryption, zero-knowledge, and attribute-based encryption, with blockchain to protect the privacy of individual information in smart grid and smart health.

Non-technical Control

Among the selected studies, a total of 35% discussed non-technical privacy control to mitigate the identified threats (Table  13 ). For example, the importance of privacy by design (PbD) as a principle of GDPR is discussed in an attempt to protect the privacy of personal information in smart health and biometric applications (S12). Several policy-based schemes are discussed to capture the imposed requirements and restrictions that enhance the privacy of shared information in smart cities (S5, S66). On the other hand, privacy management is discussed in the selected studies as a type of non-technical privacy controls (S42, S13, S68, S67). As shown in Table  13 , the non-technical privacy controls are discussed widely in the industrial reports (N1, N6, N7, N8, N9, N10, N11, N12, N4). Organisations need to reduce information disclosure as it leads to privacy and financial risks (Brian Lowans & Meunier, 2019 ). Effective privacy management programs should address privacy risk prevention and incorporate privacy-by-design principles into all business activities (Bart Willemsen, 2017 ). In this context, many risk management approaches, such as integrated risk management (IRM), data security governance (DSG) framework, privacy impact assessment(PIA), and continuous adaptive risk and trust assessment (CARTA), are discussed to help businesses dealing with risks and their consequences and also to ensure the sustainability of the protection of any project (N6, N7, N1, N11). Furthermore, the importance of designing a privacy-aware risk programme to define and assess the risk of using blockchain technology for sharing personal information is discussed in industry publications (N8, N9).

This research provided a consolidated view of the selected studies from academic and industrial sources and reported on the privacy risks, impacts, and controls related to personal information sharing in smart cities. This was done to thoroughly identify the privacy risks that affect the sharing of personal information in smart cities. Since sharing personal information in smart cities results from the interaction among different elements, this study also aims to identify these elements, including actors, technologies, facilities, and privacy laws, that are involved in sharing activity. Identifying privacy risks, including threats and vulnerabilities, the risk impacts, and existing controls, taking into account the elements involved in sharing activity, will assist organisations in determining the appropriate controls to mitigate the risks when sharing personal information in smart cities. This section describes the implications based on our review and analysis of selected studies. It also includes the limitations of this work.

Implications

Privacy risk.

Many studies have proposed threat taxonomies that organise threats into different categories (Deng et al., 2011 ; Xiong & Lagerström, 2019 ). However, to the best of our knowledge, there is a lack of systematic and theoretical understanding, which is filled by this study using the CFIP as a theoretical lens. This study proposed a taxonomy of privacy risks of sharing personal information in smart cities, including threats and vulnerabilities, based on the CFIP theoretical lens. Based on Table  5 , our findings show that the selected studies do not properly investigate policies and consent non-compliance, misuse, and ID theft as serious threats that widely affect the privacy of sharing personal information in smart cities. Furthermore, we found that selected studies did not clearly distinguish between threats’ events and their sources, making it hard to identify the relevant privacy threats to the scope of this study. Thus, there is still a great deal of work to be done in this area in both academic and industrial research.

On the other hand, based on Table  5 , we found that most selected studies discussed privacy threats associated with sharing personal information in smart cities in general and in the smart health system. In contrast, studies that discussed the same topic under the smart grid, smart government, smart business, and smart transportation systems were limited. One immediate impact of this finding on the digital economy is the reinforcement of the importance of investing in robust technological solutions and infrastructures, as well as developing risk management frameworks to mitigate the privacy and security risks associated with personal information in smart cities (Ahmed, 2021 , Jnr et al., 2023 , Jin, 2024 ).

The digital economy is the deep integration of digital technology and production factors in smart cities to manage the transformation cost, improve cities’ capabilities and implement innovative solutions (Sotirelis et al., 2022 ; Vinod Kumar & Dahiya, 2017 ; Wang et al., 2021 ; Zhiyong et al., 2024 ).

The emphasis on privacy risks of sharing personal information in smart cities highlights the need for innovative solutions that simultaneously advance their capabilities while rigorously safeguarding individual privacy. This could increase investment in implementing privacy controls to protect individual information handled within smart city sectors (Jin, 2024 ).

As smart city sectors heavily rely on sharing individual information by integrating smart technologies, there is a pressing need to address privacy risks associated with personnel. This could spur investment in privacy-enhancing technologies, regulatory frameworks, and public awareness campaigns tailored to these specific domains. This draws our attention to the need for more studies in order to cover this gap.

On the other hand, selected studies from industry sources discussed the identified privacy threats relevant to personal information without mentioning their relationship with smart cities or any other smart system.

On the other hand, it is well-accepted that any risk analysis should be done based on identified threats and relevant vulnerabilities (Stoneburner et al. 2002 , Norta et al., 2019 ). The identification of vulnerabilities is an essential factor that plays a role in identifying privacy risks. Based on Table  6 , we found that selected studies do not investigate vulnerabilities as a significant factor in addressing privacy risks relevant to sharing personal information in smart cities. As a result, the knowledge about the identified privacy risks was limited. Thus, there is a need to understand the threats and vulnerabilities to identify and mitigate privacy risks.

Based on our review, very limited studies currently explain who and what elements are involved when addressing privacy risks associated with sharing personal information in smart cities. Furthermore, to the best of our knowledge, no previous studies have demonstrated the interaction among the elements involved when addressing the topic mentioned above. To overcome the shortcomings of previous studies outlined above, we adopted Adaptive EA as a theoretical lens to map the identified privacy risks relevant to sharing personal information in smart cities, with elements involved and interacting in sharing activity. This study mapped the identified privacy risks based on CFIP dimensions, including improper access, unauthorised use, error, and collection, with Adaptive EA layers that include human, technology, facility, and environmental. Based on Figs.  5 , 6 , 7 , and 8 , we found that out of all the studies that addressed privacy risks associated with sharing personal information, most studies discussed human and technical layers, followed by the facility layer in all smart city sectors. However, few studies discussed the environmental layer, including privacy regulation and policies, only when addressing improper access and unauthorised use of privacy risks relevant to sharing personal information in smart health and smart business/organisation contexts.

