definition of literature review in health and social care

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Choosing a Review Type

For guidance related to choosing a review type, see:

"What Type of Review is Right for You?" - Decision Tree (PDF) This decision tree, from Cornell University Library, highlights key difference between narrative, systematic, umbrella, scoping and rapid reviews.
Reviewing the literature: choosing a review design Noble, H., & Smith, J. (2018). Reviewing the literature: Choosing a review design. Evidence Based Nursing, 21(2), 39–41. https://doi.org/10.1136/eb-2018-102895
What synthesis methodology should I use? A review and analysis of approaches to research synthesis Schick-Makaroff, K., MacDonald, M., Plummer, M., Burgess, J., & Neander, W. (2016). What synthesis methodology should I use? A review and analysis of approaches to research synthesis. AIMS Public Health, 3 (1), 172-215. doi:10.3934/publichealth.2016.1.172 More information less... ABSTRACT: Our purpose is to present a comprehensive overview and assessment of the main approaches to research synthesis. We use "research synthesis" as a broad overarching term to describe various approaches to combining, integrating, and synthesizing research findings.
Right Review - Decision Support Tool Not sure of the most suitable review method? Answer a few questions and be guided to suitable knowledge synthesis methods. Updated in 2022 and featured in the Journal of Clinical Epidemiology 10.1016/j.jclinepi.2022.03.004

Types of Evidence Synthesis / Literature Reviews

Literature reviews are comprehensive summaries and syntheses of the previous research on a given topic. While narrative reviews are common across all academic disciplines, reviews that focus on appraising and synthesizing research evidence are increasingly important in the health and social sciences.

Most evidence synthesis methods use formal and explicit methods to identify, select and combine results from multiple studies, making evidence synthesis a form of meta-research.

The review purpose, methods used and the results produced vary among different kinds of literature reviews; some of the common types of literature review are detailed below.

Common Types of Literature Reviews 1

Narrative (literature) review.

A broad term referring to reviews with a wide scope and non-standardized methodology
Search strategies, comprehensiveness of literature search, time range covered and method of synthesis will vary and do not follow an established protocol

Integrative Review

A type of literature review based on a systematic, structured literature search
Often has a broadly defined purpose or review question
Seeks to generate or refine and theory or hypothesis and/or develop a holistic understanding of a topic of interest
Relies on diverse sources of data (e.g. empirical, theoretical or methodological literature; qualitative or quantitative studies)

Systematic Review

Systematically and transparently collects and categorize existing evidence on a question of scientific, policy or management importance
Follows a research protocol that is established a priori
Some sub-types of systematic reviews include: SRs of intervention effectiveness, diagnosis, prognosis, etiology, qualitative evidence, economic evidence, and more.
Time-intensive and often takes months to a year or more to complete
The most commonly referred to type of evidence synthesis; sometimes confused as a blanket term for other types of reviews

Meta-Analysis

Statistical technique for combining the findings from disparate quantitative studies
Uses statistical methods to objectively evaluate, synthesize, and summarize results
Often conducted as part of a systematic review

Scoping Review

Systematically and transparently collects and categorizes existing evidence on a broad question of scientific, policy or management importance
Seeks to identify research gaps, identify key concepts and characteristics of the literature and/or examine how research is conducted on a topic of interest
Useful when the complexity or heterogeneity of the body of literature does not lend itself to a precise systematic review
Useful if authors do not have a single, precise review question
May critically evaluate existing evidence, but does not attempt to synthesize the results in the way a systematic review would
May take longer than a systematic review

Rapid Review

Applies a systematic review methodology within a time-constrained setting
Employs methodological "shortcuts" (e.g., limiting search terms and the scope of the literature search), at the risk of introducing bias
Useful for addressing issues requiring quick decisions, such as developing policy recommendations

Umbrella Review

Reviews other systematic reviews on a topic
Often defines a broader question than is typical of a traditional systematic review
Most useful when there are competing interventions to consider

1. Adapted from:

Eldermire, E. (2021, November 15). A guide to evidence synthesis: Types of evidence synthesis. Cornell University LibGuides. https://guides.library.cornell.edu/evidence-synthesis/types

Nolfi, D. (2021, October 6). Integrative Review: Systematic vs. Scoping vs. Integrative. Duquesne University LibGuides. https://guides.library.duq.edu/c.php?g=1055475&p=7725920

Delaney, L. (2021, November 24). Systematic reviews: Other review types. UniSA LibGuides. https://guides.library.unisa.edu.au/SystematicReviews/OtherReviewTypes

Integrative Reviews

"The integrative review method is an approach that allows for the inclusion of diverse methodologies (i.e. experimental and non-experimental research)." (Whittemore & Knafl, 2005, p. 547).

The integrative review: Updated methodology Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52 (5), 546–553. doi:10.1111/j.1365-2648.2005.03621.x More information less... ABSTRACT: The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process....An integrative review is a specific review method that summarizes past empirical or theoretical literature to provide a more comprehensive understanding of a particular phenomenon or healthcare problem....Well-done integrative reviews present the state of the science, contribute to theory development, and have direct applicability to practice and policy.

Conducting integrative reviews: A guide for novice nursing researchers Dhollande, S., Taylor, A., Meyer, S., & Scott, M. (2021). Conducting integrative reviews: A guide for novice nursing researchers. Journal of Research in Nursing, 26(5), 427–438. https://doi.org/10.1177/1744987121997907
Rigour in integrative reviews Whittemore, R. (2007). Rigour in integrative reviews. In C. Webb & B. Roe (Eds.), Reviewing Research Evidence for Nursing Practice (pp. 149–156). John Wiley & Sons, Ltd. https://doi.org/10.1002/9780470692127.ch11

Scoping Reviews

Scoping reviews are evidence syntheses that are conducted systematically, but begin with a broader scope of question than traditional systematic reviews, allowing the research to 'map' the relevant literature on a given topic.

