how to synthesize a literature review

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• Write a Literature Review
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Get Organized

• Lit Review Prep Use this template to help you evaluate your sources, create article summaries for an annotated bibliography, and a synthesis matrix for your lit review outline.

Synthesize your Information

Synthesize: combine separate elements to form a whole.

Synthesis Matrix

A synthesis matrix helps you record the main points of each source and document how sources relate to each other.

After summarizing and evaluating your sources, arrange them in a matrix or use a citation manager to help you see how they relate to each other and apply to each of your themes or variables.  

By arranging your sources by theme or variable, you can see how your sources relate to each other, and can start thinking about how you weave them together to create a narrative.

• Step-by-Step Approach
• Example Matrix from NSCU
• Matrix Template
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• Last Updated: Sep 26, 2023 10:25 AM
• URL: https://guides.library.jhu.edu/lit-review

Literature Syntheis 101

How To Synthesise The Existing Research (With Examples)

By: Derek Jansen (MBA) | Expert Reviewer: Eunice Rautenbach (DTech) | August 2023

One of the most common mistakes that students make when writing a literature review is that they err on the side of describing the existing literature rather than providing a critical synthesis of it. In this post, we’ll unpack what exactly synthesis means and show you how to craft a strong literature synthesis using practical examples.

This post is based on our popular online course, Literature Review Bootcamp . In the course, we walk you through the full process of developing a literature review, step by step. If it’s your first time writing a literature review, you definitely want to use this link to get 50% off the course (limited-time offer).

Overview: Literature Synthesis

• What exactly does “synthesis” mean?
• Aspect 1: Agreement
• Aspect 2: Disagreement
• Aspect 3: Key theories
• Aspect 4: Contexts
• Aspect 5: Methodologies
• Bringing it all together

What does “synthesis” actually mean?

As a starting point, let’s quickly define what exactly we mean when we use the term “synthesis” within the context of a literature review.

Simply put, literature synthesis means going beyond just describing what everyone has said and found. Instead, synthesis is about bringing together all the information from various sources to present a cohesive assessment of the current state of knowledge in relation to your study’s research aims and questions .

Put another way, a good synthesis tells the reader exactly where the current research is “at” in terms of the topic you’re interested in – specifically, what’s known , what’s not , and where there’s a need for more research .

So, how do you go about doing this?

Well, there’s no “one right way” when it comes to literature synthesis, but we’ve found that it’s particularly useful to ask yourself five key questions when you’re working on your literature review. Having done so,  you can then address them more articulately within your actual write up. So, let’s take a look at each of these questions.

1. Points Of Agreement

The first question that you need to ask yourself is: “Overall, what things seem to be agreed upon by the vast majority of the literature?”

For example, if your research aim is to identify which factors contribute toward job satisfaction, you’ll need to identify which factors are broadly agreed upon and “settled” within the literature. Naturally, there may at times be some lone contrarian that has a radical viewpoint , but, provided that the vast majority of researchers are in agreement, you can put these random outliers to the side. That is, of course, unless your research aims to explore a contrarian viewpoint and there’s a clear justification for doing so. 

Identifying what’s broadly agreed upon is an essential starting point for synthesising the literature, because you generally don’t want (or need) to reinvent the wheel or run down a road investigating something that is already well established . So, addressing this question first lays a foundation of “settled” knowledge.

Need a helping hand?

2. Points Of Disagreement

Related to the previous point, but on the other end of the spectrum, is the equally important question: “Where do the disagreements lie?” .

In other words, which things are not well agreed upon by current researchers? It’s important to clarify here that by disagreement, we don’t mean that researchers are (necessarily) fighting over it – just that there are relatively mixed findings within the empirical research , with no firm consensus amongst researchers.

This is a really important question to address as these “disagreements” will often set the stage for the research gap(s). In other words, they provide clues regarding potential opportunities for further research, which your study can then (hopefully) contribute toward filling. If you’re not familiar with the concept of a research gap, be sure to check out our explainer video covering exactly that .

3. Key Theories

The next question you need to ask yourself is: “Which key theories seem to be coming up repeatedly?” .

Within most research spaces, you’ll find that you keep running into a handful of key theories that are referred to over and over again. Apart from identifying these theories, you’ll also need to think about how they’re connected to each other. Specifically, you need to ask yourself:

• Are they all covering the same ground or do they have different focal points  or underlying assumptions ?
• Do some of them feed into each other and if so, is there an opportunity to integrate them into a more cohesive theory?
• Do some of them pull in different directions ? If so, why might this be?
• Do all of the theories define the key concepts and variables in the same way, or is there some disconnect? If so, what’s the impact of this ?

Simply put, you’ll need to pay careful attention to the key theories in your research area, as they will need to feature within your theoretical framework , which will form a critical component within your final literature review. This will set the foundation for your entire study, so it’s essential that you be critical in this area of your literature synthesis.

If this sounds a bit fluffy, don’t worry. We deep dive into the theoretical framework (as well as the conceptual framework) and look at practical examples in Literature Review Bootcamp . If you’d like to learn more, take advantage of our limited-time offer to get 60% off the standard price.

4. Contexts

The next question that you need to address in your literature synthesis is an important one, and that is: “Which contexts have (and have not) been covered by the existing research?” .

For example, sticking with our earlier hypothetical topic (factors that impact job satisfaction), you may find that most of the research has focused on white-collar , management-level staff within a primarily Western context, but little has been done on blue-collar workers in an Eastern context. Given the significant socio-cultural differences between these two groups, this is an important observation, as it could present a contextual research gap .

In practical terms, this means that you’ll need to carefully assess the context of each piece of literature that you’re engaging with, especially the empirical research (i.e., studies that have collected and analysed real-world data). Ideally, you should keep notes regarding the context of each study in some sort of catalogue or sheet, so that you can easily make sense of this before you start the writing phase. If you’d like, our free literature catalogue worksheet is a great tool for this task.

5. Methodological Approaches

Last but certainly not least, you need to ask yourself the question: “What types of research methodologies have (and haven’t) been used?”

For example, you might find that most studies have approached the topic using qualitative methods such as interviews and thematic analysis. Alternatively, you might find that most studies have used quantitative methods such as online surveys and statistical analysis.

But why does this matter?

Well, it can run in one of two potential directions . If you find that the vast majority of studies use a specific methodological approach, this could provide you with a firm foundation on which to base your own study’s methodology . In other words, you can use the methodologies of similar studies to inform (and justify) your own study’s research design .

On the other hand, you might argue that the lack of diverse methodological approaches presents a research gap , and therefore your study could contribute toward filling that gap by taking a different approach. For example, taking a qualitative approach to a research area that is typically approached quantitatively. Of course, if you’re going to go against the methodological grain, you’ll need to provide a strong justification for why your proposed approach makes sense. Nevertheless, it is something worth at least considering.

Regardless of which route you opt for, you need to pay careful attention to the methodologies used in the relevant studies and provide at least some discussion about this in your write-up. Again, it’s useful to keep track of this on some sort of spreadsheet or catalogue as you digest each article, so consider grabbing a copy of our free literature catalogue if you don’t have anything in place.

Bringing It All Together

Alright, so we’ve looked at five important questions that you need to ask (and answer) to help you develop a strong synthesis within your literature review.  To recap, these are:

• Which things are broadly agreed upon within the current research?
• Which things are the subject of disagreement (or at least, present mixed findings)?
• Which theories seem to be central to your research topic and how do they relate or compare to each other?
• Which contexts have (and haven’t) been covered?
• Which methodological approaches are most common?

Importantly, you’re not just asking yourself these questions for the sake of asking them – they’re not just a reflection exercise. You need to weave your answers to them into your actual literature review when you write it up. How exactly you do this will vary from project to project depending on the structure you opt for, but you’ll still need to address them within your literature review, whichever route you go.

