literature review on building industry

Building Information Modeling on Construction Safety: A Literature Review

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• First Online: 15 December 2022
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• Orlean G. dela Cruz 27 , 28 &
• Jason Maximino C. Ongpeng 27  

Part of the book series: Advances in Science, Technology & Innovation ((ASTI))

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Building information modeling (BIM) technology has a significant contribution to construction safety, such as the automated detection of possible safety hazards and the prevention of potential risks likely to occur. The technology has been implemented in the architecture, engineering, and construction (AEC) industry for decades and has recently been introduced in construction safety. The technology can bring significant benefits to safety management in accident prevention and provide valuable reference material for rescue activities. Therefore, construction safety management must understand the technology, application, and challenges for better utilizing BIM as a safety tool. With these BIM safety tools, we should hope to see a shift in how safety is handled. To overcome this gap, concerning the challenges discussed, future research should consider: (1) generalization of the enhancement of BIM's technicality and functionality, (2) the cost–benefit analysis, and (3) construction practitioners' perspective on BIM applications on the results generated from different tools. It also recommends developing a database of all uncertain identified hazards and potential control measures subject to expert validation.

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dela Cruz, O.G., Ongpeng, J.M.C. (2022). Building Information Modeling on Construction Safety: A Literature Review. In: Altan, H., et al. Advances in Architecture, Engineering and Technology . Advances in Science, Technology & Innovation. Springer, Cham. https://doi.org/10.1007/978-3-031-11232-4_8

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Occupational safety and health in construction: a review of applications and trends

Fabián alberto suÁrez sÁnchez.

1 Universidad de Nariño, Department of Civil Engineering, Colombia

Gloria Isabel CARVAJAL PELÁEZ

2 Universidad de Medellín, Department of Civil Engineering, Colombia

Joaquín CATALÁ ALÍS

3 Universidad Politécnica de Valencia, Department of Construction Engineering and Civil Engineering Projects, España

Due to the high number of accidents that occur in construction and the consequences this has for workers, organizations, society and countries, occupational safety and health (OSH) has become a very important issue for stakeholders to take care of the human resource. For this reason, and in order to know how OSH research in the construction sector has evolved over time, this article–in which articles published in English were studied–presents an analysis of research conducted from 1930 to 2016. The classification of documents was carried out following the Occupational Safety and Health Cycle which is composed of five steps: regulation, education and training, risk assessment, risk prevention, and accident analysis. With the help of tree diagrams we show that evolution takes place. In addition, risk assessment, risk prevention, and accident analysis were the research topics with the highest number of papers. The main objective of the study was to contribute to knowledge of the subject, showing trends through an exploratory study that may serve as a starting point for further research.

Introduction

In most industrialized countries, the construction industry is one of the most significant industries in terms of contribution to gross domestic product (GDP). It also has a significant impact on the health and safety of workers. The construction industry is both economically and socially important 1 ) . In construction, workers perform a great diversity of activities, each one with a specific associated risk. The worker who carries out a task is directly exposed to its associated risks and passively exposed to risks produced by nearby co-workers 2 ) . Building design, materials, dimensions and site conditions are often unique, which requires adaptation and a learning curve from site to site. Injuries may occur in a number of ways and at every juncture of the process 3 ) .

As a result of this situation there is a high frequency of accidents in construction, which makes it an unsafe industry. Degree of safety in this selected sector of the economy is not indicated by a single accident but by a set of accidents that have occurred within a specified time interval. Knowledge about the noticeable trends in accidents is required in order to assess the level of safety and also directions for changes 4 ) .

Occupational safety and health is an area concerned with the development, promotion, and maintenance of the workplace environment, policies and programs that ensure the mental, physical, and emotional well-being of employees, as well as keeping the workplace environment relatively free from actual or potential hazards that could injure employees 5 ) . However, the number of articles regarding OSH in construction was small until fifteen years ago. Since 2001 the number of OSH publications relating to construction has increased. From different perspectives and using different tools researchers have studied occupational hazards in construction. Sousa, Almeida, and Dias 6 ) state that there are several tools and methods to investigate and understand occupational accidents in the construction industry.

In a systematic review of construction safety studies, Zhou et al. 7 ) found that of all the research topics 44.65% were pertinent to safety management process, 20.27% to the impact of individual and group/organizational characteristics, and 33.03% to accident/incident data. The body of research on safety management process involves safety planning, safety monitoring, safety assessment, safety measurement, safety performance etc.

Taking into account the previously stated remarks, the aim of our paper was to review the literature and define current trends in research in occupational safety and health applied to the construction industry. Trends were obtained through chronological evolution. Thus, they can be properly analyzed and further research can be developed from them.

Methodology

Our literature search analyzed only peer-reviewed papers associated with occupational safety and health in construction, because the state-of-the-art of a discipline is defined in these forums; some very relevant articles from conferences were also considered, and the scope of the research was determined by the following parameters:

• – Language: English.
• – Period: from 1930 to 2016
• – Key descriptors: occupational risk; occupational accident; occupational safety; occupational prevention; occupational health; occupational safety and health and construction
• – Databases: Ebsco Host, Science Direct and Scopus. These were selected as sources of information due to their size and the quality of the publications found in them, however for future research other sources may be considered

The first problem needing to be addressed was how to suitably classify all the information. Occupational safety and health is not a homogenous issue; quite the opposite, there are many stakeholders involved. Besides, it can be considered a multi-stage process. This process approach has already been suggested by many authors in risk management, as traditionally applied to project management 8 ) which proposes a similar process based on four stages: identification, analysis, response, and control. Moreover, the OHSAS 18001:2007 Standard 9 ) proposes a cycle based on continuous improvement which comprises of: establish corporate policies, plan, implement and operate, check and correct, review, and improve. These steps are compatible with the ISO 9001:2008 quality management system 10 ) . Finally, Carvajal 11 ) proposed a five-step cycle: regulation, education and training, risk assessment, risk prevention, and accident analysis. A new Occupational Safety and Health Cycle that includes safety climate was developed, adapting the cycle suggested by Carvajal, which is created in phases of education and training, risk assessment and risk prevention ( Fig. 1 ).

Occupational Safety and Health Cycle. Adapted from Carvajal, G. I. (2008). Modelo de cuantificación de riesgos laborales en la construcción: RIES-CO . (Doctoral Thesis). Universidad Politécnica de Valencia, Valencia, España.

However, a shortcut in this Occupational Safety and Health Cycle could appear if regulations (either from the company or from public agencies) are not analyzed, improved on, or at least implemented; and later, if education and training is not provided.

A company that does not seriously apply an occupational safety and health management system may enter into a spiral of unsafeness, trying to take the easiest way out of the cycle, and making it shorter and shorter each time until a serious accident takes place. In any event, a “culture of construction safety” should be implemented; this is defined 12 , 13 ) as the whole group of knowledge, habits, and behaviors that drive companies to the willing application of safety and health approaches and procedures in the construction industry. This is a good way to achieve a “climate of safety”, which implies a subjective perception and evaluation of safety issues related to the organization, its members, structures and processes, based on experience of the organizational environment and social relationships 14 ) .

For this article, the previous cycle was taken as an example of a logical and continuous process with feedback, which allowed for an analysis of the evolution of research in occupational safety and health in construction. Risk assessment comprises risk identification and analysis, as stated in traditional risk management literature. Likewise, risk prevention consists of response and control. In order to highlight the importance of setting objectives and of organizational learning through time, two previous steps and a final one are added. Regulation is included to emphasize the significance of corporate policies issued by companies on one hand, and laws and standards issued by public agencies on the other. Training and education reflects the impact that the former steps have upon the people involved if some improvement needs to take place. Finally, accident analysis is needed to investigate the cause of accidents; thus, lessons can be learned and other accidents may be avoided in the future - obviously, this step is skipped if no accident occurs.

Articles were analyzed and classified in the Occupational Safety and Health Cycle, according to the suitability of their content according to each of the steps. Nevertheless, our goal was not to develop a bibliometric study, but to define chronological trends in research by using noteworthy articles to display the main milestones. Thus, in our second analysis of the papers, we chose only those significant articles that offered an added-value and could be used as references in a research trend. In this opportunity, the selection was developed by taking several aspects into consideration. Mainly, in order to be chosen, a paper must have enough qualitative references from other papers even if it does have many citations. Besides, we have rated the paper’s degree of importance according to our assessment of the novelty of its ideas and the future influence of this particular manuscript on others. The analysis of the evolution of research was conducted following a logical sequence of ideas in the selected papers.

Bibliographic analysis

In the first search we undertook, 285 articles were selected from 32 journals or proceedings. Papers chosen by journal and by time period are displayed in Table 1 . It can be noted from this table that the number of papers has recently increased: in the period between 2001 and 2010, a total of 129 papers related to OSH in construction were published. This amounts to 45.3% of all articles included. Likewise, in the period between 2011 and 2016, a total of 57 papers were published. Although this period is shorter, it can be observed that the amount of published papers is greater than that of the periods prior to 2001. The Journal of Construction Engineering and Management is the one with the most articles selected, followed by Safety Science and the International Journal of Project Management.

Selected articles are displayed in Table 2 according to topic, showing absolute and relative values. Risk assessment is the most popular topic, appearing in 35.4% of the papers. Accident analysis and risk prevention each get more than 20% of the share.

It is surprising not to find many papers on regulations, either from the company’s point of view (corporate policies) or from public agencies’ point of view (standards and norms). Maybe the reason is that some articles deal not just with regulations, but also with other approaches to occupational safety and health; thus, they are categorized under other steps of the cycle, mainly risk assessment or risk prevention. In our study, we observed how research has influenced the development of laws and regulations by providing new forms and tools for risk assessment and for the implementation of preventive measures at the workplace. The analyzed papers propose measures to assess results achieved and to know whether regulations are being applied and if they are meeting the objectives for which they were created.

It is not so unexpected to discover that education and training get very little attention from researchers. Pietroforte and Stefani 15 ) already found that only 1.8% of the papers published in the Journal of Construction Engineering and Management from 1983 to 2000 were related to education and professional development. Furthermore, in their analysis of trends in project management, Crawford, Pollack, and England 16 ) selected forty-seven topics relevant to the field of project management; none of them was related to education and training. Because so few articles are found for these two steps, no research trends are developed for regulations and for education and training. Safety culture and safety climate are new factors that have also few publications. According to research on occupational safety and health applied to the construction industry, three main topics obtained from our previous bibliographic analysis are described: risk assessment, risk prevention, and accident analysis (which represent 85% of the total), and this paper focuses on those subjects.