Scoping studies: Towards a methodological framework Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8 (1), 19-32. doi:10.1080/1364557032000119616 More information less... ABSTRACT: We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems.
Scoping studies: Advancing the methodology Levac, D., Colquhoun, H., & O'Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5 (1), 69. doi:10.1186/1748-5908-5-69 More information less... ABSTRACT: We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework.
Methodology for JBI scoping reviews Peters, M. D. J., Godfrey, C. M., McInerney, P., Baldini Soares, C., Khalil, H., & Parker, D. (2015). The Joanna Briggs Institute reviewers’ manual: Methodology for JBI scoping reviews [PDF]. Retrieved from The Joanna Briggs Institute website: http://joannabriggs.org/assets/docs/sumari/Reviewers-Manual_Methodology-for-JBI-Scoping-Reviews_2015_v2.pdf More information less... ABSTRACT: Unlike other reviews that address relatively precise questions, such as a systematic review of the effectiveness of a particular intervention based on a precise set of outcomes, scoping reviews can be used to map the key concepts underpinning a research area as well as to clarify working definitions, and/or the conceptual boundaries of a topic. A scoping review may focus on one of these aims or all of them as a set.

Systematic vs. Scoping Reviews: What's the Difference?

YouTube Video 4 minutes, 45 seconds

Rapid Reviews

Rapid reviews are systematic reviews that are undertaken under a tighter timeframe than traditional systematic reviews.

Evidence summaries: The evolution of a rapid review approach Khangura, S., Konnyu, K., Cushman, R., Grimshaw, J., & Moher, D. (2012). Evidence summaries: The evolution of a rapid review approach. Systematic Reviews, 1 (1), 10. doi:10.1186/2046-4053-1-10 More information less... ABSTRACT: Rapid reviews have emerged as a streamlined approach to synthesizing evidence - typically for informing emergent decisions faced by decision makers in health care settings. Although there is growing use of rapid review "methods," and proliferation of rapid review products, there is a dearth of published literature on rapid review methodology. This paper outlines our experience with rapidly producing, publishing and disseminating evidence summaries in the context of our Knowledge to Action (KTA) research program.
What is a rapid review? A methodological exploration of rapid reviews in Health Technology Assessments Harker, J., & Kleijnen, J. (2012). What is a rapid review? A methodological exploration of rapid reviews in Health Technology Assessments. International Journal of Evidence‐Based Healthcare, 10 (4), 397-410. doi:10.1111/j.1744-1609.2012.00290.x More information less... ABSTRACT: In recent years, there has been an emergence of "rapid reviews" within Health Technology Assessments; however, there is no known published guidance or agreed methodology within recognised systematic review or Health Technology Assessment guidelines. In order to answer the research question "What is a rapid review and is methodology consistent in rapid reviews of Health Technology Assessments?", a study was undertaken in a sample of rapid review Health Technology Assessments from the Health Technology Assessment database within the Cochrane Library and other specialised Health Technology Assessment databases to investigate similarities and/or differences in rapid review methodology utilised.
Rapid Review Guidebook Dobbins, M. (2017). Rapid review guidebook. Hamilton, ON: National Collaborating Centre for Methods and Tools.
NCCMT Summary and Tool for Dobbins' Rapid Review Guidebook National Collaborating Centre for Methods and Tools. (2017). Rapid review guidebook. Hamilton, ON: McMaster University. Retrieved from http://www.nccmt.ca/knowledge-repositories/search/308
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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

View inline

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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Doing a Literature Review in Nursing, Health and Social Care

Michael Coughlan - Trinity College Dublin, Ireland
Patricia Cronin - Trinity College Dublin, Ireland
Description

A clear and practical guide to completing a literature review in nursing and healthcare studies.

Providing students with straightforward guidance on how to successfully carry out a literature review as part of a research project or dissertation, this book uses examples and activities to demonstrate how to complete each step correctly, from start to finish, and highlights how to avoid common mistakes.

The third edition includes:

Expert advice on selecting and researching a topic
A chapter outlining the different types of literature review
Increased focus on Critical Appraisal Tools and how to use them effectively
New real-world examples presenting best practice
Instructions on writing up and presenting the final piece of work

Perfect for any nursing or healthcare student new to literature reviews and for anyone who needs a refresher in this important topic.

Praise for the previous edition:

'This book is an excellent resource for practitioners wishing to develop their knowledge and understanding of reviewing literature and the processes involved. It uses uncomplicated language to signpost the reader effortlessly through key aspects of research processes. Practitioners will find this an invaluable companion for navigating through evidence to identify quality literature applicable to health and social care practice.'

'Students often struggle with writing an effective literature review and this invaluable guide will help to allay their concerns. Key terms are clearly explained, and the inclusion of learning outcomes is a helpful feature for students and lecturers alike. The examples are also very helpful, particularly for less confident students. This is an accessible yet authoritative guide which I can thoroughly recommend.'

'A must have - this book provides useful information and guidance to students and professionals alike. It guides the reader through various research methods in a theoretical and pragmatic manner.'

' It's a very readable, concise, and accessible introduction to undertaking a literature review in the field of healthcare. The book’s layout has a logical format which really helped me to think methodically about my research question. An excellent reference for undergraduates who are about to undertake their first literature review.'

'This book is an essential resource for students. Clearly written and excellently structured, with helpful study tools throughout, it takes the reader step by step through the literature review process in an easy, informative and accessible manner. This text gives students the skills they need to successfully complete their own review.'

'The updating of the chapters will be exceptionally helpful given the rapid changes in online availability of resources and open-access literature.'

Excellent resource. Useful for any stage of studying

Excellent text for masters and doctoral level students

An excellent primer to help the level 7 students write their systemised review for the assignment.

This book provides a comprehensive overview of the practical process of literature review in healthcare. It contains all details required to conduct a review by students.

This is an excellent clear and concise book on undertaking literature reviews being particularly good at demystifying jargon. It is timely given the move to student dissertations being primarily literature reviews in the current Covid pandemic. However nearly all the examples are drawn from nursing and health making the text less useful for social care and social work. A little disappointing given the title. SW students are likely to gravitate to texts where their subject is more prominent for a primary text.

Accessible, informative, step to step guide

This is a really helpful, accessible text for students and academic staff alike.

A really good addition to the repertoire of skills and techniques for understanding the essential process of literature reviewing.

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Why use literature reviews in health and social care?

Course description

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Why use literature reviews in health and social care? is a free course which introduces and explains how literature reviews can support evidence-based practice in health and social care. A literature review can offer a systematic way in which to sift through information to produce relevant existing knowledge and discern knowledge gaps. This short course explores different examples of the use of literature reviews that have informed policy and practice; social work with older people, cessation of cigarette smoking in pregnant women and use of mindfulness therapy with respect to older people with dementia and their carers.

