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"Chapter 4 Literature Reviews: Examining the Background for a Study Researchers review the literature to learn what is and is not known about a study’s topic and research problem. They document this essential information in a “literature review” passage as part of the Introduction section of the report. When you read a study’s literature review, you can use this passage to understand the background behind the research study. As a practitioner, you also need to develop your own skills for reviewing literature to learn what is known about the topics that interest you. In this chapter, you will learn how to interpret and evaluate the literature reviews that researchers include in their studies. In addition, you will learn steps that you can use to locate and summarize literature and write your own literature reviews. BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: Identify and understand the literature review in a research report. Describe how researchers use literature in their research studies. Describe differences in how researchers use literature in quantitative and qualitative research. Take steps for reviewing the literature about a topic of interest to you. Identify steps useful for writing a literature review. Evaluate the quality of the literature review in a research report. One of the ways that all of us learn about topics that matter to us is from what others have already done and found. As the expression goes, there is no need to reinvent the wheel if someone else already knows how to make one! This is particularly true in our professional practices where so much is already known about topics such as teaching second language learners, preventing drug use in adolescents, assisting new parents with infant care, and providing effective interventions. In many situations, you can learn about topics such as these by watching what others do and talking to them about it. However, this strategy is only useful for learning from people who are readily accessible. Therefore, one of the best ways to develop comprehensive knowledge about topics is to read the literature that has been prepared by individuals with expertise in the topic area. Learning by reading literature is essential for anyone who wants to know the state of knowledge about a topic. You have probably been required at some point in your schooling to go to the library building or website, read some literature, and write a report about what you learned. It is likely that you have a “literature review” project assigned as a requirement for the course you are taking right now. Completing a class assignment is one important reason to review the literature, but there are also several additional reasons why individuals choose to review the literature. As we learned in Chapter 1, reviewing the literature is an essential step for researchers to complete in the process of conducting research. Researchers need to be aware of the knowledge that exists about the topic and problem they want to study, and reviewing the literature gives them access to the knowledge available. Knowing how to review the literature, however, is not only important for researchers. Students, practitioners, and policy makers also need to locate, understand, summarize, and critique literature to gain knowledge about important topics. Therefore, you need to understand the role that literature plays in a research study, and you need to develop your own skills for reviewing literature. In fact, developing these skills is probably the main reason you are taking this class and reading this book! We will consider both types of skills in this chapter. We begin by first defining what we mean by a literature review and considering how you can recognize its application in a research report. How Do You Identify the Literature Review in a Research Study? Reviewing the literature is the process that individuals use to locate, read, synthesize, and critique the literature available on a topic. The result of this process is usually a written product that is referred to as a literature review. In the process of research, a literature review is a written synthesis of journal articles, books, and other documents that summarizes and critiques the past and current state of information about a topic, organizes the literature into subtopics, and documents the background for a study. In the most rigorous forms of research, investigators develop a comprehensive review based on quality sources of literature such as journal articles and government documents. Regardless of the sources of information, individuals conduct literature reviews to learn the state of knowledge about topics. As introduced in Chapter 1, reviewing the literature is an essential step in the process of research so that researchers ensure that their study will add to the existing knowledge. Simply put, researchers cannot design a study to add to the existing knowledge if they do not know what that knowledge is. Knowing the current state of knowledge keeps them from duplicating research already available. It also informs them as to how their study can be planned so that it will build on what others have learned. In addition, researchers learn about theories and philosophies relevant to their topic areas by reading the literature. They can also examine models of how others have designed their research studies. Therefore, a good review of the literature provides important background information for researchers about what has been done, what still needs to be done, and how best to go about doing it. As you read a research study, you can identify the literature review by finding a specific section about the literature and noticing where the researchers cited the literature throughout the report. Look for the Literature Review in a Stand-Alone Section Because the literature review provides the background for a study, you can expect it to appear early in a report as part of the Introduction section(s). In some reports, you can locate a stand-alone section that reports a study’s literature review. This section typically is part of the overall Introduction and follows the statement of the problem. Researchers often use a heading of Literature Review to designate this section. Other commonly used headings include Background for the Study or Conceptual Framework. Some authors use a heading that describes the content topic being reviewed, such as Adolescent Egocentrism and Invulnerability (Frankenberger, 2004, p. 577). The literature review can vary in length from a paragraph or two to multiple pages, depending on the extent of the literature that the researchers choose to include. Once you locate a study’s literature review, read it to learn what information was available to inform the planning of the research study. Identify the major themes in the reviewed literature as well as the subtopics found within the themes. Look to the headings that appear in the report to help you understand how the literature has been organized. If headings are not used, make your own notes in the margins to identify the topic of each paragraph or section. At the end of the literature review, see if the authors provide their conclusions about the literature and some statement as to how this literature provides a background for the study they are reporting. Note Where Researchers Refer to Others’ Work from the Literature Not all research reports will include a stand-alone section for the literature review. Even if the researchers do not include a specific section, the reviewed literature is typically quite visible because of its importance in research. You can identify when researchers refer to “the literature” when they include citations within the text to other published work. These citations often appear in parentheses and include authors’ names and the year of the work being cited, such as (Smith, 2012; Young & Jones, 2008). In some reports, these citations will be indicated with numbers within brackets, such as [1, 2], or superscript numbers, such as3,8. No matter the format, researchers will clearly indicate where they are using others’ ideas in their reports by providing citations. These in-text citations indicate the authors’ use of the literature, and you can use them to identify how the current study is building on what others have found. Here’s a Tip! Good research reports include many citations to others’ work. Do not worry about understanding each one individually as you read. Instead, focus on the major ideas that the author is describing as you read a literature review. How Do Researchers Use Literature in Their Studies? Now you know a shortcut for finding reviewed literature in a report—look for the researchers’ use of citations. Noting citations will tell you where a researcher is referring to the literature in their report, but it does not tell you how that literature is being used in the study. There are five common ways that researchers use their literature review. These uses include: providing a justification for the research problem, documenting what is and is not known about the topic, identifying the theory or conceptual framework behind a study, providing models for the methods and procedures, and interpreting results. Let’s examine each of these uses in more detail so you can recognize and understand their application in research reports. Literature Provides a Justification for the Research Problem As we learned in Chapter 3, researchers use references to the literature to provide evidence for the importance of a study’s research problem. This use of literature is usually found in the study’s Introduction section as part of the statement of the problem. Literature may be used to document the extent of the problem or the issues and concerns associated with the problem. For example, read how Poyrazli and Lopez (2007) use literature to provide evidence for a “major problem” in their study about the experiences of international students attending colleges in the United States: “Homesickness, a component of culture shock, is a major problem for college students, particularly those new to the university system (S. Fisher & Hood, 1987; Tognoli, 2003)” (p. 263). Good research reports include multiple references to the literature to substantiate the importance of the research problem. Literature Documents What Is and Is Not Known About the Topic Researchers review the literature to document what is known about a topic and to uncover what is not known. Researchers include the literature in their reports to demonstrate that they are sufficiently aware of other research on the study topic. Researchers summarize and report the existing knowledge in the study’s Introduction, as part of the statement of the problem and/or in a stand-alone section. Often the key ideas are mentioned in the statement of the problem, but then discussed in detail in a separate section. As discussed in Chapter 3, in well-written reports, the researchers also clearly state the knowledge that is missing in the available literature to convey the need for the study. For example, in a study about hostile conflict in early marriages, Topham, Larson, and Holman (2005) reviewed what was known about four relevant subtopics: (1) parental marital status and offspring marital satisfaction, (2) quality of the parent–child relationship, (3) quality of parental discipline, and (4) quality of family-of-origin environment. They then concluded, “No research was found which specifically suggests a family-of-origin relationship to hostile marital conflict” (p. 108). A good use of the literature occurs when researchers provide a comprehensive summary of the literature on a topic and identify two to three explicit deficiencies in that literature. Literature Identifies the Theory or Conceptual Framework Behind a Study In many studies, researchers go beyond simply documenting what is known about a topic by identifying a perspective from the literature that guides how they approach their study of that topic. These perspectives come from theories and conceptual frameworks discussed in the literature. Researchers often mention the guiding theory or conceptual framework for their study in the Introduction sections of the research report. To understand how a researcher uses the literature in this way, we need to consider what theories and conceptual frameworks are and the role they each play in research. Researchers Use Theories to Identify Key Variables and Expected Relationships Among Them. A theory in research explains and predicts the probable relationship among different concepts (or variables). Theories about variables develop from research over time. For example, researchers test the idea that peer groups have an influence on adolescents’ beliefs and behaviors. This relationship is tested over and over, such as with the Boy Scouts, in church groups, in middle schools, in sports teams, and other settings. Repeatedly the relationship of a positive effect holds true. In light of all this evidence, someone calls this relationship a theory and assigns a name to it. “Smith’s Theory of Peer Influence” is born, reported in the literature, and tested further by other researchers. The literature includes many well-developed theories on concepts such as how students learn, what motivates people, how new ideas are adopted, and how leadership styles promote certain behaviors. Here’s a Tip! Theories can also be useful for practitioners because they provide you with a framework for thinking about your practice. Pay attention to the theories mentioned in reports to see if you can find a theory that resonates with you and can inform your practices. When you read a study in which the researchers planned to test a specific theory, then learning about the theory is important background information for understanding the study. Researchers use the literature to document and describe the important elements of the theory in their report, and they may include a figure that illustrates the theory. The use of theory strengthens the rigor and quality of research because the use of a theory from the literature provides a sound basis for the study’s selected variables and predictions about expected results. Therefore, you need to be able to recognize and understand researchers’ use of theory in studies. Here are two examples of researchers using theories from the literature to identify the variables in their studies: An example of the use of an existing theory depicted as a figure in the literature. Brady and O’Regan (2009) used a previously published theory to select the variables for their study of a Big Brothers Big Sisters program. As shown in Figure 4.1, Rhode’s Model of Mentoring is a theory that relates several variables important to youth mentoring (e.g., mutuality, cognitive development, health risk, and community context). This theory predicts that the mentor relationship influences the development of the mentored youth, which then leads to positive outcomes for the youth. The theory also suggests that various contexts and other interpersonal relationships will influence the extent to which the mentor relationship will lead to positive youth outcomes. An example of the use of an existing theory discussed in the literature. Not all theories are drawn in figures; many are simply described in words. For example, Constantine et al. (2005) discussed the Social Cognitive Career Theory in their literature review passage of their report of a study of African American adolescents’ career decisions. They used this theory to make predictions for how they expected perceived occupational barriers to be related to career certainty in their study. Researchers Use Conceptual Frameworks to Inform Their Assumptions and Beliefs About the Topic Under Study. In many studies, the researchers do not intend to test a specific theory, but they do use a theory or conceptual framework to guide how they think about the study’s topic. A conceptual framework represents a philosophical perspective, an advocacy or social justice stance on behalf of marginalized groups, or a particular way of viewing knowledge that the researcher uses to inform a study. As with the use of theory, researchers’ use of a conceptual framework drawn from the literature also strengthens the rigor and quality of research. This is because the use of Figure 4.1 Example of Using a Diagram to Depict a Theory From the LiteratureSource: This figure is reprinted from Brady and O’Regan, Journal of Mixed Methods Research, Vol. 3, Issue 3, p. 268, 2009, as adapted from the Handbook of Youth Mentoring (p. 32), edited by David L. DuBois and Michael J. Karcher, 2005. Thousand Oaks, CA: Sage. Copyright © 2005 by Sage. Reprinted with permission of Sage Publications, Inc. a conceptual framework provides researchers with a perspective for thinking about the study topic that is well thought out (as opposed to just using their own personal beliefs). When you identify the conceptual framework that researchers used, then you have a clear idea about how they approached the study. Here are three examples of how researchers use conceptual frameworks from the literature to inform their research studies: An example of the use of a philosophical perspective to inform a research study. Philosophical perspectives describe how researchers think about abstract concepts such as the nature of reality and how one can gain knowledge about reality. Churchill et al. (2007) noted the philosophical perspective that guided their study of how rural, low-income families have fun when they wrote, An interpretive, constructivist perspective guided this study (Lincoln & Guba, 2000; Newman, 2000). This means that we assumed that multiple views of reality exist, we were interested in learning about ordinary experiences in people’s every day lives, and that we openly explored participants perceptions and experiences and the contexts in which they occur (Churchill et al., 2007, p. 276). An example of the use of a social justice stance to inform a research study. Social justice stances are used when researchers are concerned about inequalities that exist in society and bring an advocacy perspective to their research. For example, Kamphoff (2010) used a feminist perspective to inform her study of why female coaches leave coaching at the college level. She discussed the use of feminism in her report, noting that “feminist research brings women’s experiences to the center, aiming to better the lives of those involved (Klein, 1983; Thompson, 1992)” (p. 361). An example of the use of a way of viewing knowledge to inform a research study. Research studies can also be informed from general ways of viewing knowledge or approaching a topic. For example, Craig (2004) described the following view of knowledge used in her study about the influence of mandated testing. She wrote, “A particular view of knowledge forms a central underpinning of this work. Personal practical knowledge (Clandinin, 1986) is embedded in, and shaped by, situations” (p. 1231). In each of these three examples, the researchers used literature to describe a perspective that was important in shaping the research study, but not something to be tested. That is, they did not set out to test constructivism, test feminism, or test the idea of personal practical knowledge. Instead, these researchers used these perspectives to guide how they thought