The best approach is to spend some time actually writing out your answers to these questions, as opposed to just thinking about them in your head. Putting your thoughts onto paper really helps you flesh out your thinking . As you do this, don’t just write down the answers – instead, think about what they mean in terms of the research gap you’ll present , as well as the methodological approach you’ll take . Your literature synthesis needs to lay the groundwork for these two things, so it’s essential that you link all of it together in your mind, and of course, on paper.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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• University of Oregon Libraries
• Research Guides

How to Write a Literature Review

• 6. Synthesize
• Literature Reviews: A Recap
• Reading Journal Articles
• Does it Describe a Literature Review?
• 1. Identify the Question
• 2. Review Discipline Styles
• Searching Article Databases
• Finding Full-Text of an Article
• Citation Chaining
• When to Stop Searching
• 4. Manage Your References
• 5. Critically Analyze and Evaluate

Synthesis Visualization

Synthesis matrix example.

• 7. Write a Literature Review

• Synthesis Worksheet

About Synthesis

Approaches to synthesis.

You can sort the literature in various ways, for example:

How to Begin?

Read your sources carefully and find the main idea(s) of each source

Look for similarities in your sources – which sources are talking about the same main ideas? (for example, sources that discuss the historical background on your topic)

Use the worksheet (above) or synthesis matrix (below) to get organized

This work can be messy. Don't worry if you have to go through a few iterations of the worksheet or matrix as you work on your lit review!

Four Examples of Student Writing

In the four examples below, only ONE shows a good example of synthesis: the fourth column, or  Student D . For a web accessible version, click the link below the image.

Long description of "Four Examples of Student Writing" for web accessibility

• Download a copy of the "Four Examples of Student Writing" chart

Click on the example to view the pdf.

From Jennifer Lim

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• Next: 7. Write a Literature Review >>
• Last Updated: May 3, 2024 5:17 PM
• URL: https://researchguides.uoregon.edu/litreview

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How to Synthesize Written Information from Multiple Sources

Shona McCombes

Content Manager

B.A., English Literature, University of Glasgow

Shona McCombes is the content manager at Scribbr, Netherlands.

Learn about our Editorial Process

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

On This Page:

When you write a literature review or essay, you have to go beyond just summarizing the articles you’ve read – you need to synthesize the literature to show how it all fits together (and how your own research fits in).

Synthesizing simply means combining. Instead of summarizing the main points of each source in turn, you put together the ideas and findings of multiple sources in order to make an overall point.

At the most basic level, this involves looking for similarities and differences between your sources. Your synthesis should show the reader where the sources overlap and where they diverge.

Unsynthesized Example

Franz (2008) studied undergraduate online students. He looked at 17 females and 18 males and found that none of them liked APA. According to Franz, the evidence suggested that all students are reluctant to learn citations style. Perez (2010) also studies undergraduate students. She looked at 42 females and 50 males and found that males were significantly more inclined to use citation software ( p < .05). Findings suggest that females might graduate sooner. Goldstein (2012) looked at British undergraduates. Among a sample of 50, all females, all confident in their abilities to cite and were eager to write their dissertations.

Synthesized Example

Studies of undergraduate students reveal conflicting conclusions regarding relationships between advanced scholarly study and citation efficacy. Although Franz (2008) found that no participants enjoyed learning citation style, Goldstein (2012) determined in a larger study that all participants watched felt comfortable citing sources, suggesting that variables among participant and control group populations must be examined more closely. Although Perez (2010) expanded on Franz’s original study with a larger, more diverse sample…

Step 1: Organize your sources

After collecting the relevant literature, you’ve got a lot of information to work through, and no clear idea of how it all fits together.

Before you can start writing, you need to organize your notes in a way that allows you to see the relationships between sources.

One way to begin synthesizing the literature is to put your notes into a table. Depending on your topic and the type of literature you’re dealing with, there are a couple of different ways you can organize this.

Summary table

A summary table collates the key points of each source under consistent headings. This is a good approach if your sources tend to have a similar structure – for instance, if they’re all empirical papers.

Each row in the table lists one source, and each column identifies a specific part of the source. You can decide which headings to include based on what’s most relevant to the literature you’re dealing with.

For example, you might include columns for things like aims, methods, variables, population, sample size, and conclusion.

For each study, you briefly summarize each of these aspects. You can also include columns for your own evaluation and analysis.

The summary table gives you a quick overview of the key points of each source. This allows you to group sources by relevant similarities, as well as noticing important differences or contradictions in their findings.

Synthesis matrix

A synthesis matrix is useful when your sources are more varied in their purpose and structure – for example, when you’re dealing with books and essays making various different arguments about a topic.

Each column in the table lists one source. Each row is labeled with a specific concept, topic or theme that recurs across all or most of the sources.

Then, for each source, you summarize the main points or arguments related to the theme.

The purposes of the table is to identify the common points that connect the sources, as well as identifying points where they diverge or disagree.

Step 2: Outline your structure

Now you should have a clear overview of the main connections and differences between the sources you’ve read. Next, you need to decide how you’ll group them together and the order in which you’ll discuss them.

For shorter papers, your outline can just identify the focus of each paragraph; for longer papers, you might want to divide it into sections with headings.

There are a few different approaches you can take to help you structure your synthesis.

If your sources cover a broad time period, and you found patterns in how researchers approached the topic over time, you can organize your discussion chronologically .

That doesn’t mean you just summarize each paper in chronological order; instead, you should group articles into time periods and identify what they have in common, as well as signalling important turning points or developments in the literature.

If the literature covers various different topics, you can organize it thematically .

That means that each paragraph or section focuses on a specific theme and explains how that theme is approached in the literature.

Source Used with Permission: The Chicago School

If you’re drawing on literature from various different fields or they use a wide variety of research methods, you can organize your sources methodologically .

That means grouping together studies based on the type of research they did and discussing the findings that emerged from each method.

If your topic involves a debate between different schools of thought, you can organize it theoretically .

That means comparing the different theories that have been developed and grouping together papers based on the position or perspective they take on the topic, as well as evaluating which arguments are most convincing.

Step 3: Write paragraphs with topic sentences

What sets a synthesis apart from a summary is that it combines various sources. The easiest way to think about this is that each paragraph should discuss a few different sources, and you should be able to condense the overall point of the paragraph into one sentence.

This is called a topic sentence , and it usually appears at the start of the paragraph. The topic sentence signals what the whole paragraph is about; every sentence in the paragraph should be clearly related to it.

A topic sentence can be a simple summary of the paragraph’s content:

“Early research on [x] focused heavily on [y].”

For an effective synthesis, you can use topic sentences to link back to the previous paragraph, highlighting a point of debate or critique:

“Several scholars have pointed out the flaws in this approach.” “While recent research has attempted to address the problem, many of these studies have methodological flaws that limit their validity.”

By using topic sentences, you can ensure that your paragraphs are coherent and clearly show the connections between the articles you are discussing.

As you write your paragraphs, avoid quoting directly from sources: use your own words to explain the commonalities and differences that you found in the literature.

Don’t try to cover every single point from every single source – the key to synthesizing is to extract the most important and relevant information and combine it to give your reader an overall picture of the state of knowledge on your topic.

Step 4: Revise, edit and proofread

Like any other piece of academic writing, synthesizing literature doesn’t happen all in one go – it involves redrafting, revising, editing and proofreading your work.

Checklist for Synthesis

•   Do I introduce the paragraph with a clear, focused topic sentence?
•   Do I discuss more than one source in the paragraph?
•   Do I mention only the most relevant findings, rather than describing every part of the studies?
•   Do I discuss the similarities or differences between the sources, rather than summarizing each source in turn?
•   Do I put the findings or arguments of the sources in my own words?
•   Is the paragraph organized around a single idea?
•   Is the paragraph directly relevant to my research question or topic?
•   Is there a logical transition from this paragraph to the next one?

