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A systematic review of the content of critical appraisal tools

Persis katrak.

1 Centre for Allied Health Evidence: A Collaborating Centre of the Joanna Briggs Institute, City East Campus, University of South Australia, North Terrace, Adelaide, 5000, Australia

Andrea E Bialocerkowski

2 School of Physiotherapy, The University of Melbourne, Melbourne, 3010, Australia

Nicola Massy-Westropp

Vs saravana kumar, karen a grimmer.

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Associated Data

Consumers of research (researchers, administrators, educators and clinicians) frequently use standard critical appraisal tools to evaluate the quality of published research reports. However, there is no consensus regarding the most appropriate critical appraisal tool for allied health research. We summarized the content, intent, construction and psychometric properties of published, currently available critical appraisal tools to identify common elements and their relevance to allied health research.

A systematic review was undertaken of 121 published critical appraisal tools sourced from 108 papers located on electronic databases and the Internet. The tools were classified according to the study design for which they were intended. Their items were then classified into one of 12 criteria based on their intent. Commonly occurring items were identified. The empirical basis for construction of the tool, the method by which overall quality of the study was established, the psychometric properties of the critical appraisal tools and whether guidelines were provided for their use were also recorded.

Eighty-seven percent of critical appraisal tools were specific to a research design, with most tools having been developed for experimental studies. There was considerable variability in items contained in the critical appraisal tools. Twelve percent of available tools were developed using specified empirical research. Forty-nine percent of the critical appraisal tools summarized the quality appraisal into a numeric summary score. Few critical appraisal tools had documented evidence of validity of their items, or reliability of use. Guidelines regarding administration of the tools were provided in 43% of cases.

Conclusions

There was considerable variability in intent, components, construction and psychometric properties of published critical appraisal tools for research reports. There is no "gold standard' critical appraisal tool for any study design, nor is there any widely accepted generic tool that can be applied equally well across study types. No tool was specific to allied health research requirements. Thus interpretation of critical appraisal of research reports currently needs to be considered in light of the properties and intent of the critical appraisal tool chosen for the task.

Consumers of research (clinicians, researchers, educators, administrators) frequently use standard critical appraisal tools to evaluate the quality and utility of published research reports [ 1 ]. Critical appraisal tools provide analytical evaluations of the quality of the study, in particular the methods applied to minimise biases in a research project [ 2 ]. As these factors potentially influence study results, and the way that the study findings are interpreted, this information is vital for consumers of research to ascertain whether the results of the study can be believed, and transferred appropriately into other environments, such as policy, further research studies, education or clinical practice. Hence, choosing an appropriate critical appraisal tool is an important component of evidence-based practice.

Although the importance of critical appraisal tools has been acknowledged [ 1 , 3 - 5 ] there appears to be no consensus regarding the 'gold standard' tool for any medical evidence. In addition, it seems that consumers of research are faced with a large number of critical appraisal tools from which to choose. This is evidenced by the recent report by the Agency for Health Research Quality in which 93 critical appraisal tools for quantitative studies were identified [ 6 ]. Such choice may pose problems for research consumers, as dissimilar findings may well be the result when different critical appraisal tools are used to evaluate the same research report [ 6 ].

Critical appraisal tools can be broadly classified into those that are research design-specific and those that are generic. Design-specific tools contain items that address methodological issues that are unique to the research design [ 5 , 7 ]. This precludes comparison however of the quality of different study designs [ 8 ]. To attempt to overcome this limitation, generic critical appraisal tools have been developed, in an attempt to enhance the ability of research consumers to synthesise evidence from a range of quantitative and or qualitative study designs (for instance [ 9 ]). There is no evidence that generic critical appraisal tools and design-specific tools provide a comparative evaluation of research designs.

Moreover, there appears to be little consensus regarding the most appropriate items that should be contained within any critical appraisal tool. This paper is concerned primarily with critical appraisal tools that address the unique properties of allied health care and research [ 10 ]. This approach was taken because of the unique nature of allied health contacts with patients, and because evidence-based practice is an emerging area in allied health [ 10 ]. The availability of so many critical appraisal tools (for instance [ 6 ]) may well prove daunting for allied health practitioners who are learning to critically appraise research in their area of interest. For the purposes of this evaluation, allied health is defined as encompassing "...all occasions of service to non admitted patients where services are provided at units/clinics providing treatment/counseling to patients. These include units primarily concerned with physiotherapy, speech therapy, family panning, dietary advice, optometry occupational therapy..." [ 11 ].

The unique nature of allied health practice needs to be considered in allied health research. Allied health research thus differs from most medical research, with respect to:

• the paradigm underpinning comprehensive and clinically-reasoned descriptions of diagnosis (including validity and reliability). An example of this is in research into low back pain, where instead of diagnosis being made on location and chronicity of pain (as is common) [ 12 ], it would be made on the spinal structure and the nature of the dysfunction underpinning the symptoms, which is arrived at by a staged and replicable clinical reasoning process [ 10 , 13 ].

• the frequent use of multiple interventions within the one contact with the patient (an occasion of service), each of which requires appropriate description in terms of relationship to the diagnosis, nature, intensity, frequency, type of instruction provided to the patient, and the order in which the interventions were applied [ 13 ]

• the timeframe and frequency of contact with the patient (as many allied health disciplines treat patients in episodes of care that contain multiple occasions of service, and which can span many weeks, or even years in the case of chronic problems [ 14 ])

• measures of outcome, including appropriate methods and timeframes of measuring change in impairment, function, disability and handicap that address the needs of different stakeholders (patients, therapists, funders etc) [ 10 , 12 , 13 ].

Search strategy

In supplementary data [see additional file 1 ].

Data organization and extraction

Two independent researchers (PK, NMW) participated in all aspects of this review, and they compared and discussed their findings with respect to inclusion of critical appraisal tools, their intent, components, data extraction and item classification, construction and psychometric properties. Disagreements were resolved by discussion with a third member of the team (KG).

Data extraction consisted of a four-staged process. First, identical replica critical appraisal tools were identified and removed prior to analysis. The remaining critical appraisal tools were then classified according to the study design for which they were intended to be used [ 1 , 2 ]. The scientific manner in which the tools had been constructed was classified as whether an empirical research approach has been used, and if so, which type of research had been undertaken. Finally, the items contained in each critical appraisal tool were extracted and classified into one of eleven groups, which were based on the criteria described by Clarke and Oxman [ 4 ] as:

• Study aims and justification

• Methodology used , which encompassed method of identification of relevant studies and adherence to study protocol;

• Sample selection , which ranged from inclusion and exclusion criteria, to homogeneity of groups;

• Method of randomization and allocation blinding;

• Attrition : response and drop out rates;

• Blinding of the clinician, assessor, patient and statistician as well as the method of blinding;

• Outcome measure characteristics;

• Intervention or exposure details;

• Method of data analyses ;

• Potential sources of bias ; and

• Issues of external validity , which ranged from application of evidence to other settings to the relationship between benefits, cost and harm.

An additional group, " miscellaneous ", was used to describe items that could not be classified into any of the groups listed above.

Data synthesis

Data was synthesized using MS Excel spread sheets as well as narrative format by describing the number of critical appraisal tools per study design and the type of items they contained. Descriptions were made of the method by which the overall quality of the study was determined, evidence regarding the psychometric properties of the tools (validity and reliability) and whether guidelines were provided for use of the critical appraisal tool.

One hundred and ninety-three research reports that potentially provided a description of a critical appraisal tool (or process) were identified from the search strategy. Fifty-six of these papers were unavailable for review due to outdated Internet links, or inability to source the relevant journal through Australian university and Government library databases. Of the 127 papers retrieved, 19 were excluded from this review, as they did not provide a description of the critical appraisal tool used, or were published in languages other than English. As a result, 108 papers were reviewed, which yielded 121 different critical appraisal tools [ 1 - 5 , 7 , 9 , 15 - 102 , 116 ].

Empirical basis for tool construction

We identified 14 instruments (12% all tools) which were reported as having been constructed using a specified empirical approach [ 20 , 29 , 30 , 32 , 35 , 40 , 49 , 51 , 70 - 72 , 79 , 103 , 116 ]. The empirical research reflected descriptive and/or qualitative approaches, these being critical review of existing tools [ 40 , 72 ], Delphi techniques to identify then refine data items [ 32 , 51 , 71 ], questionnaires and other forms of written surveys to identify and refine data items [ 70 , 79 , 103 ], facilitated structured consensus meetings [ 20 , 29 , 30 , 35 , 40 , 49 , 70 , 72 , 79 , 116 ], and pilot validation testing [ 20 , 40 , 72 , 103 , 116 ]. In all the studies which reported developing critical appraisal tools using a consensus approach, a range of stakeholder input was sought, reflecting researchers and clinicians in a range of health disciplines, students, educators and consumers. There were a further 31 papers which cited other studies as the source of the tool used in the review, but which provided no information on why individual items had been chosen, or whether (or how) they had been modified. Moreover, for 21 of these tools, the cited sources of the critical appraisal tool did not report the empirical basis on which the tool had been constructed.

Critical appraisal tools per study design

Seventy-eight percent (N = 94) of the critical appraisal tools were developed for use on primary research [ 1 - 5 , 7 , 9 , 18 , 19 , 25 - 27 , 34 , 37 - 41 ], while the remainder (N = 26) were for secondary research (systematic reviews and meta-analyses) [ 2 - 5 , 15 - 36 , 116 ]. Eighty-seven percent (N = 104) of all critical appraisal tools were design-specific [ 2 - 5 , 7 , 9 , 15 - 90 ], with over one third (N = 45) developed for experimental studies (randomized controlled trials, clinical trials) [ 2 - 4 , 25 - 27 , 34 , 37 - 73 ]. Sixteen critical appraisal tools were generic. Of these, six were developed for use on both experimental and observational studies [ 9 , 91 - 95 ], whereas 11 were purported to be useful for any qualitative and quantitative research design [ 1 , 18 , 41 , 96 - 102 , 116 ] (see Figure ​ Figure1, 1 , Table ​ Table1 1 ).

Number of critical appraisal tools per study design [1,2]

Summary of tools sourced in this review.

Critical appraisal items

One thousand, four hundred and seventy five items were extracted from these critical appraisal tools. After grouping like items together, 173 different item types were identified, with the most frequently reported items being focused towards assessing the external validity of the study (N = 35) and method of data analyses (N = 28) (Table ​ (Table2). 2 ). The most frequently reported items across all critical appraisal tools were:

The type and number of component items contained in critical appraisal tools per study design.

• Eligibility criteria (inclusion/exclusion criteria) (N = 63)

• Appropriate statistical analyses (N = 47)

• Random allocation of subjects (N = 43)

• Consideration of outcome measures used (N = 43)

• Sample size justification/power calculations (N = 39)

• Study design reported (N = 36)

• Assessor blinding (N = 36)

Design-specific critical appraisal tools

Systematic reviews.

Eighty-seven different items were extracted from the 26 critical appraisal tools, which were designed to evaluate the quality of systematic reviews. These critical appraisal tools frequently contained items regarding data analyses and issues of external validity (Tables ​ (Tables2 2 and ​ and3 3 ).

The type and number of guidelines accompanying critical appraisal tools per study design

Items assessing data analyses were focused to the methods used to summarize the results, assessment of sensitivity of results and whether heterogeneity was considered, whereas the nature of reporting of the main results, interpretation of them and their generalizability were frequently used to assess the external validity of the study findings. Moreover, systematic review critical appraisal tools tended to contain items such as identification of relevant studies, search strategy used, number of studies included and protocol adherence, that would not be relevant for other study designs. Blinding and randomisation procedures were rarely included in these critical appraisal tools.

Experimental studies

One hundred and twenty thirteen different items were extracted from the 45 experimental critical appraisal tools. These items most frequently assessed aspects of data analyses and blinding (Tables ​ (Tables1 1 and ​ and2). 2 ). Data analyses items were focused on whether appropriate statistical analysis was performed, whether a sample size justification or power calculation was provided and whether side effects of the intervention were recorded and analysed. Blinding was focused on whether the participant, clinician and assessor were blinded to the intervention.