about planning, conducting, and interpreting their studies. Therefore, it is essential to identify these perspectives when reading research studies in order to understand how the researchers approached their studies. Literature Provides Models for the Methods and Procedures Used in a Study In addition to including literature in the Introduction section(s) of a report, researchers also frequently cite literature when describing their study’s methods and procedures in the Method section. Researchers use the literature to provide models for how to design their studies and to collect and analyze their data. For example, when researchers decide to use a certain instrument for collecting data, they may explain where in the literature they found this instrument. They also use literature to justify the choice for the study’s research design or decisions about how to select people as participants. This literature may include other published studies that used the same procedures or methodological writings where scholars discuss the procedures that can be used in the research process (like this book). When you note that the researchers used procedures that have been previously discussed in the literature, you are provided with evidence for the quality of the study because it indicates that the researchers used established procedures and did not just “make things up.” We will learn more about these procedures in Chapters 6–13. Literature Helps Researchers Interpret Their Results A final use of literature that you find in research reports is the use of literature to aid in the researchers’ interpretation of the results found from the research study. Researchers cite literature in the final Conclusion section of their reports when they compare the new results with past studies in the literature or examine the overall meaning of the new results for the existing literature. We will discuss this use of the literature further in Chapter 14. What Do You Think? Read the following excerpts taken from Smith, Estudillo, and Kang’s (2011) quantitative study that investigated racial differences in middle school students’ identification with academics (e.g., perceptions of testing) and its association with grade point average (GPA). For each excerpt, determine how the researchers appear to be using the literature. “Ogbu and Simons (1998) described cultural-ecological theory as a series of belief systems held among students that influences how they perceive the education system and ultimately the potential for gains attained from engaging in the educational system” (p. 75). “While many studies compare aspirations and achievement between White and African American students, increasingly researchers point to the need to study within group differences (Meece & Kurtz-Costes, 2001)” (p. 78). “Students completed the Identification with Academics questionnaire, adapted from Osborne (1997), consisting of 13 items” (p. 80). “Contrary to the literature on teacher expectations going back to Good and Brophy (1986) that suggested that African American students cared less about school, we expected and found that African American students reported higher levels of identification with school” (p. 86). Check Your Understanding Each of these passages made reference to the literature as indicated by the citations in the sentences that identify authors’ names and years. Excerpt (a) is an example of the researchers using the literature to identify the theory or conceptual framework behind the study—namely, the cultural-ecological theory. Excerpt (b) is an example of the use of literature to establish what is and is not known about a topic to justify the need for the study because the literature needs to be extended to study within group differences. Excerpt (c) is an example of the use of the literature to provide models for the methods that the researchers applied in the study. In this case, the researchers used a measurement instrument that was adapted from one previously employed by others. Excerpt (d) is an example of using the literature to interpret the results found from the study. The researchers noted that their results differed from what others in the literature have found. How Does the Use of Literature Differ in Quantitative and Qualitative Studies? When researchers review the literature for their studies, they summarize research articles that use quantitative and qualitative approaches. Both are acceptable and useful. However, as you learned in Chapter 2, the way researchers use the reviewed literature differs in quantitative and qualitative research. There are two primary differences in its application. The use of literature differs in terms of the role it plays in the study (more prescriptive or more informative) and when in the research process it is reviewed (reviewed primarily at the start and remains more static, or reviewed throughout the process and becomes more dynamic). The Use of Literature Is More Prescriptive and Static in Quantitative Research In quantitative studies, researchers tend to focus extensive attention on reviewing the literature at the beginning of the study’s research process. They use the literature to substantiate the research problem, point to the specific variables of interest in the study, suggest theories that explain the expected relationships among variables, provide a rationale for the study’s purpose, and form the basis for the hypotheses to be tested in the study. That is, the literature is used to prescribe the direction and intent of the quantitative research study. At the end of the study, the researchers return to the literature when drawing conclusions, but this is typically the same literature reviewed at the start of the study. The researchers compare the study results to the predictions identified at the beginning. In this way, the use of literature is more static because it is primarily reviewed at the start of the study to set the quantitative study’s direction and variables, which do not change as the study is conducted. Because of the more prescriptive and static role of the literature in quantitative research, the literature typically has a prominent presence in the Introduction sections of quantitative study reports. In addition to its use in the study’s statement of the problem, quantitative researchers typically include a more thorough treatment of the literature in its own section titled Review of the Literature to highlight the important role it plays in setting the direction of the study. This literature review is often organized around the major variables of interest in the study and emphasizes how the variables have been found to relate to other variables in past research. The researchers also incorporate the literature in the Method section when they discuss the instruments used to measure the study’s variables and in the final section of the report when they interpret how the results found in the study compare to the predictions made based on the literature review. In the quantitative physical-activity-in-middle-schools study (Xu et al., 2010) from Chapter 1, you find that the citations to the literature cluster around the beginning and the end of the article. In paragraph 01, Xu et al. cite studies to document the importance of the problem: low levels of physical activity lead to serious health consequences. In paragraph 02, the authors provide a short review of literature found on school-based interventions for physical activity and identify deficiencies in this literature (i.e., a lack of research on successful programs at the middle school level). Then, in paragraph 03, the authors explain that a model (or theory) exists in the literature suggesting factors that might explain behaviors of middle school students—the Social Ecological Model. They also present study aims consistent with the factors in this model that are expected to influence physical activity opportunities. In addition, the authors use literature when they discuss the measures they used to collect data for the study’s variables (e.g., see paragraph 07). Finally, the authors return to the literature in paragraphs 14–20 by comparing their results to other studies in the literature. The Use of Literature Is More Informative and Dynamic in Qualitative Research Similar to quantitative research, qualitative researchers review existing literature at the beginning of their research process to document the importance of the research problem. Unlike quantitative research, qualitative researchers do not use this literature to prescribe specific variables or hypotheses, choosing instead to use it to inform their overall approach. Recall that qualitative researchers want to remain open to exploring their topic and learning from participants’ perspectives as opposed to testing ideas from the literature. In some qualitative studies, the researchers make little use of the literature at the beginning of their study to keep this openness. Others, however, may use the literature to describe a conceptual framework that informs their stance for the study. This framework does not set the direction of the study or introduce predictions like a theory in a quantitative study; instead, it informs how the researchers think about and approach the topic. Qualitative researchers also may use the literature to document models for their methods, but these tend to focus more on general procedures and not on specific instruments. In contrast to quantitative research, researchers using a qualitative approach often return to the literature as they are conducting the study and new ideas develop from the data. Because of the open nature of qualitative research, new concepts often emerge that were not anticipated at the start and researchers need to examine the literature about these new topics. Therefore, qualitative research involves a more dynamic process of reviewing the literature as new ideas emerge from the study. At the end of the study, the researchers use literature to describe the meaning of the results in relation to past studies. Relating qualitative results to the literature is not the same as comparing to predictions in quantitative research. In qualitative inquiry, researchers are more interested in whether the findings of a study support or modify existing ideas and practices advanced in the literature. Because of the informative and dynamic role of the literature in qualitative research, its presence in qualitative research reports may be minimal, extensive, or somewhere in between. At a minimum, the researcher will use literature in the statement of the problem to justify the importance of the research problem and in the Conclusion section to assist in the interpretation of the results. Many qualitative studies will incorporate extensive literature as part of the Introduction, often in a section titled Conceptual Framework, to explain the assumptions and perspectives that inform the researchers’ thinking about the topic and approach to the study design. In the qualitative physical-activity-at-daycare study (Tucker et al., 2011) from Chapter 1, you find that the authors begin their article by citing literature to document the research problem of insufficient physical activity and obesity for preschool-aged children (see paragraphs 01–04). The purpose and research questions (paragraph 04) were not prescribed by the literature. Rather, the researchers’ intent is general and open ended—in this way, they can learn from the participants. The authors of this study did not identify any conceptual framework that informed their research approach, so this study is an example of a more minimal approach to using the literature. The authors do cite literature in the Method section (paragraphs 05–07) to explain their procedures. Finally, they also use literature to help interpret the larger meaning of the results of the study. In the Conclusion section (see paragraphs 24–32), the authors discuss how three key findings that emerged from the participants’ perspectives both reinforce and depart from past research, and suggest ways that the literature and practice need to further consider the perspectives of daycare providers. What Are the Steps That You Can Use to Review the Literature? So far in this chapter, we have focused on how to recognize and interpret researchers’ use of literature within their research reports. It is not enough, however, for you to understand how others use literature. You also have to develop your own skills for locating and summarizing literature and writing a literature review. Most of us complete our first literature reviews as class assignments. There are many additional reasons why you should read the research literature beyond fulfilling a course requirement. Recall from Chapter 1 that reading research adds to your knowledge, informs your position in policy debates, and suggests improvements for practice. Practitioners of all professions review the literature for these same reasons. By reading the literature, practitioners keep up to date on the latest developments in their fields. They also learn about new topics that they have not previously examined. For example, a science teacher may want to review information to develop effective strategies for a new student who is visually impaired or a social worker may want to review information relevant to the issues experienced by recent immigrant families. Practitioners who are able to critically read available research studies can develop new ideas and strategies to try in their practice from reviewing literature. Completing a comprehensive, thoughtful review of the literature is a challenging process that takes determination and perseverance. Like all tasks, it becomes easier with practice and as you learn more information about the process. The good news is that you bring many useful experiences and skills to this process. Today’s literature reviews make extensive use of computer-based technologies, and your prior experiences with searching the Internet will provide a helpful starting place. Your skills for keeping records and writing reports on the computer will also be very useful in this process. As we will learn, reviewing the literature also requires you to keep track of sources and sort information into categories. Therefore, your organizational skills will be required. Your process for reviewing the literature is also enhanced by the knowledge and prior experiences you have had related to your topic of interest. This background will serve you well as you begin to think about how to locate literature. Finally, to conduct a good formal literature review, you should be able to identify and understand reports of research. As you learned in Chapter 1, research represents activities where individuals systematically gather and analyze empirical data to answer a question. Therefore, you already know how to identify reports of research, and this entire book is aimed at helping you understand the information that researchers include in these reports. Regardless of whether you are a researcher planning a study, a practitioner interested in examining the evidence for certain practices, or a student working on a class assignment, there is a set of common steps that individuals use to search for, locate, and summarize literature for a literature review. In this section, we describe the steps in terms that you can directly apply in your own work. Keep in mind as you read that these are the same steps that researchers take when they review the literature for their research studies. Knowing these steps therefore helps you understand the literature discussed in research studies and provides you with a framework for reviewing the literature for your own personal use. These steps are: Identify key terms. Use search strategies to locate literature. Select relevant documents that are of good quality. Take notes on the key aspects of each selected document. Although these steps are relatively easy to describe, you will likely find that reviewing the literature is a little like hunting for hidden treasure: It takes work and you do not always know where to dig. To help you with this process, we will discuss specific strategies for each of these steps. In addition, we will briefly consider how each step could be applied in a literature review conducted to learn about weapon possession and violence in middle schools. Step 1—Identify Key Terms Related to the Topic of the Literature Review Today you can easily search for most anything, including literature, from the comfort of your school, home, or work using a computer or smart device. Searching over the Internet is a fantastic strategy, but it only works well if you are able to tell the search programs what you want them to find. Therefore, the first step to take when searching for literature is to identify your topic and narrow it to a few key terms. These key terms should be one or two words or short phrases. Choose these terms carefully because they are important for initially locating literature through an online search. To identify these terms, you can use several strategies, such as: Pose a short, general question that you would like answered by reviewing the literature. Select the two or three terms in this question that best summarize the primary concepts. Write a preliminary working title for your project and select two to three keywords in the title that capture the central ideas. Use words that you find used in the literature. You might be interested in how different students learn and then read a journal article that refers to these differences as “learning styles.” You can then use this phrase as a key term for the topic. List synonyms for your topic. For example, you might be interested in the supports needed by family members who care for an elderly parent. You might consider synonyms such as family support, spousal care, and caregiver to access this topic. Let’s suppose you are interested in learning about student violence in general and weapon possession by middle school students in particular. Using these strategies, you might start by writing a working title for your project, “Student Violence and Weapon Use by Middle School Students.” From this title, you might consider the words violence, weapon, and middle school as key terms for this topic. You might also start listing some possible synonyms, such as fighting and physical attack for violence, guns and knives for weapon, and junior high for middle school. A good search of the literature is able to identify all the key research that has been conducted on a topic. This means that you need to be creative and clever about the key terms to use in searching to ensure that you find the relevant literature. Just as a treasure hunter must dig in many spots when looking for treasure, you will likely need to try many key terms when searching for useful literature. Here’s a Tip! Keep a list of all possible key terms that occur to you as you read and think about your topic. This will help you identify a set of best terms to use for your areas of interest. Step 2—Search Databases Using the Key Terms to Locate Literature Having identified key terms, you can begin the search for literature. There is so much literature available that you need to develop efficient strategies when searching for literature that relates to your topic of interest. Fortunately, you probably have experience searching for information on friends