Trends in risk assessment

For the topic of risk assessment, the search started with Fine’s seminal article “Mathematical evaluation for controlling hazards” 17 ) , in which a formulation to quantify risks is proposed. It is based on three factors that define risk: probability of the accident happening, personnel exposure to the risk, and consequences of the accident (or severity). From his approach, three basic lines of research were identified: management of occupational safety and health, quantifying occupational risk through modeling, and quantifying risk through probability analysis. They are displayed in Fig. 2 .

Trends in risk assessment.

Al-Bahar and Crandall 18 ) applied traditional risk management approaches to the construction industry to obtain a useful strategic tool for managers. Mohamed 19 ) introduced the influence of management and risk systems at the workplace. Koehn and Datta 20 ) analyzed ISO Standards (9000 for quality, 14000 for environment, and 18000 for safety and health), and proposed an integrated system for construction companies. Sparer and Dennerlein 21 ) created and evaluated different approaches for establishing rewards based on a threshold score, for use in safety incentive programs. Pinto 22 ) introduced safety climate variables within the calculation of the level of risk in a Qualitative Occupational Safety Risk Assessment Model (QRAM).

On the issue of quantifying risk through modeling, Knab 23 ) put forward a mathematical model based on insurance premiums. Whereas Jannadi and Almishari 24 ) developed a computer model based on Fine’s formulation. Mitropoulos and Namboodiri 25 ) developed a technique for measuring the safety risk of construction activities according to the characteristics of the activity and independent of the workers’ capabilities, and Liu and Tsai 26 ) proposed a fuzzy risk assessment method which related hazard types with construction items and hazard causes with hazard types.

On the other hand, Kaplan and Garrick 27 ) followed Fine’s assumptions to calculate the probability factor of his formulation. Using this work as reference, Cuny and Lejeune 28 ) analyzed the severity factor. Then, to solve the problem of uncertain and insufficient statistical data Gürcanli and Müngen 29 ) used fuzzy logic. Bowers 30 ) approached the probability factor by using quantitative data (e.g., historical ratios) or qualitative data (e.g., interviews). Santoso et al. 31 ) identified, analyzed, and categorized potential risk factors in construction.

In summary, three main branches of research were identified: management of occupational safety and health in construction, risk quantification through modeling, and probability applied to risk quantification. From them, twelve active lines of research were highlighted, and a representative paper for each was pointed out.

Trends in risk prevention

Heinrich’s seminal article 32 ) is the starting point of the two other topics: risk prevention and accident analysis. He suggested the concept of risk prevention based on historical accident statistics, and focused on cost reduction due to the adoption of prevention techniques. Fifty years later, Helander 33 ) discussed several interesting issues: high accident ratios, increasing costs due to accidents, lack of research, and inexperience in implementing policies and plans; unfortunately, many of these problems still remain in today’s construction industry. From this line of thought on risk prevention, three main trends were outlined, one concerning business strategy, and the other two regarding the main phases of the project life cycle: design and construction. They are displayed in Fig. 3 .

Trends in risk prevention.

Business strategy to achieve better safety performance in construction was introduced in work by Jaselskis, Anderson, and Russell 34 ) . Their article analyzes the main factors that lead to success in occupational safety and health in the construction industry. Two branches are developed from this idea, depending on the emphasis of the implementation: laws and standards at the managerial level 35 ) and plans, guidelines and checklists at the operational level 36 ) .

Hinze and Wiegand 37 ) were the first to show the importance of safety prevention in the design phase. They state the important role of designers in occupational safety and health because the success of construction works depends on their decision-making. Gambatese et al. 38 ) deepened this idea through several interviews, revealing keys for successful implementation of designing for safety. Fonseca et al. 39 ) proposed a model of risk prevention integrating production and safety through three different levels of anticipation (analysis of design, planning/scheduling of services and implementation). One year later, Zhang et al. 40 ) applied Building Information Modeling BIM-based safety to fall hazard identification and prevention in construction safety planning.

Nevertheless, most work produced on the topic of risk prevention focuses on the construction phase. Many authors explore different approaches. Hinze 41 ) analyzed human behavior in risk prevention and Chi and Han 42 ) analyzed 9,358 accidents that occurred in the U.S. construction industry between 2002 and 2011 and incorporated systems theory into Heinrich’s domino theory to explore the interrelationships of risks. Laufer and Ledbetter 43 ) assessed the efficiency of several safety tools used in the construction workplace through surveys; according to these authors, simultaneous methods should be used to achieve better levels of safety. Burkart 44 ) called for site-specific safety plans, adapted to each workplace, and useful and reliable for every stakeholder.

Along another line, Hinze 45 ) analyzed the influence of economic incentives, concluding that low-value incentives, combined with good prevention tools, are more successful, and Imriyas 46 ) developed a workers´ compensation insurance (WCI) premium-rating model for building projects.

Summing up, our exploration detected ten lines of research within risk prevention in construction. Three of them deal with business strategy, three with the design phase, and six others with the construction phase.

Trends in accident analysis

Accident analysis (or accident investigation, as it could also be called) makes it possible to determine the what, how, and why of an accident; thus, in the future, similar accidents can be avoided based on the lessons learned. This topic also originates from Heinrich’s work (1930). He considered accident statistics as the baseline for any analysis of occupational safety and health. Many years later, Leplat 47 ) approached the principle of accident causation, discussing the relationship between accidents and the work in progress at the time of the accident. Kjellen and Larsson 48 ) proposed a conceptual model to investigate accidents across two levels: the sequence of facts about an accident, and factors affecting work at the time of an accident. From these articles, three main branches are displayed in Fig. 4 .

Trends in risk analysis.

The first branch deals with different models of workplace accident causation. DeJoy 49 ) focused on human factors. Abdelhamid and Everett 50 ) reviewed different techniques and offered a theoretical explanation for root causes of accidents. Suraji et al. 51 ) described a global model for the project cycle. Rozenfeld et al. 52 ) developed a structured method for hazard analysis and assessment for construction activities called Construction Job Safety Analysis (CJSA).

The second branch is about the statistical analysis of accidents. Kisner and Fosbroke 53 ) analyzed injuries from 1980 to 1989 in the United States. Hinze et al. 54 ) supported by Occupational Safety and Health Administration (OSHA) data from 1985 to 1995, categorized accident causes and sources of injures. Huang and Hinze 55 ) also examined OSHA data on construction worker’s accidental falls from 1990 to 2001. Cheng et al. 56 ) used data mining to establish the cause–effect relationships within occupational accidents in construction in Taiwan during the period 2000–2007. Finally, Irumba 57 ) investigated the causes of construction accidents in Kampala, Uganda using ordinary least squares regression and spatial regression modeling.

The last branch evaluated occupational accidents in terms of their cost. Leopold and Leonard 58 ) assessed several British construction firms to analyze accident costs in relation to their insurance premiums. On the other hand, Everett and Frank 59 ) showed a comparative study on the actual costs of accidents and injuries in the construction industry.

The main lines of research in accident analysis can be summarized within three topics: causal model of accidents, statistical analysis of accidents, and economic cost of accidents.

Conclusions

Our paper sought to establish current research trends in occupational safety and health in the construction industry. We described an “Occupational Safety and Health Cycle” based on traditional risk management approaches with five basic steps: regulations, education and training, risk assessment, risk prevention and accident analysis. Because of a scarcity of articles in the first two steps, no trends were proposed for regulations, education or training.

Three main branches (i.e. management of occupational safety and health in construction, risk quantification through modeling and probability applied to quantifying risk) were outlined within the topic of risk assessment, which is the topic with the highest amount of publications, and were subsequently broken up until obtaining the twelve current trends. Likewise, three main branches (business strategy, focus on the design phase and focus on the construction phase) were obtained for risk prevention. These were in turn split into the ten current trends. Finally, there were three solid trends within accident analysis: a causal model of accidents, their statistical analysis, and their economic cost.

The findings of this study show the following future subjects as trends of research and implementation in OSH in construction: rewards in safety incentivization programs; increasing the usage of information technology tools; production process automation; implementing proactive measures rather than reactive measures; integrating quality, environmental and OSH management system standards and using technological tools to train workers.

• Open access
• Published: 29 August 2013

Review and analysis of augmented reality literature for construction industry

• Sara Rankohi 1 &
• Lloyd Waugh 1  

Visualization in Engineering volume  1 , Article number:  9 ( 2013 ) Cite this article

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Metrics details

Research has identified various beneficial capabilities for augmented reality technologies in the AEC industry such as virtual site visits, comparing as-built and as-planned status of projects, pre-empting schedule disputes, enhancing collaboration opportunities, and planning/training for similar projects. This paper provides an expanded foundation for future research by presenting a statistical review of augmented reality technology in the AEC industry. The review is based on articles found within eight well-known journals in architecture, engineering, construction, and facility management (AEC/FM) until the end of the year 2012. The review further narrows the literature within these journals by considering only those 133 articles found through a key word search for “augmented reality.” The selected journal articles are classified within the following dimensions: improvement focus, industry sector, target audience, project phase, stage of technology maturity, application area, comparison role, and technology. The number of articles within these dimensions are used to identify maturing and emerging trends in the literature as well as to synthesize the current state-of-the-art of augmented reality research in the AEC industry. In summary, the AR literature has increasingly focused on the demonstration of visualization and simulation applications for comparison of as-planned versus as-built statuses of the project during the construction phase to monitor project progress and address issues faced by field workers. In addition, the future trend is toward using web-based mobile augmented systems for field construction monitoring.

Introduction

The complex nature of the architecture, engineering, construction, and facility management (AEC/FM) industry and its high demand for access to information for evaluation, communication and collaboration, increases the industry’s need for information technologies. Recent visualization technologies such as virtual and augmented reality technologies are ideal in this environment.

Overview of augmented reality

Augmented reality gives a view of the real world where elements are superimposed by computer generated files such as graphics, sounds, videos, or digital information. From the first see-through head-mounted AR display developed in the 1960s by Ivan Sutherland at Harvard (Sutherland, 1968 ), to the enhanced HD 4 AR and Mobile Augmented Reality System (MARS) developed by Golparvar et al. (Bae et al. 2012 ), augmented reality technologies have been used in various disciplines and arenas, e.g. engineering, entertainment, aerospace, medicine, military, and automotive industry, as a frontline technology to meet visualization difficulties in their specific domain (Behzadan and Kamat 2011 ).