This OpenLearn course is an adapted extract from the Open University course K323 Investigating health and social care .

Course learning outcomes

After studying this course, you should be able to:

recognise how a literature review of current knowledge and research can contribute to investigation of health and social care.

First Published: 14/07/2021

Updated: 14/07/2021

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Doing a Literature Review in Health and Social Care Helen Aveyard Doing a Literature Review in Health and Social Care OUP: McGraw-Hill Education £163;17.99 184pp 9780335238859 0335238858 [Formula: see text]

PMID: 27759508
DOI: 10.7748/nop.23.1.9.s11

WRITTEN IN simple and easy to understand language, this book provides practical and useful guidance for health and social care students. each chapter is well organised and summarised. The book is well illustrated with real-life scenarios and examples encountered by students. It can help students devise their research question and develop a clear literature search strategy. It also provides detailed information about various critical appraisal tools that can be used to approach different types of studies.

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A systematic review of literature examining the application of a social model of health and wellbeing

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Rachel Rahman, Caitlin Reid, Philip Kloer, Anna Henchie, Andrew Thomas, Reyer Zwiggelaar, A systematic review of literature examining the application of a social model of health and wellbeing, European Journal of Public Health , Volume 34, Issue 3, June 2024, Pages 467–472, https://doi.org/10.1093/eurpub/ckae008

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Following years of sustained pressure on the UK health service, there is recognition amongst health professionals and stakeholders that current models of healthcare are likely to be inadequate going forward. Therefore, a fundamental review of existing social models of healthcare is needed to ascertain current thinking in this area, and whether there is a need to change perspective on current thinking.

Through a systematic research review, this paper seeks to address how previous literature has conceptualized a social model of healthcare and, how implementation of the models has been evaluated. Analysis and data were extracted from 222 publications and explored the country of origin, methodological approach, and the health and social care contexts which they were set.

The publications predominantly drawn from the USA, UK, Australia, Canada and Europe identified five themes namely: the lack of a clear and unified definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health.

The review identified a need for a clear definition of a social model of health and wellbeing. Furthermore, consideration is needed on how a model integrates with current models and whether it will act as a descriptive framework or, will be developed into an operational model. The review highlights the importance of engagement with users and partner organizations in the co-creation of a model of healthcare.

Following years of sustained and increasing pressure brought about through inadequate planning and chronic under-resourcing including the unprecedented challenges of the Covid-19 pandemic, the UK NHS is at crisis point. 1 The incidents of chronic disease continue to increase alongside an ageing population who have more complex health and wellbeing needs, whilst recruitment and retention of staff continue to be insufficient to meet these increased demands. 1 Furthermore, the Covid-19 pandemic has only served to exacerbate pressures, resulting in delays in; patient presentation, 2 poor public mental health 3 strain and burnout amongst workforce. 4 However, preceding the pandemic there was already recognition of a need for a change to the current biomedical model of care to better prevent and treat the needs of the population. 5

While it is recognized that demands on the healthcare system are increasing rapidly, the biomedical model used to deal with these issues (which is the current model of healthcare provision in the UK) has largely remained unchanged over the years. The biomedical model takes the perspective that ill-health stems from biological factors and operates on the theory that good health and wellbeing is merely the absence of illness. Application of the model therefore focuses treatment on the management of symptoms and cure of disease from a biological perspective. This suggests that the biomedical approach is mainly reactive in nature and whilst rapid advancements in technology such as diagnostics and robotics have significantly improved patient outcomes and identification of early onset of disease, it does not fully extend into managing the social determinants that can play an important role in the prevention of disease. Therefore, despite its contribution in advancing many areas of biological and health research, the biomedical model has come under increasing scrutiny. 6 This is in part due to the growing recognition of the impact of those wider social determinants on health, ill-health and wellbeing including physical, mental and social wellbeing which moves the focus beyond individual physical abilities or dysfunction. 7–9 In order to address these determinants, action needs to be taken through developing policies in a range of non-medical areas such as social, economic and environment so that they regulate the commercial and corporate determinants. In this sense, we can quickly see that the traditional biological model rapidly becomes inadequate. With the current model, health care and clinical staff can do little to affect these determinants and as such can do little to assist the individual patient or society. The efficiency and effectiveness of clinical work will undoubtedly improve if staff have the ability to observe and understand the wider social determinants and consequences of the individual patients’ condition. Therefore, in order to provide a basis for understanding the determinants of disease and arriving at rational treatments and patterns of health care, a medical model must also take into account the patient, the social context in which they live, and a system devised by society to deal with the disruptive effects of illness, that is, the physician’s role and that of the health care system. Models such as Engel’s biopsychosocial model, 9 , 10 the social model of disability, social–ecological models of health 10 , 11 including the World Health Organisation’s framework for action on social determinants of health 8 , 9 are all proposed as attempting to integrate these wider social determinants.

However, the ability of health systems to effectively transition away from a dominant biomedical model to the adoption of a social model of health and care have yet to be fully developed. Responsibility for taking action on these social determinants will need to come from other sectors and policy areas and so future health policy will need to evolve into a more comprehensive and holistic social model of health and wellbeing. Wales’ flagship Wellbeing of Future Generations Act 12 for instance outlines ways of working towards sustainable development and includes the need to collaborate with society and communities in developing and achieving wellbeing goals. However, developing and implementing an effective operational model that allows multi-stakeholder integration will prove far more difficult to achieve than creating the polices. Furthermore, if the implementation of a robust model of social health is achievable, it’s efficiency, effectiveness and ability to deliver has yet to be proven. Therefore, any future model will need to extend past its conceptual development and provide an ability to manage the complex interactions that will exist between the stakeholders and polices.

Therefore, the use of the term ‘model’ poses its own challenges and debates. Different disciplines attribute differing parameters to what constitutes a model and this in turn may influence the interpretations or expectations surrounding what a model should comprise of or deliver. 13 According to numerous authors, a model has no ontological category and as such anything from physical entities, theoretical concepts, descriptive frameworks or equations can feasibly be considered a model. 14 It appears therefore, that much discussion has focussed on the move towards a ‘descriptive’ Social Model of Health and Wellbeing in an attempt to view health more holistically and identify a wider range of determinants that can impact on the health of the population. However, in defining an operational social model of health that can facilitate organizational change, there may be a need to consider a more systems- or process-based approach.