or finding directions using Internet search engines such as GoogleTM. You might be tempted to search for literature in the same way by accessing websites and exploring the information available on a topic. Although this process may be convenient, keep in mind that not all literature posted online is dependable or of high quality, and a lot of information online is not research. To find scholarly research literature on topics, you should search places that are set up specifically to help individuals identify scholarly literature. These places include academic libraries and electronic databases. Use Academic Libraries to Find an Introduction to Your Topic. A sound approach is to begin your search in an academic library housed at a college or university. By searching an academic library’s catalogs and stacks, you will save time because you will find comprehensive holdings not available through other sources. Although a town or city public library may yield some useful literature, an academic library typically offers the largest collection of materials, especially research studies. Academic libraries typically have online catalogs of their holdings so that you can search the library materials easily to find books and summaries on your topic. Books and summaries typically do not report the details of individual research studies, but they can provide a good introduction to your topic and help you further identify appropriate key terms. Here’s a Tip! If you have trouble locating research on your topic, go to an academic library and ask for help from the reference librarians. They are experts at locating scholarly literature and all the ones that we have met have been delighted to help students locate literature. Search Electronic Databases to Find Research Articles on Your Topic. The best sources for literature reviews consist of journal articles written by the individuals who actually conducted the research or originated the ideas. You can find many scholarly journals in the stacks at your academic library, but it would take too much time to review them all by hand. Therefore, to locate journal articles on your topic, you should search the electronic databases that are available. Six useful databases that offer easy retrieval of journal articles and other documents related to educational, social, and health topics are listed in Table 4.1. If you access these databases through your school’s library, they may also indicate which documents are directly available from the library for free. Usually you will want to search more than one database to find all relevant literature on your topic. When you use one of the databases listed in Table 4.1, one possible approach is to simply enter your key terms into the main search box on the database’s website. Although this strategy is often successful for everyday searches such as looking for the best pizza restaurant in a neighborhood, it is not a very efficient way to search for research literature. For example, searching for the phrase violence in middle schools found more than 39,000 hits in Table 4.1 Electronic Databases Useful for Searching for Research Journal Articles Educational Resources Information Center (ERIC, 1991): The ERIC database consists of two parts: (1) major educational and education-related journals; and (2) documents, including conference papers, project and technical reports, speeches, unpublished manuscripts, and books. You can search ERIC on the Internet (eric.ed.gov) or online through academic libraries that have purchased access. Psychological Abstracts (APA, 1927–): This database provides a comprehensive source of psychological literature. It focuses on peer-reviewed journals, but also includes books and dissertations. You can search the database through PsycINFO on the Internet (www.apa.org) or online through academic libraries that have purchased access. Sociological Abstracts (Sociological Abstracts, Inc., 1953–): This database provides access to the world’s literature in sociology and related disciplines through abstracts of journal articles, books, dissertations, and conference papers. The Sociological Abstracts database is available from Cambridge Scientific Abstracts (www.csa.com) or online through academic libraries that have purchased access. EBSCO Information Services: This service provides online access to more than 150 databases and thousands of e-journals. Academic libraries purchase the services of EBSCO or individuals can purchase articles of interest through the pay-per-view feature (www.ebsco.com). PubMed: The PubMed database is a service of the U.S. National Library of Medicine and provides access to biomedical and life science publications, including free access to research funded by the National Institutes of Health through PubMed Central. You can search the full PubMed database (www.ncbi.nlm.nih.gov/pubmed/) and the PubMed Central database (www.ncbi.nlm.nih.gov/pmc/) on the Internet or through many academic libraries. Google Scholar: Google Scholar is a searchable database that provides access to a wide range of scholarly literature found in academic sources and other online repositories. It includes both peer-reviewed and non-peer-reviewed sources. You can search using Google Scholar (scholar.google.com) for free on the Internet. the ERIC database! A better strategy is to use the “Advanced Search” features available in all electronic databases. These advanced features can help you search for documents that meet a set of specific criteria. Making good use of advanced searches takes practice, but it will be well worth your effort to learn to use the more advanced features. Here are a few tips that we use when searching a database. For each tip, we also describe how we applied it in an advanced search for articles about violence and weapon possession in middle schools through the ERIC website (eric.ed.gov). Here’s a Tip! Although most electronic databases can be accessed directly through the Web, it is better to access them through an academic library when possible. Going through an academic library will provide you with access to full-text journal articles for free that the general public has to pay for. Use multiple key terms, but not too many. Two or three broad key terms (such as “violence” and “middle school”) can help you identify literature clearly related to your topic. Using one keyword that is too general (such as “violence”) can get you thousands of hits! Using too many key terms or terms that are very specific (such as “bring a knife to seventh grade”) may cause you to get too few hits and miss many good documents. Use “logic” terms to combine multiple key terms. Most databases will let you use logic terms to combine key terms in specific ways in an advanced search. Consider the use of the following logic terms: The word “AND” is used to indicate that two (or more) terms must appear within a document to satisfy the search criteria. An example of using the AND logic term in a search is: This search will only identify literature that includes both the term violence and the term school. The AND logic term is good to use when you want to ensure that two or more different ideas are present in an article. The word “OR” is used to indicate that at least one of the terms must appear within a document to satisfy the search criteria. An example of using the OR logic term in a search is: This search will identify all literature that includes the term weapon, that includes the term gun, and that includes both of these terms. The OR logic term is good to use when you have two or more synonyms for the same idea. Quote marks are used to indicate that an exact phrase of two or more words must appear within a document to satisfy the search criteria. An example of using quote marks in a search is: By putting the words “middle school” in quotes, this search requires a match to that exact phrase. Using quote marks can reduce the number of extra hits that occur for alternative uses of the words middle (such as an article about children caught in the middle of their parents’ divorce) and school (such as home school or elementary school). Quote marks are good to use when terms about your topic are usually used in a specific combination and order (e.g., you are interested in literature about middle school, not school middle). Limit your search to recent literature. A good literature review documents the current state of knowledge about a topic. Therefore, consider limiting your search to research on your topic that has been published recently. What is considered recent depends somewhat on your topic. If your topic is changing quickly (e.g., the use of social media in classrooms), then you may want to keep your search very recent, say the last 5 years. For most topics, a good starting place is to consider the research published in the past 10 years. To find recent research, most database search engines allow you to limit your search to certain publication dates, such as 2009–2013. Begin your search by looking for journal articles. The best sources for scholarly literature reviews are journal articles that are current and good quality. Therefore, when first starting to look for literature on a topic, consider limiting your search to journal articles. This is often an option in the database search engines. For example, the ERIC database allows you to select a “Publication Type” of “Journal Articles” as a filter in your search of the database. Once you have examined the available journal articles on your topic, you might return and search more broadly to include documents like conference papers and dissertations. Here’s a Tip! You may be tempted to limit your search to only results with free full-text access, but you might miss some good articles this way. Keep in mind that your academic library can often help you obtain the literature that is needed for your review for no cost. Keep trying new combinations of key terms to find the best literature. You might hope to search the literature once and be done. In a good literature review, that is rarely the case. You will likely need to try several different combinations of key terms to ensure that you find all the relevant literature on your topic. To facilitate this process, it is a good idea to keep a record of the different combination of terms that you use as well as notes about what did and did not work well for finding useful literature. Also keep in mind that new publications are continually becoming available and therefore you might want to repeat your best terms at a later time to check whether anything new has been published. Once you conduct a search, the database will display a list of all documents that met your search criteria. When you obtain a list of hits from a search, you can click on the title of each document to view more detailed information. For example, we ran the following search in the ERIC (eric.ed.gov) database: We limited our search to journal articles published in the last five years (2009–2013). Based on this advanced search, we found seven articles in the database that satisfied our criteria. The titles of three of these seven articles are: “Reported Occurrence and Perceptions of Violence in Middle and High Schools” (Algozzine & McGee, 2011) “The Role of Sociability Self-Concept in the Relationship Between Exposure to and Concern About Aggression in Middle School” (Miller, 2013) “Urban Seventh Grade Students: A Report of Health Risk Behaviors and Exposure to Violence” (Dowdell, 2012) By clicking on a title of one of the articles, the search engine then displays a detailed record for that journal article. Although the format of the detailed records can vary among the different databases, they generally include information such as the article title, authors’ names, journal information, publication date, article abstract, and other information about the article such as whether the publication was peer reviewed and in what language the publication was written. You can review these details about each document identified in your search to decide whether it is a good source for you to use in your literature review. What Do You Think? Suppose you want to review the literature to learn about research related to teaching science laboratory activities for students with visual impairments. What key terms might you use? What are some synonyms that might also be useful? How might you use logic operators (AND, OR) to combine the terms in an advanced search? In what database would you start searching for literature? Check Your Understanding A good place to start thinking about a search is to write down a project title or question that you want answered. An example is: What strategies are available to teach science laboratory activities to students who are visually impaired? To find literature related to this question, key terms might include visual impairment, laboratory, and science. Possible synonyms might include blind (for visual impairment) and physics or biology (for science). One possible combination of these terms in an advanced search might be: Because this is an educational topic, ERIC would be a good database to use for this search. We tried the combination of terms listed above in ERIC and found 35 journal articles published from 1979 to 2012 that met these search criteria. Step 3—Select Literature That Is Relevant and of Good Quality Let’s return to the major steps in conducting a literature review. After you have identified key terms and searched for resources in a database, your next step is to select the literature that you want to read and include in your literature review. A typical database search will narrow the literature down to 10–40 hits, but you still need to decide which of those potential sources are worth your time. A good strategy to use once you have a list of potential literature is to examine each source and consider two questions: Is it relevant? Is it good quality? Let’s consider how you can go about making these decisions for your literature review. Determining Whether a Source Is Relevant. When you examine a source identified by your search, your first consideration is whether the source is relevant for your literature review. A research study is relevant when it includes information pertinent to the topic of the review. Individuals new to reviewing the literature often think too narrowly about relevance by wanting to only include studies that are exactly the same as the situation that concerns them. For example, if a principal is concerned with gun possession by rural middle school students, she might be tempted to discount research conducted in urban settings as not relevant, but research on student weapon possession in urban settings could be highly relevant for determining possible strategies to use because it addresses the same problem. Relevance therefore has several dimensions, and your review will be more comprehensive if you are open to including literature that represents more than one of the dimensions. The following criteria can be helpful for considering different dimensions that can be relevant when selecting literature to review: Does the source focus on the same topic as the one in which you are interested? Does the source examine the same individuals or sites that you want to learn about? Does the source examine the same research problem that concerns you? If you answer “yes” to any of these questions when considering a source, then the source is likely relevant for your literature review. For example, suppose you want to review literature relevant to school-based programs for preventing student weapon possession in rural middle schools. Literature can be relevant if it examines the same topic (student weapon possession), the same context (middle school-based intervention programs), or the same problem (issues faced by children in rural schools). That is, relevant literature for this review might include literature on student weapon possession, literature about any type of prevention programs for middle school students, and literature about issues facing children in rural schools. Keep in mind that both quantitative and qualitative research studies are relevant for your review because each form of research has advantages and provides insight for our knowledge base about any educational or social science topic. A good literature review is comprehensive in that the reviewer locates sufficient literature so that the review includes the many different perspectives and research approaches to the topic that are available in the recent literature. Determining Whether a Source Is Good Quality. Once you have determined that a source is relevant for your review, your next consideration is whether it is a good-quality source. The best sources for a literature review are those that are original reports of research, are peer reviewed, and come from sources that are known to be reputable. When choosing the sources for a review, it is therefore helpful to consider the following important dimensions: Original vs. secondary sources. Original sources of research are reports of studies that are written by the people who actually conducted the research. Secondary sources of research are reports in which the author refers to studies published elsewhere. Original sources are best to review because they include the full details of the research reported by the researchers themselves so that you can make your own judgments about the quality of the work and usefulness of the results. Although secondary sources such as literature reviews, theoretical papers, and summaries can provide useful information about your topic, you need to be careful using them to understand the available research because they will not include the full details of each individual study. Peer-reviewed vs. not reviewed. Peer review is the process by which the quality of research is ensured. Researchers write reports of their studies and then submit the manuscripts to journal editors for consideration. In the peer-review process, the journal editor sends a copy of the report to independent peers (i.e., other researchers not associated with the study) who read and critique the report in an attempt to catch any problems with the research or incompleteness in the report. Although the peer-review process does not remove all problems with research, you can feel more confident in the quality of a report if it has undergone peer review. Reports of research found in journals will typically be peer-reviewed. Other types of reports, such as dissertations, conference papers, and books, typically have not been reviewed so carefully. Reputable sources vs. unknown sources. Reports of research can come from many different sources. The best sources are academic sources, such as those found through the library of your college or university. Some journals in your field may have a better reputation for their quality than others, and this is something you will learn by talking to others in the field and reading many different reports. In addition, sources associated with reputable organizations such as the federal government, professional organizations, or well-known publishers can often be trusted to maintain a high level of quality. Be cautious using other sources, such as those from organizations that publish reports for a fee paid by the author or sources prepared by for-profit companies. When the source of the information is unknown or