Application areas

The AEC industry is also moving to embrace more AR technologies for improving various stages of construction projects. This advanced computer technology provides significant advantages through simulation and visualization of the construction industry, e.g., allowing the observer to interact with both the actual and the virtual objects and to monitor the construction progress by comparing the as-planned and as-built status of the project (Shin and Dunston 2008 ). AR technologies can benefit the AEC/FM industry in at least three levels: visualization, information retrieval, and interaction (Dong and Kamat 2013 ). Various applications of AR have been recommended for the AEC/FM industry by different researchers. Dunston and Wang ( 2005 ) proposed AR systems for AEC industry to support all phases of the constructed facility project life cycle. Wang et al. ( 2007 ) explore potential AR applications in heavy construction equipment operator training. Golparvar-Fard et al. ( 2009 ) developed a 4-dimensional AR model for automating construction progress monitoring, data collection, processing and communication in construction phase of the project. Behzadan et al. ( 2011 ) investigate a mobile 3-dimensional AR system for visualizing dynamic site operations during the construction phase. Waugh et al. ( 2012 ) developed a web-based augmented panoramic environment to document construction progress. Park et al. ( 2013 ) presented a conceptual framework that integrates AR with building information modeling (BIM) to detect construction defects. These applications demonstrate the potential of this technology for future use in this domain.

AR technologies

Although the application of augmented reality technologies in construction projects has tremendously increased in recent years, these technologies are still in the research stage and their full potential is not fully achieved. There are limitations that should be addressed before these technologies will become dominant in the AEC industry such as tracking technologies, and rendering software. Moreover, appropriate application areas for different types of AR will continue to evolve.

Historically, many AR technologies were not applied on construction sites due to tracking and alignment problems, instead they were generally used at the home office for simulation or collaboration during the design phase of a project. However as the technology developed in recent years, the majority of these technologies have been used on construction sites for progress monitoring and defect detection. Moreover, trend analysis shows that web-based and wireless network technologies are becoming more and more popular in recent years, and these types of AR technologies are interesting technologies for further research and application.

A list of various input mechanisms, output mechanisms, and tracking technologies for AR systems can be found in Wang ( 2009 ). Portable and mobile AR systems including: radio-frequency based tracking technologies such as GPS, WLAN, indoor GPS; infrastructure-dependent technologies such as fiducial markers; infrastructure-independent tracking technologies such as gyroscopes; and image-based tracking techniques have been studied in many research projects (Bae et al. 2013 ). Moreover, using cloud computing technologies for web-based and ubiquitous AR systems has been explored in recent years (Wang et al. 2013 ).

Related studies

Shin et al. ( 2008 ) study various application areas for augmented reality technologies in industrial construction based on technology suitability. The research assesses different work tasks from the human factors perspective and presents a comprehensive map, which identifies eight work tasks including layout, excavation, positioning, inspection, coordination, supervision, commenting, and strategizing out of seventeen classified work tasks which could potentially benefit from AR systems.

Wang ( 2009 ) gives a detailed review of AR in the AEC industry, and gives a review of several major research efforts prior to 2009, and categorizes various AR technologies with their advantages and disadvantages.

Wang et al. ( 2013 ) reviews 120 articles published between 2005 and 2011 in various journal and conferences databases with a focus on augmented reality technologies in the built environment. The paper classifies all available toolkits for augmented reality prototyping in five categories: 2D marker AR-PC and web-cam based, 2D marker AR-mobile, 3D object recognition-mobile, marker-less tools, GPS-compass based AR. In their research, AR literature is classified in three categories: (1) application area; (2) AR system layers: concept and theory (with four sub-layers including: algorithm and modeling, conceptual framework, evaluation framework, and technology adoption), implementation (with two sub-layers: software and hardware), evaluation (with two sub-layers: effectiveness and usability), and industry adoption; (3) other technical criteria. The paper explores state-of-the-art technologies in each category and proposes future research directions.

Chi et al. ( 2013 ) discusses trends in AR applications for the AEC/FM with a specific focus on four AR technologies: localization, natural user interface, cloud computing, and mobile devices. The paper reviews 101 articles and outlines future trends and opportunities for applying AR in the AEC/FM industry in six directions: (a) field exploration based on hybrid localization, (b) in-field gesture or kinesthetic control of AR interface, (c) integration with location-specific information, (d) accessing field information using ubiquitous services, (e) portable AR devices in the field, (f) context-aware augmented reality in AEC/FM fields.

Main contributions

To apply AR technologies in AEC projects efficiently and to achieve their full potential in this domain, it is essential to systematically identify application areas in which AR can be used for better performance. This statistical review seeks to answer to these questions: what are key AR application areas in the AEC industry based on suitability of AR technologies? what are the gaps in this area which can potentially benefit from AR technologies? Based on future trends, predict how AR technologies can be further improved for future applications?

This paper presents an in-depth statistical literature review of augmented reality technologies in construction industry over a fourteen-year period (1999–2012). The goals of this review are (1) to synthesize the current state-of-the-art and trends of augmented reality technologies for construction projects, and (2) to identify key application areas which could significantly affect the construction industry. These goals are accomplished by classifying the literature in categories defined by the authors found in the literature.

The scientific contribution of this review is the presentation of a comprehensive multi-dimensional categorization for specifying AR technology and characteristics in the AEC industry. This literature review gives the researcher a broad view of the stage of AR technology maturity in built environment, which can be used to guide new augmented reality system design as well as to help evaluate existing systems for the construction industry.

This paper offers construction practitioners and researchers an assessment of the application areas of augmented reality technologies including the purposes for which these technologies have been applied in different project phases. The paper qualitatively aggregates the results of 133 research studies of AR technologies in construction projects to show researchers and practitioners how augmented reality models have been applied to address project challenges. Based on the trend analysis that is conducted, past research is studied and future research directions are recommended.

Research method

The research methodology used in this paper is illustrated in Figure  1 : (A) to select the journals and articles, (B) to review the selected articles, (C) to define relevant categories to classify the articles, (D) to classify the articles in the defined categories. Step (B) and step (C) iterate until the final results are achieved. Step (E) is described in section 6 and section 7 which presents discussion and conclusion.

Research methodology.

This paper is an extension of our conference paper (Rankouhi and Waugh 2012 ); the research methodology is similar to the methodology used previously. Five new journals are added to our database: the ASCE Journal of Computing in Civil Engineering (CCE), the Journals of Advanced Engineering Informatics (AEI), the Journal of Computer Aided Civil and Infrastructure Engineering (CACIE), the Emerald Journal of Engineering, Construction and Architectural Management (ECAM), and the Emerald Journal of Construction Innovation Information, Process, Management (CIIPM). These journals cover a wider range of database in civil engineering research domain, and increase the number of selected articles. In addition, five new dimensions (research methodology, improvement focus, industry sector, comparison role, and location) and various new categories are added to our previous defined dimensions.

Selection of the journals and articles

Eight diverse academic journals (listed in Table  1 ) were selected within the domain of AEC/FM to record the evolution of AR technology in the AEC industry. Selection of these journals is based on their prominence in the English language field of information technologies in construction engineering and management research.

The articles were selected in two phases. In phase I, a total of 199 articles were found in these eight journals using the search phrase “augmented reality.” In phase II, articles that were published in 2013 (due to the lack of a full year at the time when the search was conducted) and articles such as Calendars, Editors Notes, Subject Index, and Content of Volume were excluded. The total number of selected articles was reduced to 133. The number of articles found in each journal is listed in Table  1 .

Review and identification of the article characteristics

This section describes statistics based on information provided by the authors, whereas the next section describes our interpreted categories. The number of articles by year and journal is depicted in Table  2 .

The distribution of articles by journal and year of publication is depicted in Figure  2 . The maximum number of articles in a single year is published in both 2011 and 2012 (26 articles or 20%). The data shows highest numbers of articles for individual years in the AIC (11 articles in 2011), the ITcon (10 articles in 2008), and the CCE (8 articles in 2012) journals. The results show that the increasing trend in the number of articles is dominated by AIC, AEI, and CCE in recent year. Eighty-five percent of the articles were published in the most recent five years.

Distribution of articles by journal and year of publication.

The final characteristic identified in this section is the percentage of articles based on the first author’s country of residence which is shown in Figure  3 . With 63 articles (47%), first authors residing in the USA have the highest number of the articles about AR technology in the AEC industry. The remaining counts show that Australia has the second place while both Canada and South Korea are in the third place.

Number of articles by first author’s country of residence.

Definition of categories

To better comprehend and further segregate the literature, we defined dimensions and categories to be used in this paper; each article was then compared to these defined dimensions for identification of its principal focus area or to determine the percentage of articles including reference to that classification. Table  3 shows the defined dimensions and the relevant categories. Each dimension is further explained in the following section.

Categorization of the articles

This section discusses the classification of the current state of AR technology literature in the AEC industry. For all but three sub-sections, the articles are classified based on their principal focus and each article is counted once. The exceptions to their approach are sub-sections 5.1, 5.4, and 5.8; in these sub-sections instead of selecting a single “principal focus,” we identified the categories to which the article “made reference.” In these three sub-sections only we report percentages and do not report counts.

Research methodology

In this section articles are classified based on their research methodology which is divided in five categories: case study, experimental/empirical study, proof of concept (or proof of principle study), questionnaire (survey/interview), and literature review.

A case study is a research method in which detailed consideration is given to the development of a particular case over a period of time. An experimental or empirical study is an empirical scientific method in which an experiment arbitrates between competing models or hypotheses. A proof of concept or a proof of principle study is a research method in which a certain method or model would be recognized to demonstrate its feasibility or to verify that a certain concept, theory, or prototype has the potential of being used. Questionnaires (as well as surveys and interviews) are research techniques in which qualitative and qualitative data analysis could be conducted based on the information gathered from research participants. Literature review (historical and documentary research, trend studies), is a research method which considers the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic (Cohen et al. 2007 ).

Figure  4 depicts the percentages of articles based on their research method. Results show that large number of the articles use case studies to develop their research, while equal number of authors select an experimental method to conduct research in this area. Table  4 , presents a list of selected reference articles for each category of research method dimension.

Percentage of articles based on the research method.

Improvement focus

Articles are classified in four categories based on where the improvement which the article proposes would occur: (1) AEC industry, (2) organization, (3) projects, and (4) individuals. Moreover the organization category is divided into three subcategories of organization type including: (a) facility owner, (b) designer, and (c) contractor.

Figure  5 illustrates the number of articles within each improvement focus category. As shown, 69 articles (52%) have a principal focus on projects, while 27 articles (20%) have a principal focus on individuals in the construction industry. In addition, 19 articles (14%) and 12 articles (10%) have a principal focus on the AEC industry and the organization level, respectively.

Number of articles by improvement level.