Furthermore, according to Tables 7 , 8 , 9 , 10 , and 11 , we found that most studies that defined elements under human and technology layers are relevant to smart health, with few studies in other smart city sectors. Additionally, although applying policies and regulations is vital to mitigate privacy risks associated with personal information in any smart city, we noticed that these elements, mainly categorised under the environmental layer, have not been investigated enough in the selected studies. Based on the above, there is a need to cover these gaps in future work.

Undoubtedly, defining privacy requirements helps to study the consequences of privacy risks relevant to personal information. Moreover, it helps to choose the proper treatment for the identified risks. In this regard, we reviewed the selected studies to identify the privacy requirements based on well-known classifications such as CIA, IAAA, and the privacy requirement terminology (Pfitzmann & Hansen, 2010 ). Based on Table  12 , our findings reveal that current studies investigate CIA triad and identification, authorization, authentication, and anonymity requirements for privacy risk in smart cities. However, addressing the impact of privacy risk on accounting, undetectability, unobservability, and pseudonymity is still largely unclear. This draws our attention to the need for more studies defining those requirements when discussing the privacy risks of sharing personal information in smart cities. Another finding shows that most selected studies link the requirements with the proposed technical controls. They test proposed solutions against those requirements to explain how they should satisfy them. However, there is a lack of studies that discuss the link between these requirements and privacy risks. For example, to the best of our knowledge, secondary use, ID theft, and policy and consent non-compliance threats are not linked with any one of the identified requirements; thus, more studies need to cover this gap to address the consequences and impacts of these risks.

Existing Control

We reviewed the selected studies to extract the existing privacy controls to preserve the privacy of sharing personal information in smart cities. We categorised privacy controls based on the well-known practical framework NIST 800–30 into technical and non-technical controls. Based on Table  13 , our findings show that technical privacy controls, such as cryptography, anonymity, access control, blockchain, and machine learning, are frequently discussed in the selected studies. However, those controls are insufficient to preserve personal information privacy in smart cities because they are poorly developed due to technical and cost restrictions. Another finding shows that a set of 23 selected studies proposed technical solutions without implicitly explaining what kind of privacy threats could be mitigated by the proposed solution. This means they proposed the solution to preserve privacy issues in smart cities. Thus, linking the technical solution with specific privacy threats needs more investigation in the literature. Table 13 also finds that blockchain is widely used in privacy-preserving schemes proposed in academic literature. This indicates the importance and effectiveness of using it to share personal information in smart cities without compromising privacy when integrating it with different PETs. On the other hand, our findings show that risk management has fewer research activities in academic fields; thus, this area requires further investigation.

Finally, the current research investigates risks, impact, and existing controls in different areas of focus (e.g. information security/privacy), and  across various domains (e.g. smart health, smart grid, smart airport, and smart organisations). However, based on the analysis results, these studies seem to lack a systematic and common understanding of information privacy risks in smart cities. To address this challenge, there is a need to develop an ontology-based privacy risk assessment framework for a systematic and common understanding of privacy risks associated with sharing personal information in smart cities. Thus, this study is the first step to systematically synthesis and conceptualise the knowledge dispersed across different papers. It will provide a knowledge base and foundation for developing the personal information privacy risk ontology. The ontology will help enhance understanding the complex concepts and their relationships. Furthermore, it will help establish a common understanding for assessing and mitigating privacy risks in an informed manner. The development and evaluation of such ontology are beyond this paper’s scope and subject to further research. However, this paper provided a strong foundation for this much-needed ontology work.

Validity and Limitations

This work has some limitations like any other SLR. Given this study’s scope, we used well-known academic and industry databases to ensure sufficient coverage of the research topic. This provided a combination of academic and industrial studies explicitly emphasised in the analysis.

Given our emphasis on rigorously identifying and selecting relevant publications through systematic search strategies, the research methodology used in this study was suitable because it provided a multistage process. The process includes applying predefined inclusion and exclusion criteria and synthesising findings to derive meaningful insights to ensure that the process is unbiased.

One potential methodological limitation of the employed methodology in this study is the reliance on predefined databases, which may limit the comprehensiveness of the literature search. However, the identified databases encompass academic and industry sources, totalling six. This ensures that the selected databases cover a wide range of studies relevant to the topic at hand.

To ensure the validity and rigour of the adopted research methodology, we tested the search terms and keywords based on the identified research questions across the pre-selected databases. Furthermore, the process was reviewed to confirm the research’s quality and coverage prior to the documentation stage. In addition, the quality assessment criteria were used to avoid researcher bias and ensure the selected studies’ relevance and quality. Human error might lead to inconsistencies when conducting such research. Thus, regular meetings between the senior researcher and this study’s author were held to minimise the possibility of human error and ensure the quality of the research process and results. This also includes reviewing and learning from the SLRs published in different domains in quality academic outlets. Integrating the employed approach with an additional one to enhance the rigour and comprehensiveness of reviews is suggested as a future research direction.