promoting a particular agenda, then there is little guarantee that the information will be of high quality. Recall from Chapter 1 that there are three broad types of literature where research is reported: early stage materials, peer-reviewed journal articles, and books. Table 4.2 considers each of these types of literature along these three dimensions. Examining this information should help make it clear that reports of research published in peer-reviewed journals are the best sources of information for a literature review because they are original reports of research that have been reviewed for quality. Therefore, when reviewing research literature, it is best to select relevant literature that reports original research, is peer-reviewed, and comes from a reputable source. Depending on your topic, you may also find documents like school reports (such as about new programs) of interest, but you have to keep in mind that school report documents are often not reviewed for quality and they may not include any research component. Table 4.2 Comparing Different Types of Literature along Dimensions of Quality Type of Literature Original vs. Secondary Peer-reviewed vs. Not Reviewed Reputable vs. Unknown Early Stage Material ■ Dissertations and theses Original Not peer-reviewed Typically unknown ■ Conference papers Original Not peer-reviewed Typically unknown ■ Technical reports Original Not peer-reviewed Typically unknown, but websites maintained by the government or professional organizations are reputable sources Journal Articles ■ Research reports Original Peer-reviewed Varies by journal ■ Literature reviews Secondary Peer-reviewed Varies by journal ■ Theoretical discussions Secondary Peer-reviewed Varies by journal Books ■ Handbooks Secondary Usually not peer-reviewed, but reviewed by the editors Varies by publisher ■ Encyclopedias Secondary Usually not peer-reviewed, but reviewed by the editors Varies by publisher ■ Conceptual Books Secondary Usually not peer-reviewed Varies by publisher ■ Books Reporting Research Studies Original (but often with less detail about the methods used than a journal article) Usually not peer-reviewed Varies by publisher Step 4—Take Notes on the Key Aspects of Each Selected Source Once you have located literature that is relevant and good, you are ready to read and learn from the sources. Before you begin reading, however, you might want to organize your literature so it is easy for you to use and summarize. Make one copy of each article by photocopying the document, scanning the document, or downloading an electronic copy of the document (e.g., as an .html or .pdf file)—copyright laws permit you to make one duplicate copy of an article without the permission of the publisher. From there, you need to develop a system to easily retrieve the documents and information such as using folders to group documents on your computer or in your filing cabinet. Organize the literature in a way that makes sense to you, such as by author, by topic (e.g., possession of weapons, prevention programs, and effects of weapons), or by participant (e.g., middle school, high school, and college). In addition to organizing the literature, you also have to read it! Because you will be reading many articles over time about your topic, it is a good idea to make your own set of notes about each of the sources. This process yields a useful record so that you can recall the details of the individual studies without having to keep rereading them in their entirety. A systematic approach for keeping notes when reviewing the literature is to develop a detailed summary for each source (sometimes referred to as an abstract). A detailed article summary should include your notes about the major aspects of an article recorded in a concise way (about 350 words for this purpose). Do not use the abstract provided by the author at the beginning of a journal article for this purpose. There are several reasons why this is not appropriate. For one, there are rules about copying the words written by others so that you do not plagiarize others. We will learn more about plagiarism later in this chapter, but for now the key point is that you cannot copy someone else’s words for your own use unless you clearly document that it is a direct quote using quote marks and indicate where in the document you copied the quoted text. Direct quotes are useful for key ideas like a definition, but are not good to use for long passages such as an abstract. The second reason to not use the article abstract is because it is usually too brief to be useful as a summary for a literature review. The third reason is that article abstracts are not written in a uniform way so they will not include consistent information across the articles that you read. The final reason not to use article abstracts is because they do not include your own comments about the articles. It is very important for you to document your reflections and comments about each source and how it applies to your work as you read so that ideas are fresh in your mind. Therefore, you should write summaries of articles in your own words to avoid plagiarizing someone else’s words and to prepare notes that are useful for your literature review purposes. A good strategy for making summary notes about quantitative and qualitative research studies is to systematically record the same set of information. For each source, we recommend that you summarize: the complete reference to the source; the research problem; the purpose, research questions, and hypotheses; the data collection procedures; the major results and findings; and your comments about the study (such as the strengths and weaknesses in the research or the implications of the results for your practice). Figures 4.2 and 4.3 illustrate examples of two summaries created for articles located in a search for literature about violence and weapon possession in middle Reference: Wylie, L. E., Gibson, C. L., Brank, E. M., Fondacaro, M. R., Smith, S. W., Brown, V. E., & Miller, S. A. (2010). Assessing school and student predictors of weapons reporting. Youth Violence and Juvenile Justice, 8(4), 351–372. Research Problem: Wylie et al. (2010) noted that students, parents, and school officials are fearful of school violence, particularly school shootings. Although school personnel are implementing policies to address these concerns, they have not been very successful. Student willingness to report when another student is known to be carrying a weapon is an important prevention mechanism, but there is a gap in the literature about how school contexts combine with student characteristics to predict students’ willingness to report weapons. Purpose, Research Questions, or Hypotheses: Wylie et al.’s (2010) purpose was to study the relationship of student and school climate variables with willingness to report a weapon. They hypothesized that individual student variables and school climate variables will be significantly related to general willingness to report, but that school climate variables will not be significant predictors for students’ willingness to report anonymously. Data Collection Procedure: The research took place at 27 middle schools in five diverse U.S. states. A total of 3,197 sixth- to eighth-grade students completed an anonymous survey questionnaire. The questionnaire included items to measure the following variables: likelihood of weapons reporting, demographics, relationship with adults, self-reported delinquency, peer delinquency, school size, and socioeconomic status. Results: The results included: (1) Age significantly predicts willingness to report, with older students being less willing. (2) Students who are more involved in delinquency and those who have more delinquent peers are less willing to report. (3) Students who were less bonded to adults were less willing to report. (4) School climate as measured by collective identity and school conflict were both significant predictors of higher willingness to report in general. (5) School climate was not a significant predictor of willingness to report anonymously. Comments: Wylie et al. (2010) suggest two implications for schools: (1) work to improve the perceived climate and (2) implement a way for students to report weapons anonymously. That might be useful advice for my school district. The research was limited to middle school students from Florida, Texas, California, New Jersey, and Connecticut, but did include a large, diverse sample. Figure 4.2 Sample Summary Notes for a Quantitative Research Study Reference: King, K. A., & Vidourek, R. A. (2010). In search of respect: A qualitative study exploring youth perceptions. The International Journal on School Disaffection, 7(1), 5–17. Research Problem: King and Vidourek (2010) note that not feeling positively connected to school contributes to negative student behaviors such as violence and carrying a weapon. A lack of positive connection may arise when students experience negative school climates, such as through bullying or feeling unsafe at school. They note that there is little research that has examined school-based respect, despite its relationship to bullying and school climate. Purpose or Research Questions: The purpose of the study was to explore students’ perceptions of school-based respect. Their specific research questions related to how students define, show, and perceive respect and disrespect at school. Data Collection Procedure: King and Vidourek (2010) conducted their qualitative study at nine schools that varied in terms of type (middle, high), setting (urban, suburban, rural), and district (public, nonpublic). A total of 78 students participated in focus group discussions held at the schools. The focus groups were audio-recorded and transcribed. Findings: The researchers concluded that students felt there was a “major problem with respect” (p. 12). Their analysis identified seven themes: student definitions of school-based respect, student definitions of school-based disrespect, causes of and contributing factors to school-based disrespect, student disrespect based on sex, disrespect between students and teachers, problems resulting from school-based disrespect, and methods of increasing respect among students. Students defined respect in terms of practicing the golden rule, listening to others, honoring others’ property and space, and not talking negatively about others. They defined disrespect in terms of making fun of other students based on their attire, putting others down, not listening to others, gossiping, and bullying and threatening others. Causes of disrespect included pressures from cliques, jealousy and insecurity, wanting revenge, racial and ethnic differences, and social media outlets. Comments: This was a fresh approach to the problem of student violence. It was interesting to read the actual words of adolescents! Participants were limited to central Ohio so may not be the same as my location. Students noted how problems related to respect can lead to student violence. Suggestions for practice included: involve students in planning interventions, (2) develop programs that develop cross-cultural understandings, and (3) recognize the increasing role that social media is playing in the school environment. Figure 4.3 Sample Summary Notes for a Qualitative Research Study schools. The summary in Figure 4.2 describes the six elements for a quantitative study about middle school students’ willingness to report a weapon at school. A complete reference to the article is listed at the top so that the summary is fully documented. (Recall that the format for writing these references was introduced in Chapter 1 and is reviewed in the Appendix.) Notice in this summary that the information about each element is short. In this example, the information is written out in sentences, but some reviewers may choose to use bulleted lists for the key information in their summary notes. Whatever style you prefer for recording your notes, remember that you must record the information in your own words and indicate any direct quotes (e.g., five or more consecutive words taken from the article’s text) with quote marks. These six elements were also used to write a summary for a qualitative study about student and staff perceptions of preventing violence in middle schools. As shown in Figure 4.3, this summary also starts with a complete reference to the article and includes brief notes about each element. Here’s a Tip! A good strategy to force yourself to summarize an article in your own words is to write your summary notes on the backside of a printed copy of the article. That way, you can’t look at the author’s words as you write your summary. The elements summarized for the quantitative and qualitative studies in Figures 4.2 and 4.3 illustrate typical information extracted from research studies. You may also choose to summarize other forms of writing such as theoretical discussions or school reports as part of your review. When summarizing other forms of writing, you may want to include the following points in your summary: the complete reference; the overall problem; the question or concern; the arguments, points, or program components; the implications or importance of the information; and your reflective comments (such as the strengths and weaknesses of the argument or the implications for your practice). By developing summary notes for all the sources you select for your literature review, you are ready to turn your attention to the process of synthesizing what you learn across the sources and preparing a written document that reports this information. We consider the steps for synthesizing literature and writing a literature review in the next section. How Do You Synthesize Literature and Write a Literature Review? In many cases, individuals read literature simply to learn about a topic for themselves. Reading literature and taking notes is sufficient for this purpose. In other cases, however, individuals want to summarize the information to share it with others. If you plan to share the information, then you will probably want to write a literature review that summarizes what you have learned. The nature of this review will differ depending on its purpose. A student preparing a literature review for her class may write it differently from a teacher preparing a literature review report for his principal, who will write it differently from a researcher writing the literature review section of her research article. Each of these individuals, however, will engage in four basic steps: Organize the literature into themes. Summarize the major themes. Document the sources with citations to the literature. Provide conclusions about the review. Let’s examine the process of implementing each of these steps to help you learn to write your own literature reviews and to interpret the literature reviews written by others. Step 1—Organize the Literature into Themes As you organize and take summary notes on the articles, you will begin to understand the content of your literature review. In other words, a conceptual picture will begin to emerge. This conceptual picture usually involves organizing the studies in themes, or groupings of studies, that discuss similar subtopics within your larger topic. One way to develop this conceptual picture is to create a visual diagram that allows you to organize the literature in your mind. This visual picture results in a map of the reviewed literature. A literature map is a figure or drawing that visually organizes the literature on a topic. This visual picture helps you make sense of the literature because it encourages you to think about the larger ideas emerging across all of the relevant literature that you found in your search. It is also useful for conveying a picture of the literature with others, such as colleagues at work or an audience at a conference. Figures 4.4 and 4.5 provide two examples of literature maps created by students who reviewed literature on their topics of interest. Vlasin-Marty (2011) examined literature about food safety and developed the map pictured in Figure 4.4. At the top of the figure she lists the topic: food safety. Below the top level, she identifies three subtopics: foodborne illnesses; instruments for assessing food safety practices; and knowledge, attitudes, and behaviors. Within the third subtopic, she identifies themes in the literature that she read, such as the knowledge, beliefs, and behaviors of adolescents, low-income individuals, and families. Under each theme that she identified from her literature, she lists the specific research studies that she reviewed. At the bottom of the map, Vlasin-Marty advances her proposed study about the food safety knowledge, attitudes, and behaviors for Native American families with young children in Nebraska, which she believes is needed to extend the literature. Figure 4.4 A Sample Literature Map on Food SafetySource: Used by permission of Kara Vlasin-Marty, 2011. In another example, Hermann (2011) developed Figure 4.5 as a result of reviewing literature that described the use of interventions based on art and creativity. She found two categories of interventions: those used as formal therapy (therapeutic art) and those used in educational settings (education creativity). She organized the literature within these two subtopics into themes (e.g., medical, clinical, and K-12) and listed the studies she reviewed that formed each of these groupings. At the bottom of the figure, she identified her interest in understanding the context for these interventions: “the environment/setting at the intersection of art therapy/creative education interventions.” These two literature maps illustrate several useful features that you can include when developing your own literature map. Use the following guidelines when constructing a map of reviewed literature: Identify the key term for your general topic and place it at the top of the map. Keep this term broad so that it helps to easily orient anyone who might be reading your literature review. Take your reviewed sources and sort them into groups of related topical areas or families of studies. These “families” represent the themes you find in the literature. Your summary notes and comments should be very helpful for recalling the major topics of each article that you read. Think in terms of identifying three to five broad groupings to focus on the big ideas of the literature. Figure 4.5 A Sample Literature Map on Environments for Art/Creativity InterventionsSource: Used by permission of Rita Cihlar Hermann, 2011. Provide a name for each of the themes based on the articles in each of the groups. Use these theme names as the labels for the boxes in the figure. In each theme box, list the key sources you found in your literature search that fall within that theme. Indicate your own work on the map. For example, if you review the literature to identify a strategy for promoting parent involvement at your school, then indicate where your preferred strategy comes out of the literature. Draw a box near the bottom of the figure that says “our proposed program.” In this box, you could describe the program that you think your school should consider adopting based on your literature review. This helps others understand how the proposed program comes out of the literature. Step 2—Write a Summary of the Major Themes Once the