Diagnostic studies

Forty-seven different items were extracted from the seven diagnostic critical appraisal tools. These items frequently addressed issues involving data analyses, external validity of results and sample selection that were specific to diagnostic studies (whether the diagnostic criteria were defined, definition of the "gold" standard, the calculation of sensitivity and specificity) (Tables ​ (Tables1 1 and ​ and2 2 ).

Observational studies

Seventy-four different items were extracted from the 19 critical appraisal tools for observational studies. These items primarily focused on aspects of data analyses (see Tables ​ Tables1 1 and ​ and2, 2 , such as whether confounders were considered in the analysis, whether a sample size justification or power calculation was provided and whether appropriate statistical analyses were preformed.

Qualitative studies

Thirty-six different items were extracted from the seven qualitative study critical appraisal tools. The majority of these items assessed issues regarding external validity, methods of data analyses and the aims and justification of the study (Tables ​ (Tables1 1 and ​ and2). 2 ). Specifically, items were focused to whether the study question was clearly stated, whether data analyses were clearly described and appropriate, and application of the study findings to the clinical setting. Qualitative critical appraisal tools did not contain items regarding sample selection, randomization, blinding, intervention or bias, perhaps because these issues are not relevant to the qualitative paradigm.

Generic critical appraisal tools

Experimental and observational studies.

Forty-two different items were extracted from the six critical appraisal tools that could be used to evaluate experimental and observational studies. These tools most frequently contained items that addressed aspects of sample selection (such as inclusion/exclusion criteria of participants, homogeneity of participants at baseline) and data analyses (such as whether appropriate statistical analyses were performed, whether a justification of the sample size or power calculation were provided).

All study designs

Seventy-eight different items were contained in the ten critical appraisal tools that could be used for all study designs (quantitative and qualitative). The majority of these items focused on whether appropriate data analyses were undertaken (such as whether confounders were considered in the analysis, whether a sample size justification or power calculation was provided and whether appropriate statistical analyses were preformed) and external validity issues (generalization of results to the population, value of the research findings) (see Tables ​ Tables1 1 and ​ and2 2 ).

Allied health critical appraisal tools

We found no critical appraisal instrument specific to allied health research, despite finding at least seven critical appraisal instruments associated with allied health topics (mostly physiotherapy management of orthopedic conditions) [ 37 , 39 , 52 , 58 , 59 , 65 ]. One critical appraisal development group proposed two instruments [ 9 ], specific to quantitative and qualitative research respectively. The core elements of allied health research quality (specific diagnosis criteria, intervention descriptions, nature of patient contact and appropriate outcome measures) were not addressed in any one tool sourced for this evaluation. We identified 152 different ways of considering quality reporting of outcome measures in the 121 critical appraisal tools, and 81 ways of considering description of interventions. Very few tools which were not specifically targeted to diagnostic studies (less than 10% of the remaining tools) addressed diagnostic criteria. The critical appraisal instrument that seemed most related to allied health research quality [ 39 ] sought comprehensive evaluation of elements of intervention and outcome, however this instrument was relevant only to physiotherapeutic orthopedic experimental research.

Overall study quality

Forty-nine percent (N = 58) of critical appraisal tools summarised the results of the quality appraisal into a single numeric summary score [ 5 , 7 , 15 - 25 , 37 - 59 , 74 - 77 , 80 - 83 , 87 , 91 - 93 , 96 , 97 ] (Figure ​ (Figure2). 2 ). This was achieved by one of two methods:

Number of critical appraisal tools with, and without, summary quality scores

• An equal weighting system, where one point was allocated to each item fulfilled; or

• A weighted system, where fulfilled items were allocated various points depending on their perceived importance.

However, there was no justification provided for any of the scoring systems used. In the remaining critical appraisal tools (N = 62), a single numerical summary score was not provided [ 1 - 4 , 9 , 25 - 36 , 60 - 73 , 78 , 79 , 84 - 90 , 94 , 95 , 98 - 102 ]. This left the research consumer to summarize the results of the appraisal in a narrative manner, without the assistance of a standard approach.

Psychometric properties of critical appraisal tools

Few critical appraisal tools had documented evidence of their validity and reliability. Face validity was established in nine critical appraisal tools, seven of which were developed for use on experimental studies [ 38 , 40 , 45 , 49 , 51 , 63 , 70 ] and two for systematic reviews [ 32 , 103 ]. Intra-rater reliability was established for only one critical appraisal tool as part of its empirical development process [ 40 ], whereas inter-rater reliability was reported for two systematic review tools [ 20 , 36 ] (for one of these as part of the developmental process [ 20 ]) and seven experimental critical appraisal tools [ 38 , 40 , 45 , 51 , 55 , 56 , 63 ] (for two of these as part of the developmental process [ 40 , 51 ]).

Critical appraisal tool guidelines

Forty-three percent (N = 52) of critical appraisal tools had guidelines that informed the user of the interpretation of each item contained within them (Table ​ (Table2). 2 ). These guidelines were most frequently in the form of a handbook or published paper (N = 31) [ 2 , 4 , 9 , 15 , 20 , 25 , 28 , 29 , 31 , 36 , 37 , 41 , 50 , 64 - 67 , 69 , 80 , 84 - 87 , 89 , 90 , 95 , 100 , 116 ], whereas in 14 critical appraisal tools explanations accompanied each item [ 16 , 26 , 27 , 40 , 49 , 51 , 57 , 59 , 79 , 83 , 91 , 102 ].

Our search strategy identified a large number of published critical appraisal tools that are currently available to critically appraise research reports. There was a distinct lack of information on tool development processes in most cases. Many of the tools were reported to be modifications of other published tools, or reflected specialty concerns in specific clinical or research areas, without attempts to justify inclusion criteria. Less than 10 of these tools were relevant to evaluation of the quality of allied health research, and none of these were based on an empirical research approach. We are concerned that although our search was systematic and extensive [ 104 , 105 ], our broad key words and our lack of ready access to 29% of potentially useful papers (N = 56) potentially constrained us from identifying all published critical appraisal tools. However, consumers of research seeking critical appraisal instruments are not likely to seek instruments from outdated Internet links and unobtainable journals, thus we believe that we identified the most readily available instruments. Thus, despite the limitations on sourcing all possible tools, we believe that this paper presents a useful synthesis of the readily available critical appraisal tools.

The majority of the critical appraisal tools were developed for a specific research design (87%), with most designed for use on experimental studies (38% of all critical appraisal tools sourced). This finding is not surprising as, according to the medical model, experimental studies sit at or near the top of the hierarchy of evidence [ 2 , 8 ]. In recent years, allied health researchers have strived to apply the medical model of research to their own discipline by conducting experimental research, often by using the randomized controlled trial design [ 106 ]. This trend may be the reason for the development of experimental critical appraisal tools reported in allied health-specific research topics [ 37 , 39 , 52 , 58 , 59 , 65 ].

We also found a considerable number of critical appraisal tools for systematic reviews (N = 26), which reflects the trend to synthesize research evidence to make it relevant for clinicians [ 105 , 107 ]. Systematic review critical appraisal tools contained unique items (such as identification of relevant studies, search strategy used, number of studies included, protocol adherence) compared with tools used for primary studies, a reflection of the secondary nature of data synthesis and analysis.

In contrast, we identified very few qualitative study critical appraisal tools, despite the presence of many journal-specific guidelines that outline important methodological aspects required in a manuscript submitted for publication [ 108 - 110 ]. This finding may reflect the more traditional, quantitative focus of allied health research [ 111 ]. Alternatively, qualitative researchers may view the robustness of their research findings in different terms compared with quantitative researchers [ 112 , 113 ]. Hence the use of critical appraisal tools may be less appropriate for the qualitative paradigm. This requires further consideration.

Of the small number of generic critical appraisal tools, we found few that could be usefully applied (to any health research, and specifically to the allied health literature), because of the generalist nature of their items, variable interpretation (and applicability) of items across research designs, and/or lack of summary scores. Whilst these types of tools potentially facilitate the synthesis of evidence across allied health research designs for clinicians, their lack of specificity in asking the 'hard' questions about research quality related to research design also potentially precludes their adoption for allied health evidence-based practice. At present, the gold standard study design when synthesizing evidence is the randomized controlled trial [ 4 ], which underpins our finding that experimental critical appraisal tools predominated in the allied health literature [ 37 , 39 , 52 , 58 , 59 , 65 ]. However, as more systematic literature reviews are undertaken on allied health topics, it may become more accepted that evidence in the form of other research design types requires acknowledgement, evaluation and synthesis. This may result in the development of more appropriate and clinically useful allied health critical appraisal tools.

A major finding of our study was the volume and variation in available critical appraisal tools. We found no gold standard critical appraisal tool for any type of study design. Therefore, consumers of research are faced with frustrating decisions when attempting to select the most appropriate tool for their needs. Variable quality evaluations may be produced when different critical appraisal tools are used on the same literature [ 6 ]. Thus, interpretation of critical analysis must be carefully considered in light of the critical appraisal tool used.

The variability in the content of critical appraisal tools could be accounted for by the lack of any empirical basis of tool construction, established validity of item construction, and the lack of a gold standard against which to compare new critical tools. As such, consumers of research cannot be certain that the content of published critical appraisal tools reflect the most important aspects of the quality of studies that they assess [ 114 ]. Moreover, there was little evidence of intra- or inter-rater reliability of the critical appraisal tools. Coupled with the lack of protocols for use, this may mean that critical appraisers could interpret instrument items in different ways over repeated occasions of use. This may produce variable results [123].

Based on the findings of this evaluation, we recommend that consumers of research should carefully select critical appraisal tools for their needs. The selected tools should have published evidence of the empirical basis for their construction, validity of items and reliability of interpretation, as well as guidelines for use, so that the tools can be applied and interpreted in a standardized manner. Our findings highlight the need for consensus to be reached regarding the important and core items for critical appraisal tools that will produce a more standardized environment for critical appraisal of research evidence. As a consequence, allied health research will specifically benefit from having critical appraisal tools that reflect best practice research approaches which embed specific research requirements of allied health disciplines.

Competing interests

No competing interests.

Authors' contributions

PK Sourced critical appraisal tools

Categorized the content and psychometric properties of critical appraisal tools

AEB Synthesis of findings

Drafted manuscript

NMW Sourced critical appraisal tools

VSK Sourced critical appraisal tools

KAG Study conception and design

Assisted with critiquing critical appraisal tools and categorization of the content and psychometric properties of critical appraisal tools

Drafted and reviewed manuscript

Addressed reviewer's comments and re-submitted the article

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2288/4/22/prepub

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Systematic Reviews: Critical Appraisal by Study Design

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Tools for Critical Appraisal of Studies

“The purpose of critical appraisal is to determine the scientific merit of a research report and its applicability to clinical decision making.” 1 Conducting a critical appraisal of a study is imperative to any well executed evidence review, but the process can be time consuming and difficult. 2 The critical appraisal process requires “a methodological approach coupled with the right tools and skills to match these methods is essential for finding meaningful results.” 3 In short, it is a method of differentiating good research from bad research.

