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. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research.
Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.
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In an effort to provide guidance to authors undertaking scoping studies, Arksey and O'Malley [6] developed a six-stage methodological framework: identifying the research question, searching for relevant studies, selecting studies, charting the data, collating, summarizing, and reporting the results, and consulting with stakeholders to inform or validate study findings (Table 2). While this framework provided an excellent methodological foundation, published scoping studies continue to lack sufficient methodological description or detail about the data analysis process, making it challenging for readers to understand how study findings were determined [1]. Arksey and O'Malley [6] encouraged other authors to refine their framework in order to enhance the methodology.
In this paper, we apply our experiences using the Arksey and O'Malley framework to build on the existing methodological framework. Specifically, we propose recommendations for each stage of the framework, followed by considerations for the advancement, application, and relevance of scoping studies in health research. Continual refinement of the framework stages may provide greater clarity about scoping study methodology, encourage researchers and clinicians to engage in this process, and help to enhance the methodological rigor with which authors undertake and report scoping studies [1].
We each completed a scoping study in separate areas of rehabilitation using the Arksey and O'Malley framework [6]. Goals of these studies included: identifying research priorities within HIV and rehabilitation [7], applying motor learning strategies within pediatric physical and occupational therapy intervention approaches [8], and exploring the use of theory within studies of knowledge translation [9]. The amount of literature reviewed in our studies ranged from 31 (DL) to 146 (KO) publications. Upon discovering that we had similar challenges implementing the scoping study methodology, we decided to use our experiences to further develop the existing framework. We conducted an informal literature search on scoping study methodology. We searched CINAHL, MEDLINE, PubMed, ERIC, PsycInfo, and Web of Science databases using the search terms 'scoping,' 'scoping study,' 'scoping review,' and 'scoping methodology' for papers published in English between January 1990 and May 2010. Reference lists of pertinent papers were also searched. This search yielded seven citations that reflected on scoping study methodology, which were reviewed by one author (DL). After independently considering our own experiences utilizing the Arskey and O'Malley [6] framework, we met on seven occasions to discuss the challenges and develop recommendations for each stage of the methodological framework.
Scoping study research questions are broad in nature as the focus is on summarizing breadth of evidence. Arksey and O'Malley [6] acknowledge the need to maintain a broad scope to research questions, however we found our research questions lacked the direction, clarity, and focus needed to inform subsequent stages of the research process, such as identifying studies and making decisions about study inclusion. To clarify this stage, we recommend that researchers combine a broad research question with a clearly articulated scope of inquiry. This includes defining the concept, target population, and health outcomes of interest to clarify the focus of the scoping study and establish an effective search strategy. For example, in one author's (KO) scoping study, the research question was broadly 'what is known about HIV and rehabilitation?' Defining the concept of 'rehabilitation' was essential in order to establish a clear scope to the study, guide the search strategy, and establish parameters around study selection in subsequent stages of the process [7].
Although Arskey and O'Malley [6] outline four main purposes for undertaking a scoping study, they do not articulate that purpose be specified within a specific framework stage. We recommend researchers simultaneously consider the purpose of the scoping study when articulating the research question. Linking a clear purpose for undertaking a scoping study to a well-defined research question at the first stage of the framework will help to provide a clear rationale for completing the study and facilitate decision making about study selection and data extraction later in the methodological process. A helpful strategy may be to envision the content and format of the intended outcome that may assist researchers to clearly determine the purpose at the beginning of a study. In the abovementioned HIV study, authors linked the broadly stated research question with a more specific purpose 'to identify the key research priorities in HIV and rehabilitation to advance policy and practice for people living with HIV in Canada' [7]. The envisioned outcome was a thematic framework that represented strengths and opportunities in HIV rehabilitation research, followed by a list of the key research priorities to pursue in future work.
A strength of scoping studies includes the breadth and depth, or comprehensiveness, of evidence covered in a given field [1]. However, practical issues related to time, funding, and access to resources often require researchers to consider the balance between feasibility, breadth, and comprehensiveness. Brien et al.[5] reported that their search strategy yielded a vast amount of literature, making it difficult to determine how in depth to carry out the information synthesis. Although Arksey and O'Malley [6] identify these concerns and provide some suggestions to support these decisions, we also struggled with the trade-off between breadth and comprehensiveness and feasibility in our scoping studies. As such, we recommend that researchers ensure decisions surrounding feasibility do not compromise their ability to answer the research question or achieve the study purpose. Second, we recommend that a scoping study team be assembled whose members provide the methodological and context expertise needed for decisions regarding breadth and comprehensiveness. When limiting scope is unavoidable, researchers should justify their decisions and acknowledge the potential limitations of their study.
Arksey and O'Malley [6] provide suggestions to manage the time-consuming process of determining which studies to include in a scoping study. We experienced this stage as more iterative and requiring additional steps than implied in the original framework. While Arksey and O'Malley [6] do not indicate a team approach is imperative, we agree with others and suggest scoping studies involve multidisciplinary teams using a transparent and replicable process [2, 10]. In two of our studies (HC and DL) where decision making was primarily completed by a single author, we faced several challenges, including uncertainty about which studies to include, variables to extract on the data-charting form, and the nature and extent of detail to conduct the data extraction process. This raised questions related to rigor and led to our recommendations for undertaking a systematic team approach to conducting a scoping study.
Specifically, we recommend that the team meet to discuss decisions surrounding study inclusion and exclusion at the beginning of the scoping process. Refining the search strategy based on abstracts retrieved from the search and reviewing full articles for study inclusion is also a critical step. We recommend that at least two researchers each independently review abstracts yielded from the search strategy for study selection. Reviewers should meet at the beginning, midpoint, and final stages of the abstract review process to discuss any challenges or uncertainties related to study selection and to go back and refine the search strategy if needed. This can help to alleviate potential ambiguity with a broad research question and to ensure that abstracts selected are relevant for full article review. Next, two reviewers should independently review the full articles for inclusion. When disagreements occur, a third reviewer can be consulted to determine final inclusion.
This stage involves extracting data from included studies. Based on our experiences, we were uncertain about the nature and extent of information to extract from the included studies. To clarify this stage, we recommend that the research team collectively develop the data-charting form to determine which variables to extract that will help to answer the research question. Secondly, we recommend that charting be considered an iterative process in which researchers continually update the data-charting form. This is particularly true for process-oriented data, such as understanding how a theory or model has been used within a study. Uncertainty about the nature and extent of data that should be extracted may be resolved by researchers beginning the charting process and becoming familiar with study data, and then meeting again to refine the form. We recommend an additional step to charting the data in which two researchers independently extract data from the first five to ten studies using the data-charting form and meet to determine whether their approach to data extraction is consistent with the research question and purpose. Researchers may review one study several times within this stage. The number of researchers involved in the data extraction process will likely depend upon the number of included studies. For example, in one study, authors had difficulty developing one data-charting form that could apply to all included studies representing a range study designs, reviews, reports, and commentaries [7]. As a preliminary step, authors decided to classify the included studies into three areas --HIV disability, interventions, and roles of rehabilitation professionals in HIV care -- to help determine the nature and extent of information to extract from each of the types of studies [7]. 2ff7e9595c
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