As a result, this review seeks to systematically explore the academic literature in order to better understand how a social model of health and wellbeing is conceptualized, implemented, operationalized and evaluated in health and social care.

The review seeks to address the research questions:

How is ‘a social model of health and wellbeing’ conceptualized?

How have social models of health and wellbeing been implemented and evaluated?

A systematic search of the literature was carried out between 6 January 2022 and 20 January 2022. Using the search terms shown in table 1 , a systematic search was carried out using online databases PsycINFO, ASSIA, IBSS, Medline, Web of Science, CINHAL and SCOPUS. English language and peer-reviewed journals were selected as limiters.

Search terms

Selection and extraction criteria

The search strategy considered research that explicitly included, framed, or adopted a ‘social model of health and wellbeing’. Each paper was checked for relevance and screened. The authors reviewed the literature using the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) method using the updated guidelines from 2020. 15 Figure 1 represents the process followed.

PRISMA flow chart.

Data extraction and analysis

A systematic search of the literature identified 222 eligible papers for inclusion in the final review. A data extraction table was used to extract information regarding location of the research, type of paper (e.g. review, empirical), service of interest and key findings. Quantitative studies were explored with a view to conducting a quantitative meta-analysis; however, given the disparate nature of the outcome measures, and research designs, this was deemed unfeasible. All included papers were coded using NVivo software with the identified research questions in mind, and re-analysed using Thematic Analysis 16 to explore common themes of relevance.

The majority of papers were from the USA (34%), with the UK (28%), Australia (16%), Canada (6%) and wider Europe (10%) also contributing to the field. The ‘other’ category (6%) was made up of single papers from other countries. Papers ranged in date from 1983 to 2021 with no noticeable temporal patterns in country of origin, health context or model definition. However, the volume of papers published relating to the social model for healthcare in each decade increased significantly, thus suggesting the increasing research interest towards the social model of healthcare. Table 2 shows the number of publications per decade that were identified from this study.

Publications identifying social models of healthcare.

Year of publication .	Number of publications identifying social models of healthcare .
1980s	5
1990s	11
2000	70
2010	87
2020–22	49

Year of publication .	Number of publications identifying social models of healthcare .
1980s	5
1990s	11
2000	70
2010	87
2020–22	49

Most of the papers were narrative reviews ( n = 90) with a smaller number of systematic reviews ( n = 9) and empirical research studies including qualitative ( n = 47), quantitative ( n = 39) and mixed methods ( n = 14) research. The remaining papers ( n = 23) comprised small samples of, for example, clinical commentaries, cost effectiveness analysis, discussion papers and impact assessment development papers. The qualitative meta-analysis identified five overarching themes in relation to the research questions, some with underlying sub-themes, which are outlined in figure 2 .

Overview of meta-synthesis themes.

The lack of a clear and unified definition of a social model of health and wellbeing

There was common recognition amongst the papers that a key aim of applying a social model of health and wellbeing was to better address the social determinants of health. Papers identified and reviewed relevant frameworks and models, which they later used to conceptualize or frame their approach when attempting to apply a social model of health. Amongst the most commonly referenced was the WHO’s framework. 17 Engel’s biopsychosocial model 9 which was referred to as a seminal framework by many of the researchers. However, once criticism of the biopsychosocial model was its inability to fully address social needs. As a result, a number of papers reported the development of new or enhanced models that used the biopsychosocial model as their underpinning ‘social model’ 18 , 19 but then extended their work by including a wider set of social elements in their resulting models. 20 The Social ecological model, 11 the Society-Behaviour-Biology Nexus, 21 and the Environmental Affordances Model are such examples. 22 Further examples of ‘Social Models’ included the Model of Social Determinants of Health 23 which framed specific determinants of interest (namely social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food and transport). Similarly, Dahlgren and Whitehead’s ‘social model’ 10 illustrates social determinants via a range of influential factors from the individual to the wider cultural and socioeconomic influences. However, none of these papers formally developed a working ‘definition’ of a social model of health and wellbeing, instead applying guiding principles and philosophies associated with a social model to their discussions or interventions. 24 , 25

The need to understand context

Numerous articles highlight that in order to move towards a social model of health and wellbeing, it is important to understand the context of the environment in which the model will need to operate. This includes balancing the needs of the individual with the resulting model to have been co-created, developed and implemented within the community whilst ensuring that the complexity of interaction between the social determinants of health and their influence on health and wellbeing outcomes are delivered effectively and efficiently.

The literature identified the complex multi-disciplinary nature of a variety of conditions or situations involving medical care. These included issues such as, but not exclusively, chronic pain, 26 cancer, 27 older adult care 28 and dementia, 29 thus indicating the complex arrangement of medical issues that a model will need to address and, where many authors acknowledged that the frequently used biomedical models failed to fully capture the holistic nature and need of patients. Papers outlined some of the key social determinants of health affecting the specific population of interest in their own context, highlighting the interactions between wider socioeconomic and cultural factors such as poverty, housing, isolation and transport and health and wellbeing outcomes. Interventions that had successfully addressed individual needs and successful embedded services in communities reported improved outcomes for end users and staff in the form of empowerment, agency, education and belonging. 30 There was also recognition that the transition to more community-based care could be challenging for health and social care providers who were having to work outside of their traditional models of care and accept a certain level of risk.

The need for cultural change

A number of papers referred to the need for a ‘culture change’ or ‘cultural shift’ in order to move towards a social model of health and wellbeing. Papers identified how ‘culture change models’ were implemented as a way of adapting to a social model. It was recognized that for culture change models to be effective, staff and the general public needed to be fully engaged with the entire move towards a social model, informing and shaping the mechanisms for the cultural shift as well as the application of the model itself.

Integration and collaboration towards a holistic and person-centred approach

The importance of integration and collaboration between health professionals, (which includes public, private and third sector organizations), services users and patients were emphasized in the ambition to achieve best practice when applying a social model of health and wellbeing. Papers identified the reported benefits of improved collaboration between, and integration of services which included improved continuity of care throughout complex pathways, 31 improved return to home or other setting on discharge, 25 and social connectedness. 32 Numerous papers discussed the importance of multi-disciplinary teams who were able to support individuals beyond the medicalized model.

A number of papers suggested specific professional roles or structures that would be ideal to act as champions or integrators of collaborative services and communities. 25 , 33 These could act as a link between secondary, primary and community level care helping to identify patient needs and supporting the integration of relevant services.

