writing an integrative literature review

University of Houston Libraries

• Literature Reviews in the Health Sciences
• Review Comparison Chart
• Decision Tools
• Systematic Review
• Meta-Analysis
• Scoping Review
• Mapping Review
• Integrative Review
• Rapid Review
• Realist Review
• Umbrella Review
• Review of Complex Interventions
• Diagnostic Test Accuracy Review
• Narrative Literature Reviews
• Standards and Guidelines

Navigate the links below to jump to a specific section of the page:

When is an Integrative Review methodology appropriate?

Outline of stages, methods and guidance, examples of integrative reviews, supplementary resources.

"An integrative review is a specific review method that summarizes past empirical or theoretical literature to provide a greater comprehensive understanding of a particular phenomenon or healthcare problem" (Broome, 1993). Thus, integrative reviews have the potential to build upon nursing science, informing research, practice, and policy initiatives.

An integrative review method is an approach that allows for the inclusion of diverse methodologies (i.e. experimental and non-experimental research) and have the potential to play a greater role in evidence-based practice for nursing ( Whittemore & Knafl, 2005 ).

Characteristics:

• An integrative review is best designed for nursing research
• The problem must be clearly defined
• define concepts
• review theories
• review evidence/point out gaps in the literature
• analyze methodological issues

When to Use It: According to Toronto & Remington (2020) , Whittmore & Knafl (2005) , and Broome (2000)  an integrative review approach is best suited for:

• A research scope focused more broadly at a phenomenon of interest rather than a systematic review and allows for diverse research, which may contain theoretical and methodological literature to address the aim of the review.
• Supporting a wide range of inquiry, such as defining concepts, reviewing theories, or analyzing methodological issues.
• Examining the complexity of nursing practice more broadly by using diverse data sources.

The following stages of conducting an integrative review are derived from  Whittemore & Knafl (2005) .

Timeframe:  12+ months

*Varies beyond the type of review. Depends on many factors such as but not limited to: resources available, the quantity and quality of the literature, and the expertise or experience of reviewers" ( Grant & Booth, 2009 ).

Question:  Formulation of a problem, may be related to practice and/or policy especially in nursing.

Is your review question a complex intervention?  Learn more about  Reviews of Complex Interventions .

Sources and searches:  Comprehensive but with a specific focus, integrated methodologies-experimental and non-experimental research. Purposive Sampling may be employed. Database searching is recommended along with grey literature searching. "Other recommended approaches to searching the literature include ancestry searching, journal hand searching, networking, and searching research registries." Search is transparent and reproducible.

Selection:  Selected as related to problem identified or question, Inclusion of empirical and theoretical reports and diverse study methodologies. 

Appraisal:  "How quality is evaluated in an integrative review will vary depending on the sampling frame." Limited/varying methods of critical appraisal and can be complex. "In a review that encompasses theoretical and empirical sources, two quality criteria instruments could be developed for each type of source and scores could be used as criteria for inclusion/exclusion or as a variable in the data analysis stage."

Synthesis:  Narrative synthesis for qualitative and quantitative studies. Data extracted for study characteristics and concept. Synthesis may be in the form of a table, diagram or model to portray results. "Extracted data are compared item by item so that similar data are categorized and grouped together."  

The method consists of:

• data reduction
• data display
• data comparison
• conclusion drawing,
• verification 

The following resources are considered to be the best guidance for conduct in the field of integrative reviews.

Methods & Guidance

• Hopia, H., Latvala, E., & Liimatainen, L. (2016). Reviewing the methodology of an integrative review .  Scandinavian journal of caring sciences ,  30 (4), 662–669. doi: 10.1111/scs.12327
• Russell C. L. (2005). An overview of the integrative research review .  Progress in transplantation ,  15 (1), 8–13. doi: 10.1177/152692480501500102
• Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology .  Journal of advanced nursing ,  52 (5), 546–553. doi: 10.1111/j.1365-2648.2005.03621.x

Reporting Guideline

There is currently no reporting guideline for integrative reviews.