Critical Appraisal by Study Design (featured tools)

• Non-RCTs or Observational Studies
• Diagnostic Accuracy
• Animal Studies
• Qualitative Research
• Tool Repository
• AMSTAR 2 The original AMSTAR was developed to assess the risk of bias in systematic reviews that included only randomized controlled trials. AMSTAR 2 was published in 2017 and allows researchers to “identify high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.” 4 more... less... AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews)
• ROBIS ROBIS is a tool designed specifically to assess the risk of bias in systematic reviews. “The tool is completed in three phases: (1) assess relevance(optional), (2) identify concerns with the review process, and (3) judge risk of bias in the review. Signaling questions are included to help assess specific concerns about potential biases with the review.” 5 more... less... ROBIS (Risk of Bias in Systematic Reviews)
• BMJ Framework for Assessing Systematic Reviews This framework provides a checklist that is used to evaluate the quality of a systematic review.
• CASP Checklist for Systematic Reviews This CASP checklist is not a scoring system, but rather a method of appraising systematic reviews by considering: 1. Are the results of the study valid? 2. What are the results? 3. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
• CEBM Systematic Reviews Critical Appraisal Sheet The CEBM’s critical appraisal sheets are designed to help you appraise the reliability, importance, and applicability of clinical evidence. more... less... CEBM (Centre for Evidence-Based Medicine)
• JBI Critical Appraisal Tools, Checklist for Systematic Reviews JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis.
• NHLBI Study Quality Assessment of Systematic Reviews and Meta-Analyses The NHLBI’s quality assessment tools were designed to assist reviewers in focusing on concepts that are key for critical appraisal of the internal validity of a study. more... less... NHLBI (National Heart, Lung, and Blood Institute)
• RoB 2 RoB 2 “provides a framework for assessing the risk of bias in a single estimate of an intervention effect reported from a randomized trial,” rather than the entire trial. 6 more... less... RoB 2 (revised tool to assess Risk of Bias in randomized trials)
• CASP Randomised Controlled Trials Checklist This CASP checklist considers various aspects of an RCT that require critical appraisal: 1. Is the basic study design valid for a randomized controlled trial? 2. Was the study methodologically sound? 3. What are the results? 4. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
• CONSORT Statement The CONSORT checklist includes 25 items to determine the quality of randomized controlled trials. “Critical appraisal of the quality of clinical trials is possible only if the design, conduct, and analysis of RCTs are thoroughly and accurately described in the report.” 7 more... less... CONSORT (Consolidated Standards of Reporting Trials)
• NHLBI Study Quality Assessment of Controlled Intervention Studies The NHLBI’s quality assessment tools were designed to assist reviewers in focusing on concepts that are key for critical appraisal of the internal validity of a study. more... less... NHLBI (National Heart, Lung, and Blood Institute)
• JBI Critical Appraisal Tools Checklist for Randomized Controlled Trials JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis.
• ROBINS-I ROBINS-I is a “tool for evaluating risk of bias in estimates of the comparative effectiveness… of interventions from studies that did not use randomization to allocate units… to comparison groups.” 8 more... less... ROBINS-I (Risk Of Bias in Non-randomized Studies – of Interventions)
• NOS This tool is used primarily to evaluate and appraise case-control or cohort studies. more... less... NOS (Newcastle-Ottawa Scale)
• AXIS Cross-sectional studies are frequently used as an evidence base for diagnostic testing, risk factors for disease, and prevalence studies. “The AXIS tool focuses mainly on the presented [study] methods and results.” 9 more... less... AXIS (Appraisal tool for Cross-Sectional Studies)
• NHLBI Study Quality Assessment Tools for Non-Randomized Studies The NHLBI’s quality assessment tools were designed to assist reviewers in focusing on concepts that are key for critical appraisal of the internal validity of a study. • Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies • Quality Assessment of Case-Control Studies • Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group • Quality Assessment Tool for Case Series Studies more... less... NHLBI (National Heart, Lung, and Blood Institute)
• Case Series Studies Quality Appraisal Checklist Developed by the Institute of Health Economics (Canada), the checklist is comprised of 20 questions to assess “the robustness of the evidence of uncontrolled, [case series] studies.” 10
• Methodological Quality and Synthesis of Case Series and Case Reports In this paper, Dr. Murad and colleagues “present a framework for appraisal, synthesis and application of evidence derived from case reports and case series.” 11
• MINORS The MINORS instrument contains 12 items and was developed for evaluating the quality of observational or non-randomized studies. 12 This tool may be of particular interest to researchers who would like to critically appraise surgical studies. more... less... MINORS (Methodological Index for Non-Randomized Studies)
• JBI Critical Appraisal Tools for Non-Randomized Trials JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis. • Checklist for Analytical Cross Sectional Studies • Checklist for Case Control Studies • Checklist for Case Reports • Checklist for Case Series • Checklist for Cohort Studies
• QUADAS-2 The QUADAS-2 tool “is designed to assess the quality of primary diagnostic accuracy studies… [it] consists of 4 key domains that discuss patient selection, index test, reference standard, and flow of patients through the study and timing of the index tests and reference standard.” 13 more... less... QUADAS-2 (a revised tool for the Quality Assessment of Diagnostic Accuracy Studies)
• JBI Critical Appraisal Tools Checklist for Diagnostic Test Accuracy Studies JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis.
• STARD 2015 The authors of the standards note that “[e]ssential elements of [diagnostic accuracy] study methods are often poorly described and sometimes completely omitted, making both critical appraisal and replication difficult, if not impossible.”10 The Standards for the Reporting of Diagnostic Accuracy Studies was developed “to help… improve completeness and transparency in reporting of diagnostic accuracy studies.” 14 more... less... STARD 2015 (Standards for the Reporting of Diagnostic Accuracy Studies)
• CASP Diagnostic Study Checklist This CASP checklist considers various aspects of diagnostic test studies including: 1. Are the results of the study valid? 2. What were the results? 3. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
• CEBM Diagnostic Critical Appraisal Sheet The CEBM’s critical appraisal sheets are designed to help you appraise the reliability, importance, and applicability of clinical evidence. more... less... CEBM (Centre for Evidence-Based Medicine)
• SYRCLE’s RoB “[I]mplementation of [SYRCLE’s RoB tool] will facilitate and improve critical appraisal of evidence from animal studies. This may… enhance the efficiency of translating animal research into clinical practice and increase awareness of the necessity of improving the methodological quality of animal studies.” 15 more... less... SYRCLE’s RoB (SYstematic Review Center for Laboratory animal Experimentation’s Risk of Bias)
• ARRIVE 2.0 “The [ARRIVE 2.0] guidelines are a checklist of information to include in a manuscript to ensure that publications [on in vivo animal studies] contain enough information to add to the knowledge base.” 16 more... less... ARRIVE 2.0 (Animal Research: Reporting of In Vivo Experiments)
• Critical Appraisal of Studies Using Laboratory Animal Models This article provides “an approach to critically appraising papers based on the results of laboratory animal experiments,” and discusses various “bias domains” in the literature that critical appraisal can identify. 17
• CEBM Critical Appraisal of Qualitative Studies Sheet The CEBM’s critical appraisal sheets are designed to help you appraise the reliability, importance and applicability of clinical evidence. more... less... CEBM (Centre for Evidence-Based Medicine)
• CASP Qualitative Studies Checklist This CASP checklist considers various aspects of qualitative research studies including: 1. Are the results of the study valid? 2. What were the results? 3. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
• Quality Assessment and Risk of Bias Tool Repository Created by librarians at Duke University, this extensive listing contains over 100 commonly used risk of bias tools that may be sorted by study type.
• Latitudes Network A library of risk of bias tools for use in evidence syntheses that provides selection help and training videos.

References & Recommended Reading

1.     Kolaski, K., Logan, L. R., & Ioannidis, J. P. (2024). Guidance to best tools and practices for systematic reviews .  British Journal of Pharmacology ,  181 (1), 180-210

2.    Portney LG.  Foundations of clinical research : applications to evidence-based practice.  Fourth edition. ed. Philadelphia: F A Davis; 2020.

3.     Fowkes FG, Fulton PM.  Critical appraisal of published research: introductory guidelines.   BMJ (Clinical research ed).  1991;302(6785):1136-1140.

4.     Singh S.  Critical appraisal skills programme.   Journal of Pharmacology and Pharmacotherapeutics.  2013;4(1):76-77.

5.     Shea BJ, Reeves BC, Wells G, et al.  AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.   BMJ (Clinical research ed).  2017;358:j4008.

6.     Whiting P, Savovic J, Higgins JPT, et al.  ROBIS: A new tool to assess risk of bias in systematic reviews was developed.   Journal of clinical epidemiology.  2016;69:225-234.

7.     Sterne JAC, Savovic J, Page MJ, et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials.  BMJ (Clinical research ed).  2019;366:l4898.

8.     Moher D, Hopewell S, Schulz KF, et al.  CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials.  Journal of clinical epidemiology.  2010;63(8):e1-37.

9.     Sterne JA, Hernan MA, Reeves BC, et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.  BMJ (Clinical research ed).  2016;355:i4919.

10.     Downes MJ, Brennan ML, Williams HC, Dean RS.  Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS).   BMJ open.  2016;6(12):e011458.

11.   Guo B, Moga C, Harstall C, Schopflocher D.  A principal component analysis is conducted for a case series quality appraisal checklist.   Journal of clinical epidemiology.  2016;69:199-207.e192.

12.   Murad MH, Sultan S, Haffar S, Bazerbachi F.  Methodological quality and synthesis of case series and case reports.  BMJ evidence-based medicine.  2018;23(2):60-63.

13.   Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J.  Methodological index for non-randomized studies (MINORS): development and validation of a new instrument.   ANZ journal of surgery.  2003;73(9):712-716.

14.   Whiting PF, Rutjes AWS, Westwood ME, et al.  QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.   Annals of internal medicine.  2011;155(8):529-536.

15.   Bossuyt PM, Reitsma JB, Bruns DE, et al.  STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.   BMJ (Clinical research ed).  2015;351:h5527.

16.   Hooijmans CR, Rovers MM, de Vries RBM, Leenaars M, Ritskes-Hoitinga M, Langendam MW.  SYRCLE's risk of bias tool for animal studies.   BMC medical research methodology.  2014;14:43.

17.   Percie du Sert N, Ahluwalia A, Alam S, et al.  Reporting animal research: Explanation and elaboration for the ARRIVE guidelines 2.0.  PLoS biology.  2020;18(7):e3000411.

18.   O'Connor AM, Sargeant JM.  Critical appraisal of studies using laboratory animal models.   ILAR journal.  2014;55(3):405-417.

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• Joanna Smith 1 ,
• Helen Noble 2
• 1 School of Healthcare, University of Leeds , Leeds , UK
• 2 School of Nursing and Midwifery, Queens's University Belfast , Belfast , UK
• Correspondence to Dr Joanna Smith , School of Healthcare, University of Leeds, Leeds LS2 9JT, UK; j.e.smith1{at}leeds.ac.uk

https://doi.org/10.1136/eb-2015-102252

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Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review.

Are there different approaches to undertaking a literature review?

What stages are required to undertake a literature review.

The rationale for the review should be established; consider why the review is important and relevant to patient care/safety or service delivery. For example, Noble et al 's 4 review sought to understand and make recommendations for practice and research in relation to dialysis refusal and withdrawal in patients with end-stage renal disease, an area of care previously poorly described. If appropriate, highlight relevant policies and theoretical perspectives that might guide the review. Once the key issues related to the topic, including the challenges encountered in clinical practice, have been identified formulate a clear question, and/or develop an aim and specific objectives. The type of review undertaken is influenced by the purpose of the review and resources available. However, the stages or methods used to undertake a review are similar across approaches and include:

Formulating clear inclusion and exclusion criteria, for example, patient groups, ages, conditions/treatments, sources of evidence/research designs;

Justifying data bases and years searched, and whether strategies including hand searching of journals, conference proceedings and research not indexed in data bases (grey literature) will be undertaken;

Developing search terms, the PICU (P: patient, problem or population; I: intervention; C: comparison; O: outcome) framework is a useful guide when developing search terms;

Developing search skills (eg, understanding Boolean Operators, in particular the use of AND/OR) and knowledge of how data bases index topics (eg, MeSH headings). Working with a librarian experienced in undertaking health searches is invaluable when developing a search.

Once studies are selected, the quality of the research/evidence requires evaluation. Using a quality appraisal tool, such as the Critical Appraisal Skills Programme (CASP) tools, 5 results in a structured approach to assessing the rigour of studies being reviewed. 3 Approaches to data synthesis for quantitative studies may include a meta-analysis (statistical analysis of data from multiple studies of similar designs that have addressed the same question), or findings can be reported descriptively. 6 Methods applicable for synthesising qualitative studies include meta-ethnography (themes and concepts from different studies are explored and brought together using approaches similar to qualitative data analysis methods), narrative summary, thematic analysis and content analysis. 7 Table 1 outlines the stages undertaken for a published review that summarised research about parents’ experiences of living with a child with a long-term condition. 8

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An example of rapid evidence assessment review

In summary, the type of literature review depends on the review purpose. For the novice reviewer undertaking a review can be a daunting and complex process; by following the stages outlined and being systematic a robust review is achievable. The importance of literature reviews should not be underestimated—they help summarise and make sense of an increasingly vast body of research promoting best evidence-based practice.