The term “smart city” has become the focus of several countries striving to improve their population quality, enhance their economies, and ensure sustainability. To achieve their objectives, cities have adopted innovative technologies and applications and developed their ICT infrastructure to support smart city initiatives in many sectors. These sectors include health, government, transportation, business, and organisation. However, due to the strong relationship between ICT and smart cities, personal information is easily shared among relevant parties, leading to serious privacy risks that may affect individuals and organisations. These risks need to be addressed, as highlighted in this SLR. This study analysed and synthesised published research to identify and extract privacy risks, impacts, and existing controls related to sharing personal information in different sectors in smart cities. It also considers elements involved and interacting in the sharing activity based on the well-known CFIP framework and Adaptive EA as theoretical lenses and NIST 800–30 as a practical lens. Based on NIST 800–30, we identified seven privacy threats, three vulnerabilities, and eight requirements that might be impacted by the identified threats, along with seven privacy controls classified into technical and non-technical types. Furthermore, we used CFIP as a theoretical lens to identify and categorise privacy threats and vulnerabilities relevant to the scope of this study. Based on CFIP, we categorised the identified privacy risks (threats and vulnerabilities) into four main groups: collection, unauthorised access, improper use, and errors.

Furthermore, we mapped the identified risks to identified requirements and current controls. The Adaptive EA is used to map the identified risks under CFIP dimensions with layers that interact while sharing personal information in smart cities. Our findings show the need for contemporary solutions to improve the privacy level of sharing personal information in smart cities. Furthermore, there is a need to represent privacy risk assessment components and their relationship and the relation among elements involved in sharing personal information using ontology to facilitate common understanding and sharing of the relevant concepts between different parties involved in connected smart cities. This SLR can benefit both academia and industry by helping them better understand the privacy of sharing personal information in smart cities and providing a synthesised foundation for further work in this important area of research.

Data Availability

Not applicable.

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Open Access funding enabled and organized by CAUL and its Member Institutions. This work was supported by Taibah University, Saudi Arabia, which provided a Ph.D. scholarship that covered funding for this work. This work was done at the University of Technology Sydney, Australia.

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Alabsi, M.I., Gill, A.Q. A Systematic Review of Personal Information Sharing in Smart Cities: Risks, Impacts, and Controls. J Knowl Econ (2024). https://doi.org/10.1007/s13132-024-02126-1

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OBJECTIVES: This study employs a Discrete Choice Experiment (DCE) and Willingness to Pay (WTP) to reveal diabetic macular edema (DME) patient preferences concerning intravitreal treatment options.

METHODS: Six attributes were identified through a literature review, two focus groups, and a best-worst scaling exercise. These attributes include initial injection count, maintenance injection frequency, visual impact, retinal fluid effects, adverse reactions, and cost. Attribute levels were obtained through published clinical trials and drug instructions.

RESULTS: The study hasn't yet reached the minimum sample size. Surveys in two cities (Beijing, Tianjin) included 74 patients (mean age 55.8±14.7, 48.6% female, mean DME duration 2.2±2.7 years, and 3.27±2.0 injections in 2023). Preliminary WTP results indicate a mean price of CNY 3753±2305, with Q1 at 1992 and Q3 at CNY 5039.

Patient-Centered Research

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Adherence, Persistence, & Compliance, Patient Behavior and Incentives, Patient Engagement, Stated Preference & Patient Satisfaction

Sensory System Disorders (Ear, Eye, Dental, Skin)

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Peer-reviewed

Research Article

The impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries: A systematic review

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft

* E-mail: [email protected]

Affiliation School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland

Roles Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – review & editing

Roles Conceptualization, Formal analysis, Methodology, Supervision, Validation, Writing – review & editing

Roles Conceptualization, Formal analysis, Investigation, Project administration, Supervision, Validation, Writing – review & editing

• Muluken Basa, 
• Jan De Vries, 
• David McDonagh, 
• Catherine Comiskey

• Published: June 21, 2024
• https://doi.org/10.1371/journal.pone.0293376
• Reader Comments

COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and increasing risk factors. These challenges were expected to be more severe in sub-Saharan Africa due to the lack of physical infrastructure and inadequate resources. The quantity of studies conducted was limited, and there was a lack of published systematic reviews in the specified region. This systematic review aimed to assess the indirect impacts of the COVID-19 pandemic and associated lockdown measures on individuals with non-communicable diseases (NCDs) in sub-Saharan African countries.

This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and is registered with PROSPERO (ID CRD42023387755). Extensive searches were conducted in MEDLINE, EMBASE, and CINAHL databases in December 2023, supplemented by a manual search of references, grey literature, and the WHO COVID-19 database. Inclusion criteria encompassed studies that reported on the impact of COVID-19 on NCD patients in sub-Saharan African countries, focusing on access to care, health outcomes, and factors related to NCDs. Critical appraisal of study quality was performed using the Joanna Briggs Institute (JBI) analytical cross-sectional studies critical appraisal tool. Data were extracted and synthesized, highlighting the main findings and relevant limitations.

This review included 30 primary studies with a cumulative sample size of 25634 participants, conducted in seven sub-Saharan African countries. These studies demonstrated that the COVID-19 pandemic significantly disrupted regular NCD patient care provision, with regional variations. The studies also identified a reduction in patient health-seeking behavior and reduced medication adherence, leading to poor treatment outcome. Furthermore, the pandemic and related lockdowns have been implicated in the increased prevalence of substance use, decreased physical exercise, and increased mental health problems.

This systematic review identified the complex challenges faced by NCD patients in sub-Saharan Africa during the COVID-19 pandemic. It also underlines the need to consider the indirect impact on vulnerable populations while developing pandemic prevention and control strategies for the future. The current NCD management strategies should prioritize the restoration of access to essential healthcare services while considering the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use. The main limitation of this review was the study design and setting. All of the studies included in this review employed a cross-sectional design, which may result in a low quality of evidence. This study identified research conducted in only seven countries among the 46 UN-classified sub-Saharan nations, which may impair the generalizability of the result.