Measuring and evaluating a social model of health

Individual papers applying and evaluating interventions based on a social model used a variety of methods to evaluate success. Amongst these, some of the most common outcome measures included; general self-report measures of outcomes such as mental health and perceptions of safety, 34 wellbeing, 35 life satisfaction and health social networks and support 19 Some included condition specific self-report outcomes relevant to the condition in question (e.g. pregnancy, anxiety) and pain inventories. 36 Other papers considered the in-depth experiences of users or service implementers through qualitative techniques such as in-person interviews. 37 , 38

However, the complexity of developing effective methods to evaluate social models of health were recognized. The need to consider the complex interactions between social determinants, and health, wellbeing, economic and societal outcomes posed particular challenges in developing consistency across evaluations that would enable a conclusive evaluation of the benefits of social models to wider health systems and societal health. Some criticized the over-reliance of quantitative and evidence-based practice methods of evaluation highlighting how these could fail to fully capture the complexity of human behaviour and the manner in which their lives could be affected.

The aim of this systematic review was to better understand how a social model of health and wellbeing is conceptualized, implemented and evaluated in health and social care. The review sought to address the research questions identified in the ‘Introduction’ section of this paper.

With regards to the conceptualization of a social model of health and wellbeing, analysis of the literature suggests that whilst the ethos, values and aspirations of achieving a unified model appears to have consensus. However, a fundamental weakness exists in that there is no single unified definition or operational model of a social model of health and wellbeing applied to the health and social care sector. The decision about how best to conceptualize a ‘social model’ is important both in terms of its operational value but also the implication of the associated semantics. However, without a single or unified definition then implementation or further, operationalization of any model will be almost impossible to develop. Furthermore, use of the term ‘social model’ arguably loses site of the biological factors that are clearly relevant in many elements of clinical medicine. Furthermore, there is no clarification in the literature about what would ‘not’ be considered a social model of health and wellbeing, potentially leading to confusion within health and social care sectors when addressing their wider social remit. This raises questions and requires decisions about whether implementation of a social model of health and wellbeing will need to work alongside or replace the existing biomedical approach.

Authors have advocated that a social model provides a way of ‘thinking’ or articulating an organization’s values and culture. 24 Common elements of the values associated with a social model amongst the papers reviewed included recognition and awareness of the social determinants of health, increased focus on preventative rather than reactive care, and similarly the importance of quality of ‘life’ as opposed to a focus on quality of ‘care’. However, whilst this approach enables individual services to consider how well their own practices align with a social model, the authors suggest that this does not provide large organizations such as the NHS, with multifaceted services and complex internal and external connections and networks, sufficient guidance to enable large scale evaluation or transition to a widespread operational model of a social model of health and wellbeing. This raises questions about what the model should be: whether its function is to support communication of a complex ethos to encourage reflection and engagement of its staff and end users, or to develop the current illustrative framework into a predictive model that can be utilized as an evaluative tool to inform and measure the success of widespread systems change.

Regarding the potential implementation of a future social model of health and wellbeing, none of the papers evaluated the complex widespread organizational implementation of a social model, instead focusing on specific organizational contexts of services such as long-term care in care homes, etc. Despite this, common elements of successful implementation did emerge from the synthesis. This included the need to wholeheartedly engage and be inclusive of end users in policy and practice change to fully understand the complexity of their social worlds and to ensure that changes to practice and policy were ‘developed with’, as opposed to ‘create for’, the wider public. This also involved ensuring that health, social care and wider multi-disciplinary teams were actively included in the process of culture change from an early stage.

Implications for future research

The analysis identifies that a significant change of mindset and removal of perceived and actual hierarchical structures (that are historically embedded in health and social care structures) amongst both staff and public is needed although, eradicating socially embedded hierarchies will pose significant challenges in practice. Furthermore, the study revealed that many of the models proposed were conceptually underdeveloped and lacked the capability to be operationalized which in turn compromised their ability to be empirically tested. Therefore, in order that a future ‘implementable and operational’ model of social care and wellbeing can be created, further research into organizational behaviours, organizational learning and stakeholder theory (amongst others) applied to the social care and health environment is needed.

Towards defining a social model of health and wellbeing

In attempting to conceptualize a definition for a social model of health and wellbeing, it is important to note that the model needs to be sufficiently broad in scope in order to include the prevailing biomedical while also including the need to draw in the social determinants that provide a view and future trajectory towards social health and wellbeing. Therefore, the authors suggest that the ‘preventative’ approach brought by the improvements in the social health determinants (social, cultural, political, environmental ) need to be balanced effectively with the ‘remedial/preventative’ focus of the biomedical model (and the associated advancements in diagnostics, technology, vaccines, etc), ensuring that a future model drives cultural change; improved integration and collaboration towards a holistic and person-centred approach whilst ensuring engagement with citizens, users, multi-disciplinary teams and partner organizations to ensure that transition towards a social model of health and wellbeing is undertaken.

Through a comprehensive literature analysis, this paper has provided evidence that advocates a move towards a social model of health and wellbeing. However, the study has predominantly considered mainly literature from the USA, UK, Canada and Australia and therefore is limited in scope at this stage. The authors are aware of the need to consider research undertaken in non-English speaking countries where a considerable body of knowledge also exists and which will add to further discussion about how that work dovetails into this body of literature and, how it aligns with the biomedical perspective. There is a need for complex organizations such as the NHS and allied organizations to agree a working definition of their model of health and wellbeing, whether that be a social model of health and wellbeing, a biopsychosocial model, a combined model, or indeed a new or revised perspective. 39

One limitation seen of the models within this study is that at a systems level, most models were conceptual models that characterized current systems or conditions and interventions to the current system that result in localized improvements in systems’ performance. However, for meaningful change to occur, a ‘future state’ model may need to focus on a behavioural systems approach allowing modelling of the complete system to take place in order to understand how the elements within the model 40 behave under different external conditions and how these behaviours affect overall system performance.

Furthermore, considerable work will be required to engage on a more equal footing with the public, health and social care staff as well as wider supporting organizations in developing workable principles and processes that fully embrace the equality of a social model and challenging the ‘power’ imbalances of the current biomedical model.

Supplementary data are available at EURPUB online.

This research was funded/commissioned by Hywel Dda University Health Board. The research was funded in two phases.