• ↵ Centre for Reviews and Dissemination . Guidance for undertaking reviews in health care . 3rd edn . York : CRD, York University , 2009 .
• ↵ Canadian Best Practices Portal. http://cbpp-pcpe.phac-aspc.gc.ca/interventions/selected-systematic-review-sites / ( accessed 7.8.2015 ).
• Bridges J , et al
• ↵ Critical Appraisal Skills Programme (CASP). http://www.casp-uk.net / ( accessed 7.8.2015 ).
• Dixon-Woods M ,
• Shaw R , et al
• Agarwal S ,
• Jones D , et al
• Cheater F ,

Twitter Follow Joanna Smith at @josmith175

Competing interests None declared.

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Evidence-based practice article reviews using CASP tools: a method for teaching EBP

Affiliation.

• 1 Utah State University-Nursing, Logan, Utah, USA.
• PMID: 25156640
• DOI: 10.1111/wvn.12059
• Comprehension
• Educational Measurement / methods*
• Evidence-Based Practice / education*
• Review Literature as Topic*
• Teaching / methods*

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Critical Appraisal

Use this guide to find information resources about critical appraisal including checklists, books and journal articles.

Key Resources

• This online resource explains the sections commonly used in research articles. Understanding how research articles are organised can make reading and evaluating them easier View page
• Critical appraisal checklists
• Worksheets for appraising systematic reviews, diagnostics, prognostics and RCTs. View page
• A free online resource for both healthcare staff and patients; four modules of 30–45 minutes provide an introduction to evidence based medicine, clinical trials and Cochrane Evidence. View page
• This tool will guide you through a series of questions to help you to review and interpret a published health research paper. View page
• The PRISMA flow diagram depicts the flow of information through the different phases of a literature review. It maps out the number of records identified, included and excluded, and the reasons for exclusions. View page
• A useful resource for methods and evidence in applied social science. View page
• A comprehensive database of reporting guidelines. Covers all the main study types. View page
• A tool to assess the methodological quality of systematic reviews. View page

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• Chapter 5 covers critical appraisal of the literature. View this eBook

• Chapter 6 covers assessing the evidence base. Borrow from RCN Library services

• Section 1 covers an introduction to critical appraisal. Section 3 covers appraising difference types of papers including qualitative papers and observational studies. View this eBook

• Chapter 6 covers critically appraising the literature. Borrow from RCN Library services

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• Chapter 8 covers critical appraisal of the evidence. View this eBook

• Chapter 18 covers critical appraisal of nursing studies. View this eBook

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• Critical appraisal

Journal articles

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Shea BJ and others (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions or both, British Medical Journal, 358.

• An outline of AMSTAR 2 and its use for as a critical appraisal tool for systematic reviews. View article (open access)
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CASP checklists

CASP (Critical Appraisal Skills Programme) checklists are a series of checklists involving prompt questions to help you evaluate research studies. They are often used in Healthcare and cover the following types of research methods: Systematic Reviews, Randomised Controlled Trials, Cohort Studies, Case Control Studies, Economic Evaluations, Diagnostic Studies, Qualitative studies, and Clinical Prediction Rule.

The CASP checklists are usually structured around three main sections asking:

• Are the results of the study valid?
• What are the results?
• Will the results help locally? (in my setting) 

Scroll down for our recommended strategies and resources. 

Structure your evaluation

Use the appropriate checklist to help structure your evaluation of a research study to ensure you have considered all aspects of the study. The checklists can be found here: 

CASP Checklists

Do the groundwork but be selective

Think of the questions on the relevant CASP checklist as a logical way to evaluate the quality of evidence in each text that you read. Following the checklist helps you to do the necessary groundwork, but not everything you write in response to the CASP checklist will be relevant for your assignment. Using the checklist as a way of structuring and stimulating your own thinking means you will have a better understanding of which evidence to select for inclusion in your work, and why it is suitable evidence. 

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CASP Tool vs. Other Literature Review Assessment Methods: Pros and Cons

In the realm of literature review assessment, the choice of the right tool is crucial. Among the various options available, the CASP (Critical Appraisal Skills Programme) tool stands out as a well-recognized choice. However, it’s essential to explore its pros and cons in comparison to other assessment methods for literature reviews and systematic reviews.

Table of Contents

The Significance of Critical Appraisal

Before delving into the CASP tool’s strengths and weaknesses, let’s understand why critical appraisal is a fundamental step in any literature review .

Critical appraisal serves the following essential purposes:

• Quality Assessment : It helps assess the methodological rigor and trustworthiness of research studies, ensuring that only credible and relevant sources are included in your literature review .
• Bias Identification : Critical appraisal tools highlight potential biases, limitations, and weaknesses in research, enabling you to make informed decisions about the relevance of each study to your review.
• Research Synthesis : Through systematic critical appraisal, you can synthesize the findings and evidence from a range of studies, providing a comprehensive and robust review of the literature.

Gaps and Recommendations : It guides you in identifying gaps in the existing literature and making recommendations for future research.

The CASP Tool: An Overview

The CASP tool is one of the most widely used critical appraisal tools, recognized for its structured approach and versatility. It offers a set of checklists specifically tailored for different study types, making it suitable for assessing various research designs.

The CASP tool covers a wide range of study types, including:

• Randomized Controlled Trials (RCTs)
• Cohort Studies
• Case-Control Studies
• Qualitative Studies
• Systematic Reviews
• Diagnostic Test Studies
• Economic Evaluations

This flexibility makes the CASP tool an attractive choice for literature review assessment.

Pros of the CASP Tool

1. versatility.

The CASP tool’s versatility is one of its primary advantages. Researchers and students can use CASP to critically appraise a variety of study designs, from qualitative research to systematic reviews. This adaptability is particularly valuable in interdisciplinary fields where different research methods are employed.

2. Structured Framework

The CASP tool provides a structured and comprehensive framework for critical appraisal. Each checklist guides users through essential aspects of research quality, such as study design, sample selection, data analysis, and reporting. This systematic approach ensures that all key dimensions of a study are thoroughly evaluated.

3. Wide Acceptance

The CASP tool’s widespread use in the academic and research community lends credibility to its assessment. Many institutions and journals recognize the CASP tool as a reliable method for evaluating research quality, making it a valuable asset for researchers and students seeking broader recognition.

Cons of the CASP Tool

1. learning curve.

One of the potential drawbacks of the CASP tool is that it may have a steep learning curve for beginners. New users may require some time and guidance to become proficient in applying the checklists effectively. However, various training resources and workshops are available to address this issue.

2. Focus on Methodology

The CASP tool emphasizes methodological aspects of research, which can sometimes overshadow other essential components such as the relevance of the study to a specific research question. Researchers should use the tool judiciously, ensuring it aligns with the objectives of their literature review .

Alternatives to the CASP Tool

While the CASP tool has its advantages, other critical appraisal methods offer unique benefits, depending on the context of your literature review .

1. JBI (Joanna Briggs Institute) Critical Appraisal Tools

The JBI offers a set of critical appraisal tools designed for systematic reviews, text and opinion papers, and other study types. These tools provide specialized assessment criteria for specific research designs, ensuring in-depth evaluation.

2. AMSTAR (A Measurement Tool to Assess Systematic Reviews)

AMSTAR is tailored for the assessment of systematic reviews and meta-analyses. It focuses on the quality and reporting of systematic reviews, helping researchers determine the reliability of these comprehensive studies.

3. ROBIS (Risk Of Bias In Systematic Reviews)

ROBIS is a tool dedicated to assessing the risk of bias in systematic reviews. It is particularly valuable for those conducting reviews of reviews, where the focus is on the reliability of systematic reviews as a whole.

Pros and Cons of Alternative Tools

Pros of alternative tools.

• Specialization : Alternative tools often provide a specialized focus on certain study types, ensuring in-depth evaluation.
• Simplicity : Some tools are designed to be user-friendly, reducing the learning curve for beginners.
• Robustness : For specific research types, alternative tools may offer more robust assessment criteria, enabling researchers to uncover nuanced details.

Cons of Alternative Tools

• Limited Versatility : Specialized tools may not cover as wide a range of study designs as the CASP tool .
• Recognition : While some tools are widely recognized, they may not enjoy the same level of universal acceptance as the CASP tool .

Selecting the right critical appraisal tool for your literature review is a decision that requires careful consideration. The CASP tool is a versatile, well-structured, and widely recognized choice, making it a valuable asset for researchers across disciplines. However, it is essential to be aware of its learning curve and potential bias toward methodological aspects.

Alternative critical appraisal tools, such as those offered by the JBI, AMSTAR, and ROBIS, provide valuable options when specialized focus and simplicity are required. Researchers should choose the tool that aligns most closely with their specific literature review objectives and study designs.

In the end, the choice of the right tool is a crucial step in ensuring the credibility and quality of your literature review . Consider the pros and cons of each tool, and let your research objectives guide you toward the most suitable critical appraisal method for your review.

What you can read next

The Ultimate Guide to Writing a Stellar Literature Review

Unlocking the Power of the Literature Review: A Guide for Dissertation Success

How a Custom Literature Review Template Can Boost Your Research

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• Volume 25, Issue 1
• Critical appraisal of qualitative research: necessity, partialities and the issue of bias
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• http://orcid.org/0000-0001-5660-8224 Veronika Williams ,
• Anne-Marie Boylan ,
• http://orcid.org/0000-0003-4597-1276 David Nunan
• Nuffield Department of Primary Care Health Sciences , University of Oxford, Radcliffe Observatory Quarter , Oxford , UK
• Correspondence to Dr Veronika Williams, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; veronika.williams{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2018-111132

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• qualitative research

Introduction

Qualitative evidence allows researchers to analyse human experience and provides useful exploratory insights into experiential matters and meaning, often explaining the ‘how’ and ‘why’. As we have argued previously 1 , qualitative research has an important place within evidence-based healthcare, contributing to among other things policy on patient safety, 2 prescribing, 3 4 and understanding chronic illness. 5 Equally, it offers additional insight into quantitative studies, explaining contextual factors surrounding a successful intervention or why an intervention might have ‘failed’ or ‘succeeded’ where effect sizes cannot. It is for these reasons that the MRC strongly recommends including qualitative evaluations when developing and evaluating complex interventions. 6

Critical appraisal of qualitative research

Is it necessary.

Although the importance of qualitative research to improve health services and care is now increasingly widely supported (discussed in paper 1), the role of appraising the quality of qualitative health research is still debated. 8 10 Despite a large body of literature focusing on appraisal and rigour, 9 11–15 often referred to as ‘trustworthiness’ 16 in qualitative research, there remains debate about how to —and even whether to—critically appraise qualitative research. 8–10 17–19 However, if we are to make a case for qualitative research as integral to evidence-based healthcare, then any argument to omit a crucial element of evidence-based practice is difficult to justify. That being said, simply applying the standards of rigour used to appraise studies based on the positivist paradigm (Positivism depends on quantifiable observations to test hypotheses and assumes that the researcher is independent of the study. Research situated within a positivist paradigm isbased purely on facts and consider the world to be external and objective and is concerned with validity, reliability and generalisability as measures of rigour.) would be misplaced given the different epistemological underpinnings of the two types of data.

Given its scope and its place within health research, the robust and systematic appraisal of qualitative research to assess its trustworthiness is as paramount to its implementation in clinical practice as any other type of research. It is important to appraise different qualitative studies in relation to the specific methodology used because the methodological approach is linked to the ‘outcome’ of the research (eg, theory development, phenomenological understandings and credibility of findings). Moreover, appraisal needs to go beyond merely describing the specific details of the methods used (eg, how data were collected and analysed), with additional focus needed on the overarching research design and its appropriateness in accordance with the study remit and objectives.