Citation: Basa M, De Vries J, McDonagh D, Comiskey C (2024) The impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries: A systematic review. PLoS ONE 19(6): e0293376. https://doi.org/10.1371/journal.pone.0293376

Editor: Seyed Aria Nejadghaderi, Shahid Beheshti University of Medical Sciences School of Medicine, ISLAMIC REPUBLIC OF IRAN

Received: October 9, 2023; Accepted: February 28, 2024; Published: June 21, 2024

Copyright: © 2024 Basa 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 paper and its Supporting information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Non-communicable diseases (NCDs), or chronic diseases, are illnesses of long duration with typically slow progression that cannot be transmitted from one person to another [ 1 ]. These are primarily diabetes, cancer, chronic respiratory diseases, and cardiovascular diseases, and they account for 74% of all fatalities worldwide and 84% of premature deaths in low- and middle-income countries [ 1 ]. Sub-Saharan Africa accounts for about 27% of all non-communicable disease-related deaths in Africa [ 2 ]. The COVID-19 pandemic has exacerbated the situation due to the direct and indirect impact on NCD patients [ 3 , 4 ]. Especially, the implementation of COVID-19 prevention and control measures, such as travel restrictions, self-isolation, quarantine, lockdown, and social distancing, have hampered routine follow-up care for people with NCDs [ 5 – 7 ]. WHO reported that nearly 80% of countries globally experienced substantial disruption of NCD services due to the COVID -19 pandemic [ 3 ].

The extent of disruption has varied across nations, depending on factors such as the country’s existing healthcare system and COVID-19 prevention measures [ 8 ]. In sub-Saharan countries, the impact of these disruptions has been particularly severe due to more fragile and less resilient health systems, inadequate resources, and preexisting structural inequality [ 9 ]. According to cross-sectional studies performed in Ethiopia, Nigeria, and Kenya, the COVID-19 pandemic caused 80%, 51.0%, and 42% of disruptions in NCD care, respectively [ 10 – 12 ]. Furthermore, these studies reported that population-level NCD screening programs had been discontinued in Ethiopia (73.3%) and Kenya (49.8%) [ 10 , 11 ].

People with NCDs were also found to be more vulnerable to the psychological effects of COVID-19 and required additional support due to social distancing and other preventative measures [ 13 , 14 ]. Moreover, studies conducted during the COVID-19 pandemic identified a significant increase in the prevalence of NCD risk factors such as cigarette smoking, alcohol drinking, inadequate physical excessive, and unhealthy diet/eating poorly [ 13 , 15 , 16 ]. An increased need for substance use treatment resulting from pandemic related stress, anxiety and social isolation has also been reported [ 13 , 17 , 18 ].

Considering these noted impacts, this systematic review is aimed at a comprehensive exploration of the existing literature on the impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries. It is the first of its kind with a focus on these countries and differs from other reviews because it draws connections between multiple variables.

This systematic review made use of the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines [ 19 ] and was registered with the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) (ID CRD42023387755) [ 20 ].

Search method and selection method

The following databases were used: MEDLINE, EMBASE, and CINAHL. The search was conducted in November 2022 and included relevant medical terms and keywords with word variants for NCDs, COVID-19 and names of specific countries in the Sub-Saharan Region. An additional manual search was conducted focused on references using Google Scholar, grey literature, and the WHO COVID-19 database. The complete search strategy is available in supplementary file, S2 File . Full search terms.

Search results were exported into Covidence, a web-based tool that manages the different steps of the procedure for conducting systematic reviews. Duplicates were removed, and the titles and abstracts of the remaining literature were screened. If deemed relevant, full texts were then reviewed for eligibility by two reviewers independently according to the pre-defined selection criteria. Any disagreements between reviewers were resolved through discussion.

Inclusion and exclusion criteria

Studies were considered eligible for inclusion in the review only if they:

• Reported on the impact of COVID-19 on NCD patients in sub-Saharan African countries.
• Focused on one or more of the review objectives (access to care, health outcomes, risk and protective factors related to NCDs)
• Were primary research studies.
• Were published in English.
• Studies conducted in adult population (aged 18 years or older)

Studies were excluded from the review if they:

• Did not report on the impact of COVID-19 on NCD patients in sub-Saharan African countries (e.g. Studies about vaccine utilization)
• Were not published in English/ did not have translated version.
• Did not focus on one or more of the review objectives (access to care, health outcomes, other factors related to NCDs)
• Were not primary research studies (e.g., review articles, editorials)
• Studies conducted on different study population, for example children.

Quality appraisal

The Joanna Briggs Institute (JBI) analytical cross sectional studies critical appraisal tool was used to assess the quality of the studies [ 21 ]. The aim of this evaluation was to evaluate a study’s methodology and ascertain how well it has addressed the possibility of bias in the research process. Eight questions are included in this checklist, which focus on methodological aspects of each study. Each question in the quality appraisal tool was given one mark, and the final score was added up, divided by eight, and multiplied by a hundred to determine a percentage. For example, if a study properly addressed 6 aspects on the checklist, it would get 6/8*100 = 75%. Finally, studies were classified as high risk of Bias (score ≤49%), Moderate risk of Bias (50%–69%) =), and low risk of Bias (above 70%), based on their respective quality score. See supplementary file, S1 Table . Risk of bias assessments. The investigators evaluated the quality of the papers independently and then met to discuss and agree on individual scoring differences.