Industry sector

In the construction industry various project types can benefit from AR technologies including: (1) municipal/infrastructure, e.g., evaluation of dynamic city models and an emission model for transportation (Aschwanden et al. 2012 ), (2) residential, e.g., virtual and augmented reality for designing and customizing mass housing (Duarte 2005 ), (3) building/commercial, e.g., visualizing high-rise building construction strategies (Russell et al. 2009 ), and virtual and augmented reality technologies for maintenance of exterior closures and interior finishes of walls and in the construction of buildings (Sampaio et al. 2012 ), (4) heavy/highway, e.g., developing virtual reality system for optimized simulation of road design data (Kang L. S. et al. 2010 ), and segmentation and recognition of highway assets using image-based 3D point clouds and semantic Texton forests (Golparvar-Fard et al. 2012 ), and (5) industrial, e.g., application areas for augmented reality in industrial construction (Shin and Dunston 2008 ).

Figure  6 presents the number of articles within each industry type category. As shown, 34 articles (26%) have a principal focus on building/commercial as an industry type for AR technology. Municipal/infrastructure, heavy/highway, industrial, and residential categories have 18 articles (14%), 14 articles (11%), 13 articles (10%) and 8 (6%) articles respectively. Thirty-six articles focus on multiple areas while these categories were not applicable for 10 articles. Table  5 , presents a list of selected reference articles for each category of industry sector dimension.

Number of articles by industry sector.

Target audience

Due to the complexity of construction projects and the collaborative nature of the AEC industry, the application of AR systems has a wide range of target audiences. To classify these articles the following audiences were chosen partially based on Muramoto et al. ( 2008 ): (1) worker, e.g., machine operators and technicians, (2) design team, e.g., architects, interior and exterior designers, (3) schedule and budget professional, in particular referred to as project manager, (4) building systems engineer, e.g., structural, mechanical, and electrical engineers, (5) inspector, e.g., project safety officers (6) engineering student, (7) project end user, e.g., building occupants, office employees, (8) other stakeholder, e.g., clients, and building owners. If an article proposed a change in, or enhancement of, the work of one of these audiences, it was classified in that category.

As noted above, in this section instead of giving the number of articles with a “principal focus on” a category, we report the percentage of articles “including reference to” that category, since in this section each article may refer to more than one category. Figure  7 presents the percentage of articles by target audience. The results indicate that the largest number of articles include reference to workers as the target audience. A list of selected reference articles for each category of target audience dimension is shown in Table  6 .

Percentage of articles by target audiences.

• Project phase

The life cycle of a construction project consists of a sequence of steps or project phases to be completed in order to reach project goals and objectives. These phases are defined by N. Dawood ( 2009 ) as: (1) initiation and outline design, (2) design development, (3) [procurement], contract and pre-construction, (4) construction, and (5) maintenance. The number of the articles by project phase is depicted in Figure  8 . A list of selected reference articles for each category of project phase dimension is shown in Table  7 .

Number of articles by project phase.

Figure  9 illustrates the number of articles for each project phase by year of publication. In this diagram articles with a focus on multiple phases are excluded (reducing the total to 98 articles). The highest number of articles in a single year is for the construction phase in the year 2012. The focus on the design phase of a project reached its highest number (5 articles) in the year 2008. Figures  8 and 9 show that the highest number of articles occur in the construction phase of a project for AR technologies and applications.

Number of articles by project phase and year (articles spanning multiple phases are excluded).

Stage of technology maturity

From a stage of technology maturity perspective, the articles are divided into five categories: (1) theory, (2) framework, (3) sub-system technical issues, e.g., investigation of tracking, positioning and orienting issues for AR-based technology for steel column inspection (Shin and Dunston 2010 ), (4) proposed system development, e.g., development of ARVISCOPE (AR animation scripting language) and ROVER a mobile computing framework for information modeling and simulation of construction operation (Behzadan et al. 2011 ), and (5) system application demonstration and production, e.g., application of D 4 AR for construction progress monitoring (Golparvar-Fard et al. 2011a ), application of AR Training System for training the operation of heavy construction equipment (Wang et al. 2007 ).

Figure  10 illustrates the number of articles within each stage-of-technology-maturity category. Results also show that only four articles (3%) have a principal focus on AR theory, while six articles (5%) have a focus on multiple areas (i.e., more than one of the previous stages); these multiple areas are typically a combination of application demonstration and proposed system development. A list of selected reference articles for each category of stage of technology maturity dimension is shown in Table  8 .

Number of articles by stage of technology maturity.

Application area

Augmented reality technology has many applications in the AEC industry. We classify AR application areas in the AEC industry as follows: (1) visualization or simulation, (2) communication or collaboration, (3) information modeling, (4) information access or evaluation, (5) progress monitoring, (6) education or training, and (7) safety or inspection.

Figure  11 presents application areas for AR technologies in the AEC industry. As shown, 26 articles (20%) have a principal focus on visualization and simulation as an application area for AR technology. Thirteen articles focus on multiple application areas, while these subcategories were not applicable for 8 articles. A list of selected reference articles for each category of AR application area dimension is shown in Table  9 .

Application areas for AR technology.

Comparison role

Construction participants use augmented reality technologies to compare different statuses of a project. Articles that “make reference” to the comparison role of AR technologies are divided in two categories; (1) comparison modes: (a) reality versus reality, e.g., comparing two construction site 360 degree panoramas at two different times for virtual reality documentation of Inuvik Super School (Waugh et al. 2012 ), (b) model versus reality, e.g., integrating sequential as-built and as-planned representation with D4AR tools (Golparvar-Fard et al. 2011a ), and (c) model versus model, e.g., the application of Experimental Virtual Environment (EVE) (Savioja et al. 2003 ); and (2) comparison purpose, e.g., progress monitoring, defect detection, validating the model, updating the model, and evaluating the model.

Sixty-two articles (47% of articles) have reference to the comparison role of augmented reality technologies in construction industry. For these 62 articles only, Figure  12 illustrates the number and the percentage of articles within each comparison mode category. A list of selected reference articles for each category of comparison mode dimension is shown in Table  10 .

Number and percentage of articles by comparison modes.

Figure  13 depicts the percentage of articles within each comparison purpose category for these 62 articles. As shown, 32% refer to comparison for progress monitoring, 28% for defect detection, 16% for evaluating the model, 13% for updating the model, and 11% for validating the model. A list of selected reference articles for each category of comparison purpose dimension is shown in Table  11 .

Number and percentage of articles by comparison purpose.

Augmented reality technology, which typically layers virtual information on a real scene, utilizes different hardware (personal computers (PC), laptops, head mounted displays (HMD), GPS, data gloves, smart boards, etc.) and software (AutoCAD, Photoshop, AC3D, 3D Studio, building information model (BIM), etc.). From a technology perspective articles are classified into three categories: (1) user experience: (a) immersive or (b) non-immersive, i.e., desktop-based; (2) device: (a) mobile, (b) stationary or non-mobile; (3) delivery: (a) web-based, (b) standalone.

Devices such as HMD and data-gloves create immersive AR systems, in which users feel immersed in a virtual environment just as they usually feel in a real environment. Due to the improving performance of handheld devices and recent solutions to technical difficulties such as tracking, there is an opportunity for augmented reality systems to become portable, as well there is a growing interest in the use of mobile AR applications. Web-based augmented reality technologies can deliver project information to remote locations and are very useful to manage virtual projects around the globe. Finally, due to the wide range of AR applications, these technologies can be used both on-site for progress monitoring and in an office (not-on-site) for design control.

From the user experience perspective, 32 articles have a principal focus on immersive AR technologies, 76 articles (57%) have a principal focus on non-immersive or desktop-based AR technologies, while 25 articles were not applicable. Figure  14 presents the number of articles with immersive and non-immersive technologies as a principal focus by year.

Immersive and non-immersive AR technology by year.

Figure  15 presents the number of articles within the device category that had a principal focus on mobile and non-mobile AR technologies in the AEC industry. The diagram implies an increasing trend in mobile AR technologies in AEC industry. Of the selected articles, one was published in 2000 that discussed mobile AR technology; while 7 articles (5%) focus on mobile AR technologies in both year 2011 and year 2012; 41 articles were not applicable to this category.

Number of articles for mobile and non-mobile AR technology by year.

Figure  16 depicts the number of articles within the delivery category that had a principal focus on web-based and on standalone AR technologies in the AEC industry. Fifty-two articles (40%) were not applicable to this category. A list of selected reference articles for each category of technology dimension is shown in Table  12 .

Number of articles for web-based and standalone AR technology by year.

Augmented reality technologies can be applied in different locations during a construction project. From a location perspective, AR technologies can be classified in two categories: (a) field, e.g., using robot-aided tunnel inspection and maintenance system on construction site (Victores et al. 2011 ), (b) home office, e.g., virtual environments for synchronous and remote collaborative design (Germani et al. 2012 ).

Figure  17 depicts the number of articles within the technology category that had a principal focus of on-site and on not-on-site. The diagram implies an increasing trend in the on-site application of AR technologies in construction projects. The highest number of articles in a single year is for the on-site technologies in the year 2012. Twenty-two articles (17%) were not applicable to this category. A list of selected reference articles for each category of location dimension is shown in Table  13 .

Number of articles for field and home-office AR technology by year.

Figure  18 shows the total number of articles in defined dimensions and categories, in which increasing trends over the period are indicated by an up arrow and dominant categories are indicated by bold font.

Literature review summary.

The following results are concluded for the categories defined in this research.

Journals: Automation in construction has the highest overall number of articles among the journals. The maximum number of AR technology articles published in these eight journals in a single year, occurred both in 2011 and 2012. Eighty-three percent of the articles were published in most recent five years.

First authors: USA , with more than half of articles, is the dominant residence of the first authors.

Research methodology: Case studies and experimental studies with 32% and 31% respectively, are the most frequent research method among selected articles.

Improvement focus: The majority of the articles focus on projects rather than on the AEC industry, organization or individual level.

Industry sector: building/commercial with 35% have the highest number of articles, whereas, residential have the least number of articles.

Target audience: The most frequent focus is the workers (e.g., machine operators and technicians), whereas the least focus is on project end users.

Project phase: The most frequent focus is the construction phase with the maintenance phase being next with approximately half as many articles. Twenty-six articles cover two phases (e.g., initiation/design) or all phases. Procurement phase shows a lack of focus in the area of AR systems.

Stage of technology maturity: The most number of articles focus on AR system application rather than system development or sub-system technical issues.

Application areas: Approximately half of the articles had a principal focus on visualization/simulation or communication/collaboration , and just a few articles focus on education/training and safety/inspection.