Poorly conducted qualitative research has been described as ‘worthless, becomes fiction and loses its utility’. 20 However, without a deep understanding of concepts of quality in qualitative research or at least an appropriate means to assess its quality, good qualitative research also risks being dismissed, particularly in the context of evidence-based healthcare where end users may not be well versed in this paradigm.

How is appraisal currently performed?

Appraising the quality of qualitative research is not a new concept—there are a number of published appraisal tools, frameworks and checklists in existence. 21–23  An important and often overlooked point is the confusion between tools designed for appraising methodological quality and reporting guidelines designed to assess the quality of methods reporting. An example is the Consolidate Criteria for Reporting Qualitative Research (COREQ) 24 checklist, which was designed to provide standards for authors when reporting qualitative research but is often mistaken for a methods appraisal tool. 10

Broadly speaking there are two types of critical appraisal approaches for qualitative research: checklists and frameworks. Checklists have often been criticised for confusing quality in qualitative research with ‘technical fixes’ 21 25 , resulting in the erroneous prioritisation of particular aspects of methodological processes over others (eg, multiple coding and triangulation). It could be argued that a checklist approach adopts the positivist paradigm, where the focus is on objectively assessing ‘quality’ where the assumptions is that the researcher is independent of the research conducted. This may result in the application of quantitative understandings of bias in order to judge aspects of recruitment, sampling, data collection and analysis in qualitative research papers. One of the most widely used appraisal tools is the Critical Appraisal Skills Programme (CASP) 26 and along with the JBI QARI (Joanna Briggs Institute Qualitative Assessment and Assessment Instrument) 27 presents examples which tend to mimic the quantitative approach to appraisal. The CASP qualitative tool follows that of other CASP appraisal tools for quantitative research designs developed in the 1990s. The similarities are therefore unsurprising given the status of qualitative research at that time.

Frameworks focus on the overarching concepts of quality in qualitative research, including transparency, reflexivity, dependability and transferability (see box 1 ). 11–13 15 16 20 28 However, unless the reader is familiar with these concepts—their meaning and impact, and how to interpret them—they will have difficulty applying them when critically appraising a paper.

The main issue concerning currently available checklist and framework appraisal methods is that they take a broad brush approach to ‘qualitative’ research as whole, with few, if any, sufficiently differentiating between the different methodological approaches (eg, Grounded Theory, Interpretative Phenomenology, Discourse Analysis) nor different methods of data collection (interviewing, focus groups and observations). In this sense, it is akin to taking the entire field of ‘quantitative’ study designs and applying a single method or tool for their quality appraisal. In the case of qualitative research, checklists, therefore, offer only a blunt and arguably ineffective tool and potentially promote an incomplete understanding of good ‘quality’ in qualitative research. Likewise, current framework methods do not take into account how concepts differ in their application across the variety of qualitative approaches and, like checklists, they also do not differentiate between different qualitative methodologies.

On the need for specific appraisal tools

Current approaches to the appraisal of the methodological rigour of the differing types of qualitative research converge towards checklists or frameworks. More importantly, the current tools do not explicitly acknowledge the prejudices that may be present in the different types of qualitative research.

Concepts of rigour or trustworthiness within qualitative research 31

Transferability: the extent to which the presented study allows readers to make connections between the study’s data and wider community settings, ie, transfer conceptual findings to other contexts.

Credibility: extent to which a research account is believable and appropriate, particularly in relation to the stories told by participants and the interpretations made by the researcher.

Reflexivity: refers to the researchers’ engagement of continuous examination and explanation of how they have influenced a research project from choosing a research question to sampling, data collection, analysis and interpretation of data.

Transparency: making explicit the whole research process from sampling strategies, data collection to analysis. The rationale for decisions made is as important as the decisions themselves.

However, we often talk about these concepts in general terms, and it might be helpful to give some explicit examples of how the ‘technical processes’ affect these, for example, partialities related to:

Selection: recruiting participants via gatekeepers, such as healthcare professionals or clinicians, who may select them based on whether they believe them to be ‘good’ participants for interviews/focus groups.

Data collection: poor interview guide with closed questions which encourage yes/no answers and/leading questions.

Reflexivity and transparency: where researchers may focus their analysis on preconceived ideas rather than ground their analysis in the data and do not reflect on the impact of this in a transparent way.

The lack of tailored, method-specific appraisal tools has potentially contributed to the poor uptake and use of qualitative research for informing evidence-based decision making. To improve this situation, we propose the need for more robust quality appraisal tools that explicitly encompass both the core design aspects of all qualitative research (sampling/data collection/analysis) but also considered the specific partialities that can be presented with different methodological approaches. Such tools might draw on the strengths of current frameworks and checklists while providing users with sufficient understanding of concepts of rigour in relation to the different types of qualitative methods. We provide an outline of such tools in the third and final paper in this series.

As qualitative research becomes ever more embedded in health science research, and in order for that research to have better impact on healthcare decisions, we need to rethink critical appraisal and develop tools that allow differentiated evaluations of the myriad of qualitative methodological approaches rather than continuing to treat qualitative research as a single unified approach.

• Williams V ,
• Boylan AM ,
• Lingard L ,
• Orser B , et al
• Brawn R , et al
• Van Royen P ,
• Vermeire E , et al
• Barker M , et al
• McGannon KR
• Dixon-Woods M ,
• Agarwal S , et al
• Greenhalgh T ,
• Dennison L ,
• Morrison L ,
• Conway G , et al
• Barrett M ,
• Mayan M , et al
• Lockwood C ,
• Santiago-Delefosse M ,
• Bruchez C , et al
• Sainsbury P ,
• ↵ CASP (Critical Appraisal Skills Programme). date unknown . http://www.phru.nhs.uk/Pages/PHD/CASP.htm .
• ↵ The Joanna Briggs Institute . JBI QARI Critical appraisal checklist for interpretive & critical research . Adelaide : The Joanna Briggs Institute , 2014 .
• Stephens J ,

Contributors VW and DN: conceived the idea for this article. VW: wrote the first draft. AMB and DN: contributed to the final draft. All authors approve the submitted article.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Correction notice This article has been updated since its original publication to include a new reference (reference 1.)

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From economic wealth to well-being: exploring the importance of happiness economy for sustainable development through systematic literature review

• Open access
• Published: 23 May 2024

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• Shruti Agrawal   ORCID: orcid.org/0000-0002-1620-9429 1 , 5 ,
• Nidhi Sharma 1 , 5 ,
• Karambir Singh Dhayal   ORCID: orcid.org/0000-0002-0000-4330 2 &
• Luca Esposito   ORCID: orcid.org/0000-0001-5983-6898 3 , 4  

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The pursuit of happiness has been an essential goal of individuals and countries throughout history. In the past few years, researchers and academicians have developed a huge interest in the notion of a ‘happiness economy’ that aims to prioritize subjective well-being and life satisfaction over traditional economic indicators such as Gross Domestic Product (GDP). Over the past few years, many countries have adopted a happiness and well-being-oriented framework to re-design the welfare policies and assess environmental, social, economic, and sustainable progress. Such a policy framework focuses on human and planetary well-being instead of material growth and income. The present study offers a comprehensive summary of the existing studies on the subject, exploring how a happiness economy framework can help achieve sustainable development. For this purpose, a systematic literature review (SLR) summarised 257 research publications from 1995 to 2023. The review yielded five major thematic clusters, namely- (i) Going beyond GDP: Transition towards happiness economy, (ii) Rethinking growth for sustainability and ecological regeneration, (iii) Beyond money and happiness policy, (iv) Health, human capital and wellbeing and (v) Policy push for happiness economy. Furthermore, the study proposes future research directions to help researchers and policymakers build a happiness economy framework.

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1 Introduction

Happiness is considered the ultimate goal of human beings (Ikeda, 2010 ; Lama, 2012 ). All economic, social, environmental and political human activities are aligned towards achieving this goal. This fundamental pursuit of human life introduces a new scope of research, namely the ‘happiness economy’ (Agrawal and Sharma 2023 ). The happiness economy is an emerging economic domain wherein many countries are working to envision and implement a happiness-oriented framework by expanding how they measure economic success, which includes wellbeing and sustainability (Cook and Davíðsdóttir 2021 ; Forgeard et al., 2011 ). The investigation of happiness, life-satisfaction and subjective well-being has witnessed increasing research interest across the disciplines- from psychology, philosophy, psychiatry, and cognitive neuroscience to sociology, economics and management (Diener 1984 ; Hallberg and Kullenberg, 2019 ).

In the post-Covid era, the world seeks an enormous transformation shift in the public system (Costanza 2020 ). However, public authorities need more time to realize such needs. To experience the ‘policy transformation’ within the coming few years, we require a paradigm shift that helps warm peoples’ hearts and minds. The new economic paradigm can penetrate the policy processes in advanced economies and every part of the world affected by the epidemic with the support of intellectuals, researchers, entrepreneurs and professionals.

OECD ( 2016 ) proposed a well-being economy framework to measure living conditions and people’s well-being. In 2020, developed countries like Finland, New Zealand, Iceland, Scotland and Wales have become members of the Wellbeing Economy Government (WEGo) (Abrar 2021 ). Since then, the network of government and international authorities across the globe has gained a quick momentum concerning an increasing tendency about a growing tendency to concentrate governmental decisions around human well-being rather than wealth and economic growth (Coscieme et al. 2019 ; Costanza et al. 2020 ).

In light of these circumstances, the purpose of this article is to describe the concept of a “happiness economy” or one that seeks to give everyone fair possibilities for growth, a sense of social inclusion, and stability that can support human resilience (Coyne and Boettke 2006 ). It provides a promising route towards improved social well-being and environmental health and is oriented towards serving individuals and communities (Skul’skaya & Shirokova, 2010 ). Moreover, the happiness economy paradigm is a transition from material production and consumption of commodities and services as the only means to economic development towards embracing a considerable variety of economic, social, environmental and subjective well-being dynamics that are considered fundamental contributors to human happiness (Atkinson et al., 2012 ; King et al., 2014 ; Agrawal and Sharma 2023 ). In following so, it reflects the ‘beyond growth’ approach that empathizes with the revised concept of growth, which is not centred around an increase in income or material production; instead it is grounded in the philosophy of achieving greater happiness for more people (Fioramonti et al. 2019a ).

Whereas the other critiques of economic growth emphasize contraction, frugality and deprivation, the happiness economy relies on a cumulative approach of humanity, hope and well-being, with a perceptive to build a ‘forward-looking’ narrative of ways for humans to live a happy and motivated life by inspiring the cumulative actions and encouraging policy-reforms in the measuring growth of an economy (Stucke 2013 ). Agrawal et al. ( 2023a , b ) explore the domain of happiness economics through a review of the various trends coupled with the future directions and highlight why it needs to be supported for a well-managed economic system and a happy society.

In this paper, we define a “happiness economy as an economy that aims to achieve the well-being of individuals in a nation, promoting human happiness, environmental up-gradation, and sustainability. Alternatively, as an economy where the wellbeing of people counts more than the goals of production and income”. Moreover, we have examined the existing body of research on the happiness economy and analyzed the emerging research themes related to rethinking the conventional approach to economic growth. We conclude by discussing how the happiness economy concept has been accepted so far and realizing its importance by triggering policy reforms at the societal level, by outlining potential future directions that might be included into the current national post-growth policies.

Various researchers and experts in the field of happiness economy support the idea that there is a lack of thorough studies related to the concept, definitions, and themes of the happiness economy model in the nations. This gap has motivated us to conduct a SLR in order to identify the evolution in the domain of happiness economy and to identify the emerging themes in this context. Therefore, this present study seeks to offer a holistic outline of the emerging research area of the happiness economy and helps to understand how the happiness economy can accelerate sustainable development. With the following research questions, this study seeks to give an all-encompassing review of this subject.

What is the annual publication trend in this domain and the most contributing authors, journals, countries etc?

Which themes and upcoming research areas are present in this field?

What directions will the happiness economics study field go in the future?