Conflicts of interest: None declared.

The datasets generated and/or analysed during the current study are available in the Data Archive at Aberystwyth University and have been included in the supplementary file attached to this submission. A full table of references for studies included in the review will be provided as a supplementary document. The references below refer to citations in the report which are in addition to the included studies of the synthesis.

The review identified five themes namely: the lack of a clear definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health.

The review identified a need for organizations to decide on how a social model is to be defined especially at the interfaces between partner organizations and communities.

The implications for public policy in this paper highlights the importance of engagement with citizens, users, multi-disciplinary teams and partner organizations to ensure that transition towards a social model of health and wellbeing is undertaken with holistic needs as a central value.

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A review of health literacy: Definitions, interpretations, and implications for policy initiatives

Original Article
Published: 01 August 2016
Volume 37 , pages 334–352, ( 2016 )

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definition of literature review in health and social care

Leslie J Malloy-Weir 1 ,
Cathy Charles 2 ,
Amiram Gafni 2 &
Vikki Entwistle 3

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Definitions and interpretations of ‘health literacy’ have important implications for the delivery of health care and for health policy-related initiatives. We conducted a systematic review and critical analysis to determine the extent to which definitions of health literacy differ in the academic literature, the similarities and differences across definitions, and possible interpretations for the most commonly used definitions. We identified 250 different definitions of health literacy and grouped them into three categories: (i) most commonly used definitions ( n =6), (ii) modified versions of these most commonly used definitions ( n =133), and (iii) ‘other’ definitions ( n =111). We found the most commonly used definitions to be open to multiple interpretations and to reflect underlying assumptions that are not always justifiable. Attention is needed to the ways in which differing definitions and interpretations of health literacy may affect patient care and the delivery of health literacy-related policy initiatives.

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Health Literacy in Europe: The Concept, Its Impact and Application

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Leslie J Malloy-Weir

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Malloy-Weir, L., Charles, C., Gafni, A. et al. A review of health literacy: Definitions, interpretations, and implications for policy initiatives. J Public Health Pol 37 , 334–352 (2016). https://doi.org/10.1057/jphp.2016.18

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The Role of Empathy in Health and Social Care Professionals

Maria moudatsou.

1 Department of Social Work, Hellenic Mediterranean University, 71410 Heraklion, Greece; rg.oohay@muostaduom

2 Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of Life (Quality of Life Lab), Hellenic Mediterranean University, 71410 Heraklion, Greece; moc.liamg@uoluoporvatsitera

3 Centre of Mental Health, 71201 Heraklion, Greece

Areti Stavropoulou

4 Nursing Department, University of West Attica, 12243 Athens, Greece

Anastas Philalithis

5 Department of Social Medicine, Medical School, University of Crete, 70013 Heraklion, Greece; rg.cou@lalihp

Sofia Koukouli

The current article is an integrative and analytical literature review on the concept and meaning of empathy in health and social care professionals. Empathy, i.e., the ability to understand the personal experience of the patient without bonding with them, constitutes an important communication skill for a health professional, one that includes three dimensions: the emotional, cognitive, and behavioral. It has been proven that health professionals with high levels of empathy operate more efficiently as to the fulfillment of their role in eliciting therapeutic change. The empathetic professional comprehends the needs of the health care users, as the latter feel safe to express the thoughts and problems that concern them. Although the importance of empathy is undeniable, a significantly high percentage of health professionals seem to find it difficult to adopt a model of empathetic communication in their everyday practice. Some of the factors that negatively influence the development of empathy are the high number of patients that professionals have to manage, the lack of adequate time, the focus on therapy within the existing academic culture, but also the lack of education in empathy. Developing empathetic skills should not only be the underlying objective in the teaching process of health and social care undergraduate students, but also the subject of the lifelong and continuous education of professionals.

1. Introduction

Communication skills have been described as the most important ability for a health professional. Efficient communication depends upon the therapist feeling certain that they have really heard and recorded the health care user’s needs so as to provide personalized care [ 1 ]. It is important for health professionals to understand people’s feelings, opinions and experiences in order to assess their real needs and act accordingly, offering tailor-made services. Reaching that goal makes the development of empathetic skills necessary [ 2 ].

The concept of empathy is a common denominator for many health professionals such as nurses, doctors, psychologists, and social workers [ 3 , 4 , 5 , 6 ]. The person-centered approach for the unconditional acceptance of the health care user and empathy have for years been the fundamental values in the education and implementation of clinical social practice [ 3 , 7 , 8 , 9 ].

2. Material and Methods

The aim of the present paper was to analyze the concept of empathy and emphasize its importance to the health professions. The research questions under consideration have been the following: 1. What does empathy mean and which are its dimensions; 2. What are the role and meaning of empathy in health and social care professions for the therapeutic journey of the health care user; 3. How can we assess the levels of empathy in professionals (assessment tools); 4. Which factors influence empathy?

A literature search was conducted by searching PubMed and Scopus databases, to identify studies of the last fifteen years published in English and Greek language. The key-words used were ‘empathy’ and ‘health professionals’. Out of the search, 78 studies were identified that better answer the aim and purposes of the present paper. These studies were discussed and evaluated by the authoring team in order to reach consensus on the eligibility of each one with the proposed research questions. After agreement was reached, re-examination and analysis of the studies’ findings lead to the formulation of four thematic categories, namely, a) Concept definition and dimensions, b) The role of empathy in health and social care professionals, c) Assessing empathy, and d) Factors that influence empathy.

3.1. Concept Definition and Dimensions

Empathy is the ability to understand and share other people’s feelings [ 10 ]. It is a core concept as, according to the psychodynamic, behavioral and person-centered approaches, it facilitates the development of a therapeutic relationship with the health care user, providing the basis for therapeutic change [ 11 ].

Empathy was first mentioned in a psychotherapeutic context in the 1950s [ 7 ]. The person-centered approach defined it as the temporary condition that a health professional experiences in his/her effort to understand a health care user’s life without bonding with them [ 3 , 12 ].

The contemporary concept of empathy is multidimensional and consists of affective, cognitive, and behavioral aspects [ 6 , 11 , 13 ]. Throughout history, the development and integration of this concept evolved along three different time periods. Until the end of the 1950s, the cognitive dimension was mostly prevalent. From 1960 onwards, emphasis was given to the affective dimension, whereas since 1970, empathy has been defined in all its multi-dimensionality; that is, the behavioral aspect has been added to the everyday practice of the health care professionals [ 14 ].