Comparison role: 47% of the articles made reference to the comparison role of augmented reality technologies for comparing different statuses of projects. More than half of those articles focused on comparing a model with a reality to monitor progress and detect construction defects. Comparing model vs. model captured the least attention in this area. In addition, majority (%60) of the comparison articles focus on field audience (for progress monitoring and defect detection), while less than half of the comparison articles focus on home office audience (for model improvement).

Hardware system: From the user-experience perspective most of the articles discussed non-immersive technologies . From the delivery perspective, most of the articles discussed standalone technologies , and from device perspective, most of the articles focus on non-mobile technologies. A spike in the number of articles focusing on mobile technologies occurred in 2011.

Location: The most frequent focus is AR technologies which can be applied in the field (rather than in the home-office). The field category included almost 80% of those articles which referred to a location.

Future trends

Table  14 provides a list of the categories for which there was a significant and consistently-increasing trend in the most recent five years. There were no categories for which the number of articles was consistently-decreasing over the 14 year period.

AR technologies provide proven benefits especially in the areas of visualization/simulation and communication/collaboration, however these benefits are not yet widely adopted by AEC industry participants nor have they been incorporated into industry-wide workflow processes. As a result, industry participants choose to pilot (i.e., system development and application) AR technologies on a few projects rather than adopting or piloting the technology across their organization.

Building/commercial projects provide a good test bed for visualization and communication of different perspectives of a project, since these projects typically entail more complexity and more need for integration than an infrastructure, heavy/highway, or residential projects. However, the trend in the most recent five years shows that heavy/highway projects are getting an area of focus for new AR technologies. We also predict that use on industrial projects will grow rapidly as technologies are improved and confidence is gained.

We predict expansion of AR technologies from a principal role in the construction and maintenance phases to other phases (especially the design and procurement phases) as the ability to compare virtual models with previous virtual models (and realities with previous realities) to monitor project progress and detect construction defections, rather than the narrow focus of comparing a current construction phase reality with a final design phase model.

The uniform distribution of target audiences among the design team, the project management team, and on-site personnel reflects integration being the essential purpose of AR technologies.

We predict continued growth in the use of internet and web-based devices to enhance integration of perspectives. Collaborative, ubiquitous, and internet-based AR systems enable users to update and synchronize the information from a remote location. Cloud computing technologies could help next generation construction professionals to access massive amount of field information such as BIM rapidly and conveniently (Chi et al. 2013 ).

We also predict continued growth in the use of mobile and portable multi-user AR devices to display (and capture) models and realities. The next generation mobile technologies are likely to have natural user interface (Wang et al. 2013 ), which would be controlled by human movement and gestures, and makes it easy for field workers to use AR systems on construction sites. It is also predicted that next generation mobile AR systems would have context-aware and location-aware applications. We also speculate that the cost of immersive hardware is, and will continue to be, an impediment to its widespread use.

A structured methodology was used to identify 133 articles on the topic of augmented reality from eight prominent AEC industry journals. The first article was published in 1999; a significant increase in the number of articles on this topic occurred during the year 2008. In addition to statistics on the counts of articles by year and the first author’s country of residence, ten interpreted dimensions were developed for classification of these articles. Literature show field workers and project managers have high interests in using non-immersive and desk-top standalone (individual) AR technologies during construction phase of a project to compare as-planned versus as-built statuses to monitor progress and defect detection. Whereas, it is predicted that future trend, is more toward using collaborative and internet based mobile AR systems which have applications not only in construction phase, but also in procurement and maintenance phases of a project. Due to various benefits of AR technology for construction industry, the application of AR systems for initiation and procurement phase of a project to compare model vs. model and reality vs. reality is recommended. Moreover, lightweight mobile and immersive AR systems are also recommended for field personnel due to dynamic environment of construction fields.

Based on this review, our recommendation for researchers in the area of AR technology is that the current trial systems should have narrow applications and there is an essential need for more comprehensive systems. There is an opportunity for more research on the application of AR systems during the procurement phase of construction projects, since literature shows a lack of research in these phases of project. In addition, the assessment of success of developed systems should be validated by researcher and practitioner from academy and industry. From a theory and framework perspective, integration of multiple projects (within an organization) and integration of multiple organizations (within the industry) could be a considered for future research in the area of AR systems. Integration might be easier in less complex types of work, i.e., residential projects. Comparisons are fundamental to AR system within the AEC industry to be able to monitor projects and defect detections, therefore, our testing of five comparison purposes (progress monitoring, defect detection, evaluating the model, updating the model, validating the model) need to be further investigated.

We assume that construction industry practitioners would assess an AR system based on the system contents, features, and value. From the content perspective they would seek current (possibly real-time) information as well as a historical record that may be integrated with traditional project information (e.g., BIM). From a feature perspective, they would seek a user friendly interface (possibly internet-based) that can be integrated into their content workflow process and that facilitate the comparison of project statuses over time. From the value perspective, they would seek an affordable cost (initial and ongoing) for which the payback period is short. We assume the benefits of AR contribute to this payback are virtual site visits, defect detection, pre-empting dispute resolution, photographic as-built, and training of personnel. Currently, most of systems found in the literature are trial/demonstration, hence they are developed for specific purposes they do not have all of the above criteria, however some new systems offers some valuable feature and may provide a competitive advantages. As the technology is rapidly evolving, it is recommended to the construction participants to monitor this developing area closely in order to get the latest update.

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Both authors contributed extensively to the work presented in this paper. SR searched the databases, selected the articles, reviewed and analyzed the literature, and prepared the manuscript. LW defined dimensions and categories, supervised the overall review, and edited the manuscript. Both authors read and approved the final manuscript.

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Rankohi, S., Waugh, L. Review and analysis of augmented reality literature for construction industry. Vis. in Eng. 1 , 9 (2013). https://doi.org/10.1186/2213-7459-1-9

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Accepted : 05 August 2013

Published : 29 August 2013

DOI : https://doi.org/10.1186/2213-7459-1-9

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Redefining Construction: An In-Depth Review of Sustainable Polyurethane Applications

• Mistry, Mansi
• Prajapati, Vimalkumar
• Dholakiya, Bharatkumar Z.

The construction sector is a prominent resource-intensive industry on a global scale, contributing significantly to environmental challenges through material production and construction operations. Selecting sustainable and energy-efficient building materials is crucial, considering green sustainable construction. Over the past two decades, polyurethane (PU) technology has experienced remarkable progress and is emerging as a versatile alternative to traditional building materials, but concerns still arise due to the petrochemical origins of the PU feedstocks. This increasing demand for eco-friendly building materials has spurred significant advancements in the research, development, and utilization of bio-based polyurethane (BPU) within the construction industry. Responding to the global shift towards sustainable development, this study aims to systematically identify bio-based and sustainable sources of PU, analyse advancements in production processes, and evaluate their properties compared to conventional materials. The purpose of this study is addressed by conducting a literature review, wherein findings from a diverse range of current studies in the field are compiled and the specific application areas covered are PU foam, coating, sealants, concrete systems, adhesives and road construction. The results suggest that BPU present various possibilities, benefits, and challenges. The review underscores BPU as a sustainable alternative with comparable properties to traditional counterparts with insights into BPU market highlighting a promising future in construction. By highlighting potential challenges, this review emphasises avenues for new research. Providing a comprehensive analysis of BPU sources, performance, and applications in construction, it would serve as a valuable resource for researchers, aiding in identifying unexplored research areas, fostering industry collaborations, and recognizing the expanding scope of BPU in the field.

• Sustainable construction;
• Bio-based polyurethane;
• Energy-efficient;
• Concrete systems;
• Challenges;
• Promising future

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Labor rules giving building unions more powers on projects

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New rules on wages and workplace conditions expanded by Queensland Labor have given construction unions more power over state projects worth billions of dollars and are threatening to blow out costs for green energy projects by as much as 30 per cent.

The Best Practice Industry Conditions – extended to renewable energy projects in April after being brought in earlier for commercial construction and civil infrastructure – are also fuelling a turf war in Queensland between the disgraced CFMEU and the rival Australian Workers’ Union (AWU), industry figures said.

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Paris Olympics Opening Ceremony: All the Biggest Moments From the Games’ Kickoff

After braving political chaos, major train disruptions and threats of defecating in the Seine, the Paris Olympics are finally about to kick off under cloudy skies.

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For the first time, the opening ceremony is unfolding outdoors and outside of a stadium. A nautical parade of 85 boats carrying some 10,500 athletes from each Olympic delegation will unfold along the Seine running through the city, starting from the Pont d’Austerlitz and culminating at the foot of the Eiffel Tower.

More than 3,500 actors, dancers and musical performers will take their marks on Paris’ historical sites, bridges and rooftops. Jolly, who is best known for his rock-opera musical “Starmania,” has created 12 tableaux, or scenes, that will encapsulate the ambition of these Paris Olympics to mix postcard-worthy settings with ultra-contemporary artists, choreography, costumes and props. Bringing the Summer Olympics back to Paris for the first time in a century, these games will also stand out as the first ever gender-balanced edition.

However, the weather isn’t playing ball, as rain is expected to fall down during festivities. But organizers have made sure no technical glitches could ruin the show by pre-recording the voices of all performers, while immersive audio from the performances will be produced through walls positioned along the Seine.

Read on for the biggest moments from this year’s Olympics opening ceremony, updating live.

Zizou Kicked Things Off

Then things went gaga.

After the opening video, Lady Gaga took over headline proceedings and on a flamboyant note, giving a colorful performance of Renée Jeanmaire’s “Mon Truc en Plumes” (My Thing With Feathers). She was accompanied by a troupe of dancers from the revered Moulin Rouge cabaret and played on a piano floating down the Seine. Although this marks the first time Gaga has performed at the Olympics, she has sang in French before – Edith Piaf’s La Vie en Rose — in Bradley Cooper’s “A Star is Born.” This is to be her biggest performance to date, topping her 2017 SuperBowl Halftime Show. 

Celine Dion Brought it All to a Tear-Jerking Close

As had been widely – and excitedly — touted in the days leading up the event, Celine Dion made a spectacular and emotional comeback performance as the opening night ceremony drew to a close, her first live show since disclosing that she had a rare medical disorder in 2022. The Canadian icon and Queen of Power Ballads didn’t just sing Edith Piaf’s “Hymne A L’Amour,” but did so halfway up the Eiffel Tower and beneath a set of giant Olympic rings. No, you’re crying!

Vive La Rock!