literature is organized, then the writing process begins. But how do you report what you learned from the literature? Using your literature map as a guide, a good first step is to prepare an outline for your review. Well-written literature reviews are organized so that a reader can easily follow the ideas presented and preparing an outline will help you organize your writing. Therefore, you should develop an outline that follows the logical order of topics and subtopics that you identified in your literature map. For example, see how the outline for a literature review in Figure 4.6 follows the themes presented in the literature map depicted in Figure 4.5. Another writing strategy is to use the themes in your outline as headings in your written paper. Headings are signposts that writers use to designate the topics and subtopics within a written document. Good headings are descriptive of the content, but Figure 4.6 A Sample Literature Review OutlineSource: Used by permission of Rita Cihlar Hermann, 2011. also short; that way, they are easy for the reader to interpret. Good headings are also formatted in a consistent manner so readers can readily differentiate major topics from subtopics. Recall that we were introduced to different style manuals in Chapter 1. These style manuals provide directions for how to format the different levels of headings within a written document. The levels of headings provide logical subdivisions of the text from topics to subtopics. Figure 4.7 summarizes the different styles used for different levels of headings in the APA (2010) style. This style was used to format the headings listed in Figure 4.6 as well as the sample paper found in the Appendix. Once you have your outline and headings planned, the next step is to write a summary of what you learned from the literature for each of the major themes that you identified. There are two common styles for writing this summary from which you can choose: a study-by-study literature review or a thematic literature review. The Title Is Centered and in Title Case Level 1 Heading Is Centered, Bold, and in Title Case Level 2 Heading Is Left Justified, Bold, and in Title Case Level 3 heading is indented, bold, in sentence case, and ends with a period. Level 4 heading is indented, bold, italicized, in sentence case, and ends with a period. Level 5 heading is indented, italicized, in sentence case, and ends with a period. Figure 4.7 Title and Headings in the APA StyleSource: APA, 2010, p. 62.Note: “Title Case” is where every major word is capitalized; “sentence case” is where only the first word is capitalized. One convenient approach to summarizing literature is to describe each reviewed study one at a time. In this way, a study-by-study review of the literature provides a detailed summary of each study grouped under each of the broad themes identified in the review. The detailed summary of each study is usually one paragraph in length and highlights the elements shown in Figures 4.2 and 4.3. This form of literature review typically appears in journal articles that summarize the literature on a topic and in student work, such as class papers, theses, or dissertations. When presenting a study-by-study review, authors link the summaries of the studies using transitional sentences. They also organize the summaries under subheadings that reflect the major themes in the reviewed literature (i.e., the topics identified in boxes of the literature map). Young et al.’s (2012) review of the literature about video games in education in the journal Review of Educational Research illustrates the study-by-study review approach. As you read the following excerpt, note that the authors discuss the research that addresses video gaming in mathematics education one study at a time. In our review of the math gaming literature, we initially identified an investigation by A. Harris, Yuill, and Luckin (2008) that addressed how video games may be used to effectively facilitate student collaboration on complex logic problems. The study included 34 primary school students aged 8 to 10 years, and the researchers examined the influence of mastery and performance goals on the nature of children’s participation during video gaming. Each student was matched with a partner based on his or her goal orientation, and each pair spent 20 minutes cooperatively playing a logic-development game (The Logical Journey of Zoombinis). A. Harris et al. observed that students with different goal orientations interacted in different ways while solving mathematical problems and concluded that goal-focused instructions could be used to influence the nature and quality of children’s partnered interactions, potentially improving long-term academic achievement. Similarly, Mayo’s (2009) study found that although many educators were not open to the idea of using video games in their classrooms, such programs increased achievement (as measured by standardized testing) from 7% to 40%, including high school algebra and college-level numerical methods. . . . (p. 67) In this excerpt, the authors first described the study by A. Harris and colleagues in one paragraph. Then, in the next paragraph, they described the study by Mayo. In this way, they discussed one study at a time. They also provided a detailed description of each study, which included the research problem (e.g., whether video games effectively facilitate student collaboration), an implied question (e.g., whether student goals influence the nature of participation with a partner), the data collection (e.g., 34 participants in the study), and a summary of the results (e.g., students with different goal orientations interacted with partners in different ways). In contrast to the study-by-study approach, you can use a thematic review of the literature where you identify a theme and briefly cite literature to document this theme. In this approach, you would discuss only the major ideas or results from studies rather than the detail of any single study. Authors use this approach frequently in journal articles that report research studies. You can recognize this form by locating a theme and noting the references (typically multiple references) to the literature used to support the theme. For example, Musher-Eizenman et al. (2011) reviewed the literature about influences on individuals’ eating patterns. The following passage, appearing in an early section in their study report, illustrates a thematic literature review approach: Research on the effects of external cues on eating patterns in children has primarily included efforts to reduce food neophobia, or avoidance of unfamiliar foods, particularly for fruits and vegetables. Increased exposure to a food (Birch and Marlin, 1982; Sullivan and Birch, 1994), access and availability (Hearn et al., 1998), and parent and peer modeling (Birch, 1980; Wardle et al., 2003a, 2003b) have all demonstrated success in increasing children’s consumption of healthy foods. . . . (p. 192) In this excerpt, the authors reviewed the literature about the theme “external cues and children’s eating patterns” and briefly mentioned multiple references to support the theme. The authors do not discuss the details of each reviewed study separately. Step 3—Document the Sources by Including Citations to the Literature Regardless of whether you choose to write a study-by-study or thematic literature review, you must include citations (or references) for all of the sources that you have reviewed. You must give credit to these sources, so as to not plagiarize others’ work. To plagiarize means to represent someone else’s ideas and writings as if they were your own. Examples of plagiarism include copying someone else’s words directly without putting them into quotes and giving credit, using someone else’s ideas without giving them credit, or using someone else’s sentences but changing just a few words. It is not only rude to plagiarize someone else’s work, but it is wrong to do. In many cases, plagiarizing someone else’s work can result in serious consequences such as failing a class, being dismissed from school, or losing a job. Therefore, you must learn to always give proper credit to your sources. Here’s a Tip! Understanding plagiarism and how to avoid it is challenging. A good resource to learn more about this important topic is http://plagiarism.org/ We have already seen how summary notes can include a complete reference to a source (see Figures 4.4 and 4.5). Documenting your sources for your own use is an important part of the literature review process, but you also have to document these sources in your writing about the literature. Fortunately, style manuals such as the one by APA (2010) provide guidance on including citations in scholarly writing in addition to formatting headings. There are two approaches related to writing citations found in the APA style that you need to use when writing about the literature on a topic: in-text references and end-of-text references. In-text references are references cited in a brief format within the body of the text to provide credit to authors. In-text references should be used in your writing whenever you refer to an idea, procedure, or result from someone else’s work. The APA style lists several conventions for citing these in-text references. You can find examples of in-text references using the APA style in Figure 4.8. Key features of this style include the following elements: Type of Reference In-Text Examples Single author Rogers (2004) compared reaction times for athletes and nonathletes in high schools. Previous research has examined differences between athletes and nonathletes (Rogers, 2004). Two authors Bacyn and Alon (2008) tested the effectiveness of group learning on reaction times. Studies have also tested the effectiveness of group learning (Bacyn & Alon, 2008). Three to five authors, first mention in a paper The difficulty of test taking and reaction times has been examined by Smith, Paralli, John, and Langor (2012). Reaction times are important considerations for test design (Clark, Peabody, & Johnson, 2008). Three to five authors, subsequent mention in a paper Six or more authors, any mention The study of test taking and reaction times (Clark et al., 2008). . . . Smith et al. (2012) suggest there is a need for research on test taking to move beyond only considering reaction times. Multiple references (listed in alphabetical order) Past studies of reaction times (Clark et al., 2008; Gogel, 1992; Lucky & Jones, 1994; Rogers, 2004; Smith et al., 1994) showed. . . . Direct quote Reaction times are defined as “the time to react to an unexpected stimulus” (Mills & Haas, 2007, p. 42). Figure 4.8 Examples of In-Text References in the APA Style Use only the last names of authors, listed in the order they appear in the article. Include the year of the publication. If there is more than one author, write out the word “and” if the names are used as part a sentence text or use “&” if the names are referenced within parentheses. If a reference has three to five authors, write all of the authors’ last names the first time you refer to the work and then only list the first name followed by “et al.” (meaning “and others”) subsequently. If a reference has six or more authors, then use the “et al.” form each time you refer to the work. An example of the “et al.” form is: Xu et al. (2010). If you use a direct quote from the source, include the original page number of the quote as part of the in-text reference. End-of-text references are the references listed at the end of a research report. It is essential that you provide the full details of each reference in this list at the end of your writing. Common forms for these references in the APA style were introduced in Chapter 1. When combined into an end-of-text references list, the APA style includes the following features: Start the end-of-text references on a new page and title this section “References.” List all cited references alphabetically by the last names of the first authors. Include all the references mentioned in the body of the paper and only the references mentioned in the body of the paper in the end-of-text references list. Use a hanging indent form for each reference. This means that the first line is left adjusted and the subsequent lines are indented. Double space the text in the end-of-text references list. An example of an end-of-text references list in the APA style is located at the end of the sample paper in the Appendix. Step 4—Provide Your Conclusions About the Literature Once you have summarized the literature, you are ready to write an ending for your literature review. A good review concludes with a thoughtful discussion that summarizes the literature and provides commentary about the literature. To write a conclusion for your literature review, first restate the major themes that you found. Ask yourself, “What are the major ideas from all of the studies I reviewed?” Your answer to this question will result in the identification of three to five themes that summarize the literature. With these themes in mind, briefly highlight what you learned about each theme. This discussion should emphasize the big ideas under each major heading in the literature review and point out what the reader should remember from the review. The discussion should also identify strengths and weaknesses you identified about what is known and not known in the literature. In addition to noting the major themes found from the review, your concluding discussion should also explain how the literature informs your work. For example, if you are a practitioner reviewing the literature to learn what is known about different available programs, then you should conclude the literature review with a statement giving your recommendation for which program should be adopted by your organization based on what you learned. Likewise, when researchers conclude their literature reviews in their study reports, they often explicitly state how information from the literature (such as an identified theory or conceptual framework) was used to shape the research study they conducted. How Do You Evaluate a Literature Review in a Research Study? Now that you know how individuals conduct and write literature reviews, you can more easily interpret and evaluate the literature review sections included as part of the Introduction sections of research reports. Recall that the primary purpose of including a literature review in a research report is for the author to inform readers about the background for the study and demonstrate that the research is grounded in the knowledge that exists in the literature. A good, rigorous literature review therefore conveys that the researcher completed a comprehensive review of the literature, organized and synthesized this literature, and made it clear how the literature was used to direct or inform the conducted study. Table 4.3 lists criteria that are useful to consider when Table 4.3 Criteria for Evaluating the Literature Review in a Research Report Quality Criteria Indicators of Higher Quality Indicators of Lower Quality The Key Elements 1. The review includes the relevant literature. +The review is comprehensive, including numerous sources that clearly relate to the study’s topic. +Important subtopics are included in the reviewed literature. -The review is superficial, including only a small number of sources, some of which does not seem related to the study’s topic. -Important subtopics are missing from the reviewed literature. 2. The review examines sources that are recent and of high quality. +The reviewed literature focuses on reports of original research published in peer-reviewed journals that are considered recent for the topic (e.g., from the last 10 years for many topics). -The reviewed literature focuses on books, secondary sources, materials that have not undergone peer review, and materials that are no longer current for the topic. 3. The literature review is appropriately documented. +Citations are provided as support for all ideas drawn from the literature. +The citations are correct, complete, and in a consistent style. -Not all ideas drawn from the literature are supported with citations. -Some citations are incorrect, incomplete, or in an inconsistent style. 4. The literature is thoughtfully synthesized. +The literature is organized into major themes and subtopics that make sense in the context of the study’s topic. +The major ideas that the researcher found from the literature are clearly identified by headings and/or a visual map. -The organization of the literature does not make sense in the context of the study’s topic. -It is difficult to identify the main ideas that the researcher found from the literature. 5. The literature is critically examined. +The researcher critiques the literature by considering issues such as its deficiencies, strengths and weaknesses, and implications for the study’s design. -The researcher only summarizes the literature without offering critical commentary about it. General Evaluation 6. The study has a strong foundation in the literature. +The study’s problem, purpose, approach, methods, and interpretations are clearly connected to and informed by the literature. +The study report includes explicit statements that explain how the literature is being used in the study, such as by providing a guiding theory or conceptual framework. -There is a lack of connection between the literature and the study’s problem, purpose, approach, methods, and interpretations. -The study report does not indicate how the literature is being used in the study. 