The affective dimension consists of the concepts of caring and that of the sincere, unconditional acceptance of the health care user (congruence) [ 8 , 15 , 16 ]. Caring refers to the assistance and support as byproducts of an emotional interaction. The concept of the full and sincere unconditional acceptance refers to the approval of the ‘other’ and a consensus between people, without preconceptions or stereotypes.

The cognitive dimension pertains to the interpersonal sensitivity and the ability to understand the position the other person is in (perspective taking) [ 17 , 18 ]. Interpersonal sensitivity means objectively understanding the other person’s situation. It is a deep process of getting to know someone, based in both verbal and non-verbal cues. The ability to understand the other person’s situation refers to the flexibility and the objective understanding of the point of view of the other person (walk in their shoes, comprehending the way they perform cognitively, emotionally, and mentally) [ 17 , 18 ].

Altruism and the therapeutic relationship both belong to the behavioral dimension which develops empathy into practice [ 19 , 20 ]. Altruism is a socially directed behavior aimed at relieving difficulties, problems, and the pain associated with them [ 11 ].

Sympathy, empathy, and compassion are closely related terms that are often used interchangeably. Sympathy has been defined as an emotional reaction of pity toward the misfortune of another, especially those who are perceived as suffering unfairly [ 21 ]. Empathy is understood as a more complex interpersonal construct that involves awareness and intuition, while compassion is a ‘complementary social emotion, elicited by witnessing the suffering of others’ and is related with the feelings of concern, warmth associated to motivating of support [ 22 ]. Empathetic listening might result in compassion fatigue because of prolonged exposure to stress and all it evokes [ 23 ]. Self-care practice, well-being, and self-awareness are fundamental in enhancing empathy and reducing compassion fatigue [ 23 , 24 ].

3.2. The Role of Empathy in Health and Social Care Professionals

In a qualitative research study, nurse students, who were asked their opinion on empathy, emphasized the three dimensions of the concept [ 3 ]. Participants described it as the nurse’s ability to understand and experience other people’s feelings, thoughts, and wishes, as well as the nurse’s capacity to comprehend the emotional and cognitive state of the person they work with. To sum up, empathy is perceived as a combination of the emotional, cognitive and practical skills involved when caring for a patient [ 3 ].

Empathy is one of the fundamental tools of the therapeutic relationship between the carers and their patients and it has been proven that its contribution is vital to better health outcomes [ 8 , 25 , 26 ]. As it allows the health care providers to detect and recognize the users’ experiences, worries, and perspectives [ 27 ], it strengthens the development and improvement of the therapeutic relationship between the two parts [ 28 ]. It is widely acknowledged that the health professional’s empathetic ability leads to better therapeutic results [ 29 ].

The empathetic relationship of the health professionals with their health care users reinforces their cooperation towards designing a therapeutic plan and a tailor-made intervention, increasing thus the patient’s satisfaction from the therapeutic process. This way, quality of care is enhanced, errors are eliminated, and an increased percentage of health care recipients positively experience therapy [ 30 , 31 , 32 , 33 , 34 ]. Furthermore, it has been noted that the empathetic relationship developed during the process of care reinforces the therapeutic results, as the users better comply with the therapeutic course of action [ 34 ].

Studies performed in various groups of patients with different health problems generated positive results regarding the progress of their health. Specifically, studies of patients with diabetes showed that there is an association between empathy and the positive therapeutic course of disease [ 31 , 35 ]. Moreover, patients with cancer demonstrate less stress, depression, and aggressiveness when receiving empathetic nursing care [ 36 ]. The empathetic relationship between a midwife and a future mother increases the latter’s satisfaction and lessens the stress, the agony, and the pain of the forthcoming labor as the mother feels security, trust, and encouragement [ 37 ].

Understanding based on empathy is critical to the relationship between the health professional and the recipient of care. When that happens, health care users feel secure and trust the professional’s abilities. Therefore, the distance between the expert and the patient shortens and both of them come closer, enjoying mutual benefits [ 12 ]. Moreover, a relationship based on empathy helps the therapists lessen their stress and burnout in the workplace and adds to their quality of life [ 37 , 38 ]. It has been shown that physicians who have higher levels of empathy experience less burnout or depression [ 39 , 40 ].

Empathy is especially important to the social care professions. It has been noted that the ability of the social worker for empathy and understanding of the users’ experiences and feelings plays a crucial role in social care as empathy is one of the most important skills that these professionals may employ to develop a therapeutic relationship [ 5 , 41 ].

Health care users who experience empathy during their treatment exhibit better results and a higher possibility for a potential improvement [ 42 ]. Moreover, social workers with higher levels of empathy work more efficiently and productively as to the fulfillment of their role in creating social change [ 13 ]. This happens because empathy helps the social worker understand and feel compassion towards their health care users so as the latter can feel secure to express their thoughts and problems. This way, a basis for trust is created, one that leads to therapeutic change and the improvement of the care recipient’s overall social functionality [ 13 ]. Social functionality levels are assessed by the social worker and refer to the ability of a person to accomplish their everyday activities (preparing and keeping meals, seeking accommodation, taking care of their selves, commuting) as well as their ability to fulfill social roles (parent, employee, member of a community) according to the requirements of their cultural environment [ 43 ].

Empathy contributes to the precise assessment of the situation the health care user is in. It offers the therapists the chance to make good use of non-verbal cues (behavior modeling, body movements, tone of voice, etc.) and helps them manage the user’s emotions. What is more, empathy enhances the user’s ability to comprehend reality and improve the quality of their life [ 13 ].

3.3. Assessing Empathy

Although both health care users and health professionals consider empathy as very important for the development of the therapeutic relationship and a necessary skill for a therapist, studies show a reduction of empathy in professional relationships. Often, health care users believe that health professionals do not understand the situation that health care users are in, whereas research findings showed that health professionals and health care users have different views on the communication abilities of the former, as if they come from different worlds [ 44 , 45 ]. It is especially important that—according to research findings deriving from medical student samples—empathy seems to increase in the first year of studies, but starts decreasing around the third year and remains low up to graduation [ 46 , 47 ].

As mentioned before, there are different dimensions, but also levels of empathy. Accordingly, there are different assessment scales for professionals and patient-users [ 48 ].