Data extraction method

The relevant data were identified based on the aim of the study, which includes study design, sample size and characteristics, study setting, data collection methods, and main findings related to access to care, mental health outcomes, and risk and protective factors related to non-communicable diseases (NCDs). Following study identification, data extraction was conducted using a standardized data extraction form prepared in Microsoft Word. Data extraction was done by two authors, and any discrepancies or uncertainties in the extracted data were resolved through discussion among the research team to ensure accuracy and consistency. Finally, the extracted data were checked for accuracy and completeness before data synthesis began.

Data synthesis method

The extracted data was first arranged according to the study focus and main findings, and the emerging themes were coded. Then, the data was further organized by themes, with a separate section for each new theme and its subthemes (such as access to care and mental health outcomes, risk, and protective factors of NCDs, etc.). The synthesized data were analyzed and interpreted to identify any patterns or trends that emerge. This process involved comparing the findings across different studies to identify commonalities and differences. Additionally, any gaps or inconsistencies in the data were noted and explored further to ensure a comprehensive synthesis of the available evidence. In addition, this incorporates examining the relationships between variables (such as access to care and mental health outcomes or substance use and mental health). This systematic review also highlighted inconsistencies or gaps in the literature, and suggested areas for further research.

Ethical approval

Since all the data was in the public domain, no ethical approval was needed for this review.

Search results

A total of 4310 studies were imported to Covidence, with 759 duplicates. After the evaluation of the titles and abstracts of 3552 studies and the full-text screening of 263 studies, 30 met the inclusion criteria for a systematic review (see Fig 1 for a PRISMA diagram). The diagram was developed according to the PRISMA 2020 statement: an updated guideline for reporting systematic reviews [ 22 ].

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0293376.g001

Characteristics of included studies

Table 1 , describes characteristics of the 30 primary studies with a cumulative total of 25634 sample size gathered from seven different sub-Saharan African countries (Ethiopia, Nigeria, Rwanda, Kenya, Botswana, South Africa, and Uganda). Among this, 15 studies focused on chronic disease patients, six focused on diabetes, four focused on hypertension, two focused on diseases and/ or hypertension, two focused on cancer, and one focused on cardiovascular disease. The review findings were organized into five frequently reported themes and subthemes: these are 1) disruption of follow-up care and poor health care utilization reported by 14 studies [ 10 , 11 , 23 – 31 , 55 , 57 , 58 ]; 2) increased anxiety, stress, depression, and increased mental health problems reported by nine studies [ 15 , 32 , 34 , 35 , 37 – 39 , 43 , 56 ]; 3) substance use reported by four studies [ 36 , 37 , 41 , 44 ]; 4) decreased physical activity and sedentary life reported by three studies [ 33 , 36 , 44 ]; and 5) increased food insecurity and poor dietary habits due to COVID-19 among NCDs patients, reported in five studies [ 36 , 40 , 42 – 44 ] Studies included in this review did not focus on the same subject matter. Some studies focused on one theme and others focus on more than two themes; for instance, Andualem [ 36 ] examined adherence to lifestyle modifications and reported on diet, exercise, smoking, and alcohol, whereas Abate [ 33 ] examined adherence to physical exercise recommendations and reported only on exercise compliance.

https://doi.org/10.1371/journal.pone.0293376.t001

According to the JBI quality assessment score, 24 studies were found to be low risk of bias and the remaining six studies scored moderate risk of bias. Regarding response rate, 20 studies have of more than 90%, eight studies did not report, and two studies have more than 80% of response rate.

Main findings

Disruption of follow-up care and poor health care utilization..

Disruption of follow-up care and poor healthcare utilization in sub-Saharan Africa were the most frequently reported challenges reported by ten studies included in this systematic review [ 10 , 11 , 23 – 31 , 55 , 57 , 58 ]. Moreover, NCD patients in the region encountered substantial obstacles throughout the pandemic, including limited availability of medications and medical supplies, which led to inadequate disease control [ 24 , 30 , 58 ]. Some of the reasons for this disruption include fear of contracting COVID-19, transportation challenges, and limited access to healthcare facilities due to lockdowns and restrictions [ 30 ]. In addition, the lack of telemedicine infrastructure and inadequate resources for virtual consultations further exacerbated the problem in the region.

The magnitude of disruption varied across the region; cross-sectional studies conducted in Nigeria [ 12 ], Kenya [ 23 ], and Ethiopia [ 11 ] reported 17.3%, 42%, and 80% of NCD care disruptions, respectively. There was also a statistically significant association between the emergence of COVID-19 and a decline in outpatient volume at NCD management services (83.3%), the closure of population-level NCD screening programs (73.3%), and the closure of disease-specific NCD clinics (76.7%) [ 33 ]. The closure of these critical services, a lack of transportation, and NCD patients’ fear of contracting COVID-19 all contributed to poor health-seeking behaviour and an increase in missed appointments [ 31 , 57 ]. For example, the rate of missed appointments increased from 12.5% prior to the pandemic to 26.8% during the pandemic (p < 0.001) in Ethiopia [ 31 ]. A similar study conducted among 409 hypertensive patients in West Ethiopia reported that 29% of patients had experienced poor follow-up conditions due to the pandemic [ 57 ]. In addition, the COVID-19 pandemic contributed to poor medication adherence among diabetic and hypertensive patients in Ethiopia, with prevalence rates of 72% and 63%, respectively [ 18 , 31 ].

The pandemic also exacerbated the prevalence of inadequate treatment control for NCDs in sub-Saharan Africa. Mujuru et al.’s 2023 study in South Africa demonstrated a correlation between COVID-19 lockdown measures and inadequate diabetes management in patients, highlighting the need for improved diabetes management [ 58 ]. In Ethiopia, the number of people with inadequate treatment control went from 24.81% (95% CI 21.95%–27.92%) before the COVID-19 pandemic to 36.69% (95% CI 33.40%–40.12%) just three months after the first COVID-19 case was found [ 27 ]. A similar study in Ethiopia found that the prevalence of inadequate treatment control increased from 26.2% (95% CI 22.5%, 30.2%) before the pandemic to 35.3% (95% CI 31.6%, 39.3%) during the pandemic [ 24 ].