Further Information

How to Synthesise: a Step-by-Step Approach

Help…I”ve Been Asked to Synthesize!

Learn how to Synthesise (combine information from sources)

How to write a Psychology Essay

Related Articles

Student Resources

How To Cite A YouTube Video In APA Style – With Examples

How to Write an Abstract APA Format

APA References Page Formatting and Example

APA Title Page (Cover Page) Format, Example, & Templates

How do I Cite a Source with Multiple Authors in APA Style?

How to Write a Psychology Essay

Literature Review Basics

• What is a Literature Review?
• Synthesizing Research
• Using Research & Synthesis Tables
• Additional Resources

Synthesis: What is it?

First, let's be perfectly clear about what synthesizing your research isn't :

• - It isn't  just summarizing the material you read
• - It isn't  generating a collection of annotations or comments (like an annotated bibliography)
• - It isn't  compiling a report on every single thing ever written in relation to your topic

When you  synthesize  your research, your job is to help your reader understand the current state of the conversation on your topic, relative to your research question.  That may include doing the following:

• - Selecting and using representative work on the topic
• - Identifying and discussing trends in published data or results
• - Identifying and explaining the impact of common features (study populations, interventions, etc.) that appear frequently in the literature
• - Explaining controversies, disputes, or central issues in the literature that are relevant to your research question
• - Identifying gaps in the literature, where more research is needed
• - Establishing the discussion to which your own research contributes and demonstrating the value of your contribution

Essentially, you're telling your reader where they are (and where you are) in the scholarly conversation about your project.

Synthesis: How do I do it?

Synthesis, step by step.

This is what you need to do  before  you write your review.

• Identify and clearly describe your research question (you may find the Formulating PICOT Questions table at  the Additional Resources tab helpful).
• Collect sources relevant to your research question.
• Organize and describe the sources you've found -- your job is to identify what  types  of sources you've collected (reviews, clinical trials, etc.), identify their  purpose  (what are they measuring, testing, or trying to discover?), determine the  level of evidence  they represent (see the Levels of Evidence table at the Additional Resources tab ), and briefly explain their  major findings . Use a Research Table to document this step.
• Study the information you've put in your Research Table and examine your collected sources, looking for  similarities  and  differences . Pay particular attention to  populations ,   methods  (especially relative to levels of evidence), and  findings .
• Analyze what you learn in (4) using a tool like a Synthesis Table. Your goal is to identify relevant themes, trends, gaps, and issues in the research.  Your literature review will collect the results of this analysis and explain them in relation to your research question.

Analysis tips

• - Sometimes, what you  don't  find in the literature is as important as what you do find -- look for questions that the existing research hasn't answered yet.
• - If any of the sources you've collected refer to or respond to each other, keep an eye on how they're related -- it may provide a clue as to whether or not study results have been successfully replicated.
• - Sorting your collected sources by level of evidence can provide valuable insight into how a particular topic has been covered, and it may help you to identify gaps worth addressing in your own work.
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Literature Review How To

• Things To Consider
• Synthesizing Sources
• Video Tutorials
• Books On Literature Reviews

What is Synthesis

What is Synthesis? Synthesis writing is a form of analysis related to comparison and contrast, classification and division. On a basic level, synthesis requires the writer to pull together two or more summaries, looking for themes in each text. In synthesis, you search for the links between various materials in order to make your point. Most advanced academic writing, including literature reviews, relies heavily on synthesis. (Temple University Writing Center)  

How To Synthesize Sources in a Literature Review

Literature reviews synthesize large amounts of information and present it in a coherent, organized fashion. In a literature review you will be combining material from several texts to create a new text – your literature review.

You will use common points among the sources you have gathered to help you synthesize the material. This will help ensure that your literature review is organized by subtopic, not by source. This means various authors' names can appear and reappear throughout the literature review, and each paragraph will mention several different authors. 

When you shift from writing summaries of the content of a source to synthesizing content from sources, there is a number things you must keep in mind: 

• Look for specific connections and or links between your sources and how those relate to your thesis or question.
• When writing and organizing your literature review be aware that your readers need to understand how and why the information from the different sources overlap.
• Organize your literature review by the themes you find within your sources or themes you have identified. 
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• Last Updated: Nov 30, 2018 4:51 PM
• URL: https://libguides.csun.edu/literature-review

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• Research Guides

Literature Review: A Self-Guided Tutorial

• 6. Synthesize
• Literature Reviews: A Recap
• Peer Review
• Reading the Literature
• Using Concept Maps
• Developing Research Questions
• Considering Strong Opinions
• 2. Review discipline styles
• Super Searching
• Finding the Full Text
• Citation Searching This link opens in a new window
• When to stop searching
• Citation Management
• Annotating Articles Tip
• 5. Critically analyze and evaluate
• How to Review the Literature
• Using a Synthesis Matrix
• 7. Write literature review

You can sort the literature in various ways, for example:

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Library Guides

Literature reviews: synthesis.

• Criticality

Synthesise Information

So, how can you create paragraphs within your literature review that demonstrates your knowledge of the scholarship that has been done in your field of study?  

You will need to present a synthesis of the texts you read.  

Doug Specht, Senior Lecturer at the Westminster School of Media and Communication, explains synthesis for us in the following video:  

Synthesising Texts  

What is synthesis? 

Synthesis is an important element of academic writing, demonstrating comprehension, analysis, evaluation and original creation.  

With synthesis you extract content from different sources to create an original text. While paraphrase and summary maintain the structure of the given source(s), with synthesis you create a new structure.  

The sources will provide different perspectives and evidence on a topic. They will be put together when agreeing, contrasted when disagreeing. The sources must be referenced.  

Perfect your synthesis by showing the flow of your reasoning, expressing critical evaluation of the sources and drawing conclusions.  

When you synthesise think of "using strategic thinking to resolve a problem requiring the integration of diverse pieces of information around a structuring theme" (Mateos and Sole 2009, p448). 

Synthesis is a complex activity, which requires a high degree of comprehension and active engagement with the subject. As you progress in higher education, so increase the expectations on your abilities to synthesise. 

How to synthesise in a literature review: 

Identify themes/issues you'd like to discuss in the literature review. Think of an outline.  

Read the literature and identify these themes/issues.  

Critically analyse the texts asking: how does the text I'm reading relate to the other texts I've read on the same topic? Is it in agreement? Does it differ in its perspective? Is it stronger or weaker? How does it differ (could be scope, methods, year of publication etc.). Draw your conclusions on the state of the literature on the topic.  

Start writing your literature review, structuring it according to the outline you planned.  

Put together sources stating the same point; contrast sources presenting counter-arguments or different points.  

Present your critical analysis.  

Always provide the references. 

The best synthesis requires a "recursive process" whereby you read the source texts, identify relevant parts, take notes, produce drafts, re-read the source texts, revise your text, re-write... (Mateos and Sole, 2009). 

What is good synthesis?  

The quality of your synthesis can be assessed considering the following (Mateos and Sole, 2009, p439):  

Integration and connection of the information from the source texts around a structuring theme. 

Selection of ideas necessary for producing the synthesis. 

Appropriateness of the interpretation.  

Elaboration of the content.  

Example of Synthesis

Original texts (fictitious): 

Synthesis: 

Animal experimentation is a subject of heated debate. Some argue that painful experiments should be banned. Indeed it has been demonstrated that such experiments make animals suffer physically and psychologically (Chowdhury 2012; Panatta and Hudson 2016). On the other hand, it has been argued that animal experimentation can save human lives and reduce harm on humans (Smith 2008). This argument is only valid for toxicological testing, not for tests that, for example, merely improve the efficacy of a cosmetic (Turner 2015). It can be suggested that animal experimentation should be regulated to only allow toxicological risk assessment, and the suffering to the animals should be minimised.   