In a segment dedicated to the French revolution, local metal icons Gojira pulled out their angular guitars for a head-banging performance alongside French-Swiss opera singer Marina Viotti. Adding to the dramatic display, they appeared in front of castle while cannons belched out fire.

‘Pookie’ on the Pont

French-Malian singer Aya Nakamura, who ranks as the world’s most popular contemporary French-speaking artist, sang her two biggest hits, “Pookie” and “Djadja,” whose lyrics were laced with Aznavour’s “Ma Boheme” and “For Me Formidable.” Dancing and singing on the Pont des Arts, she was accompanied by the orchestra of the French Republican Guard and 36 choristers from the French Army. 

There were some exquisitely choreographed dance performances throughout the entire show, most taking place all along the Seine. From a high-kicking Moulin Rouge show by dancers kitted out in pink, to an extreme splashy display featuring hundreds of performers in a fountain and one in which dancers looking like hotel bellboys pushed around large Louis Vuitton cases (LVMH is a sponsor, of course). There were also some quieter individual performances, including a ballet display on a rooftop.

Parkour Mystery?

A trip to the minions.

In a special segment dedicated to French filmmaking, there were nods to the Lumiere Brothers and their groundbreaking “The Arrival of a Train at La Ciotat Station” (the one where people thought the train was coming through the cinema screen) plus Georges Méliès sci-fi classic “A Trip to the Moon.” But much of the time was devoted to more contemporary icons of local cinema, the banana-loving, nonsense-talking yellow creatures known as the Minions. While the “Despicable Me” franchise may be produced by Universal’s U.S. animation powerhouse Illumination, at the helm has been French filmmaker Pierre-Louis Padang Coffin, who co-directed four films and provided most of the Minions iconic voices. In honor of this — and perhaps Illumination’s French tax rebate — an extended and specially-made animation was shown in which Kevin, Stuart, Bob and co attempted various sports in a submarine (with predictably disastrous results).

Gender Balancing Act

Kicking off the first ever gender-balanced edition of the Olympics, the ceremony also fittingly celebrated 10 French female icons, including philosopher Simone de Beauvoir; Simone Veil, an Auschwitz survivor who championed abortion rights in France; Louise Michel, a 19th century political activist and leader of the French anarchist movement; Olympe de Gouges, an 18th century social reformer and playwright; Alice Milliat, a pioneer of women’s sport; Gisele Halimi, a Tunisian-French lawyer and feminist; and Alice Guy, the first female filmmaker, among others. These women were feted as part of the Sororité, Sisterhoo tableau. Jolly said “the French national anthem becomes a symbol of unification and a call to pay tribute to the women of France’s history, represented by 10 golden statues emerging from the Seine.” Last time Paris hosted the Paris Olympics, in 1902, there were only 2% of female athletes. Estanguet said inclusiveness was a key goal for these Olympics. 

100m Drag Race

Fashion was — of course — a part of the Olympic festivities, with a special section towards the end involving a red-carpeted catwalk over a bridge on which various models and celebrities showcased the work of young French designers while local DJ-producer Barbara Butch took care of the music. Alongside the DJ various stars of “Drag Race France” were spotted, including contestants Paloma and Piche and host Nicky Doll. The “Assassin’s Creed”-y parkour athlete also turned up on the runway, performing some impressive one-handed cartwheels (he was still carrying the Olympic flame).

Rain (and LeBron James in a Plastic Poncho)

More from variety, josh klinghoffer, former red hot chili peppers guitarist, sued for wrongful death, licensing your movie & tv content for ai training: can you should you, vfx working conditions need to change, but current unionization option may not be the answer, more from our brands, u.s. wins first gold at men’s 4×100-meter freestyle relay at 2024 paris olympics, the new ducati panigale v4 s superbike is a polarizing powerhouse, ooh la la: opening ceremony of paris olympics draws 28.6m viewers, the best loofahs and body scrubbers, according to dermatologists, paris olympics opening ceremony delivers nearly 29 million viewers — grade it.

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Current status review of corrosion resistance applications of titanium alloys in the petroleum industry.

1. Introduction

2. research progress in microstructure and mechanical properties of titanium alloys, 2.1. common additive elements in titanium alloys, 2.2. microstructure, 2.3. mechanical properties, 2.4. chemical properties, 2.5. processing methods of titanium alloys, 3. application of titanium alloy in petroleum industry, 3.1. drill pipe, 3.2. oil casing, 4. research progress on corrosion resistance in titanium alloy oil well pipe, 4.1. corrosion resistance in titanium alloy drill pipe, 4.2. corrosion resistance in titanium alloy oil casing, 4.3. factors affecting corrosion resistance of titanium alloy oil well pipe, 5. preparation and optimization of titanium alloy, 6. summary and outlook, author contributions, conflicts of interest.

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Wang, L.; Zhao, X.; Wang, X.; Shang, S.; Xiu, Z.; Xi, Y.; Jia, H.; Xu, S.; Liu, H.; Wen, L.; et al. Current Status Review of Corrosion Resistance Applications of Titanium Alloys in the Petroleum Industry. Coatings 2024 , 14 , 941. https://doi.org/10.3390/coatings14080941

Wang L, Zhao X, Wang X, Shang S, Xiu Z, Xi Y, Jia H, Xu S, Liu H, Wen L, et al. Current Status Review of Corrosion Resistance Applications of Titanium Alloys in the Petroleum Industry. Coatings . 2024; 14(8):941. https://doi.org/10.3390/coatings14080941

Wang, Lei, Xiaohong Zhao, Xiaodong Wang, Shuilong Shang, Zhengwu Xiu, Yuntao Xi, Hongmin Jia, Shanna Xu, Haitao Liu, Lei Wen, and et al. 2024. "Current Status Review of Corrosion Resistance Applications of Titanium Alloys in the Petroleum Industry" Coatings 14, no. 8: 941. https://doi.org/10.3390/coatings14080941

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• Published: 25 July 2024

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review

• Ali Mohammad Mosadeghrad 1 ,
• Mahnaz Afshari 2 ,
• Parvaneh Isfahani 3 ,
• Farahnaz Ezzati 4 ,
• Mahdi Abbasi 4 ,
• Shahrzad Akhavan Farahani 4 ,
• Maryam Zahmatkesh 5 &
• Leila Eslambolchi 4  

BMC Health Services Research volume  24 , Article number:  841 ( 2024 ) Cite this article

52 Accesses

Metrics details

Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies.

Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software.

Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems.

Conclusions

The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

Peer Review reports

The health system is a complex network that encompasses individuals, groups, and organizations engaged in policymaking, financing, resource generation, and service provision. These efforts collectively aim to safeguard and enhance people health, meet their expectations, and provide financial protection [ 1 ]. The World Health Organization's (WHO) framework outlines six foundational building blocks for a robust health system: governance and leadership, financing, workforce, infrastructure along with technologies and medicine, information systems, and service delivery. Strengthening these elements is essential for health systems to realize their objectives of advancing and preserving public health [ 2 ].

Effective governance in health systems encompasses the organization of structures, processes, and authority, ensuring resource stewardship and aligning stakeholders’ behaviors with health goals [ 3 ]. Financial mechanisms are designed to provide health services without imposing financial hardship, achieved through strategic fund collection, management and allocation [ 4 , 5 ]. An equitable, competent, and well-distributed health workforce is crucial in delivering healthcare services and fulfilling health system objectives [ 2 ]. Access to vital medical supplies, technologies, and medicines is a cornerstone of effective health services, while health information systems play a pivotal role in generating, processing, and utilizing health data, informing policy decisions [ 2 , 5 ]. Collectively, these components interact to offer quality health services that are safe, effective, timely, affordable, and patient-centered [ 2 ]

The WHO, at the 1978 Alma-Ata conference, introduced primary health care (PHC) as the fundamental strategy to attain global health equity [ 6 ]. Subsequent declarations, such as the one in Astana in 2018, have reaffirmed the pivotal role of PHC in delivering high-quality health care for all [ 7 ]. PHC represents the first level of contact within the health system, offering comprehensive, accessible, community-based care that is culturally sensitive and supported by appropriate technology [ 8 ]. Essential care through PHC encompasses health education, proper nutrition, access to clean water and sanitation, maternal and child healthcare, immunizations, treatment of common diseases, and the provision of essential drugs [ 6 ]. PHC aims to provide protective, preventive, curative, and rehabilitative services that are as close to the community as possible [ 9 ].

Global health systems, however, have faced significant disruptions from various shocks and crises [ 10 ], with the COVID-19 pandemic being a recent and profound example. The pandemic has stressed health systems worldwide, infecting over 775 million and claiming more than 7.04 million lives as of April 13th, 2024 [ 11 ]. Despite the pandemic highlighting the critical role of hospitals and intensive care, it also revealed the limitations of specialized medicine when not complemented by a robust PHC system [ 12 ].

The pandemic brought to light the vulnerabilities of PHC systems, noting a significant decrease in the use of primary care for non-emergency conditions. Routine health services, including immunizations, prenatal care, and chronic disease management, were severely impacted [ 13 ]. The challenges—quarantine restrictions, fears of infection, staffing and resource shortages, suspended non-emergency services, and financial barriers—reduced essential service utilization [ 14 ]. This led to an avoidance of healthcare, further exacerbating health inequalities and emphasizing the need for more resilient PHC systems [ 15 , 16 , 17 ].

Resilient PHC systems are designed to predict, prevent, prepare, absorb, adapt, and transform when facing crises, ensuring the continuity of routine health services [ 18 ]. Investing in the development of such systems can not only enhance crisis response but also foster post-crisis transformation and improvement. This study focuses on identifying global interventions and strategies to cultivate resilient PHC systems, aiding policymakers and managers in making informed decisions in times of crisis.

In 2023, we conducted a scoping review to collect and synthesize evidence from a broad spectrum of studies addressing the COVID-19 pandemic. A scoping review allows for the assessment of literature's volume, nature, and comprehensiveness, and is uniquely inclusive of both peer-reviewed articles and gray literature—such as reports, white papers, and policy documents. Unlike systematic reviews, it typically does not require a quality assessment of the included literature, making it well-suited for rapidly gathering a wide scope of evidence [ 19 ]. Our goal was to uncover the breadth of solutions aimed at bolstering the resilience of the PHC system throughout the COVID-19 crisis. The outcomes of this review are intended to inform the development of a model that ensures the PHC system's ability to continue delivering not just emergency services but also essential care during times of crisis.