Impact of the COVID-19 pandemic on physical activity.

Importantly, four of the studies included in this systematic review reported that patients with noncommunicable diseases experienced a significant decrease in physical activity during the COVID-19 pandemic, with some variance between them [ 33 , 36 , 44 ]. As one of the four risk factors for NCDs, the decline in physical activity levels during the pandemic could potentially increase the risk of worsening NCDs. Two cross-sectional studies conducted among patients with hypertension and diabetes revealed a decrease of 30%-73.6% in the execution of a recommended exercise regimen during the pandemic [ 33 , 36 ]. Furthermore, this study also showed that more than 75% of participants did not adhere to recommended lifestyle changes during the pandemic [ 33 ]. Additionally, a study by Ayele et al. (2022a) demonstrated that participants with a sedentary lifestyle were significantly more likely to miss a medical appointment than their counterparts (AIRR = 1.36, 95% CI: 1.12; 1.71) [ 26 ].

The impact of COVID-19 on dietary habits among NCDs.

Five studies reported that the pandemic had a significant negative impact on food insecurity and dietary habits among noncommunicable diseases patients [ 36 , 40 , 42 – 44 ]. Two cross-sectional studies conducted among patients with diabetes, revealed that more than half of participants had poor dietary practices [ 40 , 42 ]. An analogous study conducted among adults with hypertension reported a higher proportion (74%) of nonadherence to dietary recommendation [ 36 ]. Moreover, Azzouzi (2022), reported that 52.8% of participants had insufficient dietary knowledge. In addition, a cross-sectional study conducted in three rural districts of Rwanda demonstrated that the number of daily meals consumed in households decreased by 19.1% during lockdown [ 43 ].

Several factors were identified as being associated with adherence to dietary recommendations. These included higher educational level (college and above) [Adjusted Odds Ratio (AOR) = 3.64, 95% CI [1.59–8.34]], being a government employee [AOR = 2.38, 95% CI (1.13–4.99)], living in an urban area [AOR = 1.30, 95% CI (1.09–2.42)], having a smaller family size (family size of less than five) [AOR = 1.27, 95% CI (1.08–1.97)], having a good income level [AOR = 2.26, 95% CI (1.67–4.54)] [ 36 , 42 ].

Increased stress, anxiety, depression and other mental health problems.

Another important impact of the COVID-19 pandemic was identified in seven studies that reported a negative impact of pandemic on the mental health and psychological well-being of noncommunicable disease patients [ 15 , 32 , 34 , 35 , 37 – 39 , 43 , 56 ]. Increased stress and anxiety can be a result of fear of contracting the virus, disruptions in healthcare services, social isolation, and economic hardships. The social and economic consequences of the pandemic were identified as major determinants of mental health [ 19 , 36 ] with the prevalence of COVID-19-related stress and psychological effects ranging from 14.7% to 33.8% [ 8 , 19 , 26 ].

Risk factors for these effects include older age, unemployment, the presence of comorbid diseases, the duration of chronic illness, respiratory symptoms, and a lack of social support [ 19 , 36 ]. Depression and anxiety were also shown to be relatively common among NCD patients. The prevalence of depression, ranged from 32.0% to 33.1% [ 8 , 10 , 26 , 11 ], while the outcomes for anxiety demonstrated a huge variation across the studies with a prevalence range between 6.3% and 68.4% [ 9 , 11 , 26 ]. In contrast, a lower proportion of anxiety was reported in a South African study. Irusen et al., 2021 did a cross-sectional investigation to determine the extent of COVID-19-related anxiety among 60 men with localized prostate cancer in Cape Town, South Africa, and reported their findings. Merely 3% exhibited symptoms of COVID-19 anxiety disorder. Furthermore, men undergoing treatment for CaP resilience did not experience notable anxiety as a result of COVID-19 [ 56 ].

The impact of COVID-19 on substance use among NCD patients.

Four studies included in this review showed that COVID-19 had a significant impact on substance use among NCD patients [ 36 , 37 , 41 , 44 ]. According to these studies, there has been a variable effect on alcohol use during the COVID-19 lockdown. While some studies have reported increased alcohol use and non-adherence to recommendations for alcohol consumption, others have noted an increase in hazardous drinking [ 36 , 37 , 41 , 44 ]. Sociodemographic factors, such as age and gender, political and economic factors, and the ban on alcohol sales in some countries, also played a big role in the prevalence of the problem. For example, a cross-sectional study on changes in alcohol use before, during, and after the alcohol sales ban during the COVID-19 pandemic in Botswana demonstrated a significant decrease in the prevalence of alcohol use among participants with a past 12-month drinking history, from 91.7% (95% CI: 90.1–93.1) before the second ban to 62.3% (95% CI: 59.7–64.9) during the second ban [ 41 ]. However, it returned to 90.4% (95% CI = 88.7–91.8), after the second ban. Similarly, hazardous drinking temporarily decreased by 30% during the second alcohol sales ban and increased to approximately 60% of its pre-ban levels after the ban [ 41 ].

In a cross-sectional study conducted in Ethiopia identified a statistically significant association between inadequate treatment control and hazardous drinking (AOR = 1.29, 95% CI: 1.02, 1.60). Furthermore, the smoking of tobacco was also shown to increase during the lockdown [ 36 , 37 ]. Political and economic factors, as well as a lack of knowledge about the risks of non-communicable diseases (NCDs) associated with smoking, played a significant role [ 44 ].