Bibliography

Mateos, M. and Sole, I. (2009). Synthesising Information from various texts: A Study of Procedures and Products at Different Educational Levels. European Journal of Psychology of Education,  24 (4), 435-451. Available from https://doi.org/10.1007/BF03178760 [Accessed 29 June 2021].

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• Last Updated: Nov 18, 2023 10:56 PM
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How to Write a Literature Review - A Self-Guided Tutorial

• Literature Reviews: A Recap
• Reading Journal Articles
• Does it describe a Literature Review?
• 1. Identify the question
• 2. Review discipline styles
• Searching article databases - video
• Finding the article full-text
• Citation trails
• When to stop searching
• Citation Managers
• 5. Critically analyze and evaluate
• 6. Synthesize
• 7. Write literature review
• Additional Resources

You can meet with a librarian to talk about your literature review, or other library-related topics.

You can sort the literature in various ways, for example:

Synthesis Vizualization

Four examples of student writing.

In the four examples below, only ONE shows a good example of synthesis: the fourth column, or  Student D . For a web accessible version, click the link below the image.

Long description of "Four Examples of Student Writing" for web accessibility

• Download a copy of the "Four Examples of Student Writing" chart

Synthesis Matrix Example

From Jennifer Lim

Synthesis Templates

Synthesis grids are organizational tools used to record the main concepts of your sources and can help you make connections about how your sources relate to one another.

• Source Template Basic Literature Review Source Template from Walden University Writing Center to help record the main findings and concepts from different articles.
• Sample Literature Review Grids This spreadsheet contains multiple tabs with different grid templates. Download or create your own copy to begin recording notes.
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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• 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 sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Writing a Literature Review: Organize, Synthesize, Evaluate

• Literature Review Process
• Literature Search
• Record your Search
• Organize, Synthesize, Evaluate
• Getting help

Table of Contents

On this page you will find:

Organizing Literature and Notes

How to scan an article.

• Reading for Comprehension
• Synthesis Matrix Information

Steps to take in organizing your literature and notes:

• Find common themes and organize the works into categories.
• Develop a subject level outline with studies you’ve found
• Expand or limit your search based on the information you found.
• How the works in each category relate to each other
• How the categories relate to each other and to your overall theme.

Available tools:

• Synthesis Matrix The "synthesis matrix" is an approach to organizing, monitoring, and documenting your search activities.
• Concept Mapping Concept Maps are graphic representations of topics, ideas, and their relationships. They allow users to group information in related modules so that the connections between and among the modules become more readily apparent than they might from an examination of a list. It can be done on paper or using specific software.
• Mind Mapping A mind map is a visual representation of hierarchical information that includes a central idea surrounded by connected branches of associated topics.
• NVIVO NVIVO is a qualitative data analysis software that can be applied for engineering literature review.

Synthesis Matrix

• Writing A Literature Review and Using a Synthesis Matrix Writing Center, Florida International University
• The Matrix Method of Literature Reviews Article from Health Promotion Practice journal.

Sample synthesis matrix

Synthesis matrix video

Skim the article to get the “big picture” for relevancy to your topic. You don’t have to understand every single idea in a text the first time you read it.

• Where was the paper published?
• What kind of journal it is? Is the journal peer-reviewed?
• Can you tell what the paper is about?
• Where are they from?
• What are the sections of the article?
• Are these clearly defined?  
• Can you figure out the purpose of the study, methodology, results and conclusion?
• Mentally review what you know about the topic
• Do you know enough to be able to understand the paper? If not, first read about the unfamiliar concepts  
• What is the overall context?
• Is the problem clearly stated?
• What does the paper bring new?
• Did it miss any previous major studies?
• Identify all the author’s assumptions.  
• Analyze the visuals for yourself and try to understand each of them. Make notes on what you understand. Write questions of what you do not understand. Make a guess about what materials/methods you expect to see. Do your own data interpretation and check them against the conclusions.  
• Do you agree with the author’s opinion?
• As you read, write down terms, techniques, unfamiliar concepts and look them up  
• Save retrieved sources to a reference manager

Read for Comprehension and Take Notes

Read for comprehension

• After first evaluation of sources, critically read the selected sources. Your goal is to determine how much of it to accept, determine its value, and decide whether you plan to include it in your literature review.
• Read the whole article, section by section but not necessarily in order and make sure you understand:

Introduction : What is known about the research and what is still unknown. Methods : What was measured? How was measured? Were the measurement appropriate? Did they offer sufficient evidence? Results : What is the main finding? Were there enough data presented? Were there problems not addressed? Discussions : Are these conclusions appropriate? Are there other factors that might have influenced? What does it need to be done to answer remaining questions?

• Find answers to your question from first step
• Formulate new questions and try to answer them
• Can you find any discrepancies? What would you have done differently?
• Re-read the whole article or just sections as many times you feel you need to
• When you believe that you have understood the article, write a summary in your own words (Make sure that there is nothing left that you cannot understand)

As you read, take (extensive) notes. Create your own system to take notes but be consistent. Remember that notes can be taken within the citation management tool.

What to write in your notes:

• identify key topic, methodology, key terms
• identify emphases, strengths, weaknesses, gaps (if any)
• determine relationships to other studies
• identify the relationship to your research topic
• new questions you have  
• suggestions for new directions, new sources to read
• everything else that seems relevant
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Chapter 7: Synthesizing Sources

Learning objectives.

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

• synthesize key sources connecting them with the research question and topic area.

7.1 Overview of synthesizing

7.1.1 putting the pieces together.

Combining separate elements into a whole is the dictionary definition of synthesis.  It is a way to make connections among and between numerous and varied source materials.  A literature review is not an annotated bibliography, organized by title, author, or date of publication.  Rather, it is grouped by topic to create a whole view of the literature relevant to your research question.

Your synthesis must demonstrate a critical analysis of the papers you collected as well as your ability to integrate the results of your analysis into your own literature review.  Each paper collected should be critically evaluated and weighed for “adequacy, appropriateness, and thoroughness” ( Garrard, 2017 ) before inclusion in your own review.  Papers that do not meet this criteria likely should not be included in your literature review.

Begin the synthesis process by creating a grid, table, or an outline where you will summarize, using common themes you have identified and the sources you have found. The summary grid or outline will help you compare and contrast the themes so you can see the relationships among them as well as areas where you may need to do more searching. Whichever method you choose, this type of organization will help you to both understand the information you find and structure the writing of your review.  Remember, although “the means of summarizing can vary, the key at this point is to make sure you understand what you’ve found and how it relates to your topic and research question” ( Bennard et al., 2014 ).

As you read through the material you gather, look for common themes as they may provide the structure for your literature review.  And, remember, research is an iterative process: it is not unusual to go back and search information sources for more material.

At one extreme, if you are claiming, ‘There are no prior publications on this topic,’ it is more likely that you have not found them yet and may need to broaden your search.  At another extreme, writing a complete literature review can be difficult with a well-trod topic.  Do not cite it all; instead cite what is most relevant.  If that still leaves too much to include, be sure to reference influential sources…as well as high-quality work that clearly connects to the points you make. ( Klingner, Scanlon, & Pressley, 2005 ).

7.2 Creating a summary table

Literature reviews can be organized sequentially or by topic, theme, method, results, theory, or argument.  It’s important to develop categories that are meaningful and relevant to your research question.  Take detailed notes on each article and use a consistent format for capturing all the information each article provides.  These notes and the summary table can be done manually, using note cards.  However, given the amount of information you will be recording, an electronic file created in a word processing or spreadsheet is more manageable. Examples of fields you may want to capture in your notes include:

• Authors’ names
• Article title
• Publication year
• Main purpose of the article
• Methodology or research design
• Participants
• Measurement
• Conclusions

  Other fields that will be useful when you begin to synthesize the sum total of your research:

• Specific details of the article or research that are especially relevant to your study
• Key terms and definitions
• Strengths or weaknesses in research design
• Relationships to other studies
• Possible gaps in the research or literature (for example, many research articles conclude with the statement “more research is needed in this area”)
• Finally, note how closely each article relates to your topic.  You may want to rank these as high, medium, or low relevance.  For papers that you decide not to include, you may want to note your reasoning for exclusion, such as ‘small sample size’, ‘local case study,’ or ‘lacks evidence to support assertion.’