The SCOPUS database was used to achieve the above research objectives. We have selected 257 articles for examination by hand-selecting the pertinent keywords and going over each one. In the methods section, a thorough explanation of the procedures for gathering, reviewing, and selecting documents is provided.

The remainder of this paper is structured as follows; A thorough survey of the literature on the happiness economy is provided in Sect.  2 . The research approach employed in the study is presented in Sect.  3 . A thorough data analysis of the research findings is given in Sect.  4 . After discussing the results in Sect.  5 , Sect.  6 suggests areas for further research in this field. The study is summarised with a conclusion in Sect.  7 . Section  8 outlines the study’s limitation.

2 Literature review

The supporters of conventional economic growth proclaim that the material production of goods and services and consumption is vital to enhancing one’s living standards. The statement is true to some degree, mainly in countries of enormous deprivation. Some studies have found significantly less correlation between growth and happiness after fulfilling minimum threshold needs (Easterlin 1995 ; Kahneman and Krueger, 2006 ; Inglehart et al., 2008 ). These studies recommend that rather than concentrating solely on economic growth, governmental policy should give priority to non-economic aspects of human existence above a particular income level. According to some researchers, it is challenging to distinguish between the use and emissions of natural resources and economic growth (absolute decoupling) because of the interdependence between socioeconomic conditions and their biophysical basis (Wiedenhofer et al. 2020 ; Wang and Su, 2019 ; Wu et al., 2018 ). However, a shred of increasing evidence shows that it could be possible for humans to maintain a quality of life and a decent standard of living inside the ecological frontier of the environment, given that a contemporary perspective on the production and use of materials are adopted in conjunction with more fair wealth distribution (Millward-Hopkins et al. 2020 ; Bengtsson et al., 2018 ; Ni et al., 2022 ).

The scholarly discourse and institutional framework on the relationship between happiness and economic progress are synthesised in the happiness economy (Frey and Gallus 2012 ; Sohn, 2010 ; Clark et al., 2016 ; Easterlin, 2015 ; Su et al., 2022 ). From a happiness economy perspective, extreme materialism is unsustainable as it significantly impacts natural resources and hinders social coherence and individuals psychological and physical well-being (Fioramonti et al. 2022a ). Additionally, inequalities within countries have grown, while psychological suffering has increased, especially during accelerated growth (Vicente 2020 ; Galbraith, 2009 ). The modern world is witnessing anxiety, depression, wars, reduction of empathy, climate change, pandemics, loss of social bonds and other psychological disorders (Brahmi et al., 2022 ; Santini et al., 2015 ).

It has been scientifically proven that cordial human relations, care-based activity, voluntary activities and the living environment immensely impact a person’s health and societal well-being (Bowler et al. 2010 ; Keniger et al., 2013 ). Ecological economists demonstrated that free ecosystem services have enhanced human well-being (Fang et al. 2022 ). Social epidemiologists have long argued that an increase in inequalities has a negative influence on society while providing equality tends to improve significant objective ways of well-being, from healthier communities to happier communities, declining hate and crime and enhancing social cohesion, productivity, unity and mutual trust (Aiyar and Ebeke 2020 ; Ferriss, 2010 ).

From moving beyond materialistic growth, the happiness economy promotes, appreciates, and protects the environmental, societal, and human capital contributions that lead to cummalative well-being. In a happiness economy framework, a multidimensional approach is needed to evaluate the level of development based on the environmental parameters, health outcomes, as well as public trust, hope, value-creating education and social bonds (Agrawal and Sharma 2023 ; Bayani et al. 2023 ; Lavrov, 2010 ). Such factors have consistently been excluded from any traditional concept or assessment of economic growth. As a result, countries have promoted more industrial activities that deteriorate the authentic ways of human well-being and, hence, the foundations of economic progress.

An excess of production can create a detrimental effect on climate and people’s health, thereby creating a negative externality for society (Fioramonti et al. 2022b ). Moderation of output may be more efficient and desirable than hyper/over-production, as the former can reduce negative environmental externalities (e.g. waste, climate change) and create positive externalities (e.g. employment of the local resources and community) (Kim et al. 2019 ; Kinman and Jones, 2008 ). Moreover, people can also be productive in other contexts outside of the workplace, such as as volunteers, business owners, artists, friends, or members of the community (Fioramonti et al. 2022a ).

Various scholars and scientific research have established that the essential contributions to happiness in one’s life are made by natural surroundings, green and blue spaces, eco-friendly environment, healthy social relations, spirituality, good health, responsible consumption and value-creating education (Helliwell et al. 2021 ; Francart et al., 2018 ; Armstrong et al., 2016 ; Gilead, 2016 ; Giannetti et al., 2015 ). Unfortunately, existing conventional growth theories have ignored all these significant contributions. For example, GDP considers natural ecosystems as economically helpful only up until they are mined and their products are traded (Carrero et al. 2020 ). The non-market benefits they generate, such as natural fertilization, soil regeneration, climate regulation, clean air and maintenance of biodiversity, are entirely ignored (Boyd 2007 ; Hirschauer et al., 2014). The quality time people spend with their families and communities for leisure, educating future generations and making a healthy communal harmony is regarded meaningless, even in the event that they are important to enhance people’s well-being and, hence, to assist any dimension of economic engagement (Griep et al. 2015 ; Agrawal et al., 2020 ). Similarly, if an economy is focusing on people’s healthy lifestyle (for example, by providing comfortable working hours, improving work-life balance, emphasizing mental health, focusing on healthy food, reducing pollution, and promoting sustainable consumption), it is not considered in sync with the growth paradigm (Roy 2021 ; Scrieciu et al., 2013; Shrivastava and Zsolnai 2022 ; Lauzon et al., 2023 ).

Among the latest reviews, Bayani et al. ( 2023 ) highlight that the economics of happiness helps reduce the country’s financial crime by providing a livelihood that reduces financial delinquency. Chen ( 2023 ) highlights that smart city performance enhances urban happiness by adopting green spaces, reusing and recycling products, and controlling pollution. The study by (Agrawal and Sharma 2023 ) proposed a conceptual framework for a happiness economy to achieve sustainability by going beyond GDP. Similarly, Fioramonti et al. ( 2019b ) explored going beyond GDP for a transition towards a happy and well-being economy. The article by Laurent et al. ( 2022 ) has intensively reviewed the well-being indicators in Rome and proposed a conceptual framework for it.

Table  1 provides a thorough summary of the prior review studies about the happiness economy and its contribution to public policy and sustainable development.

3 Research methodology

In the current study, we have adopted an integrative review approach of SLR and bibliometric analysis of the academic literature to get a detailed knowledge of the study, which could also help propose future research avenues. The existing scientific production’s qualitative and quantitative context must be incorporated for a conclusive decision. The study by Meredith ( 1993 ) defines that SLR enables an “integrating several different works on the same topic, summarising the common elements, contrasting the differences, and extending the work in some fashion”. In the present study, the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) is applied to perform the SLR to follow systematic and transparent steps for the research methodology, as shown in Fig.  1 . The PRISMA technique includes the identification, screening, eligibility, and exclusion criteria parts of the review process.

Additionally, examples of the data abstraction and analysis processes are provided (Mengist et al. 2020 ; Moher et al., 2015 ). The four main phases of the PRISMA process are eligibility, identification, screening, and data abstraction and analysis. Because the PRISMA technique employs sequential steps to accomplish the study’s purpose, it benefits SLR research. Moreover, the bibliometric analysis helps summarise the existing literature’s bibliographic data and determine the emerging condition of the intellectual structure and developing tendencies in the specified research domain (Dervis 2019 ).

3.1 Identification

The step to conduct the PRISMA is the identification of the relevant keywords to initiate the search for material. Next, search strings for the digital library’s search services are created using the selected keywords. The basic search query is for digital library article titles, keywords, and abstracts. Next, a Boolean AND or OR operator is used to generate the search string (Boolean combinations of the operators may also be used).

There are different search databases to conduct the review studies, such as Scopus, Sage, Web of Science, IEEE, and Google Scholar. Among all the available search databases, we have used the Scopus database to identify the articles; since 84% of the material on Web of Science (WoS) overlaps with Scopus, very few authors have addressed the benefits of adopting Scopus over WoS (Mongeon and Paul-Hus 2016 ). Scopus is widely used by academicians and researchers for quantitative analysis (Donthu et al. 2021 ). It is the biggest database of scientific research and contains citations and abstracts from peer-reviewed publications consisting of journal research articles, books and conference articles (Farooque et al., 2019 ; Dhayal et al., 2022 ; Brahmi et al., 2022 ). The following search term was used: (TITLE-ABS-KEY (“happiness economy” OR “economics of happiness” OR “happiness in economy” OR “economy of happiness” OR “economy of wellbeing” OR “wellbeing economy” OR “wellbeing in economy” OR “beyond growth”). This process yields 380 artciles in the initial phase.

3.2 Screening

The second phase is completed by all identified articles from the Scopus database obtained from the search string in the identification phase. The publications are either included or excluded throughout the screening process based on the standards established by the authors and with the aid of particular databases. Exclusion and inclusion criteria are shown during the screening phase to identify pertinent articles for the systematic review procedure. The timeline of this study’s selected articles is from 1995 to 2023. The first article related to the research domain was published in 1995. The second criterion for the inclusion includes the types of documents. In the present research, the authors have regarded only peer-reviewed journals and review articles. Other types of articles, such as books, book chapters, conference articles, notes, and editorials, are excluded to maintain the quality of the review. The third inclusion and exclusion criterion is based on language. All the non-English language documents are excluded to avoid translation confusion; hence, only the English language articles are considered for the final review. After the screening process, 297 articles are obtained.

3.3 Eligibility

Articles are manually selected or excluded depending on specific criteria specified by the authors during the eligibility process. During the elimination process, the authors excluded the articles that did not fit into the scope of review after manual screening of the articles. Two hundred fifty-seven articles were selected after the eligibility procedure. These selected articles are carefully reviewed for the study by reviewing the titles, abstracts, and standards from earlier screening processes.

3.4 Data abstraction and analysis

Analysis and abstraction of data are part of the fourth step. Finally, 257 papers were taken into account for final review. After that, the studies are culled to identify pertinent themes and subthemes for the current investigation by thoroughly reviewing each article’s text. An integrative review is a form of study that combines mixed, qualitative, and quantitative research procedures. It is carried out as shown in Fig.  1 . R-studio Bibliometrix and VOSviewer version 1.6.18 were used to evaluate the final study dataset corpus of 257 articles. Since the Bibliometrix software package is a free-source tool programmed in the R language. It is proficient of conducting comprehensive scientific mapping. It also contains several graphical and statistical features with flexible and frequent updates (Agrawal et al. 2023a , b ).

Extraction of articles and selection process

This section provides an answer to the first research question, RQ1, by indicating the main information of corpus data, research publication trends, influential prolific authors, journals, countries and most used keywords, etc. (Refer to Tables  2 , 3 and 4 ) and (Refer to Figs.  2 , 3 , 4 , 5 and 6 ).

4.1 Bibliometric analysis

Table  2 shows the relevant information gathered from the publication-related details. It presents the cognitive knowledge of the research area, for instance, details about authors, annual average publication, average citations and collaboration index. By observing the rate of document publishing, the study illustrates how much has already been done and how much remains to be investigated.

The annual publication trend is shown in Fig.  2 . It is reflected that the first article related to happiness in an economy was released in the year 1995 when (Bowling 1995 ) published the article “What things are important in people’s lives? A survey of the public’s judgements to inform scales of health related quality of life” where the article discussed “quality of life” and “happiness” as an essential component of a healthy life. Oswald ( 1997 ) brought the concept of happiness and economics together and raised questions such as “Does money buy happiness?” or “Do you think your children’s lives will be better than your own?”. Eventually, the gross national product of the past year and the coming year’s exchange rate was no longer the concern; instead, happiness as the sublime moment became more accurate (Schyns 1998 ; Easterlin, 2001; Frey and Stutzer, 2005 ). Post-2013, we can see exponential growth in the publication trend, and the reason behind the growth is the report published by the “ Stiglitz-Sen-Fitoussi” Commission, which has identified limitations of GDP and questioned the metric of wealth, economic and societal progress. The affirmed questions have gained the attention of researchers and organizations, and thus, they have explored the alternatives to GDP. As a result, the “Organization for Economic Co-operation and Development” (OECD) have proposed a wellbeing framework. Some research work has significantly impacted that time, contributing to the immense growth in this research area (Sangha et al. 2015 ; Spruk and Kešeljević, 2015 ; Nunes et al., 2016 ).