The results of this review revealed the presence of a clear relationship between the COVID-19 pandemic, mental health, and risk and protective factors for NCDs. Several studies identified a significant association between increased substance use and increased levels of anxiety and depression [ 36 , 37 , 41 , 44 ]. Similar associations were found between missed medical appointment and sedentary lifestyle and, poor treatment control and sedentary lifestyles, physical inactivity and substance use, and poor health-seeking behavior and substance use [ 25 – 27 ].

This systematic review synthesized evidence from 30 studies to investigate the indirect impacts of the COVID-19 pandemic and associated lockdown measures on individuals with non-communicable diseases (NCDs) in sub-Saharan African countries. This review identified that the COVID-19 pandemic impacted the delivery of a broad range of vital health services to patients with non-communicable diseases, which increased mental health problems, and risk factors for NCDs, including increased substance use, decreased physical activity, poor dietary practices, and household food insecurity in these countries.

The findings indicated a decrease in healthcare utilization, health-seeking behavior, and preventative healthcare services utilization, which could potentially lead to increased morbidity and mortality associated with NCDs [ 10 , 11 , 23 – 30 , 31 , 45 , 55 , 57 , 58 ]. The findings of this review were consistent with other international reviews conducted on populations in different parts of the world, including Latin American [ 46 ], Asia [ 47 ], Europe and the USA [ 48 ]. These similarities demonstrate that there was a clear pattern of disruption in access to NCD care across the world due to the pandemic. However, as our findings suggest, the problem may have been more severe in sub-Saharan countries, where the existing health system is more fragile and less resilient due to limited resources and preexisting structural inequality [ 9 , 57 ]. Factors such as socioeconomic and demographic factors, self-funding for medication costs, disruption of transportation, increased medication costs due to disruption, and poverty have been identified as contributing to the negative impact of the pandemic on NCD prevention and management in sub-Saharan countries [ 31 , 57 ]. The COVID-19 pandemic has also disrupted referral and supply chain systems, leading to limited availability and affordability of medication in Ethiopia [ 18 , 37 , 55 ], South Africa and Uganda [ 22 , 45 ]. Acute health facility staff absenteeism has also been observed in Uganda [ 35 ]. This could lead to a further increase in NCD-related morbidity and mortality in sub-Saharan countries, exacerbating the already existing burden of these diseases.

In addition, COVID-19 pandemic has had a significant impact on physical exercise among individuals with non-communicable diseases in sub-Saharan countries. This impact was variable across studies, with some studies finding significant decreases in adherence, and others finding small changes [ 33 , 36 ]. In a study by Abate et al. (2022), only 26.4% of type 2 diabetes patients were found to be adhering to exercise recommendations during the COVID-19 pandemic [ 33 ]. In contrast, Andualem (2020) found that 60.1% of hypertensive patients were adhering to exercise recommendations, although overall adherence to lifestyle modifications was low at 23.6% [ 36 ]. Similarly, studies from Canada [ 49 ] and Australia [ 50 ] reported that the pandemic was associated with a decrease in physical activity among individuals with NCDs. On the other hand, a cross-sectional study from Brazil and a systematic review of 15 studies revealed that the pandemic was not significantly associated with changes in physical activity among individuals with NCDs [ 6 , 51 ]. This variation is maybe due to the difference in the level and type of COVID-19 prevention measure the countries applied and the study time and setting [ 52 ]. Therefore, these diverging results suggest that the effect of the COVID-19 pandemic on physical activity among people with NCDs may depend on a number of factors, such as access to resources and support for physical activity, the specific context in which the pandemic is happening, but also individual characteristics [ 33 , 36 ].

Our systematic review identified that the COVID-19 pandemic had a negative impact on dietary habits among individuals with NCDs in sub-Saharan countries, with a higher prevalence of poor dietary practices and food insecurity being reported [ 36 , 40 , 42 ] While poor dietary practices are commonly reported problem in several countries, developing countries, including sub-Saharan countries, face additional challenges, such as a lack of food in households resulting from the loss of income and transportation due to the pandemic [ 36 , 40 , 42 ]. A study by Peimani et al. (2021) revealed that significant amount of individuals with diabetes reported an increase in unhealthy food intake and a decrease in the intake of fruits and vegetables in Iran [ 59 ]. In addition, this study identified that lower education levels and lower income show a significant association with the problem. Furthermore, a study conducted in Brazil demonstrated that 65.1% of individuals reported an increase in unhealthy food intake and a decrease in the intake of fruits and vegetables among hypertensive patients [ 53 ].

Moreover, the pandemic is also resulting in an increased prevalence of stress, anxiety, depression, and other mental health issues [ 13 , 15 , 16 , 38 ]. These findings are consistent with other studies conducted on the topic in different parts of the world [ 6 , 51 ]. According to WHO (2020), the negative impact of the COVID-19 pandemic on the psychological well-being of individuals with chronic diseases has not been uniform across different countries and populations. Factors such as the availability and quality of mental health care infrastructure, the degree of COVID-19 transmission, and the socio-economic status of the population have been identified as potential determinants of the impact of the pandemic on the psychological well-being of individuals with chronic diseases [ 13 , 15 , 16 , 38 ]. Overall, these findings highlight the importance of addressing the psychological well-being of individuals with chronic diseases during the COVID-19 pandemic [ 38 ]. In addition, research has shown that some people may use drugs or alcohol to deal with the stress and negative feelings caused by the pandemic or to pass the time during lockdowns [ 54 ]. Therefore, it is important to consider the psychological well-being of people with NCDs during pandemics, as they may be at a higher risk of experiencing anxiety and depression. Moreover, healthcare providers should be aware of the potential increase in substance use among people dealing with stress and negative emotions during this time.