This short video demonstrates how a nursing researcher might create a summary table.

7.2.1 Creating a Summary Table

  Summary tables can be organized by author or by theme, for example:

For a summary table template, see http://blogs.monm.edu/writingatmc/files/2013/04/Synthesis-Matrix-Template.pdf

7.3 Creating a summary outline

An alternate way to organize your articles for synthesis it to create an outline. After you have collected the articles you intend to use (and have put aside the ones you won’t be using), it’s time to identify the conclusions that can be drawn from the articles as a group.

  Based on your review of the collected articles, group them by categories.  You may wish to further organize them by topic and then chronologically or alphabetically by author.  For each topic or subtopic you identified during your critical analysis of the paper, determine what those papers have in common.  Likewise, determine which ones in the group differ.  If there are contradictory findings, you may be able to identify methodological or theoretical differences that could account for the contradiction (for example, differences in population demographics).  Determine what general conclusions you can report about the topic or subtopic as the entire group of studies relate to it.  For example, you may have several studies that agree on outcome, such as ‘hands on learning is best for science in elementary school’ or that ‘continuing education is the best method for updating nursing certification.’ In that case, you may want to organize by methodology used in the studies rather than by outcome.

Organize your outline in a logical order and prepare to write the first draft of your literature review.  That order might be from broad to more specific, or it may be sequential or chronological, going from foundational literature to more current.  Remember, “an effective literature review need not denote the entire historical record, but rather establish the raison d’etre for the current study and in doing so cite that literature distinctly pertinent for theoretical, methodological, or empirical reasons.” ( Milardo, 2015, p. 22 ).

As you organize the summarized documents into a logical structure, you are also appraising and synthesizing complex information from multiple sources.  Your literature review is the result of your research that synthesizes new and old information and creates new knowledge.

7.4 Additional resources:

Literature Reviews: Using a Matrix to Organize Research / Saint Mary’s University of Minnesota

Literature Review: Synthesizing Multiple Sources / Indiana University

Writing a Literature Review and Using a Synthesis Matrix / Florida International University

 Sample Literature Reviews Grid / Complied by Lindsay Roberts

Select three or four articles on a single topic of interest to you. Then enter them into an outline or table in the categories you feel are important to a research question. Try both the grid and the outline if you can to see which suits you better. The attached grid contains the fields suggested in the video .

Literature Review Table  

Test yourself.

• Select two articles from your own summary table or outline and write a paragraph explaining how and why the sources relate to each other and your review of the literature.
• In your literature review, under what topic or subtopic will you place the paragraph you just wrote?

Image attribution

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

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Literature Reviews

• Introduction
• Tutorials and resources
• Step 1: Literature search
• Step 2: Analysis, synthesis, critique
• Step 3: Writing the review

If you need any assistance, please contact the library staff at the Georgia Tech Library Help website . 

Analysis, synthesis, critique

Literature reviews build a story. You are telling the story about what you are researching. Therefore, a literature review is a handy way to show that you know what you are talking about. To do this, here are a few important skills you will need.

Skill #1: Analysis

Analysis means that you have carefully read a wide range of the literature on your topic and have understood the main themes, and identified how the literature relates to your own topic. Carefully read and analyze the articles you find in your search, and take notes. Notice the main point of the article, the methodologies used, what conclusions are reached, and what the main themes are. Most bibliographic management tools have capability to keep notes on each article you find, tag them with keywords, and organize into groups.

Skill #2: Synthesis

After you’ve read the literature, you will start to see some themes and categories emerge, some research trends to emerge, to see where scholars agree or disagree, and how works in your chosen field or discipline are related. One way to keep track of this is by using a Synthesis Matrix .

Skill #3: Critique

As you are writing your literature review, you will want to apply a critical eye to the literature you have evaluated and synthesized. Consider the strong arguments you will make contrasted with the potential gaps in previous research. The words that you choose to report your critiques of the literature will be non-neutral. For instance, using a word like “attempted” suggests that a researcher tried something but was not successful. For example: 

There were some attempts by Smith (2012) and Jones (2013) to integrate a new methodology in this process.

On the other hand, using a word like “proved” or a phrase like “produced results” evokes a more positive argument. For example:

The new methodologies employed by Blake (2014) produced results that provided further evidence of X.

In your critique, you can point out where you believe there is room for more coverage in a topic, or further exploration in in a sub-topic.

Need more help?

If you are looking for more detailed guidance about writing your dissertation, please contact the folks in the Georgia Tech Communication Center .

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• Next: Step 3: Writing the review >>
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Writing the Literature Review

• Getting Started
• Step 1: Choose A Topic
• Step 2: Find Information
• Step 3: Evaluate
• Step 4: Take Notes
• Step 5: Synthesize
• Step 6: Stay Organized
• Write the Review

Synthesizing

What is "Synthesis"?

Synthesis?  

Synthesis refers to combining separate elements to create a whole.  When reading through your sources (peer reviewed journal articles, books, research studies, white papers etc.) you will pay attention to relationships between the studies, between groups in the studies, and look for any pattterns,  similarities or differences.  Pay attention to methodologies, unexplored themes, and things that may represent a "gap" in the literature.  These "gaps" will be things you will want to be sure to identify in your literature review.  

• Using a Synthesis Matrix to Plan a Literature Review Introduction to synthesis matrices, and explanation of the difference between synthesis and analysis. (Geared towards Health Science/ Nursing but applicable for other literature reviews) ***Includes a synthesis matrix example***
• Using a Spider Diagram Organize your thoughts with a spider diagram

Ready, Set...Synthesize

• Create an outline that puts your topics (and subtopics) into a logical order
• Look at each subtopic that you have identified and determine what the articles in that group have in common with each other
• Look at the articles in those subtopics that you have identified and look for areas where they differ.
• If you spot findings that are contradictory, what differences do you think could account for those contradictions?  
• Determine what general conclusions can be reported about that subtopic, and how it relates to the group of studies that you are discussing
• As you write, remember to follow your outline, and use transitions as you move between topics 

Galvan, J. L. (2006). Writing literature reviews (3rd ed.). Glendale, CA: Pyrczak Publishing

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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Open Access

Peer-reviewed

Research Article

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

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

* E-mail: [email protected]

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

Roles Investigation, Methodology, Writing – review & editing

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

Roles Supervision, Validation, Writing – review & editing

• Paulina Rudziak, 
• Evans Batung, 
• Isaac Luginaah

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

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

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

Editor: Helen Onyeaka, University of Birmingham, UNITED KINGDOM

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

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

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

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

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

Introduction

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

Level of analysis

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

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

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

The current solutions to food waste emissions

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

Relevance of this study

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

Hypothesis and objectives

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

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

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

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

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

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

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

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

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

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

Results and discussion

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

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

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

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

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

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

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

Classification of food waste emissions

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

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

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

Seasonal fluctuations in food waste emissions

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

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

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

Connection to human health

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

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

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

Key components in food waste

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

Bioaerosols

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

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

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

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

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

Potential solutions to food waste emissions

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

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

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

Public policies

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

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

Limitations and strengths

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

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

Areas for future research

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

Conclusions

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

Supporting information

S1 fig. search strategy strings..

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

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

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

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

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

S4 Fig. Articles from references.

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

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

S5 Fig. Critical appraisals of search strategy 2021.

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

S6 Fig. Critical appraisals of search strategy 2022.