7. The use of the literature fits the study’s overall research approach. In a quantitative study: +The literature review justifies the problem, provides direction by identifying the major variables and hypotheses from theories, supports the procedures, and is used to compare the results to the predictions. In a qualitative study: +The literature review justifies the problem, informs the researcher’s approach and stance through a conceptual framework, is examined further as new findings emerge, and is used to interpret the meaning of the findings. In a quantitative study: -The literature review is minimal for the topic and does not support the choice of variables and stated hypotheses. In a qualitative study: -The literature review is used to specify variables or make predictions that limit the researcher’s openness to learn from participants or remains static even when new findings emerge. Figure 4.9 A Rating Scale for Evaluating the Literature Review in a Research Report evaluating the contents, organization, and use of the literature review in a research study. This table also provides indicators of higher quality and lower quality for the criteria to help you make your own judgments when evaluating the literature review in a research report. The rating scale in Figure 4.9 provides a convenient means for you to apply the quality criteria to the literature review in any research report. For each of the criteria you locate, assign a quality rating from fair (1) to excellent (3), and document your evidence and/or reasoning behind the rating. If one of the criteria is missing or very poorly stated, then indicate poor (0) as your rating. Although research reports will vary in the extent of literature they include, good reports should still score well on most of the items listed in Figure 4.9. By adding up the rating scores for each of the criteria and using the suggested cutoff values provided at the bottom of the figure, you will have an indicator that you can use to help you determine your overall assessment of a report’s literature review. Reviewing What You’ve Learned To Do ■ Identify and understand the literature review in a research report. A literature review is a written synthesis of available documents that organizes the information into subtopics, and summarizes and critiques the past and current state of knowledge about a topic. Researchers use literature reviews to provide the background for their research studies. Literature reviews are often found as a part of the Introductions in research reports. In addition, researchers’ use of literature can be identified when they refer to the literature in citations throughout the report’s text. ■ Describe how researchers use literature in their research studies. Researchers use literature in the Introduction section of their reports to provide evidence for the research problem, to document what is and is not known about the study topic, and to identify the theory or conceptual framework behind the study. They also use the literature to provide models for the procedures used in the study and to interpret the results at the end of the study. ■ Describe differences in how researchers use literature in quantitative and qualitative research. In quantitative studies, researchers complete their literature review at the start of the research. They use the literature to help prescribe the variables and hypotheses of interest at the start of the study, and to compare the results with the expectations found in the literature at the end of the study. In qualitative studies, researchers review the literature at the start of the research and during the research when new topics emerge from the data. They use the literature to inform the researchers’ stance and assumptions about the study topic, and to interpret the meaning of the findings as they relate to other studies found in the literature. ■ Take steps for reviewing the literature about a topic of interest to you. Four useful steps for reviewing the literature include identifying key terms, searching academic libraries and electronic databases, selecting literature that is relevant and of good quality, and preparing summary notes on each source of information located in the literature. ■ Identify steps useful for writing a literature review. Four useful steps for writing a literature review include organizing the literature into themes, summarizing the sources within each of the major themes, documenting the sources with citations, and discussing conclusions about the literature. ■ Evaluate the quality of the literature review in a research report. The evaluation of a literature review begins by considering the extent to which the researchers examined literature that is relevant and of good quality and the extent to which they appropriately cited, thoughtfully synthesized, and critically considered the literature. The evaluation of a literature review is also based on the extent to which the researchers used the literature to provide the background for the study and the extent to which the use of the literature fits the study’s quantitative or qualitative approach. ✓ To assess what you’ve learned to do, click here to answer questions and receive instant feedback. Reading Research ArticlesAt the end of this chapter, you will find a research article to help you practice your new skills. Carefully read the qualitative adolescent-homelessness study by Haldenby, Berman, and Forchuk (2007) starting on p. 148. First, write a complete, APA-style reference for each article.As you read the article, pay close attention to the use of literature throughout, particularly in the Introduction section (paragraphs 01–20). Use the highlighting tool in the Pearson etext to indicate where the authors have provided information from their literature review, and use the notetaking tool to add marginal notes that name each use you highlighted and note how each one is related to the study’s background. Within the literature review, you will want to look for the ways the authors use literature to specify: Justification for the research problem What is and is not known Theory or conceptual framework Models for the methods Interpretation of resultsNote, however, that sometimes authors do not use their literature in all of these ways—for example, they might not include a theory or conceptual framework or they might not use literature to provide models for the methods. If one of these uses is missing, indicate that in your marginal notes. Click here to open the rating scale form (Figure 4.9) to enter your ratings, evidence, and reasoning. Understanding Research ArticlesApply your knowledge of the content of this chapter to the qualitative adolescent-homelessness study by Haldenby et al. (2007) starting on p. 148. Click here to answer questions and receive instant feedback. There are five ways that researchers tend to use literature in their research reports. For each of the following ways, identify an example of this use in the adolescent-homelessness study. If you do not find an example for any of the listed uses, then state where you would have expected to find this use in the report. Providing justification for the research problem. Documenting what is and is not known about the topic. Identifying the theory or conceptual framework behind the study. Providing models for the methods and procedures. Interpreting results. Using Figure 4.3 as a guide, develop summary notes for the qualitative adolescent-homelessness study. Assume that you want to conduct a literature review on the topic of adolescent homelessness. What key terms and logic terms (e.g., AND, OR) would you use to complete an advanced search to locate additional research on this topic? Try your search using the ERIC database (eric.ed.gov) and note how many hits you obtained with these search terms. Write a sentence about the adolescent-homelessness study using an in-text reference in the APA style. Write an end-of-text references list in the APA style that includes the adolescent homelessness study plus two other studies you identified in your ERIC search. Identify the major topics and subtopics that the authors summarized in their literature review in the adolescent-homelessness study. Using Figures 4.4 and 4.5 as a guide, sketch a literature map that represents this literature review. ✓ Click here to answer the questions and receive instant feedback. Evaluating Research ArticlesPractice evaluating a study’s literature review, using the qualitative adolescent-homelessness study by Haldenby et al. (2007) starting on p. 148. Use the criteria discussed in Table 4.3 to evaluate the quality of the literature review in the adolescent-homelessness study. Note that, for this question, the rating form includes advice to help guide your evaluation. Click here to go to the qualitative adolescent-homelessness study by Haldenby et al. (2007) so that you can write a complete APA-style reference for the article and enter marginal notes about the study. An Example of Qualitative Research: The Adolescent-Homelessness Study Let’s examine another published research article to apply the ideas you are learning. Throughout this book, we will refer to this study as the “qualitative adolescent-homelessness” study. This journal article reports a qualitative research study conducted and reported by Haldenby et al. (2007). Examine this article to practice your skills with reading, understanding, and evaluating research. Click here to write a complete APA-style reference for this article and receive instant feedback. Homelessness and Health in Adolescents Qualitative Health Research Volume 17 Number 9 November 2007 1232-1244 © 2007 Sage Publications 10.1177/1049732307307550 http://qhr.sagepub.com hosted at http://online.sagepub.com Amy M. Haldenby Helene Berman Cheryl Forchuk The University of Western Ontario Despite an abundance of resources, many of the world's wealthiest nations have a large homeless population. People at all stages of development are affected by this problem, but adolescents who are homeless face a unique set of challenges. In this critical narrative study the authors examined the experiences of homeless adolescents with particular attention to the role of gender and public policy, health experiences and perceptions, and barriers to health care services. Six girls and 7 boys participated in semistructured dialogic interviews. Their stories revealed that living without a home had a substantial impact on their health and wellness. The findings from this study support the need for health care professionals to work in collaboration with homeless youth so that more effective care that is sensitive to their unique health needs can be provided. Keywords: adolescence homelessness health critical theory narrative (01) Many of the world's wealthiest nations have a large homeless population despite an abundance of natural and material resources. Because of the inherently transient nature of homelessness and few agreedon definitions, it is difficult to obtain an accurate picture of those who are living without a home (Panter-Brick, 2002). However, there is evidence that a significant proportion is made up of adolescents (City of Calgary, 2006). The leader of the New Democratic Party of Canada, Jack Layton (2000), observed that the word homeless conjures up powerful images of people who have no roof under which to reside or individuals and families who live in “substandard” housing. How the term is defined is rooted in ideology (Ensign, 1998) and can influence who is researched and how the findings are interpreted. For the purposes of this study, homelessness includes individuals who live in the streets, are in the shelter system, or are continuously moving between temporary housing arrangements. Throughout this research the terms homeless, street-involved, and living on the streets are used interchangeably. (02) The City of Toronto report commissioned by the Mayor's Homelessness Action Task Force (1999) identified youth under the age of 18 as the fastest growing group of users of emergency hostels. Living without a home, and thus at the margins of society, is thought to create grim consequences for adolescents' health, development, and overall well-being (Panter-Brick, 2002). Authors' Note: This study was funded by the Sigma Theta Tau International Honour Society-Iota Omicron Chapter Background and Significance (03) In the past 10 years changes in the national economy, including socioeconomic restructuring in Canada, have had a substantial impact on adolescents nation-wide (Dematteo et al., 1999). The effects of this restructuring are demonstrated through cuts to social programs and supports as well as drastic reductions to welfare and unemployment insurance. These factors have led to an increase in the number of youth living in poverty. Although there are many other factors, including various forms of abuse and neglect, that play a role in the homelessness of adolescents (Martijn & Sharpe, 2005), such structural changes are also thought to contribute to the rise of street-involved youth in Canada. There is, however, little knowledge regarding how these social and political factors influence the experience of being without a home. (04) The gender stratification of contemporary Western society can be characterized by a devaluing of the lives of girls and women (Neysmith, 1995). Consequently, gender is a powerful shaper of an individual's experiences and can therefore influence how young women and men create different meanings out of similar circumstances. Because of their lower position in the social hierarchy, it has been suggested that living without a home places adolescent women at a significant disadvantage (Ensign & Panke, 2002). Little research, however, has been conducted to confirm or refute this idea. In the absence of such knowledge, health care professionals are typically limited in their ability to provide care for this population. (05) It has been well documented that homeless adolescents experience a variety of health-related concerns (Boivin, Roy, Haley, & du Fort, 2005). Despite this fact, many researchers have found that these youth are the least likely to access the available health care services (Barkin, Balkrishnan, Manuel, Anderson, & Gelberg, 2003; Shiner, 1995). It is therefore crucial for health care providers to better understand the health perceptions and experiences of this group in order that more effective approaches to health care can be provided. More specifically, it is anticipated that the findings from this research can be used to assist in the development and implementation of programs and policies designed to meet the needs of homeless adolescents. Literature Review Homeless Youth (06) There is a widely accepted misconception that youth who reside on the streets are there by choice (City of Toronto, 1999). In fact, numerous reports have identified various forms of abuse, including physical, sexual, or emotional, as main factors that can cause young people to flee their homes (Health Canada, 2005; Russell, 1996). It is thought that a comprehensive understanding of homelessness also requires attention to macrolevel factors such as poverty, support networks, and employment (Boydell, Goering, & Morell-Bellai, 2000; Morrell-Bellai, Goering, & Boydell, 2000). In this section, the literature that relates to the health of adolescents once they become homeless, and the barriers that they face when trying to access health care, will be discussed. Health Sequelae Associated With Homelessness (07) Many adolescents who are homeless experience a range of physical and emotional health problems (Panter-Brick, 2004). Several quantitative studies have shown that this population has a high rate of suicide ideation (Leslie, Stein, & Rotheram-Borus, 2002; Rew, Taylor-Seehafer, & Fitzgerald, 2001). It is thought that this risk is amplified among gay, lesbian, bisexual, and transgendered youths (Cochran, Stewart, Ginzler, & Cauce, 2002; Noell & Ochs, 2001). Homeless youth have a high prevalence of depression and other psychiatric disorders, which is associated with elevated rates of intravenous drug use (Rhode, Noell, Ochs, & Seeley, 2001). Substance abuse often contributes either directly or indirectly to the homelessness of adolescents (Mallett, Rosenthal, & Keys, 2005). Homeless youth also suffer from an increased rate of acute and chronic respiratory diseases (Clatts, Davis, Sotern, & Attillasoy, 1998; Hwang, 2001). The increase in respiratory disease might be related to exposure to tuberculosis and influenza (O'Connell, 2004), which can result from staying in crowded quarters such as emergency shelters or squats. (08) In addition to being at risk for various physical and emotional problems, homeless adolescents are often forced to engage in “survival sex,” whereby sexual activity is traded for money, drugs, or shelter (Rew, Chambers, & Kulkarni, 2002). As a result, these adolescents might have more sexual partners than the adolescent population in general (Anderson et al., 1996; Clatts et al., 1998). They are also likely to be involved in some form of high-risk sexual activity, such as inconsistent condom use and prostitution (Johnson, Aschkenasy, Herbers, & Gillenwater, 1996). (09) Several large quantitative studies conducted in urban centers in North America have shown that homeless adolescents are at high risk for contracting HIV infection (Dematteo et al., 1999; Walters, 1999). It has been estimated that these youth are 6 to 12 times more likely to become infected with HIV than any other group of youth (Rotheram-Borus et al., 2003) and are more likely to contract chlamydia (Shields et al., 2004). (10) Many researchers have observed that homeless adolescents are more likely to become victims of many forms of violence than those who are not homeless (Kipke, Simon, Montgomery, Unger, & Iversen, 1997; Whitbeck, Hoyt, & Ackley, 1997). Street involvement has also been found to increase the risk of mortality by 8 to 11 times that of the general population (Hwang, 2000; Roy et al., 2004). (11) A number of researchers have examined the experience of adolescent homelessness (Kidd, 2004; Paradise & Cauce, 2002). In a study with street youth in Brazil, experiences of homelessness varied according to the local context and circumstances (Raffaelli et al., 2000). This finding is important because it highlights the problems inherent in attempts to generalize the experiences of street-involved youth across diverse settings and cultures. The illness experiences of urban homeless youth have also been examined (Ensign & Bell, 2004). Of particular interest, Ensign and Bell concluded that health-seeking behaviors differed by gender. Female youth sought care more often and typically preferred to be accompanied by a friend. Another finding of interest was that females reported more safety concerns while ill and living on the streets than their male counterparts. Barriers to Care (12) Although homeless adolescents experience a variety of health-related concerns, they rarely access health care services (Barkin et al., 2003; Shiner, 1995). Some barriers they encounter are fears that they will experience discriminatory attitudes (Gerber, 1997) and be negatively judged by health providers (Ensign, 2001; Reid, Berman, & Forchuk, 2005). (13) There is evidence that these concerns among homeless youth might be warranted. In research with medical students, more negative attitudes toward homeless people were found at the end of their courses than at the beginning (Masson & Lester, 2003). Among nursing students care has been declined to homeless clients in certain situations (Zrinyi & Balogh, 2004). It is possible that health professionals' negative attitudes regarding homeless individuals dissuade this population from accessing needed health care and, in turn, contribute to their poorer level of health. Unique Challenges Faced by Homeless Adolescent Women (14) Several investigators have examined the unique challenges faced by homeless female adolescents and have concluded that they are the most vulnerable subculture within the homeless population (Ensign & 2anke, 2002). In this section, the research related to young women's risks for sexual victimization and health problems more broadly will be examined. Sexual Victimization (15) There is some evidence that the nature of victimization while residing on the streets differs for women and men. More specifically, several researchers have observed that women and girls are significantly more likely to be sexually assaulted than are men and boys (Kipke et al., 1997; Rew, Taylor-Seehafer, et al., 2001; Tyler, Hoyt, Whitbeck, & Les, 2001). The detrimental effects that result from such violence have been described to include fear, anger, hostility, depression, anxiety, and humiliation (Fontaine & Fletcher, 1999; Hall, 2000; Nehls & Sallmann, 2005). Sexualized violence can also increase the risk of contracting HIV, a problem that is well documented among this subpopulation (Clements, Gleghorn, Garcia, Katz, & Marx, 1997; O'Connor, 1998). Health (16) Several investigators (Chen, Tyler, Whitbeck, & Hoyt, 2004; Harrison, Fulkerson, & Beebe, 1997) have found that a history of childhood sexual