In general, this systematic review identified the challenges faced by NCD patients in sub-Saharan Africa during the COVID-19 pandemic is very complex. It is vital health policymakers and decision-making bodies to seriously consider the indirect impact on vulnerable populations while developing pandemic prevention and control strategies for the future. The current NCD management strategies should prioritize the restoration of access to essential healthcare services while considering the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use. Future pandemic prevention and control strategies should prioritize restoring access to essential healthcare services, taking into account the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use in vulnerable populations.

In general, our systematic review revealed that the COVID-19 pandemic impacted Sub-Saharan countries similarly to elsewhere in the world, but perhaps more so as it has exacerbated existing health inequities, especially for vulnerable populations. This highlights the need for urgent interventions to mitigate the impact of the pandemic on NCD patients in sub-Saharan African countries. Such interventions should prioritize maintaining access to essential health services and addressing social determinants of health.

The findings from our review highlight the link between COVID-19 and various risk factors for NCD patients. This stresses the importance for policymakers and healthcare providers to take these factors into account when dealing with the impact of the pandemic on NCD prevention and management. While more research is necessary to fully understand the long-term effects of COVID-19 on NCDs, it is clear that we need to develop strategies now to minimize potential harm and be better prepared for future pandemics like this one. Future primary research is recommended to assess the level of underlying healthcare inequality and its impact on the vulnerability of NCD patients to COVID-19. Additionally, exploring the effectiveness of existing healthcare systems in addressing NCD prevention and management during a pandemic could provide valuable insights for improving future response strategies.

To avoid devastating consequences for future pandemics like COVID-19, it is crucial to establish comprehensive and resilient healthcare systems that can effectively address the unique challenges posed by such outbreaks. This includes strengthening primary healthcare services, ensuring equitable access to healthcare resources, and implementing proactive measures to mitigate the negative effects on vulnerable populations. Additionally, investing in research and development of innovative technologies and interventions can further enhance our preparedness and response capabilities for future pandemics.

Limitation of the study

The main limitation of this review was the study design and setting. All of the studies included in this review were observational in nature, which limits the ability to establish causality between NCD management strategies and their outcomes. This study included studies from seven countries out of 46 UN-classified sub-Saharan nations, which may impair the generalizability of the result. Furthermore, the majority of the studies focused on urban populations, neglecting the potential differences in health behaviors and outcomes in rural areas. Therefore, caution should be exercised when applying these findings to other sub-Saharan African countries or rural communities. Future research should aim to include a more diverse range of study designs and settings to enhance the robustness and generalizability of the results.

Supporting information

S1 table. risk of bias assessments..

https://doi.org/10.1371/journal.pone.0293376.s001

S2 Table. PRISMA 2020 checklist.

https://doi.org/10.1371/journal.pone.0293376.s002

S1 File. Review protocol.

https://doi.org/10.1371/journal.pone.0293376.s003

S2 File. Full search terms for one database.

https://doi.org/10.1371/journal.pone.0293376.s004

https://doi.org/10.1371/journal.pone.0293376.s005

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Elektrostal , city, Moscow oblast (province), western Russia . It lies 36 miles (58 km) east of Moscow city. The name, meaning “electric steel,” derives from the high-quality-steel industry established there soon after the October Revolution in 1917. During World War II , parts of the heavy-machine-building industry were relocated there from Ukraine, and Elektrostal is now a centre for the production of metallurgical equipment. Pop. (2006 est.) 146,189.

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Unveiling the Mask: Exploring the Angry Black Woman Steroretype

Historically Black Colleges and Universities (HBCUs) serve as pivotal cultural and educational institutions, fostering academic excellence and community engagement. However, within the HBCU workplace, Black women often navigate complex dynamics shaped by pervasive stereotypes and societal expectations.

We invite scholars, researchers, educators, administrators, and practitioners from diverse fields to contribute abstracts for chapters to be included in an anthology Unveiling the Mask: Exploring the Angry Black Woman Stereotype. This anthology aims to illuminate the multifaceted experiences of Black women in these cultural spaces, critically examining stereotypes such as the "Angry Black woman" and other detrimental narratives that impact our professional and personal lives. 

We welcome abstracts exploring a breadth of topics, including but not limited to:

Literature Reviews:

• Historical perspectives on stereotypes of Black women within academia and the workplace.
• Analysis of media representations and their influence on perceptions of Black female professionals in the academic setting.
• Examination of existing research on the intersection of race, gender, and workplace dynamics within HBCUs.

Reflective Papers:

• Personal narratives and lived experiences of Black women working in HBCUs, encompassing challenges, triumphs, and strategies for empowerment.
• Intersectional analyses considering how factors such as class, sexuality, and ability intersect with race and gender in shaping workplace experiences.
• Exploration of resistance strategies and resilience among Black women in navigating stereotypes and bias within the HBCU workplace.
• In addition to the themes outlined above, we encourage submissions that explore innovative pedagogical approaches, curriculum development, fostering inclusivity and diversity, and classroom engagement techniques within the context of HBCU environments.
• This anthology aims to be inclusive and welcomes contributions from scholars representing diverse perspectives and methodologies. We particularly value submissions that amplify marginalized voices and offer innovative insights into the complexities of Black female experiences within HBCUs.

Submission Guidelines:

• Abstracts should be no more than 500 words and should clearly outline the proposed chapter's objectives, methodology, and potential contributions to the anthology's theme.
• Please include a brief author biography (100 words) with your submission.
• Abstracts should be submitted via email to  [email protected]  by the deadline specified below.
• Selected contributors will be notified of acceptance and provided with guidelines for full chapter submission.

Deadline: Fri. Aug. 30,  2024