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

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

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

Acknowledgments

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

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The relationship between Imposter syndrome, household income, and level of education

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Miebaka Favour Roberts , Liberty University Follow

Poster - Theoretical Proposal

Description

Background: Imposter syndrome has been documented in the literature as a challenge across all professional fields, for men and women. Imposter syndrome is defined as a state of high-performing individuals attributing achievements to luck and contingency rather than skill and merit. Those experiencing imposter syndrome often live in fear of being exposed as a fraud or losing credibility. Methods: The current study applies the Literature Matrix Method by Judith Garrad to aggregate and synthesize literature for three factors: Imposter Syndrome, household income, and educational level. Further, inclusion criteria for search terms included publication year (2019-2023), document type (Peer-reviewed), and language (English). Database searches included ProQuest Central, PubMed, and Google Scholar. Results: Initial searches were screened for inclusion criteria with only full-text articles selected for review. Several articles were excluded due to insufficient relevance to the terms: imposter syndrome AND income OR educational level. The final pool of articles was added to the Literature Matrix and patterns and themes identified to identify potential correlations between factors. Conclusion: Results indicate further research is needed to understand the correlation between education, household income, and imposter syndrome. Future research can provide insight into how to provide professional development and interventions to mitigate this concerning challenge among working professionals.

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Investigating Success in the Transition to University: A Systematic Review of Personal Risk and Protective Factors Influencing Academic Achievement

• Review Article
• Published: 18 May 2024
• Volume 36 , article number  52 , ( 2024 )

Cite this article

• Isabelle Ball   ORCID: orcid.org/0009-0000-6025-2021 1 ,
• Moitree Banerjee   ORCID: orcid.org/0000-0002-7031-8909 1 ,
• Andrew Holliman   ORCID: orcid.org/0000-0002-3132-6666 2 &
• Ian Tyndall   ORCID: orcid.org/0000-0003-2108-9203 1  

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The transition to university is a time of great change and adjustment. The challenges of university life can lead to numerous negative consequences for the students. Despite the importance of successful transition for both the student and the university, the current body of literature comprises methodological inconsistencies and disparate analytical goals that make it difficult to identify the most salient and effective factors that help predict transition success. This paper presents a systematic review of research linking personal level risk and protective factors to the outcome of academic achievement among students making the transition to university. This is part of a larger review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis Without Meta-analysis (SWiM) guidelines, preregistered on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022330515), searching PsychInfo, Web of Science, and ERIC databases. Records were included if they studied ‘traditional’ first year students transitioning to university and were longitudinal in design and excluded if they looked at specific subgroups of students (e.g. international students). The search yielded 27 articles that were eligible, highlighting a broad range of salient factors ranging from personality traits to procrastination and perfectionism. The findings are discussed in relation to moving the research forward towards an intervention to enhance the probability of successful student transition to university.

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Full details of data extraction can be found in the Supplementary Materials.

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Ball, I., Banerjee, M., Holliman, A. et al. Investigating Success in the Transition to University: A Systematic Review of Personal Risk and Protective Factors Influencing Academic Achievement. Educ Psychol Rev 36 , 52 (2024). https://doi.org/10.1007/s10648-024-09891-0

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Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review

• Agani Afaya 1 , 2 ,
• Emmanuel Anongeba Anaba 3 ,
• Victoria Bam 4 ,
• Richard Adongo Afaya 5 ,
• Ahmed-Rufai Yahaya 6 ,
• Abdul-Aziz Seidu 7 &
• Bright Opoku Ahinkorah 8  

BMC Women's Health volume  24 , Article number:  288 ( 2024 ) Cite this article

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Breast cancer is currently the most commonly diagnosed cancer in Ghana and the leading cause of cancer mortality among women. Few published empirical evidence exist on cultural beliefs and perceptions about breast cancer diagnosis and treatment in Ghana. This systematic review sought to map evidence on the socio-cultural beliefs and perceptions influencing the diagnosis and treatment of breast cancer among Ghanaian women.

This review was conducted following the methodological guideline of Joanna Briggs Institute and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The literature search was conducted in PubMed, CINAHL via EBSCO host , PsycINFO, Web of Science, and Embase. Studies that were conducted on cultural, religious, and spiritual beliefs were included. The included studies were screened by title, abstract, and full text by three reviewers. Data were charted and results were presented in a narrative synthesis form.

After the title, abstract, and full-text screening, 15 studies were included. Three categories were identified after the synthesis of the charted data. The categories included: cultural, religious and spiritual beliefs and misconceptions about breast cancer. The cultural beliefs included ancestral punishment and curses from the gods for wrongdoing leading to breast cancer. Spiritual beliefs about breast cancer were attributed to spiritual or supernatural forces. People had the religious belief that breast cancer is a test from God and they resorted to prayers for healing. Some women perceived that breast cancer is caused by spider bites, heredity, extreme stress, trauma, infections, diet, or lifestyle.

This study adduces evidence of the socio-cultural beliefs that impact on the diagnosis and treatment of breast cancer among women in Ghana. Taking into consideration the diverse cultural and traditional beliefs about breast cancer diagnosis and treatment, there is a compelling need to intensify nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. We recommend the need to incorporate socio-cultural factors influencing breast cancer diagnosis and treatment into breast cancer awareness programs, education, and interventions in Ghana.

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Introduction

Breast cancer is a global public health concern due to its increasing incidence coupled with the high mortality rate among women in low- and high-income countries [ 1 ]. In 2020, it was estimated that 2.3 million breast cancer cases were newly diagnosed with approximately 685,000 deaths globally [ 1 ]. In Ghana, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women [ 2 ]. In 2020, breast cancer accounted for approximately 31.8% of all cancer cases in Ghana [ 3 ].

Evidence shows that cultural factors such as conceptualizations of health, illness, beliefs, and values influence breast cancer screening among women in certain populations [ 4 , 5 , 6 ]. Breast cancer screening is reported to be relatively low among women living in Ghana. A nationwide study revealed that only 4.5% of Ghanaian women aged 50 years and older had undergone mammography screening [ 7 ]. The low levels of breast cancer screening lead to undetected breast cancer symptoms, contributing to the late-stage diagnosis of breast cancer and subsequent poorer outcomes and mortality [ 8 ]. There have been low levels of awareness and knowledge about breast cancer among women in Ghana [ 9 ]. Also, there is a lack of understanding of the perceptions and beliefs toward breast cancer diagnosis and treatment in Ghana.

Culture is considered a multidimensional set of shared beliefs and socially transmitted ideologies about the world, which are passed on from generation to generation [ 10 , 11 ]. Cultural beliefs within certain communities across the globe are considered a determinant of health risk perceptions and behaviors in promoting or seeking health care in diverse populations [ 12 ]. In traditional Ghanaian communities, good health is recognized as a suitable relationship between the living and the dead and being in harmony with the individuals’ environment. Thus, disease is conceptualized as a malfunctioning of the body system which is probably due to a lack of harmony with supernatural/ancestral forces [ 13 ]. This belief influences how diseases are treated and the steps taken to manage the disease and ultimately how the disease is experienced [ 13 , 14 ]. Cultural beliefs connected to breast cancer are among the key determinants in women’s decision-making regarding breast cancer screening practices in traditional societies [ 14 , 15 ]. In most Ghanaian communities, breast cancer is believed to be associated with supernatural powers, hence, women seek alternative treatments (healing/prayer camps) first and only report to health facilities in advanced stages of breast cancer [ 16 ].

It is therefore important to consider how socio-cultural factors impact breast cancer diagnosis and treatment because these factors influence cancer care in resource-limited settings. To the best of our knowledge, no review has been conducted in Ghana specifically to address the cultural, religious, and spiritual beliefs influencing timely diagnosis and treatment of breast cancer among women. To fill this gap, this systematic review sought to map evidence on the cultural beliefs and perceptions that influence the timely diagnosis and treatment of breast cancer among women.