abuse increases the risk of substance abuse among homeless youth. As girls are sexually abused with much greater frequency than are boys (Trocme & Wolfe, 2001), homeless adolescent women are thought to be at considerable risk for substance abuse. There are reports that a relationship between substance abuse and prostitution among homeless female adolescents exists, which are thought to have adverse consequences for the women's physical and emotional health (Weber, Boivin, Blais, Haley, & Roy, 2004). Finally, there is some evidence that suicide is more prevalent among adolescent homeless women than it is among their male counterparts (Leslie et al., 2002; Molnar, Shade, Kral, Booth, & Watters, 1998). Collectively, these research findings offer compelling documentation that homeless young women are at a substantial health disadvantage. Summary and Critique of the Literature (17) Much of the current research related to homeless adolescents focuses on the rates at which disease and violence occur and the barriers faced when trying to access care. With regard to gender, several researchers have brought attention to the sexual victimization and ensuing health problems suffered by young homeless women. Missing from this body of work, however, is consideration of the youths' perceptions about homelessness. As well, there are few studies that explore the experiences of homeless adolescents, or the ways in which gender and public policy influence their experiences. Many researchers have tended to characterize this population as a homogeneous group. In effect, this depiction negates the importance of gender, race, ability, or other social locations and identities. To present a comprehensive analysis, a brief commentary regarding current policy that affects homeless youth is presented. The Contemporary Policy Context (18) Over the past 10 years the Canadian federal government has dissolved its responsibility for homelessness by forcing the funding and implementation of most affordable housing programs onto the provinces and territories, which have, in some cases, directed the issue onto the municipalities. Each level of government has its own perspective on the issue of homelessness, with little consensus as to possible solutions. Consequently, millions of allocated social housing dollars have been left unspent (Federation of Canadian Municipalities, 2006). With lack of federal leadership, there are limits to what can be accomplished. Failure of the Canadian government to work as a cohesive whole contributes to an inability to meet the unique housing needs of homeless individuals, including adolescents. (19) Among the scant social housing programs, only a few have addressed youth as a subpopulation of the homeless, and even fewer have addressed young women in particular. Historically, the Youth Homeless Strategy, which was part of the National Housing Initiative (NHI) established in 1999 by the Liberal government, narrowly focused on adolescents' job training (Government of Canada, 2004). Although employment status contributes to a person's ability to find and maintain housing, this program overlooked major factors that contribute to their homelessness such as poor levels of well-being and lack of affordable housing. All NHI programs have since been dissolved. Currently, there are few remaining policies that relate to housing needs for youth. Of these, the federal government's Shelter Enhancement Program focuses solely on emergency and second-stage housing (Canada Mortgage and Housing Corporation [CMHC], 2007b). Although this type of shelter is needed to initially help those fleeing violent situations, this program fails to address the long-term housing needs of individuals with histories of abuse. Also, individuals who access this program are expected to contribute financially to the operating costs (CMHC, 2007b). With a few exceptions, such as the First Nations Market Housing Fund (CMHC, 2007a), the current government's housing policies fail to consider how a multitude of factors such as poverty, age, ability, race, and gender influence the housing needs of homeless individuals. Ontario Works Act (20) The Ontario Works Act is provincial legislation that provides either employment or financial assistance to those “in need” (Government of Ontario, 2006). Although it varies slightly between municipalities, in most regions it is mandatory for individuals under the age of 18 to be enrolled full time in school or an alternative learning program to be eligible. To have mandatory enrolment in the school system could be viewed as encouraging adolescents to continue their education. It does not, however, consider a variety of factors that might keep youths from attending school, such as homelessness or a variety of health concerns. Purpose of the Study and Research Questions (21) The overall purpose of this study was to explore the experience of homelessness among adolescents. More specifically, the research questions that guided this investigation are How is homelessness experienced by adolescents? How does gender shape these experiences? How is health perceived and experienced by homeless adolescents, and what are the barriers they encounter with respect to the health care system? and How does current Canadian policy shape these experiences? Method Design (22) The selected research design was a critical narrative analysis. This approach integrates key ideas from critical social theory and narrative inquiry. Critical theory builds on Marxist thought to consider that multiple, often overlapping forms of oppression exist. From an epistemological perspective, knowledge within a critical theory framework is historically constructed and socially situated. Thus, characteristics such as social class, race, age, ability, and gender are considered to be social constructions that afford different access to power and privilege within our society (Browne, 2000). Depending on one's social location, or identity, individuals and groups have unequal ability to fully participate in society. One aim of research that is informed by critical theory is to examine individual experiences but to simultaneously consider how these are shaped by broader social, political, and historical contexts. (23) As selected study participants were from a group who are often in the margins of society, this research created a “space” for the voices and perspectives of homeless adolescents to be heard. At the same time, their individual, subjective experiences were analyzed with particular attention to the manner by which those experiences are shaped by gender and by public policy. (24) Narrative inquiry is a research method that is highly compatible with critical social theory. Narrative inquiry involves using language as the medium that reflects meanings, which are understood as the groundwork of reality (Riessman, 1993). The participants' stories are rooted in time, place, and personal experience (Lieblich, Tuval-Mashiach, & Zilber, 1998; Riessman, 1993), which provide insight into social patterns as they are seen through the lens of an individual (Patton, 2002; Riessman, 1993). In this research the social patterns and culture that were revealed though the individual's stories can be used to better understand the experiences of living without a home. Sample (25) After ethics approval was obtained through the University of Western Ontario's research ethics board, the study participants were recruited from a community center that works with adolescents who are homeless. This center is located in the downtown area of a southwestern city in Ontario. Information about the study was provided to the agency staff, who assisted with recruitment by allowing discussion about the study during various youth group meetings. The youth who were interested in participating were asked to contact the researcher by phone or e-mail or in person during a visit to the centre. After meeting the adolescent, the researcher provided a letter of information. The main points of the letter were reviewed at the beginning of the interview, and any questions the participants had were addressed. Informed consent was obtained verbally and in writing at the time of the interview. (26) All male and female participants had self-identified as being homeless, were able to speak and understand English, and, with one exception, ranged in age from 14 to 19 years. The rationale for the lower age limit is that 14 is the legal age at which individuals can agree to participate in research without parental consent. In recognition of the diversity within the homeless adolescent population, efforts were made to recruit youth from a variety of backgrounds and ethnicities. One Black male participant who was 6 months above the specified age range was granted acceptance to participate. All other youth were White. (27) The total sample consisted of 6 female and 7 male participants. All participants were given the choice of taking part in group or individual interviews. Five young women and 4 young men opted to be interviewed individually. Two group interviews were conducted, one consisting of 2 adolescent boys and another consisting of 1 adolescent boy and 1 adolescent woman participant. In both of these interviews the two participants knew one another and considered each other friends. The final decision regarding sample size was determined during the course of the research according to the criterion of saturation (Patton, 2002). In essence, sampling was discontinued when no new themes emerged from the data. Data Collection Procedures (28) The individual and group interviews followed a semi- structured format and were dialogic and interactive in nature. Critical theory assumes that the standards of truth are always social (Campbell & Bunting, 1991). Thus, new knowledge is coconstructed between the nurse researcher and the participants. Field notes were taken after the interviews, which assisted the nurse researcher in revising the interview guide as the study progressed as well as assisting in data analysis (Patton, 2002). Data Analysis (29) All interviews were audio-recorded and transcribed verbatim as soon as possible following the interview. Transcripts were reviewed by the interviewer for accuracy. Once transcription was completed, a narrative style of analysis was conducted with the assistance of Atlas-Ti, a qualitative software program. This process involved several readings of the transcripts to capture initial impressions (Lieblich et al., 1998). More focused codes were then developed as ideas surfaced from the narratives. The code list was continuously revised to accommodate new perspectives and to collapse overlapping categories. The focused code list guided the analysis, and more abstract themes evolved from the transcribed stories. Attention was paid to both the content of the story and the way in which it was told (Lieblich et al., 1998). (30) Zimmerman and West (1987) have argued that society “invisibly” guides people to behave socially within the dichotomous norms of femininity and masculinity. It is therefore thought that gender is embedded in our everyday experiences (Zimmerman & West, 1987), which influence how youth create different meanings out of similar circumstances. Social understandings of gender and their influence on the narratives were therefore considered throughout the analysis. Ideas that emerged from the transcripts that did not fit the evolving code list were recognized as important and considered throughout the analysis. In all cases except for the one boy/girl group interview, young women's and young men's transcripts were initially analyzed separately. Finally, dominant themes were identified, and conclusions were made. Findings (31) All participants appeared eager to share their stories and did so in an insightful way. From their narratives five themes emerged: (a) the realities of exiting street life, (b) negotiating dangerous terrain, (c) rethinking family, (d) the hazards of being female, and (e) the elusive nature of health and the health care system. Because critical research invites reflection into the contextual factors that shape and influence a person's experience, a separate analysis of current Canadian policy was completed. These findings will be addressed in relation to the participants' stories. “You're Just Stuck”: The Realities of Exiting Street Life (32) Several participants expressed the belief that they were unable to change their current situation and obtain stable housing. Seeing few options, many participants stated that they felt “stuck.” As one youth who was living at a shelter at the time of the interview explained, Um like the fact that I'm just like stuck in my life, there's nothing really I could do right now . . . well just like stuck in a shelter. I can't really—I don't talk to my dad so I don't really want to live with him. I don't really want to live with my mom, plus where she lives it's too crowded anyway. (33) One male participant had received assistance from the Children's Aid Society (CAS) and noted that without their involvement, “then you're just stuck. You got no one to help you out pretty much.” Thus, feeling stuck meant perceiving few options and little or no support. It was clear, however, that the youths were dissatisfied with their homeless status and aspired to something better. Often, the participants described a strong determination to reach their goals. Throughout their stories, positive images of the future were shared, including their hope that living without a home “does not last a long time.” One youth talked about his desire to follow in his brother's footsteps and “try and get college done” and maybe “join the [army] Reserves.” Recognizing that this would not be easy, he also asserted that he was determined to get himself “off the streets.” (34) Although many comments reflected a desire to bring about change, it was acknowledged that achieving personal goals would be extremely difficult. Many spoke about the desire to get off the streets but described various barriers that kept them from doing so. The inability to obtain stable employment, education, or training was commonly mentioned. In one group interview, participants shared that being judged negatively by potential employers because of residing in a shelter could impede finding employment. Another participant, who suffered from chronic fatigue syndrome, explained how her health condition prevented her from finding employment: I'd like to have a job, you know. I'd like to be able to be more independent, but I can't um because society doesn't really understand um where—they don't understand chronic fatigue. And I mean a job can't be based around how the employee is feeling, you know, they've got to be you know—if they book you in there, you have to be there, right? And so it's hard. That's tough to deal with. (35) Feeling misunderstood, judged, and unsupported while attempting to overcome barriers contributed to a belief among many of the youths that they could rely only on themselves and that reversing their homeless status would be extremely difficult. (36) In summary, many of the participants explained that they felt stuck, and meaningful strategies to end their homelessness seemed elusive. They believed that their efforts were thwarted by barriers over which they had little or no control. They described feeling unsupported and judged and ultimately began to rely only on themselves to bring about change. “I Can't Really Feel Safe”: Negotiating Dangerous Terrain (37) Several of the participants discussed the desire to have a place for themselves that was safe and comfortable, a place they could call “home.” The living circumstances for the homeless youth in this research varied but included couch surfing, staying in shelters, and sleeping in parks, stairwells, or abandoned cars. Residing in public spaces often left the youth exposed to violence, which further threatened their sense of safety. Living in a shelter at the time of the interview, one participant commented, I don't know because I can't really feel safe because I'm out here in this world . .. you can't really feel safe because you don't know what's going to happen next. You don't know if this drunk is going to come up and punch you in the face for no reason just because he's drunk or if this guy's going to start something with you, and you can't really feel safe there. (38) Several youths explained that they had been robbed, threatened, and ridiculed or forced to witness physical fights. After being beaten to the point of hospitalization by three older men in a back alley, a male participant commented that he “can't feel safe anymore.” (39) Being exposed to constant threats of violence with no safe place to go, the youth's daily focus was on meeting their urgent safety and physical needs. Many of the youth chose to tell stories that portrayed them as survivors. The fact that they were living on the streets and still alive was something that they were proud of. The participants told about creative strategies they used in an attempt to feel safe. These included being part of a group, which served as a form of protection while sleeping outside. This peer group would also “help you out” in the event of a fight. Others talked about feeling safer when they were a “one-man army” or when they wore neutral colors so as not to be affiliated with a gang. Carrying a weapon such as a knife and using humor to distract a potential “enemy” were also described as ways to create a sense of safety. Although staying within the confines of the shelter afforded some protection, safety seemed to be an unattainable goal when lacking places of their own. “They're in the Same Situation as You”: Rethinking Family (40) A multitude of complex factors combined to contribute to the homelessness among the study participants. Most of the participants had grown up in poverty. Several described various forms of violence, including sexual, emotional, and physical abuse by one or more parent or step-parent that occurred during their childhoods. Others told of emotional abuse by a sibling. Some of the participants explained that problems experienced by their parents, including substance abuse, mental health problems, or unresolved grief, led to neglect of them as children. One youth had a cognitively impaired sibling who needed full-time care at home, requiring the full attention of her mother. (41) A few participants described their efforts to seek help for the abuse, confiding in an adult or youth pastor. According to them, their concerns were either perceived to be untrue or trivialized. These responses resulted in feelings of abandonment and betrayal. A young female participant who had fled from her home because of emotional abuse by her parents and sister commented, “I just um—I find that—I mean I have parents but in many ways I feel like an orphan.” (42) In addition to feeling betrayed and abandoned by their families, several participants also felt similarly disconnected from their peers. Many youths explained that they felt like an outcast, “being on the bottom of the list,” or “the most made fun of person at school.” One youth was forced to quit high school while he was homeless because the only shelters were downtown and he could not afford the necessary bus tokens. He commented, I don't really talk to anybody from my high school any more. Things went sour with a lot of