Publication trend

Table  3 shows the top prolific journals concerning the topmost publications in the domain of happiness economy for the corpus of 257 articles, namely “International Journal of Environmental Research and Public Health”, “Ecological Economics”, “Ecological Indicators”, “Sustainability” and “Journal of Cleaner Production” with 5, 4, 4,4 and 4 articles respectively (Refer to Table  4 ). Moreover, the most influential journals with maximum citations are “Nature Human Behavior”, “Quality of Life Research”, “Journal of Applied Behavior Analysis”, “Journal of Cleaner Production” and “Ecological Economics”, with 219, 205, 186, 154 and 142 citations, respectively. “Journal of Cleaner Production” and “Ecological Economics” are highly prolific and the most influential journals in the happiness economy research domain.

Table  4 shows the most influential authors. Baños, R.M. and Botella, C. are the two most contributing authors with maximum publications. For the maximum number of citations, Zheng G. and Coscieme L. are the topmost authors for their research work. The nations were sorted according to the quantity of publications, and Fig.  3 showed where the top ten countries with the highest number of publications are listed originated. It can be seen from the figure that the United Stated has contributed the maximum publications, 66, followed by the United Kingdom with 41 articles, followed by Germany with 32 articles. It is worth noting that emerging nation such as India and China have also made significant contributions.

Top ten contributing countries

Figure  4 shows semantic network analysis in which the relationships between words in individual texts are performed. In the present study, we have identified word frequency distributions and the co-occurrences of the authors’ keywords in this study. We employed co-word analysis to find repeated keywords or terms in the title, abstract, or body of a text. In Fig.  5 , the circle’s colour represents a particular cluster, and the circle’s radius indicates how frequently the words occur. The size of a keyword’s node indicates how frequently that keyword appears. The arcs connecting the nodes represent their co-occurrence in the same publication. The greater the distance between two nodes, the more often the two terms co-occur. It can be seen that “happiness” is linked with “growth” and “life satisfaction”. The nodes of “green economy”, “ecological economics”, and “climate change” are in a separate cluster that shows they are emerging areas, and future studies can explore the relationship between happiness economy with these keywords.

Co-ocurrance of author’s keyword (Author’s compilation)

4.2 Thematic map analysis through R studio

The thematic analysis map, as shown in Fig.  5 , displays, beneath the author’s keywords, the visualisation of four distinct topic typologies produced via a biblioshiny interface. The thematic map shows nine themes/clusters under four quadrants segregated in “Callon’s centrality” and “density value”. The degree of interconnectedness between networks is determined by Callon’s centrality, while Callon’s density determines the internal strength of networks. (Chen et al. 2019 ). The rectangular boxes in Fig.  5 represent the subthemes under each topic or cluster that are either directly or indirectly connected to the major themes, based on the available research. In the upper-right quadrant, four themes have appeared, namely “circular economy”, “well-being economy”, “depression”, and “sustainable development”, they fall under the category of motor themes since they are extremely pertinent to the research field, highly repetitious, and well-developed. When compared to other issues with internal linkages but few exterior relations, “urban population” in the upper-left quadrant is seen as a niche concern since it is not as significant. This cluster may have affected the urban population’s happiness (Knickel et al. 2021 ). “Social innovation” is categorised as an emerging or declining subject with low centrality and density, meaning it is peripheral and undeveloped. It is positioned in the lower-left quadrant. Last but not least, the transversal and fundamental themes “happiness economy”, “subjective well-being”, and “climate change” in the lower-right quadrant are seen to be crucial to the happiness economy study field but are still in the early stages of development. As a result, future research must place greater emphasis on the quantitative and qualitative growth of the study area in light of the key themes that have been identified.

Thematic map analysis

4.3 Science mapping through cluster analysis

In the study, science mapping was conducted to examine the interrelationship between the research domains that could be intellectual (Aria and Cuccurullo 2017 ; Donthu et al. 2021 ). It includes various techniques, such as co-authorship analysis, co-occurrence analysis, bibliographic coupling, etc. We have used R-Studio for the study’s temporal analysis by cluster analysis. To answer RQ2, the authors have performed a qualitative examination of the emerging cluster themes through the science mapping of the existing research corpus of 257 articles by performing bibliographic coupling of documents. Bibliographic coupling analysis helps identify clusters reflecting the most recent research themes in the happiness economy field to illuminate the field’s current areas of interest.

The visual presentation of science mapping relied on VoSviewer version 1.6.18 (refer to Fig.  6 ). Five significant clusters emerged in this research domain (refer to Table  5 ). Going beyond GDP: Transition towards happiness economy, rethinking growth for sustainability and ecological regeneration, beyond money and happiness policy, health, human capital and wellbeing and Policy-Push for happiness economy. A thorough examination identified cluster analyzes has also assists us in identifying potential future research proposals. (Franceschet 2009 )

4.4 Cluster 1: Going beyond GDP: transition towards happiness economy

It depicts from the green colour circles and nodes, where seven research articles were identified with a common theme of beyond GDP that can be seen in Fig.  6 . Cook and Davíðsdóttir ( 2021 ) investigated the linkages between the alternative measure of the beyond growth approach such as a well-being economy prespective and the SDGs. They proposed a conceptual model of a well-being economy consisting of four capital assets interrelated with SDGs that promote well-being goals and domains. To extend the concept of going beyond GDP, various economic well-being indicators are being aligned with the different economic, environmental, and social dimensions to target the set goals of SDG. It is found that the “Genuine Progress Indicator” (GPI) is consider as the most extensive method that covers the fourteen targets among the seventeen’s SDG’s. Cook et al. ( 2022 ) consider SDGs to represent the classical, neoclassical and growth-based economy model and as an emerging paradigm for a well-being economy. The significance of GDP is more recognized within the goals of sustainable development.

GPI is considered an alternative indicator of economic well-being. On this basis, excess consumption of high-quality energy will expand macro-economic activity, which GDP measures. For such, a conceptual exploration of the study is conducted on how pursuing “Sustainable Energy Development” (SED) that can increase the GPI results. As the study’s outcome, according to the GPI, SED will have a significant advantage in implementing energy and environment policy and will also contribute to the advancement of social and economic well-being. Coscieme et al. ( 2020a ) explored the connection between the unconditional growth of GDP and SDG. The author considered that policy coherence for sustainable development should lessen the damaging effects of cyclic manufacturing on the ecosystem. Thus, the services considered free of charge in the GDP model should be valued as a component of society. Generally, such services include ecosystem services and a myriad of “economic” functions like rainfall and carbon sequestration. To work for SDG 8, defined by the “United Nations Sustainable Development Goals” (UNSDGs), a higher GDP growth rate would eventually make it more difficult to achieve environmental targets and lessen inequality. Various guidelines were proposed to select alternative variables for SDG-8 to enhance coherence among all the SDG and other policies for sustainability.

Fioramonti et al. ( 2019a ) state their focus is to go beyond GDP toward a well-being economy rather than material output with the help of convergence reforms in policies and economic shifts. To achieve the SDG through protecting the environment, promoting equality, equitable development and sharing economy. The authors have developed the Sustainable Well-Being Index (SWBI) to consolidate the “Beyond GDP” streams as a metric of well-being matched with the objectives to achieve SDG. The indicators of well-being for an economy have enough possibility to connect current transformations in the economic policies and the economy that, generally, GDP is unable to capture.

Fioramonti et al. ( 2022a ) investigate the critical features of the Wellbeing Economy (WE), including its various parameters like work, technology, and productivity. Posting a WE framework that works for mainstream post-growth policy at the national and international levels was the study’s primary goal. The authors have focused on building a society that promotes well-being that should be empowering, adaptable, and integrative. A well-being economic model should develop new tools and indicators to monitor all ecological and human well-being contributors. A multidimensional approach including critical components for a well-being economy was proposed that creates value to re-focus on economic, societal, personal, and natural aspects. Rubio-Mozos et al. ( 2019 ) conducted in-depth interviews with Fourth Sector business leaders, entrepreneurs, and academicians to investigate the function of small and medium-sized businesses and the pressing need to update the economic model using a new measure in line with UN2030. They have proposed a network from “limits to growth” to a “sustainable well-being economy”.

4.5 Cluster 2: Rethinking growth for sustainability and ecological regeneration

Figure  6 depicts it from blue circles and nodes, wherein four papers were identified. Knickel et al. ( 2021 ) proposed an analytical approach by collecting the data from 11 European areas to examine the existing conditions, difficulties, and anticipated routes forward. The goal of the study is to define the many ideas of a sustainable well-being economy and territorial development plans that adhere to the fundamental characteristics of a well-being economy. A transition from a conventional economic viewpoint to a broader view of sustainable well-being is centred on regional development plans and shifting rural-urban interactions.

Pillay ( 2020 ) investigates the new theories of de-growth, ecosocialism, well-being and happiness economy to break the barriers of traditional economic debates by investigating ways to commercialise and subjugate the state to a society in line with non-human nature. The significant indicator of Gross National Happiness (GNH) is an alternative working indicator of development; thus, the Chinese wall between Buddha and Marx has been built. They questioned the perspective of Buddha and Marx, whether they were harmonized or became a counter-hegemonic movement. In order to determine if the happiness principle is grounded in spiritual values and aligns with the counter-hegemonic ecosocialist movement, the author examined the ecosocialist perspective. Shrivastava and Zsolnai ( 2022 ) have investigated the theoretical and practical ramifications of creative organisations for well-being rooted in the drive for a well-being economy. Wellbeing and happiness-focused economic frameworks are emerging primarily in developed countries. This new policy framework also abolishes GDP-based economic growth and prioritizes individual well-being and ecological regeneration. To understand its application and interpretation, Van Niekerk ( 2019 ) develops a conceptual framework and theoretical analysis of inclusive economics. It contributes to developing a new paradigm for economic growth, both theoretically and practically.

4.6 Cluster 3: ‘Beyond money’ and happiness policy

It depicts pink circles and nodes, wherein five articles were identified, as shown in Fig.  6 . According to Diener and Seligman ( 2004a ) economic indicators are critical in the early phases of economic growth when meeting basic requirements is the primary focus. However, as society becomes wealthier, an individual’s well-being becomes less dependent on money and more on social interactions and job satisfaction. Individuals reporting high well-being outperform those reporting low well-being in terms of income and performance. A national well-being index is required to evaluate well-being variables and shape policies systematically. Diener and Seligman ( 2018 ) propounded the ‘Beyond Money’ concept in 2004. In response to the shortcomings of GDP and economic measures, other quality-of-life indicators, such as health and education, have been created. The national account of well-being has been proposed as a common path to provide societies with an overall quality of life metric. While measuring the subjective well-being of people, the authors reasoned a societal indicator of the quality of life. In this article, the authors have proposed an economy of well-being model by combining subjective and objective measures to convince policymakers and academicians to enact policies that enhance human welfare. The well-being economy includes quality of life indicators and life satisfaction, subjective well-being and happiness.

Frey and Stutzer ( 2000 ) perceived the microeconomic well-being variables in countries. In the study, survey data was used from 6000 individuals in Switzerland and showed that the individuals are happier in developed democracies and institutions (government federalization). They analyzed the reported subjective well-being data to determine the function of federal and democratic institutions on an individual’s satisfaction with life. The study found a negative relationship between income and unemployment. Three criteria have been employed in the study to determine happiness: demographic and psychological traits, macro- and microeconomic factors, and constitutional circumstances. Thus, a new pair of determinants reflects happiness’s effect on individuals’ income, unemployment, inflation and income growth.