This systematic review was conducted following the updated methodological guideline of Joanna Briggs Institute (JBI) [ 17 , 18 ] and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The updated JBI methodological guidance regarding conducting a mixed methods systematic review recommends that reviewers use a convergent approach to synthesize and integrate both qualitative and quantitative studies [ 18 ]. Therefore, using a mixed methods systematic review involving both quantitative and qualitative studies was deemed the most appropriate study design because this is the first evidence synthesis on the cultural, religious, and spiritual beliefs that influence breast cancer diagnosis and treatment in Ghana.

Inclusion and exclusion criteria

Studies conducted among women and explored the cultural beliefs and perceptions about breast cancer were included.

Studies that were only limited to Ghanaian communities were included.

Empirical studies published in peer-review journals.

Observational studies, using qualitative and/or quantitative methods were also included.

The exclusion criteria involved review studies, conference papers, editorials and abstracts.

Studies published before 2012 were also excluded.

Search strategy

This review adopted the triple-step search strategy proposed by the JBI for all types of reviews [ 19 ]. The first step involved an initial limited search in PubMed for already existing published research articles on sociocultural beliefs and perceptions about breast cancer in Ghana. The initial limited search ensured the identification of relevant keywords used in developing the preliminary search terms. Step two involved a formal search after finalizing and combining the following keywords (‘breast cancer’, ‘cultural beliefs’, ‘religious beliefs’, ‘traditional beliefs’, ‘perception’, and ‘Ghana’) using Boolean operators. A comprehensive search was conducted in PubMed, CINAHL via EBSCO host , PsycINFO, Web of Science, and Embase from 2012–2022. The final step involved manual tracing of the reference list of studies for additional studies. This was done up to the point of saturation where no new information emanated from the subsequent manual search of articles.

Study selection

Following the searches, the identified records were exported into EndNote 2020 reference manager for duplicate removal. After the duplicate removal, the reviewers ensured consistency in screening through the following process: (1) joint screening by two reviewers was conducted until they felt confident to start independent screening, (2) independent blinded screening of titles/abstracts followed by a meeting and discussion of discrepancies and (3) repetition of step 2 until an acceptable agreement was met. Following the screening of the titles/abstracts, full-text review was conducted following a two-step process. The first step involved two reviewers who screened all the articles identified after the title/abstract screening. Thereafter, two independent reviewers assessed the full-text articles for inclusion or exclusion. In the course of the full-text screening, any disagreements that emerged were discussed for consensus. Throughout the screening of the abstracts, full-texts, and data extraction, the reviewers regularly met to discuss and solve emerging issues.

Data extraction

A data extraction form was developed in line with the aim of this review. Two authors independently extracted the relevant information from the included articles. The following information was extracted from the articles: first author’s name, year of publication, study location, study type, aim, study population, and key findings. Disagreements during the data extraction process were resolved by a discussion and where a resolution was not reachable, the last author resolved it through further adjudication. Study selection and data extraction were conducted manually.

Data analysis

A convergent integrated approach [ 20 ] was employed to transform the data into narrative form because the extracted information was from quantitative and qualitative studies. The analysis followed JBI recommendation where we qualitized quantitative data for data transformation because this is less prone to error when codified than when qualitative data is given numerical values. Qualitizing entails taking data from quantitative studies, translating or converting it into textual descriptions so that it can be integrated with qualitative data, and providing a narrative interpretation of the quantitative results [ 18 ]. Following the convergent synthesis of the transformed data, the reviewers undertook repeated, detailed examination of the assembled data to identify categories on the basis of similarity in meaning [ 18 ]. Out of these, three categories were derived from the analysis.

Assessment of methodological quality

Using the Mixed Methods Appraisal Tool (MMAT)  version 2018, two researchers (AA and RAA) evaluated each included study’s quality separately [ 21 ]. After discussing disagreements between the two reviewers (AA and RAA), BOA helped to forge a consensus. Methodological quality standards for evaluating research using mixed methodologies, quantitative, and qualitative approaches are included in the MMAT. The MMAT assesses the suitability of the research objective, study design, technique, participant recruitment, data collection, data analysis, results presentation, author comments, and conclusions. Hong et al. [ 21 ] discourages the overall quality scoring of the included studies, therefore, the methodological quality of the studies was evaluated using the recommended guidelines.

Flow Chart of evidence selection

Literature search

Our search yielded a total of 176 records from the electronic databases. After duplicates were automatically removed through the EndNote ( n  = 76), 100 records were reviewed independently by two authors based on the title and abstract. Records that did not meet the inclusion ( n  = 75) were removed after holding discussions to identify discrepancies in the review process. Thereafter, full texts of the remaining 25 articles were assessed for eligibility. Hand-search of the included study references yielded no results. In total, we included 15 studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The article selection process is shown in the PRISMA flow diagram (Fig.  1 ).

Characteristics of the included studies and quality

The majority of the studies [ 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] were conducted in the southern part of Ghana where there are better health infrastructures compared to the northern part of Ghana. Eight of the included studies were qualitative while the rest employed quantitative study designs. The summary of the characteristics of the 15 studies is shown in Table  1 . The appraisal of the included studies was assessed using the MMAT. All the studies were included, and none were excluded due to poor methodological quality. All 15 studies met the screening criteria and provided clear research questions. The studies included clearly stated and described research design, and target population, and used appropriate measurements.

Cultural beliefs

Breast cancer is believed by some sections of Ghanaians to be a curse or a punishment from the lesser gods for sins committed by the individual [ 22 ]. Some women believed that an extra-marital immoral lifestyle provokes God’s retribution for breast cancer development [ 29 ]. Some people believed that it is an ancestral punishment for the woman’s refusal to give birth in order to continue the ancestral lineage [ 23 ] and because of this, they are given spiritual babies to suckle the breast which then causes cancer [ 23 ]. It is also believed some women have been pronounced cursed due to some wrongdoings [ 25 ]. Due to the cultural belief, some women prayed to their ancestors so that traditional medicine will heal them of the breast cancer [ 26 ].

“…when it started, my uncles came to my aid, they took me to the village to see a “Tim Lana” (referring to a traditional healer). He was very good. He told me everything about my problem. So, there was no need for visiting the hospital…” [ 36 ].

Spiritual and religious beliefs

Some studies in Greater Accra, Tamale, and Kumasi indicated that breast cancer was a spiritual attack from humans or family members that sought to kill them while some believe it emanated from evil forces [ 29 , 31 , 36 ]. Participants in some studies indicated that breast cancer is attributed to some spiritual or supernatural forces [ 32 , 33 , 36 ] and can only be cured through spiritual means [ 33 ]. Due to the spiritual beliefs, some women went to traditional healers for treatment [ 26 , 36 ]. A study in the northern part of Ghana revealed that women who suffer from breast cancer are witches and have used their breasts for ritual purposes [ 25 ] while in the southern part of Ghana some participants believed that breast cancer is caused by witches [ 22 ]. For example, a narration from a participant stated:

“I believe my condition is spiritual and I realized it is coming from my mother’s side” [ 31 ].

“The problem is that my disease is a spiritual attack, so it has to be treated spiritually; the hospital drugs cannot get this out of me…” [ 36 ].

Some studies in the southern and northern part of Ghana stated that participants had a religious belief that the disease was a test from God and resulted in prayers for healing [ 31 , 36 ] and also believed that God had the supernatural powers to miraculously melt the breast lump [ 29 , 32 ] and completely cure them [ 32 ]. Some women also believed that it was their fate to get breast cancer [ 36 ]. Due to these religious beliefs some women had to resort to prayer camps for healing which leads to delay in diagnosis and treatment of breast cancer [ 26 ].