them too though, eh, because they found out I was living on the streets. If you know anything about high school kids gossiping and like that are talking behind your back, it kind of starts, “Oh (participant's name) is homeless,” blah, blah, blah, and they all have this, you know, impression of homelessness that um— that has stuck with them, I guess. It's not exactly the cool thing to be, the homeless guy in high school, you know what I mean? They like you more if you're the captain of the football team, I think. Prior to becoming homeless, he had been well liked by his peers but subsequently felt like an outcast. (43) The sense of betrayal and abandonment at both the family and the peer levels led to deeper connections with individuals who shared similar experiences. While living on the streets, all of the participants developed meaningful relationships in which they felt supported, cared for, and protected. Some youth found these relationships to be more “real,” as they could empathize with one another and talk about their situations without feeling that they were being judged negatively. After living on the streets, one participant was able to establish meaningful relationships with other homeless youth because, as he stated, “they're in the same situation as you.” (44) Often, street culture provided the youth with the “family” that they felt they never had. Close friends were the people in their lives that could be trusted and on whom they could rely. It was stated that friends would not “blow me off like my family did.” After being dropped off at a shelter because her father and stepmother couldn't “deal with her,” one female participant commented, And when you're homeless too, like you kind of— like because nobody that's living in a shelter really has like close family. It's like everyone kind of like connects and you find your own group and like your own family within that. (45) Meaningful relationships were desired by all par- ticipants. Sharing similar experiences often allowed the youths to feel connected and supported after being abandoned and betrayed by family and peers. “More Things Can Happen to You”: The Hazards of Being Female (46) Although all of the participants had discussed being exposed to various types of violence while homeless, vulnerability to gender-based violence was particularly pronounced among the female participants. Some told of physical and financial abuse, and one participant was forced to return to living in a shelter after she fled her verbally abusive boyfriend. Other females told about harassment while living on the streets, which is captured in the following comment: “I just feel like if you're a girl like a lot of the older, sort of weird guys at places like that may hit on you and make you feel strange about yourself.” It was also shared that women are more likely to sell their bodies as a means to meet their various needs, one of which was a place to sleep. (47) Being female meant having more complex health concerns. Money was needed for feminine hygiene products and birth control. Fears of getting pregnant were expressed by several young women. One female participant commented, With a girl, with me being a girl there's maybe a biased thing just because I am a girl. But there are more things that can happen to you. Like if you're living on the streets you have to afford feminine hygiene products. You've got to afford like everything that there is to do with that. You've got to worry about if you get pregnant. . . and guys don't have to worry about getting pregnant, they don't have to worry about getting their period. They don't have to worry about getting raped in the middle of the night because usually guys—especially guys who live on the street are tough enough to take care of themselves. There are some girls who can; there are a lot of girls I know who can't. (48) There was a common perception that young women living on the streets are unable to take care of themselves: I think that sometimes like living in the street especially females need to be a little bit more tough .. . because guys think that we're not that tough so if we stand up for ourselves and show them we are, then like they're not going to mess with you or whatever. As a result of this perception, some of the young women felt forced to prove otherwise. To one female participant, it was important that she “not back down when called on to fight,” even if the opponent was male and much larger than she. Developing a reputation of being tough, in some cases, helped a woman feel safer. (49) In summary, young female adolescents had a mul- titude of concerns while living on the streets. They experienced a variety of forms of violence, had complex health concerns, and were viewed as unable to care for them themselves. For one participant, being female and homeless equated to feeling “more used than you are appreciated.” “It Takes a Toll on You”: The Elusive Nature of Health and the Health Care System (50) Many youth spoke about the energy and effort that being homeless demands. A young male participant, who fled from a violent home where he was ridiculed and physically abused for being gay, stated that he was “very fatigued all the time, like not tired but fatigued I think is the right word. I don't know, like not really tired to go to bed but you're just like exhausted by the littlest thing.” Another youth spoke about how fatigue prevented him from “getting stuff accomplished.” A few participants felt that no one wanted to talk to them. Many others were depressed, lonely, and ashamed to tell people of their current situation. Describing how he feels about himself, one participant stated, Really like insecure and like I didn't have like very health—like high self-esteem and like I'd always think that like people thought I was like a bad person and didn't want to like hang out with me because of who I was. And like I'd just sort of like get really depressed and like start thinking that everybody hates you, and really they don't. And like scared to talk to people because you think that they're not going to want to like interact with you, or whatever. (51) When hurt or feeling ill, several participants indi- cated that, if necessary, they would access traditional forms of health care, such as emergency rooms and clinics. However, many described obstacles that kept them from doing so. No longer covered by his father's health insurance, one participant was left feeling as though he would have to pay to use Canada's public system. Others noted their inability to afford expensive prescriptions or eye exams. Another youth commented that she “will do anything and everything to stay out of going to a hospital” after she experienced what she considered insensitive care while being hospitalized following the death of her newborn daughter. (52) Whereas some participants described barriers to care, others claimed there was inadequate support available for them to feel healthy. Feeling healthy involved having access to resources such as a place to have a shower and a safe place to live. Others described health as eating each day, living a low-stress life, and being able to support themselves. It was perceived that there was a tendency for some homeless people to “give up” because they were not initially supported. This idea was captured in the following statement: Yeah, but the way that happened is because no one would help them in the first place. People that need support and they don't have, if they would just have that support they could like make a whole world of a difference from turning someone from committing suicide and someone turning into a good citizen and having a job, just because they never had support. And they didn't know where to turn, or what to do and they got in with the wrong crowd. They needed money for a place to stay, so they started prostituting themselves or selling drugs and end up in jail or whatever, end up robbing houses, blah-blah-blah, and go down the wrong road all because they didn't know where to turn. They had no help. According to the participants, lack of support contributed to a more complex situation than they had faced prior to becoming homeless. (53) A perception among other participants was that homelessness is hidden from society, a perception that made it difficult to access services. It was explained that before becoming homeless, a male participant viewed the shelter system as a service used by “just old people, like old guys.” Similarly, a few other participants said that when initially homeless, they were unaware that there were even shelters available, let alone ones that are primarily for youth or women. This lack of knowledge about available services led them to sleep outside, sometimes in the middle of winter. During one pair interview, participants shared that health services were not publicly advertised because of the negative image it would have on the government. (54) Several of the participants spoke about the lack of specific health care services. When reflecting back on her time in a group home, a young female participant commented that the counselors to whom she had access were not trained “to deal with a lot of stuff.” She also noted that she “would have liked to have more actual counseling, like on a weekly basis to deal with a lot of my stuff.” Recognizing that she needed someone to whom she could talk, this young woman observed that there were not appropriate health care services available to her. Another participant had a similar experience. Trying to come to terms with her history of sibling abuse, she found that the violence that she endured was often dismissed as sibling rivalry. She said there were no resources to help her because the seriousness of sibling violence was not recognized. Dealing with her history was described as being “really hard.” Homelessness and the Public Policy Context (55) Public policy regarding housing shaped the lives of homeless youth in subtle and direct ways. Not having the education or the proper training kept many youth from finding employment. Chronic health problems and feelings of being judged negatively also prevented the youth from being able to obtain work. As a result, poverty was a central context in the lives of virtually all of the participants. Some youth noted that small amounts of money were fairly easy to come by, but having enough money for rent and other necessities was much more difficult. According to one, it was “just that large amounts of money where you could, you know, go get your own place and stuff like that, that's you know, that's kind of a bit harder to get.” Having this “jump start” was seen as a way to get out of their situation. (56) Several youth spoke about the difficulties of con- tinuing their education while homeless. Not knowing where they were going to sleep at night, feeling insecure, and having no income with which to buy food made regular school attendance extremely difficult. Recently discharged from jail to a shelter, a male participant commented on his frustration of not being able to receive Ontario Works: No, not really because like there's not much you can really do when you're 17 at all. Like if you're 18 you can get on Welfare, like no big deal but when you're 17 you have to have like—the only way you can get on Welfare is like Student Welfare and it's like too late. . . . It's too late in like the semester to even start school right now. Not being able to continue their schooling meant that many of the participants were not eligible for Ontario Works. Discussion (57) All of the participants created stories that included ideas and issues that were current in their lives. They discussed the desire for a situation that was “better” than the one they currently had. Although their narratives revealed a sense of determination, the youth encountered many barriers, such as social policies that were not sensitive to their situations, chronic health issues, and perceived judgment of others. These obstacles prevented them from reaching their goals. This analysis shifts the sole blame of a person's homelessness from the individual and captures how public policy contributes to their lack of options. This research challenges the socially accepted idea that homeless youth are “lazy” and cannot be “bothered” to find a job. Exposure to various forms of violence and being forced to focus on their daily survival had detrimental effects on the adolescents' perceptions of their health and wellbeing. As they observed, having a safe and secure place of their own would allow them to redirect their energies to the fulfillment of other goals, such as completion of their education or finding employment. This brings attention to the fundamental role that affordable housing plays in the well-being of youth. In addition, in this study gender was clearly an important context to homelessness, with homeless adolescent females particularly vulnerable to distinct forms of violence. Although many described a range of physical and emotional health problems, the participants generally perceived little available material or emotional support. The accessibility gap that exists between homeless youth and needed health-related services emerged as an important feature in their lives. Implications (58) Based on the findings from this research, several important implications might be suggested. Of particular importance, this study highlighted the agency of adolescents experiencing homelessness. Health care professionals working with homeless youth have ample opportunity to facilitate group discussions that address their circumstances. Through discussion, health care professionals and the youths can collaboratively identify solutions to their situations. All care providers can invite homeless youth to join them in their lobbying of local governments as a way to initiate change. In addition, health professionals can encourage adolescents to participate in community-based programs that help raise awareness regarding the issue of homelessness. Public health professionals can facilitate peer-led support groups for those who have experienced violence as well as advocate for affordable long-term counseling services. They can also work with homeless youth to increase the visibility of homelessness in the school system. This awareness will ultimately help link youth in the process of becoming homeless to the needed health-related services. (59) This study makes it clear that adolescent females have complex health needs while homeless. To promote the health of young homeless women, all health care providers should consider the fact that being female places homeless adolescents in a position where they are likely to experience various forms of violence such as sexual assault and harassment. For supportive and effective care to be provided, it is crucial to be able to recognize that these events have detrimental effects on the health and well-being of homeless adolescents. Creating “safe spaces” where homeless youth can talk with one another about the challenges they face, and about violence in particular, is a possible avenue for a health promotion intervention. (60) With respect to education, inclusion of nursing, medical, and social work curriculum related to the needs and challenges of homeless youth is essential. Offering clinical practice opportunities that would afford exposure to this population, and to street culture more broadly, increases the likelihood that health services can be provided in a compassionate and nonjudgmental manner. (61) More research is needed that will examine the per- ceptions of homeless youth. To understand how youth perceive their health, more effective care programs can be developed and implemented. This study noted an accessibility gap between health care services and those who need them. Research that explores the nature of where adolescents are receiving health-related information would be helpful to better develop care programs. Because the health of lesbian, gay, bisexual, and transgendered individuals is generally considered to be poorer than that of other homeless youth (Cochran et al., 2002; Noell & Ochs, 2001), research that considers their perspectives on health is needed to provide effective health care programs. In addition, more research that attempts to create a deeper understanding of how ability and race influence the health and wellbeing of homeless youth is needed. (62) Social policies that influence an adolescent's homeless situation extend beyond the urgent need to expand our current affordable housing initiatives. Living on the streets often forces adolescents to focus on daily survival, making it difficult to stay enrolled in school or to maintain a job. It is essential that all social policies consider homeless youths' situations so that those who choose to exit street life have the ability and the resources to do so. Changes to the eligibility criteria for Ontario Works so that homeless youth would be able to receive support under this initiative is an important policy direction. Limitations (63) There are several limitations with regard to this study. First, despite the researchers' efforts, only one community service was used to recruit the participants. Because critical research examines a variety of contextual factors, such as race, gender, and socioeconomic status, lack of a diverse sample inhibits an understanding of homelessness among these groups. Second, in this study gender was examined as a binary concept. To do so limits the involvement of youth who do not selfidentify as either one of the two dominantly accepted gender identities, female and male. This further limited the ability to understand how various factors such as gender orientation shape the perceptions and experiences of homeless adolescents. The third limitation of this study was the inability to share emerging findings with many of the participants. Because of the transient nature of homeless adolescents' lifestyle, it was difficult to locate many of the youth following the initial interview. Finally, the findings of this research suggest that adolescent boys do not experience sexualized violence. As there is stigma surrounding this issue, some of the male participants might have chosen not to disclose such information. Conclusion (64) The findings of this study highlight the experiences of homeless youth and offer insights into the complex nature of homelessness. Pulling the issue beyond the individual allows for the consideration of how contextual factors influence the experiences of homeless adolescents. This study draws attention to the fundamental roles that affordable housing policies and gender play in shaping the health of homeless adolescents. 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Haldenby, RN, MScN, currently works at the Odette Cancer Centre, which is part of Sunnybrook Health Sciences Centre. Helene Berman, RN, PhD, holds the Scotiabank Chair at the Centre for Research and Education on Violence Against Women and Children and is an associate professor at The University of Western Ontario, School of Nursing, London, Ontario, Canada. Cheryl Forchuk, RN, PhD, is a professor at The University of Western Ontario, School of Nursing, London, Ontario, Canada. Source: This article is reprinted from Qualitative Health Research, Vol. 17, Issue 9, pp. 1232–1244, 2007. Reprinted with permission of Sage Publications, Inc."