We employed Arksey and O'Malley's methodological framework, which consists of six steps: formulating the research question, identifying relevant studies, selecting the pertinent studies, extracting data, synthesizing and reporting the findings, and, where applicable, consulting with stakeholders to inform and validate the results [ 20 ]. This comprehensive approach is designed to capture a wide range of interventions and strategies, with the ultimate aim of crafting a robust PHC system that can withstand the pressures of a global health emergency

Stage 1: identifying the research question

Our scoping review was guided by the central question: "Which strategies and interventions have been implemented to enhance the resilience of primary healthcare systems in response to the COVID-19 pandemic?" This question aimed to capture a comprehensive array of responses to understand the full scope of resilience-building activities within PHC systems.

Stage 2: identifying relevant studies

To ensure a thorough review, we conducted systematic searches across multiple databases, specifically targeting literature up to December 31st, 2022. The databases included PubMed, Web of Science, Scopus, Magiran, and SID. We also leveraged the expansive reach of Google Scholar. Our search strategy incorporated a bilingual approach, utilizing both English and Persian keywords that encompassed "PHC," "resilience," "strategies," and "policies," along with the logical operators AND/OR to refine the search. Additionally, we employed Medical Subject Headings (MeSH) terms to enhance the precision of our search. The results were meticulously organized and managed using the Endnote X8 citation manager, facilitating the systematic selection and review of pertinent literature.

Stage 3: selecting studies

In the third stage, we meticulously vetted our search results to exclude duplicate entries by comparing bibliographic details such as titles, authors, publication dates, and journal names. This task was performed independently by two of our authors, LE and MA, who rigorously screened titles and abstracts. Discrepancies encountered during this process were brought to the attention of a third author, AMM, for resolution through consensus.

Subsequently, full-text articles were evaluated by four team members—LE, MA, PI, and SHZ—to ascertain their relevance to our research question. The selection hinged on identifying articles that discussed strategies aimed at bolstering the resilience of PHC systems amidst the COVID-19 pandemic Table 1 .

We have articulated the specific inclusion and exclusion criteria that guided our selection process in Table 2 , ensuring transparency and replicability of our review methodology

Stage 4: charting the data

Data extraction was conducted by a team of six researchers (LE, MA, PI, MA, FE, and SHZ), utilizing a structured data extraction form. For each selected study, we collated details including the article title, the first author’s name, the year of publication, the country where the study was conducted, the employed research methodology, the sample size, the type of document, and the PHC strengthening strategies described.

In pursuit of maintaining rigorous credibility in our study, we adopted a dual-review process. Each article was independently reviewed by pairs of researchers to mitigate bias and ensure a thorough analysis. Discrepancies between reviewers were addressed through discussion to reach consensus. In instances where consensus could not be reached, the matter was escalated to a third, neutral reviewer. Additionally, to guarantee thoroughness, either LE or MA conducted a final review of the complete data extraction for each study.

Stage 5: collating, summarizing and reporting the results

In this stage, authors LE, MZ, and MA worked independently to synthesize the data derived from the selected studies. Differences in interpretation were collaboratively discussed until a consensus was reached, with AMM providing arbitration where required.

We employed a framework thematic analysis, underpinned by the WHO's health system building blocks model, to structure our findings. This model categorizes health system components into six foundational elements: governance and leadership; health financing; health workforce; medical products, vaccines, and technologies; health information systems; and service delivery [ 2 ]. Using MAXQDA 10 software, we coded the identified PHC strengthening strategies within these six thematic areas.

Summary of search results and study selection

In total, 4315 articles were found by initial search. After removing 397 duplicates, 3918 titles and abstracts were screened and 3606 irrelevant ones were deleted. Finally, 167 articles of 312 reviewed full texts were included in data synthesis (Fig.  1 ). Main characteristics of included studies are presented in Appendix 1.

PRISMA Flowchart of search process and results

Characteristics of studies

These studies were published in 2020 (18.6%), 2021 (36.5%) and 2022 (44.9%). They were conducted in 48 countries, mostly in the US (39 studies), the UK (16 studies), Canada (11 studies), Iran (10 studies) and Brazil (7 studies) as shown in Fig.  2 .

Distribution of reviewed studies by country

Although the majority of the reviewed publications were original articles (55.1 %) and review papers (21 %), other types of documents such as reports, policy briefs, analysis, etc., were also included in this review (Fig.  3 ).

An overview of the publication types

Strengthening interventions to build a resilient PHC system

In total, 194 interventions were identified for strengthening the resilience of PHC systems to respond to the COVID-19 pandemic. They were grouped into six themes of PHC governance and leadership (46 interventions), PHC financing (21 interventions), PHC workforce (37 interventions), PHC infrastructures, equipment, medicines and vaccines (30 interventions), PHC information system (21 interventions) and PHC service delivery (39 interventions). These strategies are shown in Table 3 .

This scoping review aimed to identify and categorize the range of interventions employed globally to strengthen the resilience of primary healthcare (PHC) systems in the face of the COVID-19 pandemic. Our comprehensive search yielded 194 distinct interventions across 48 countries, affirming the significant international efforts to sustain healthcare services during this unprecedented crisis. These interventions have been classified according to the WHO’s six building block model of health systems, providing a framework for analyzing their breadth and depth. This review complements and expands upon the findings from Pradhan et al., who identified 28 interventions specifically within low and middle-income countries, signaling the universality of the challenge and the myriad of innovative responses it has provoked globally [ 178 ].

The review highlights the critical role of governance and leadership in PHC resilience. Effective organizational structure changes, legal reforms, and policy development were crucial in creating adaptive healthcare systems capable of meeting the dynamic challenges posed by the pandemic. These findings resonate with the two strategies of effective leadership and coordination emphasized by Pradhan et al. (2023), and underscore the need for clear vision, evidence-based policy, and active community engagement in governance [ 178 ]. The COVID-19 pandemic posed significant challenges for PHC systems globally. A pivotal response to these challenges was the active involvement of key stakeholders in the decision-making process. This inclusivity spanned across the spectrum of general practitioners, health professionals, health managers, and patients. By engaging these vital contributors, it became possible to address their specific needs and to design and implement people-centered services effectively [ 41 , 42 , 43 ].

The development and implementation of collaborative, evidence-informed policies and national healthcare plans were imperative. Such strategies required robust leadership, bolstered by political commitment, to ensure that the necessary changes could be enacted swiftly and efficiently [ 41 , 45 ]. Leaders within the health system were called upon to foster an environment of good governance. This entailed promoting increased participation from all sectors of the healthcare community, enhancing transparency in decision-making processes, and upholding the principles of legitimacy, accountability, and responsibility within the health system [ 10 ]. The collective aim was to create a more resilient, responsive, and equitable healthcare system in the face of the pandemic's demands.

In the wake of the COVID-19 pandemic, governments were compelled to implement new laws and regulations. These were designed to address a range of issues from professional accreditation and ethical concerns to supporting the families of healthcare workers. Additionally, these legal frameworks facilitated the integration of emerging services such as telemedicine into the healthcare system, ensuring that these services were regulated and standardized [ 38 , 40 , 61 ]. A key aspect of managing the pandemic was the establishment of effective and transparent communication systems for patients, public health authorities, and the healthcare system at large [ 60 , 61 ]. To disseminate vital information regarding the pandemic, vaccination programs, and healthcare services, authorities leveraged various channels. Public media, local online platforms, and neighborhood networks were instrumental in keeping the public informed about the ongoing situation and available services [ 53 , 60 , 86 ]. For health professionals, digital communication tools such as emails and WhatsApp groups, as well as regular meetings, were utilized to distribute clinical guidelines, government directives, and to address any queries they might have had. This ensured that healthcare workers were kept up-to-date with the evolving landscape of the pandemic and could adapt their practices accordingly [ 60 , 144 ].

Healthcare facilities function as complex socio-technical entities, combining multiple specialties and adapting to the ever-changing landscape of healthcare needs and environments [ 179 ]. To navigate this dynamic, policy makers must take into account an array of determinants—political, economic, social, and environmental—that influence health outcomes. Effective management of a health crisis necessitates robust collaboration across various sectors, including government bodies, public health organizations, primary healthcare systems, and hospitals. Such collaboration is not only pivotal during crisis management but also during the development of preparedness plans [ 63 ]. Within the health system, horizontal collaboration among departments and vertical collaboration between the Ministry of Health and other governmental departments are vital. These cooperative efforts are key to reinforce the resilience of the primary healthcare system. Moreover, a strong alliance between national pandemic response teams and primary healthcare authorities is essential to identifying and resolving issues within the PHC system [ 29 ]. On an international scale, collaborations and communications are integral to the procurement of essential medical supplies, such as medicines, equipment, and vaccines. These international partnerships are fundamental to ensuring that health systems remain equipped to face health emergencies [ 63 ].

To ensure the PHC system's preparedness and response capacity was at its best, regular and effective monitoring and evaluation programs were put in place. These included rigorous quarterly stress tests at the district level, which scrutinized the infrastructure and technology to pinpoint the system’s strengths and areas for improvement [ 43 ]. Furthermore, clinical audits were conducted to assess the structure, processes, and outcomes of healthcare programs, thereby enhancing the quality and effectiveness of the services provided [ 63 ]. These evaluation measures were crucial for maintaining a high standard of care and for adapting to the ever-evolving challenges faced by the PHC system.

Financial strategies played a critical role in enabling access to essential health services without imposing undue financial hardship. Various revenue-raising, pooling, and purchasing strategies were implemented to expand PHC financing during the pandemic, illustrating the multifaceted approach needed to sustain healthcare operations under strained circumstances [ 9 , 19 ].

In response to the COVID-19 pandemic, the Indian government took decisive action to bolster the country's healthcare infrastructure. By enhancing the financial capacity of states, the government was able to inject more funds into the Primary Health Care (PHC) system. This influx of resources made it possible to introduce schemes providing free medications and diagnostic services [ 50 ]. The benefits of increased financial resources were also felt beyond India's borders, enabling the compensation of health services in various forms. In Greece, it facilitated the monitoring and treatment of COVID-19 through in-person, home-based, and remote health services provided by physicians in private practice. Similarly, in Iran, the financial boost supported the acquisition of basic and para-clinical services from the private sector [ 21 , 65 ]. These measures reflect a broader international effort to adapt and sustain health services during a global health crisis.