Misconceptions about breast cancer

Some women perceived that breast cancer is caused by spider bites [ 24 ], heredity, extreme stress [ 22 , 32 ], trauma, infections [ 22 ], diet, or lifestyle [ 22 , 35 ]. Some perceived risk factors of breast cancer as stated by some women included non-breastfeeding women, obesity, or overweight [ 25 , 30 , 33 ], and contraceptive use [ 30 ]. Some women had the perception that male health practitioners would not be allowed to examine or see their breasts while some preferred male doctors to examine their breasts [ 27 ]. A study in Accra conducted among female nonmedical students revealed that suckling the breast by a male caused breast cancer [ 28 ]. It is also perceived that putting money in the brassieres could be a possible cause of breast cancer among females [ 23 , 35 ]. A study by Iddrisu et al. [ 31 ] and Agbokey [ 23 ] revealed that breast cancer is a disgraceful disease, dangerous, and a fast killer. Some people also believed that breast cancer can be cured [ 27 , 32 ] by herbal treatment or medicine [ 25 ] while some believed that it is not curable [ 27 ]. Some people also believed that breast cancer was contagious and transmissible and avoided sharing equipment with breast cancer survivors [ 31 ]. A breast cancer survivor narrated:

“…my mum believes the disease can be transmitted so she does not allow me to eat with my son. I have separate bowls, spoons, and cups from that of the family…” [ 31 ].

This study reviews the existing literature on socio-cultural beliefs influencing the timely diagnosis and treatment of breast cancer among women, and this revealed diverse cultural, spiritual, and religious beliefs across the regions of Ghana. The current findings emphasize critical issues that lead to misguidance and share ignorance about breast cancer and its treatment among a section of Ghanaian communities which is rooted in their personal beliefs. Cultural beliefs are key in the decision-making process for the treatment of ailments depending on their knowledge level about the condition. This could probably lead to making the right decision or the wrong treatment decision. The diverse cultural, spiritual, and religious beliefs about breast cancer could affect the health seeking behavior of women diagnosed with breast cancer within the Ghanaian communities.

Consistent with a systematic review findings [ 13 ] it is believed that breast cancer emanates as a result of supernatural forces, curses, and punishment from lesser gods/ancestors for wrongdoings. Though not all Africans hold this traditional belief in ancestral spirits, some believe that health and illness are in the hands of a higher power such as God or Allah [ 13 ]. Hence, in most African communities it is common practice to seek traditional medicine for the treatment of diseases which is in line with their beliefs [ 37 ]. Due to the cultural/traditional belief systems and practices, most women report to health facilities with advanced stages of breast cancer which adversely impacts the breast cancer diagnosis and treatment [ 36 ]. Most women resort to traditional or spiritual healing because this method of treatment combines body, soul, and spirit. In some African settings, traditional healers are trusted to treat diseases including cancer because women believe they look for both scientific and metaphysical causes of the disease. It is possible that breast cancer patients who combine both traditional and modern methods of treatment may experience treatment interference. This dual approach can impact treatment effectiveness and lead to adverse effects or complications. The provision of culturally sensitive care by recognizing unique cultural, religious, and social beliefs and practices is of paramount importance for early detection and treatment of breast cancer among women [ 38 , 39 , 40 ]. Globally, women’s cultural beliefs and perceptions towards breast cancer should be examined to optimize timely breast cancer diagnosis and treatment.

Religious fanaticism coupled with lack of knowledge about the disease condition could impede the utilization of medical treatment, especially when religious beliefs impact negatively on people’s health-seeking behaviors [ 36 ]. A study in Nigeria revealed that religious beliefs about breast cancer were observed to be a barrier to breast cancer screening among women [ 41 ]. This review found that some women in the southern part of Ghana believed that breast cancer was a test from God and resorted to prayers because they believed that God had supernatural powers to heal them from the disease. Though religious beliefs are considered to be a source of spiritual strength and help people to cope with the disease, the religious misconceptions, and mistaken beliefs are thought to contribute to delayed heath-seeking attitudes and lack of breast cancer screening among women [ 42 ]. In the current review, it was reported that some women stayed in prayer camps for almost one year seeking healing and later reported to health facilities with advanced breast cancer which has dire consequences on the survival rate of women. Efforts to sensitize women and religious leaders about the early presentation of breast disease to health facilities for diagnosis and treatment would be key to reduce the number of breast cancer cases detained in religious camps. It is also imperative for religious bodies to discuss health related issues including breast cancer to create much awareness about the condition.

This review identified varied perceptions of breast cancer where breast cancer has been attributed to spider bites and putting money in the brassieres among others. Some believed that breast cancer was a contagious and transmissible disease. These findings show poor knowledge level among women concerning breast cancer. Even though in this review most women had heard or were aware of breast cancer, the varied perceptions about breast cancer suggests low knowledge level of breast cancer. The low knowledge level of breast cancer among women have been associated with late presentation of breast cancer to health facilities [ 40 ]. Women presenting to health facilities with advanced stage breast cancer have been associated with low survival rate in the African region as compared to high income countries [ 43 ]. A study conducted in Ghana revealed that the breast cancer survival rate among women was below 50% which was probably due to late presentation and lack of breast cancer screening [ 44 ]. We recommend intensification of public health education campaigns on breast cancer in order to improve women’s knowledge of the disease which will subsequently enhance early presentation, diagnosis, and treatment.

Implication for policy and practice

Metaphors such as spider bites, supernatural forces, witchcraft, and many other beliefs are associated with breast cancer in Ghana which impact the understanding of the disease and whether or not to seek medical treatment. Therefore, culturally sensitive intervention programs targeted at improving breast cancer awareness among women, religious and traditional leaders are imperative. These intervention programs could entail community engagement, workshops, or educational materials tailored to address specific cultural beliefs and misconceptions.

Taking into consideration the diverse cultural beliefs about breast cancer, there is a compelling need for nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. The education program should be culturally tailored to address the myths and misconceptions. It is important that considerations are given to these issues, not only focusing on how these issues affect women’s lives post-treatment but also on how these issues can be resolved to improve diagnosis and treatment of the disease. We recommend that socio-cultural factors influencing breast cancer diagnosis and treatment should be incorporated into breast cancer awareness programs, education, and intervention programs in Ghana. We believe these would help inform women and encourage them to report to health facilities early with breast cancer symptoms to initiate timely diagnosis and treatment to improve the outcomes of the disease in Ghana.

Further research is required to explore appropriate and effective multidimensional culturally sensitive intervention research that integrates cultural beliefs and breast cancer treatment especially, in different Ghanaian communities.

Strengths and limitations of the study

This study has several strengths, one major strength is the extensive and comprehensive search in various electronic databases following the methodological guideline of JBI and reported in accordance with the PRISMA guidelines. Also, the inclusion of both qualitative and quantitative studies, allowed for a more comprehensive understanding of the socio-cultural beliefs influencing breast cancer diagnosis and treatment in Ghana.

The review considered only published studies and possibly may have overlooked unpublished or gray literature that could contribute to a more comprehensive understanding of the subject matter. Most of the studies were concentrated in the southern part of Ghana and therefore the results might not represent all the regions in Ghana.

This study adduces evidence on the socio-cultural beliefs that impact diagnosis and treatment of breast cancer among women in Ghana. As policy makers, clinicians and other stakeholders strive to improve breast cancer diagnosis and treatment, there is a need to address the socio-cultural beliefs to improve breast cancer outcomes in Ghana and potentially reduce breast cancer-related mortality.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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AA, and EAA conceived the study, analyzed and wrote the methods section. AA, VB and RAA conducted the literature search and wrote the background. AA, RAA, and RY screened the included articles and extracted the data. AA, AS and BOA conducted literature search and discussed the results. All the authors reviewed and provided intellectual content and modification. All the authors reviewed and approved the final draft of the manuscript.

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Book Reviews

Two new novels investigate what makes magic, what is real and imagined.

Marcela Davison Avilés

In an enchanted world, where does mystery begin? Two authors pose this question in new novels out this spring.

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