• Collins, J. W., Zoucha, R., Lockhart, J. S., & Mixer, S. J. (2018). Cultural aspects of end-of-life care planning for African Americans: an integrative review of literature .  Journal of transcultural nursing ,  29 (6), 578–590. doi: 10.1177/1043659617753042
• Cowdell, F., Booth, A., & Appleby, B. (2017). Knowledge mobilization in bridging patient-practitioner-researcher boundaries: a systematic integrative review protocol .  Journal of advanced nursing ,  73 (11), 2757–2764. doi: 10.1111/jan.13378
• Frisch, N. C., & Rabinowitsch, D. (2019). What's in a definition? Holistic nursing, integrative health care, and integrative nursing: report of an integrated literature review .  Journal of holistic nursing ,  37 (3), 260–272. doi: 10.1177/0898010119860685
• Kim, J., Kim, Y. L., Jang, H., Cho, M., Lee, M., Kim, J., & Lee, H. (2020). Living labs for health: an integrative literature review .  European journal of public health ,  30 (1), 55–63. doi: 10.1093/eurpub/ckz105
• Luckett, T., Sellars, M., Tieman, J., Pollock, C. A., Silvester, W., Butow, P. N., Detering, K. M., Brennan, F., & Clayton, J. M. (2014). Advance care planning for adults with CKD: a systematic integrative review .  American journal of kidney diseases ,  63 (5), 761–770. doi: 10.1053/j.ajkd.2013.12.007
• Shinners, L., Aggar, C., Grace, S., & Smith, S. (2020). Exploring healthcare professionals' understanding and experiences of artificial intelligence technology use in the delivery of healthcare: an integrative review .  Health informatics journal ,  26 (2), 1225–1236. doi: 10.1177/1460458219874641
• Silva, D., Tavares, N. V., Alexandre, A. R., Freitas, D. A., Brêda, M. Z., Albuquerque, M. C., & Melo, V. L. (2015). Depressão e risco de suicídio entre profissionais de Enfermagem: revisão integrative [Depression and suicide risk among nursing professionals: an integrative review] .  Revista da Escola de Enfermagem da U S P ,  49 (6), 1027–1036. doi: 10.1590/S0080-623420150000600020
• Stormacq, C., Van den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the relationship between socioeconomic status and health disparities? integrative review .  Health promotion international ,  34 (5), e1–e17. doi: 10.1093/heapro/day062
• Broome M.E. (1993). Integrative literature reviews for the development of concepts. In Rodgers, B. L., & Knafl, K. A. (Eds.),  Concept development in nursing  (2nd ed., pp. 231-250). W.B. Saunders Company.
• da Silva, R. N., Brandão, M., & Ferreira, M. A. (2020). Integrative Review as a Method to Generate or to Test Nursing Theory .  Nursing science quarterly ,  33 (3), 258–263. doi: 10.1177/0894318420920602
• Garritty, C., Gartlehner, G., Nussbaumer-Streit, B., King, V. J., Hamel, C., Kamel, C., Affengruber, L., & Stevens, A. (2021). Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews .  Journal of clinical epidemiology ,  130 , 13–22. doi: 10.1016/j.jclinepi.2020.10.007
• Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies .  Health information and libraries journal ,  26 (2), 91–108. doi: 10.1111/j.1471-1842.2009.00848.x

Toronto, C. E., & Remington, R. (2020).  A Step-By-Step Guide to Conducting an Integrative Review.  Springer International Publishing AG. doi: 10.1007/978-3-030-37504-1

• Torraco, R. J. (2005). Writing integrative literature reviews: guidelines and examples .  Human Resource Development Review, 4 (3), 356–367. doi: 10.1177/1534484305278283
• Whittemore. (2007). Rigour in Integrative Reviews . In Webb, C., & Roe, B. (Eds.),  Reviewing Research Evidence for Nursing Practice (pp. 149–156). Blackwell Publishing Ltd. https://doi.org/10.1002/9780470692127.ch11
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Other Names for an Integrative Review

• Integrative Literature Review
• Systematic Integrative Review
• Integrative Research Review

Limitations of an Integrative Review

The following challenges of integrative reviews are derived from Toronto & Remington (2020) , Whitmore & Knafl (2005) , and Broome (2000) .

• The combination and complexity of incorporating diverse methodologies can contribute to lack of rigor, inaccuracy, and bias.
• Methods of analysis, synthesis, and conclusion-drawing remain poorly formulated.
• Combining empirical and theoretical reports can be difficult.
• There is no current guidance on reporting.

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• Last Updated: Sep 5, 2023 11:14 AM
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Not every source you found should be included in your annotated bibliography or lit review. Only include the most relevant and most important sources.

BOOKS (sorted by title)

Organizing Your Review

Your lit review should not be a summary and evaluation of each article, one after the other.  Your sources must be integrated together to create a narrative on your topic.  Consider the following ways to organize your review:

• By themes, variables, issues.
• By varying perspectives regarding a topic of controversy.
• Chronologically, to show how the topic and research have developed over time.

Main Components of a Literature Review

Introduction.

• Describe the topic and provide a basic definition.
• Parameters of the topic. (What does the topic include and exclude?)
• Why did you select the literature you did?
• Historical background.
• Definitions in use.
• Mainstream ideas vs. alternative theoretical or ideological views.
• Principle questions being asked.
• Current research studies and discoveries.
• Methodologies.
• General conclusions.
• Summary of agreements and disagreements from the literature.
• How does your thesis fit in?
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• Last Updated: Sep 26, 2023 10:25 AM
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Writing an integrative review

• PMID: 9616108
• DOI: 10.1016/s0001-2092(06)62653-7
• Injections, Subcutaneous
• Nursing Research* / organization & administration
• Perioperative Nursing*
• Review Literature as Topic*

Do zinc products really help shorten a cold? It’s hard to say

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You feel a cold coming on, or maybe it’s already upon you: the telltale cough, sore throat and stuffy head. You swing by the drugstore, where a shelf full of over-the-counter products containing the mineral zinc claim to be able to shorten the duration of your symptoms.