Happiness policy, according to Frey and Gallus ( 2013b ), is an intrinsic aspect of the democratic process in which various opinions are collected and examined. “Happiness policy” is far more critical than continuing a goal such as increasing national income and instead considered an official policy goal. The article focuses on how politicians behave differently when they believe that achieving happiness is the primary objective of policy. Frey et al. ( 2014 ) explored the three critical areas of happiness, which are positive and negative shocks on happiness, choice of comparison and its extent to derive the theoretical propositions that can be investigated in future research. It discussed the areas where a more novel and comprehensive theoretical framework is needed: comparison, adaptation, and happiness policy. Wolfgramm et al. ( 2020 ) derived a value-driven transformation framework in Māori economics of wellbeing. It contributes to a multilevel and comprehensive review of Māori economics and well-being. The framework is adopted to advance the policies and implement economies of well-being.

4.7 Cluster 4: Health, human capital and wellbeing

It is depicted as a red colour circle and nodes in Fig.  6 , and only three papers on empirical investigations were found. Laurent et al. ( 2022 ) investigated the Health-Environment Nexus report published by the “Wellbeing Economy Alliance”. In place of increased production and consumption, they suggested a comprehensive framework for human health and the environment that includes six essential paths. The six key pathways are well-being energy, sustainable food, health care, education, social cooperation and health-environment nexus. The proposed variables yield the co-benefits for the climate, health and sustainable economy. Steer clear of the false perception of trade-offs, such as balancing the economy against the environment or the need to save lives. McKinnon and Kennedy ( 2021 ) focuses on community economics of well-being that benefits entrepreneurs and employees. They investigated the interactions of four social enterprises that work for their employees inside and within the broader community. Cylus et al. ( 2020 ) proposed the opportunities and challenges in adopting the model of happiness or well-being in an economy as an alternative measure of GDP. Orekhov et al. ( 2020 ) proposed the derivation of happiness from the World Happiness Index (WHI) data to estimate the regression model for developed countries.

4.8 Cluster 5: Policy-push for happiness economy

It is depicted as an orange circle and nodes in Fig.  6 , and only five papers on empirical and review investigations were found. Oehler-Șincai et al. ( 2023 ) proposed the conceptual and practical perspective of household-income-labour dynamics for policy formulation. It discusses the measurement of well-being as a representation of various policies focusing on health, productivity, and longevity. It focuses on the role of policy in building the subjective and objective dimensions of well-being, defines the correlation between well-being, employment policies, and governance, is inclined to the well-being performance of various countries, and underscores present risks that jeopardize well-being. Musa et al. ( 2018 ) have developed a “community happiness index” by incorporating the four aspects of sustainability—economic, social, environmental, and urban governance—as well as the other sustainability domains, such as human well-being and eco-environmental well-being. From then onwards, community happiness and sustainable urban development emerged. Chernyahivska et al. ( 2020 ) developed strategies to raise the standard of living for people in countries undergoing economic transition by using the quality of life index. The methods uncovered are enhancing employment opportunities and uplifting the international labour market in urban and rural areas, prioritizing human capital, eliminating gender inequality, focusing on improving the individual’s health, and enhancing social protection. Zheng et al. ( 2019 ) investigated the livelihood and well-being index of the population that makes liveable conditions and city construction in society based on people’s happiness index. The structure of a liveable city should be emphasised on sustainable development. The growth strategy in urban areas is an essential aspect of building a liveable city. Frey and Gallus ( 2013a ) criticised the National Happiness Index as a policy goal in a country because it cannot be measured and thus fails to measure the true happiness of people. To measure real happiness, the government should establish living conditions that enable individuals to become happy. The rule of law and human rights must support the process.

The structure of a liveable city should be emphasized in sustainable development. The growth strategy in urban areas is an essential aspect of building a liveable city. Frey and Gallus ( 2013a ) criticized the National Happiness Index as a policy goal in a country because it cannot be measured and thus fails to identify the true individuals happiness. To measure real happiness, the government should establish living conditions that enable individuals to be happy. The process needs to be supported by human rights and the rule of law.

Visualization of cluster analysis

5 Discussion of findings

Concerns like the improved quality-of-life and a decent standard of living within the ecological frontier of the environment have various effects on individuals overall well-being and life satisfaction. The ‘beyond growth’ approach empathized with the revised concept of growth, which is based on the idea of maximising happiness for a larger number of people rather than being driven by a desire for financial wealth or production. In that aspect, the notion of happiness economy is designed that prioritizes serving both people and the environment over the other. This present article has focused on the beyond growth approach and towards a new economic paradigm by doing bibliometric and visual analysis on the dataset that was obtained from Scopus, helping to determine which nations, publications, and authors were most significant in this field of study.

In this field of study, developed nations have made significant contributions as compared to the developing nations. In total, 59 countries have made the substantial contribution to the beyond growth approach literature an some of them have proposed their respective national well-being economy framwework. Among 59 countries the United States and the United Kingdom have been crucial to the publishing. With the exception of five of the top 10 nations, Europe contributes the most to scientific research. The existing research shows the inclination of developed and developing countries to build a new economic paradigm that goes beyond growth by prioritizing the happiness level at individual as well as at collective level.

The most prolific journals in this research domain are the “International Journal of Environmental Research” and “Public Health” with the total publication of 5 and 4. The top two cited journals were the “ Nature Human Behavior” with 219 citations and the “Quality of Life Research” with 205 citations. Due to various economic and non-economic factors, these journals struggled to strike a balance between scientific accuracy and timeliness, and it became vital to spread accurate and logical knowledge. For, example, discussing the relationship between inequality and well-being, exploring the challenges and opportunites of happiness economy in different countries, assessing the role of health in all policies to support the transition to the well-being economy. Visualization of semantic network analysis of co-ocurrance of authors keywords from the VOSviewer showed the future research scope to explore the association between happiness economy along with green economy, climate change, spirituality and sustainability. However, in the thematic mapping, the motor themes denotes the themes that are well-developed and repetative in research, such as, well-being economy, depression, sustainable development and circular economy. The basic themes depicts the developing and transveral themes such as happiness economy, subjective well-being and climate condition. As a result, future research must place greater emphasis on the theoretical and practical expansion of the research field in view of the determined major subjects.

The present study have performed the cluster analysis to identify the emerging research themes in this domain through VOSviewer that helps to analyze the network of published documents. Based on published papers, the author can analyse the interconnected network structure with the use of cluster analysis. We have identified the top five clusters from the study. Each cluster denote the specific and defined theme of the research in this domain. In cluster 1, the majorly of the authors are working in the area of going beyond GDP and transition towards happiness economy, which consists of empirical and review studies. Cluster 2 represents that authors are exploring the relationship between rethinking growth for sustainability and ecological regeneration to evaluate the transition from a conventional economic thought to a broader view of sustainable well-being which is centred on regional development plans and shifting rural-urban interactions. In cluster 3, the authors are exploring the beyond money and happiness policy themes and identified the shortcomings of GDP and economic measures, other quality-of-life indicators, such as health and education. They have proposed the well-being index to evaluate the well-being variables and shape socio-economic policies systematically. The authors have proposed an economy of well-being model by combining subjective and objective measures to convince policymakers and academicians to enact policies that enhance human welfare. The well-being economy includes quality of life indicators and life satisfaction, subjective well-being and happiness. In cluster 4, the authors are working of related theme of Health, human capital and wellbeing, whereby they have put up a comprehensive framework for health and the environment that includes several important avenues for prioritising human and ecological well-being over increased production and consumption. In cluster 5, the authors have suggested the policy-push for happiness economy in which they have identified the conceptual and practical perspective of household-income-labour dynamics for policy formulation. Majorly of the authors in this clutster have focused on the role of policy in building the subjective and objective dimensions of well-being, defines the correlation between well-being, employment policies, and governance, is inclined to the well-being performance of various countries, and underscores present risks that jeopardize well-being. Hence, the present study will give academics, researchers, and policymakers a thorough understanding of the productivity, features, key factors, and research outcomes in this field of study.

6 Scope for future research avenues

The emergence of a happiness economy will transform society’s traditional welfare measure. Such changes will generate more reliable and practical means to measure the well-being or welfare of an economy. After a rigorous analysis of the existing literature, we have proposed the scope for future research in Table  6 .

7 Conclusion

In 2015, the United Nations proposed the pathbreaking and ambitious seventeen “Sustainable Development Goals” (SDGs) for countries to steer their policies toward achieving them by 2030. In reality, economic growth remains central to the agenda for SDGs, demonstrating the absence of a ground-breaking and inspirational vision that might genuinely place people and their happiness at the core of a new paradigm for development. As this research has reflect, there are various evidence that the happiness economy strategy is well-suited to permeate policies geared towards sustainable development. In this context, ‘happiness’ may be a strong concept that ensures the post-2030 growth will resonate with the socioeconomic and environmental traits of everyone around the world while motivating public policies for happiness.

The current research has emphasized the many dynamics of the happiness economy by using a bibliometric analytic study of 257 articles. We have concluded that the happiness economy is an emerging area that includes different dimensions of happiness, such as ecological regeneration, circular economy, sustainability, sustainable well-being, economic well-being, subjective well-being, and well-being economy. In addition to taking into consideration the advantages and disadvantages of human participation in the market, a happiness-based economic system would offer new metrics to assess all contributions to human and planetary well-being. In terms of theoretical ramifications, we suggest that future scholars concentrate on fusing the welfare and happiness theory with economic policy. As countries are predisposed to generate disharmony and imbalance, maximizing societal well-being now entails expanding sustainable development. Since the happiness economy is still a relatively novel field, it offers numerous potential research opportunities.

8 Limitations

Similar to every other research, this one has significant restrictions as well. We are primarily concerned that all our data were extracted from the Scopus database. Furthermore, future research can utilize other software like BibExcel and Gephi to expound novel variables and linkages. Given the research limitations, this article still provides insightful and relevant direction to policymakers, scholars, and those intrigued by the idea of happiness and well-being in mainstream economics.

The study offers scope for future research in connecting the happiness economy framework with different SDGs. Future studies can also carry empirical research towards creating a universally acceptable ‘happiness economy index’ with human and planetary well-being at its core.

Data availability

Data not used in this article.

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All authors contributed to the study conception and design. Shruti Agrawal: Conceptualization, Material preparation, Data Collection, Formal analysis, Methodology, Writing - Original Draft, Review and Editing. Nidhi Sharma: Validation, Project Administration, Supervision, and Writing - Review & Editing. Karambir Singh Dhayal: Validation, Formal analysis, Methodology, Writing - Review and Editing. Luca Esposito: Validation, Writing - Review and Editing. The first draft of the manuscript was written by Shruti Agrawal and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript

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Agrawal, S., Sharma, N., Dhayal, K.S. et al. From economic wealth to well-being: exploring the importance of happiness economy for sustainable development through systematic literature review. Qual Quant (2024). https://doi.org/10.1007/s11135-024-01892-z

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All Business Strategies Fall into 4 Categories

• Jerome Barthelemy

Some are more creative than others.

The problem with strategy frameworks is that although they can help you determine whether an opportunity is attractive or whether a given strategy is likely to work, they generally don’t help you in the task of identifying the opportunity or crafting the strategy in the first place. This article introduces a framework, built on an in-depth analysis of the creativity literature, that aims to fill that gap by providing a systematic approach to identifying potential strategies. The framework categorizes all strategies into the following four groups, from the least creative to the most creative: adapting an existing industry strategy, combining different existing industry strategies, importing strategies from other industries, and creating a brand new strategy from scratch.

The problem with strategy frameworks is that although they can help you determine whether a given opportunity is attractive or whether a particular strategy is likely to work, they generally don’t help you in the task of identifying the opportunity or crafting the strategy in the first place. As the legendary strategy expert Gary Hamel put it: “ The dirty little secret of the strategy industry is that it doesn’t have any theory of strategy creation .”

• Jérôme Barthélemy is Executive Vice-President, Dean for Post Experience Programs, Corporate Programs and Relations and Professor of Strategy and Management at ESSEC Business School. He is the author of Myths of Strategy (Kogan Page, 2023)

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