One of the most important tools for the quantitative assessment of empathy is the Jefferson Scale of Empathy (JSE) which was originally used to evaluate empathy in medical students [ 27 , 49 ]. Subsequently, its use was extended to other professional groups also, for example physicians, health professionals in general and students of other health professions [ 27 , 49 , 50 , 51 ]. The Jefferson scale has been used in many countries, such as the USA, Poland, Korea, Italy, Japan and has been standardized for its validity and reliability [ 12 , 49 , 50 , 52 , 53 ]. It is self-administered and completed by physicians and other health professionals who provide care to patients in clinical settings. Moreover, students of medical, nursing, and other health care sciences may also complete it. The scale includes 20 questions and the overall score ranges from twenty to one hundred and forty; higher scores indicate a better empathic relationship in the medical and therapeutic care [ 26 , 49 , 53 , 54 ].

More specifically, for social work, the Empathy Scale for Social Workers (ESSW) is a questionnaire designed for the quantitative assessment of empathy in social care professionals and students. It can be very useful in practice settings to support decision making processes, assist career choice decisions, continuing education, and supervision needs in the field of social care. Its usefulness is also underscored for potential social work supervisors, as it helps identifying the types of empathy needed while supervising clinicians and staff. The scale is a screening and self-evaluation tool completed by social work students and practitioners [ 13 ]. It consists of 41 questions and every question is marked on a five point scale and higher scores indicate higher levels of empathy [ 13 ].

3.4. Factors that Influence Empathy

As mentioned before, although research has showed the value of empathy, there are still many difficulties in regards to its implementation in the clinical practice [ 32 ]. A relatively high percentage of health professionals, about 70%, find it difficult to develop empathy with their health care users [ 32 ].

Age, self-reflection, appraisal, and emotions’ expressions were associated with women’s social workers empathy. Social workers had a higher score of empathy whenever they had previous work experience [ 55 ]. Additionally, there are studies that support that being female is associated with higher levels of empathy [ 56 , 57 ].

Research outcomes suggest that protective factors of social workers’ empathy are prosocial behavior toward work and positive personal and environmental resources [ 58 ]. Self-esteem, work engagement, and emotional regulation are also positively associated with empathy [ 58 , 59 ]. On the other hand, empathy is limited due to daily stress, that is a risk factor for burnout and compassion fatigue [ 59 , 60 ].

Empathy is positively correlated with reflective ability and emotional intelligence both in professional social workers and social work students [ 55 , 61 ]. According to a study in social work students in India, empathy and emotional intelligence were extracted as predictors of resilience through regression analysis. The authors underlined the need to enhance these attributes in social work students through the provision of appropriate curricular experiences [ 62 ].

The lack of empathy—or the low empathy levels—depends on several reasons. The most important are the large number of health care users that professionals have to deal with, the lack of adequate time, the focus on therapy, the predominant culture in medical schools, and the lack of training in empathy [ 30 ].

Further reasons include presumptions, a sense of superiority from the health professionals, and a fear of boundary violation. Time pressure, anxiety, a lack of self-awareness, and a lack of appropriate training, as well as the different socio-economic status, all the above do not favor empathy either [ 13 ].

According to scientific views from the Medicine field, empathy can be learned and Medical schools should educate their students in this respect [ 63 , 64 ]. Many studies have pointed out the necessity for future professionals to receive training in order to enhance their empathetic skills [ 64 , 65 ].

Although empathy is a core, quality principle for the health care professions, there are studies that show that health professionals cannot adequately express it and implement it [ 66 , 67 ]. According to studies in undergraduate nursing students, empirical education through learning processes can positively influence empathy [ 4 , 68 ]. Education is considered, both by students and professionals, as especially important for the reinforcement of empathetic skills [ 4 , 69 , 70 ].

Nevertheless, research data on the effectiveness of education in empathy are limited [ 71 , 72 , 73 ]. In a research study, conducted in the USA regarding the effect that empathy education has on health professionals, it was found that education contributes a great deal to the improvement of the therapeutic relationship [ 32 ]. In the same study, trained professionals are more likely to detect the emotion and progress of their health care users and therefore further explore and meet their needs. Education can be offered through hands-on work, multimedia use, role play, and experiential learning [ 32 ].

In a qualitative study, health professionals made suggestions regarding the enhancement of empathy. These suggestions included more holistic, educational interventions in behaviors that are central to the patient’s needs, with an emphasis on personal development, professional training, and supervision programs, rather than education in behavioral and communication skills [ 74 ].

‘Diversity Dolls’ is a hands-on educational method for the reinforcement of empathy that is used among social care students in a Greek university, so that students can instill empathetic skills in socially vulnerable populations [ 75 ]. It is believed that the use of such based-on-art methods helps social care students to feel safe, to explore, and give meaning to the real circumstances people live in, through pleasant, participatory, interactive activities [ 76 ].

Globally, creative educational methods such as journaling, art, role-play, and simulation games globally are becoming more popular in the health and social care fields helping students to increase their knowledge and skills in relation to empathy [ 75 , 76 ].

Teaching techniques and classroom methodologies familiarize social workers to empathetic skills [ 55 ]. In a study, among social work students, the results suggest that empathetic modeling from professors and field supervisors enhance social work students’ empathy. Social work educators should not focus on traditional teaching but they ought to concentrate on interactive and creative education that enhances the empathetic modeling and relationship between educators and students [ 77 ]. Apart from teaching social work students with mental flexibility, regulation of emotional and perspective taking, social workers should be taught empathy throughout the phenomenological psychological approach (seminars that utilize transcribed audio recordings of interactions) [ 78 , 79 ]. Additionally, regular supervision has a key role in enabling social workers to process their own feelings and to deal with empathy [ 80 ].

4. Conclusions

Empathy among health care users and professionals significantly contributes to how both groups behave as well as to their therapy and overall well-being. The development of empathetic skills constitutes an important priority in the education of health and social care students and should be encouraged. Educational programs should primarily be performed in a hands-on way that will strengthen the students’ personal and social skills and allow them to effectively communicate with their patients.

Moreover, health care professionals should be supported through continuous and personal development education programs as well as through supervision sessions that will allow them to develop empathetic skills. Political will is a prerequisite for the financing and encouragement of further actions.

Author Contributions

All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

IMAGES

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COMMENTS

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