The promise of relief is tempting. But is it one these products can make good on?

A new analysis of studies published on zinc and cold viruses concludes that there isn’t enough evidence to say whether over-the-counter zinc treatments have any effect on preventing the common cold.

For those who pop lozenges or inhale nasal sprays once a cold has come on, the available research together indicates that the products may reduce the duration of symptoms by up to two days, said Daryl Nault, an assistant professor at Maryland University of Integrative Health and first author of the paper, published Wednesday by the nonprofit organization Cochrane .

But those studies are so inconsistent in terms of the dosage, type of zinc, patient population and definition of cold symptoms that “confidence in the evidence is mostly low to very low,” the review states. “It is likely that additional studies are required before any firm conclusions can be drawn.”

In other words: Nearly 30 years after zinc lozenges first hit the market, we still can’t say for sure if these things do what they say they do.

“We aren’t saying [zinc] does” have any effect on the common cold, Nault said. “We aren’t saying it doesn’t. We’re saying we need more consistent evidence that is replicable. That’s a cornerstone of good science.”

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The age of zinc cold products dawned in 1996, when researchers from the Cleveland Clinic Foundation convinced 100 clinic employees to volunteer as research subjects within 24 hours of developing a cold.

Half were given placebos, and half were given lozenges containing 13.3 milligrams of zinc from zinc gluconate every two waking hours as long as their symptoms persisted. Those receiving the zinc got better after 4.4 days on average, while the placebo group felt sick for an average of 7.6 days.

Most people consume a sufficient amount of zinc, a vital nutrient, through a regular diet. The mineral is plentiful in red meat and poultry, and present in many grains and fruits. (Oysters contain more zinc per serving than any other known food, with a single serving containing nearly 300% of the daily recommended intake.)

Scientists aren’t exactly sure how the mineral works to alleviate cold symptoms. But the idea of an over-the-counter way to shorten the misery of a common cold has proved wildly popular.

Total U.S. sales of zinc products, such as Zicam and Cold-Eeze, were $340 million in 2023, said Hannah Esper, managing editor of the trade publication Nutrition Business Journal. Demand for zinc and other supplements exploded during the COVID-19 pandemic , with sales for zinc growing 168.3% during 2020.

Based in the U.K., Cochrane uses rigorous research methods to evaluate existing scientific evidence and produce reports to help people make decisions about their health, according to its website.

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For this review, the Cochrane team looked at 34 studies conducted across 13 countries that examined zinc products and the treatment or prevention of the common cold.

Drawing strong conclusions from the available research is difficult, as the studies tend to measure different things, said author Susan Wieland, an assistant professor at the University of Maryland School of Medicine and director of the Cochrane Complementary Medicine Field.

The cold “is a very common condition that is a difficult one to study,” Wieland said. It comes and goes quickly, making it difficult to enroll research subjects. Dosages and the type of zinc administered to study subjects varied widely.

“The designs of each study are different. So different dosages, different dosage forms, different patient populations, different criteria of exclusion and inclusion, different outcomes [and] definitions of cold,” said Dr. Jason Yee, an antimicrobial stewardship pharmacist at Cedars Sinai Medical Center in Los Angeles who was not involved with the review. “It’s really hard to draw the same conclusion based on different studies.”

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Physicians said they weren’t surprised by the findings.

“I agree with the study. ... It is consistent with my clinical experience in the hospital,” said Dr. Samia Faiz , an internal medicine specialist at UC Riverside Health. “In general, healthy people may be able to take zinc supplements if they make them feel better or if they get some comfort. They should not take these supplements if they have distaste or stomach upset.”

While over-the-counter zinc products are generally harmless to patients battling colds, said Dr. Pritish Tosh , an infectious disease physician and researcher at the Mayo Clinic, popping lozenges “shouldn’t come at the expense of doing things that really matter, which is getting plenty of rest, plenty of fluids and taking care of yourself.”

So why do we continue to fork over our cash for these things when we don’t really have more than a hunch that they work?

When a cold hits, “it’s natural for consumers to just reach for anything that may help alleviate those symptoms. But average consumers aren’t really educated on the literature and studies that are out there showing that there’s limited evidence and efficacy with these products,” Yee said.

Buying the lozenges or huffing the nasal spray can make us feel like we have more agency in a situation where we’re at the mercy of time and our immune systems, Nault said.

“Having a sense of control makes a lot of people feel better, and feel like they’re doing something,” Nault said. “Even if they aren’t.”

Times researcher Scott Wilson contributed to this report.

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Corinne Purtill is a science and medicine reporter for the Los Angeles Times. Her writing on science and human behavior has appeared in the New Yorker, the New York Times, Time Magazine, the BBC, Quartz and elsewhere. Before joining The Times, she worked as the senior London correspondent for GlobalPost (now PRI) and as a reporter and assignment editor at the Cambodia Daily in Phnom Penh. She is a native of Southern California and a graduate of Stanford University.

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