The COVID-19 pandemic presented a formidable challenge to the PHC workforce worldwide. Healthcare workers were subjected to overwhelming workloads and faced significant threats to both their physical and mental well-being. To build resilience in the face of this crisis, a suite of interventions was implemented. These included recruitment strategies, training and development programs, enhanced teamwork, improved protective measures, comprehensive performance appraisals, and appropriate compensation mechanisms, as documented in Table 3 . To address staffing needs within PHC centers, a range of professionals including general practitioners, nurses, community health workers, and technical staff were either newly employed or redeployed from other healthcare facilities [ 63 ]. Expert practitioners were positioned on the frontlines, providing both in-person services and telephone consultations, acting as gatekeepers in the health system [ 49 , 63 ]. Support staff with technological expertise played a crucial role as well, assisting patients in navigating patient portals, utilizing new digital services, and conducting video visits [ 102 ]. Furthermore, the acute shortage of healthcare workers was mitigated by recruiting individuals who were retired, not currently practicing, or in training as students, as well as by enlisting volunteers. This strategy was key to bolstering the workforce and ensuring continuity of care during the pandemic [ 109 ].

During the pandemic, new training programs were developed to prepare healthcare staff for the evolving demands of their roles. These comprehensive courses covered a wide array of critical topics, including the correct use of personal protective equipment (PPE), the operation of ventilators, patient safety protocols, infection prevention, teamwork, problem-solving, self-care techniques, mental health support, strategies for managing stress, navigating and applying reliable web-based information, emergency response tactics, telemedicine, and direct care for COVID-19 patients [ 74 , 95 , 100 , 108 , 110 , 112 , 117 ].

Acknowledging the psychological and professional pressures faced by the primary healthcare workforce, health managers took active measures to safeguard both the physical and mental well-being of their employees during this challenging period [ 124 ]. Efforts to protect physical health included monitoring health status, ensuring vaccination against COVID-19, and providing adequate PPE [ 63 , 72 ]. To address mental health, a variety of interventions were deployed to mitigate anxiety and related issues among frontline workers. In Egypt, for instance, healthcare workers benefited from psychotherapy services and adaptable work schedules to alleviate stress [ 126 ]. Singapore employed complementary strategies, such as yoga, meditation, and the encouragement of religious practices, to promote relaxation among staff [ 133 ]. In the United States, the Wellness Hub application was utilized as a tool for employees to enhance their mental health [ 132 ]. In addition to health and wellness initiatives, there were financial incentives aimed at motivating employees. Payment protocols were revised, and new incentives, including scholarship opportunities and career development programs, were introduced to foster job satisfaction and motivation among healthcare workers [ 63 ].

The resilience of PHC systems during the pandemic hinged on several key improvements. Enhancing health facilities, supplying medicines and diagnostic kits, distributing vaccines, providing medical equipment, and building robust digital infrastructure were all fundamental elements that contributed to the strength of PHC systems, as outlined in Table 3 . Safe and accessible primary healthcare was facilitated through various means. Wheelchair routes were created for patients to ensure their mobility within healthcare facilities. , dedicated COVID-19 clinics were established, mass vaccination centers were opened to expedite immunization, and mobile screening stations were launched to extend testing capabilities [ 23 , 33 , 63 , 140 ].

In Iran, the distribution and availability of basic medicines were managed in collaboration with the Food and Drug Organization, ensuring that essential medications reached those in need [ 89 ]. During the outbreak, personal protective equipment (PPE) was among the most critical supplies. Access to PPE was prioritized, particularly for vulnerable groups and healthcare workers, to provide a layer of safety against the virus [ 63 ]. Vaccines were made available at no cost, with governments taking active measures to monitor their safety and side effects, to enhance their quality, and to secure international approvals. Furthermore, effective communication strategies were employed to keep the public informed about vaccine-related developments [ 32 , 83 ].

These comprehensive efforts underscored the commitment to maintaining a resilient PHC system in the face of a global health every individual in the community could access healthcare services. To facilitate this, free high-speed Wi-Fi hotspots were established, enabling patients to engage in video consultations and utilize a range of e-services without the barrier of internet costs crisis. Significant enhancements were made to the digital infrastructure. This expansion was critical in ensuring that [ 30 , 54 ]. Complementing these measures, a variety of digital health tools were deployed to further modernize care delivery. Countries like Nigeria and Germany, for instance, saw the introduction of portable electrocardiograms and telemedical stethoscopes. These innovations allowed for more comprehensive remote assessments and diagnostics, helping to bridge the gap between traditional in-person consultations and the emerging needs for telemedicine [ 141 , 180 ].

Throughout the COVID-19 pandemic, targeted interventions were implemented to bolster information systems and research efforts, as outlined in Table 3 . Key among these was the advancement of a modern, secure public health information system to ensure access to health data was not only reliable and timely but also transparent and accurate [ 33 , 45 , 49 ]. The "Open Notes" initiative in the United States exemplified this effort, guaranteeing patient access to, and editorial control over, their health records [ 141 ]. Management strategies also promoted the "one-health" approach, facilitating the exchange of health data across various departments and sectors to enhance public health outcomes [ 10 ].

In addition to these information system upgrades, active patient surveillance and early warning systems were instituted in collaboration with public health agencies. These systems played a pivotal role in detecting outbreaks, providing precise reports on the incidents, characterizing the epidemiology of pathogens, tracking their spread, and evaluating the efficacy of control strategies. They were instrumental in pinpointing areas of concern, informing smart lockdowns, and improving contact tracing methods [ 33 , 63 , 72 ]. The reinforcement of these surveillance and warning systems had a profound impact on shaping and implementing a responsive strategy to the health crisis [ 10 ].

To further reinforce the response to the pandemic, enhancing primary healthcare (PHC) research capacity became crucial. This enabled healthcare professionals and policymakers to discern both facilitators and barriers within the system and to devise fitting strategies to address emerging challenges. To this end, formal advisory groups and multidisciplinary expert panels, which included specialists from epidemiology, clinical services, social care, sociology, policy-making, and management, were convened. These groups harnessed the best available evidence to inform decision-making processes [ 30 ]. Consequently, research units were established to carry out regular telephone surveys and to collect data on effective practices, as well as new diagnostic and therapeutic approaches [ 31 , 89 ]. The valuable insights gained from these research endeavors were then disseminated through trusted channels to both the public and policymakers, ensuring informed decisions at all levels [ 36 ].

The COVID-19 pandemic acted as a catalyst for the swift integration of telemedicine into healthcare systems globally. This period saw healthcare providers leverage telecommunication technologies to offer an array of remote services, addressing medical needs such as consultations, diagnosis, monitoring, and prescriptions. This transition was instrumental in ensuring care continuity and mitigating infection risks for both patients and healthcare workers, highlighting an innovative evolution in healthcare delivery [ 170 , 181 ].

Countries adapted to this new model of healthcare with varied applications: Armenia established telephone follow-ups and video consultations for remote patient care, while e-pharmacies and mobile health tools provided immediate access to medical information and services [ 29 ]. In France and the United States, tele-mental health services and online group support became a means to support healthy living during the pandemic [ 147 , 158 ] . New Zealand introduced the Aroha chatbot, an initiative to assist with mental health management [ 139 ].

The implementation and effectiveness of these telehealth services were not limited by economic barriers, as underscored by Pradhan et al. (2023), who noted the key role of telemedicine in low and middle-income countries. These countries embraced the technology to maintain health service operations, proving its global applicability and utility [ 178 ]. The widespread adoption of telemedicine, therefore, represents a significant and perhaps lasting shift in healthcare practice, one that has redefined patient care in the face of a global health crisis and may continue to shape the future of healthcare delivery [ 170 , 178 , 181 ].

The study highlighted PHC strengthening strategies in COVID-19 time . Notably, the adaptations and reforms spanned across governance, financing, workforce management, information system, infrastructural readiness, and service delivery enhancements. These interventions collectively contributed to the robustness of health systems against the sudden surge in demand and the multifaceted challenges imposed by the pandemic and resulted.

Significantly, the findings have broader implications for health policy and system design worldwide. The pandemic has highlighted the critical need for resilient health systems that are capable of not only responding to health emergencies but also maintaining continuity in essential services. The strategies documented in this review serve as a template for countries to fortify their health systems by embedding resilience into their PHC frameworks (Fig.  4 ). Future health crises can be better managed by learning from these evidenced responses, which emphasize the necessity of integrated, well-supported, and dynamically adaptable health care structures.

A model for strengthening the resilience of the primary health care system

Looking ahead, realist reviews could play a pivotal role in refining PHC resilience strategies. By understanding the context in which specific interventions succeed or fail, realist reviews can help policymakers and practitioners design more effective health system reforms, as echoed in the need for evidence-based planning in health system governance [ 9 ] ​​. These reviews offer a methodological advantage by focusing on the causality between interventions and outcomes, aligning with the importance of effective health system leadership and management [ 50 , 182 ] ​​. They take into account the underlying mechanisms and contextual factors, thus providing a nuanced understanding that is crucial for tailoring interventions to meet local needs effectively [ 28 , 86 ] ​​, ultimately leading to more sustainable health systems globally. This shift towards a more analytical and context-sensitive approach in evaluating health interventions, as supported by WHO's framework for action [ 2 , 10 ] ​​, will be crucial for developing strategies that are not only effective in theory but also practical and sustainable in diverse real-world settings.

Limitations and future research

In our comprehensive scoping review, we analyzed 167 articles out of a dataset of 4,315, classifying 194 interventions that build resilience in primary healthcare systems across the globe in response to pandemics like COVID-19. While the review's extensive search provides a sweeping overview of various strategies, it may not capture the full diversity of interventions across all regions and economies. Future research should focus on meta-analyses to evaluate the effectiveness of these interventions in greater detail and employ qualitative studies to delve into the specific challenges and successes, thus gaining a more nuanced understanding of the context. As the review includes articles only up to December 31, 2022, it may overlook more recent studies. Regular updates, a broader linguistic range, and the inclusion of a more diverse array of databases are recommended to maintain relevance and expand the breadth of literature, ultimately guiding more focused research that could significantly enhance the resilience of PHC systems worldwide.

Availability of data and materials

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

Abbreviations

Primary Health Care

World Health Organization

Sustainable Development Goals

Universal Health Coverage

Personal Protective Equipment

General Practitioner

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Acknowledgments

We would like to thank Dr. Arshad Altaf for his invaluable comments on the earlier drafts of this work.

Funding for this project was provided by the World Health Organization Eastern Mediterranean Region.

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Farahnaz Ezzati, Mahdi Abbasi, Shahrzad Akhavan Farahani & Leila Eslambolchi

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LE, MA, MZ and AMM participated in the design of the study. LE, AMM, MA, MZ, PI, FE, MA and SHA undertook the literature review process. All authors drafted the manuscript. All authors read and approved the final manuscript.

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Mosadeghrad, A.M., Afshari, M., Isfahani, P. et al. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res 24 , 841 (2024). https://doi.org/10.1186/s12913-024-11278-4

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